1 - Angina Pectoris

this condition is characterized as chest pain by ischemic heart disease. Decreased oxygen supplying the heart

angina pectoris

with angina pectoris the oxygen supply to the heart is ___ than the oxygen demand

less

the lack of oxygen supply to the heart with angina pectoris is usually due to

coronary artery disease

• often ther us an obstruction or spasm of one or more of the coronary arteries supplying the heart

what are the 4 coronary arteries we are concerned about

right coronary a

left coronary a

left anterior descending a

circumflex a

what are the 4 factors which may cause myocardial ischemia/ischemic heart disease

1. coronary artery spasm/obstruction

2. severe blood pressure reduction

3. anemia

4. ventricular hypertrophy

what could cause there to be a severe blood pressure reduction

shock (hypovolemic - losing a lot of blood)

aortic stenosis

coronary embolism

coronary thrombosis

a blockage in a heart artery caused by a traveling object

pulmonary embolism

a blockage caused by a clot that forms directly inside that heart artery

coronary thrombosis

how does anemia cause myocardial ischemia

with anemia there is a reduction in RBC. this means there is less hemoglobin carrying O2 to the heart

who is angina pectoris most common in

men over the age of 40

what are the clinical signs of angina pectoris

chest pain upon exertion/stress

squeezing/crushing pain

pain below sternum, above stomach, back of chest

radiates to left arm, back, shoulder, neck, mandible

increased pulse, BP

angina may be alleviated by (2)

decreasing myocardial oxygen demand and/or

increasing coronary artery blood supply

how would you increase coronary artery blood supply

B blockers, Ca channel blockers

How do B blockers and Ca channel blockers increase coronary artery blood supply

decreasing HR, contractility, increased vasodilation

best method of treatment for angina is

PREVENTION

frequency of stable angina

infrequent

pain in stable angina is (unpredictable/predictable)

predictable (exercise,etc)

how is stable angina relieved

rest or medication (nitroglycerin)

unstable angina frequency

increased

unstable angina duration

increased

pain in unstable angina is (predictable/nonpredictable)

non-predictable - can occur at rest

how can pain from unstable angina be relieved

requires medication

angina management

patients myocardial oxygen demand should be ______ while oxygen supply is ______

decreased, increased

what factors increase myocardial oxygen demand (4)

exercise

anxiety

stress

pain

what are 3 ways we can decrease myocardial oxygen demand

1. anxiety reduction protocol

2. profound local anesthesia prior to starting surgery

3. limit amount of epi to 0.04mg

epi calculation:

1:1000 = __ mg/ml

1

epi calculation:

1:10,000 = __ mg/ml

0.1

epi calculation:

1:10,000 = __ mg/ml

0.01

2 ways for anxiety reduction

before appt use hypnotic agent to promote sleep the nigh before surgery

• may use sedative to decrease anxiety morning of surgery

During appt, may use non-pharmalogical means

• verbal reassurance, sufficient local anesthesia, NO, IV sedation

Anxiety reduction protocol after tx

post op instructions

expected post op symptoms

reassurance

effective pain management

person to contact if problems

after hours phone number

in addition to decreasing O2 demand, we can increase patients oxygen supply by (2)

administer supplement oxygen via nasal cannula (3L/min)

use nitroglycerin tablets if necessary

what do nitroglycerin tablets or spray do

causes coronary artery vasodilation, thereby supplying greater amount of oxygen rich blood to myocardium

patients with angina should limit epi to __mg

0.04 mg

if angina is unstable we should avoid ___ care

elective

• if TX is necessary, perform minimal treatment aimed pain reduction and

infection control

treatment of angina episode:

immediately ___ treatment and place the patient in an ____ position, loosen clothing

halt

upright or semi upright

this will allow them to feel like they can breathe better

treatment of angina episode:

after the patient is seated upright, administer ____ and monitor _____ ____

oxygen (cannula/face mask)

vital signs

treatment of angina episode:

during episode you want to ensure to administer _____, and give another dose after __ mins if it does not get better

nitroglycerin

5

treatment of angina episode:

if pain persists 5 mins after second dose, give third dose and assume ____, call EMS

MI

we want to ensure that the BP of the patient is at least ___/___ before giving a third dose of nitroglycerin

90/60