coronary artery disease/CAD

classification:
1. unstable ungina
  1. unpredictable
  2. SOB
  3. indigestion
  4. anxiety
  5. fatigue
2. NSTEMI
  1. not ECG confirmed
  2. laboratory confirmed
3. STEMI
  1. ECG confirmed
  2. common
    1. emergency
4. stable angina ( most common)
5. less common types of angina
  1. silent angina
    1. ECG confirmed
    2. related to diabetic neuropathy
    3. DM pts most common
    4. absence of s/s
  2. angina decubitus
    1. relieved by standing or sitting
    2. during lying down position
  3. nocturnal angina
    1. at night
  4. atypical angina
    1. back or neck pain
    2. nausea and indigestion
    3. fatigue
    4. SOB
  5. microvascular angina/syndrome x
    1. narrowing tiny coronary vessels
  6. prinzmetal angina/variant
    1. no predictable pattern
    2. hx of migrant/Raynaud's syndrome
    3. spasm of major coronary artery
    4. at rest
signs /symptoms of stable angina
1. chest pain
  1. PQRSTU assessment
  2. 3-5 minutes in duration
  3. radiates to left shoulder/arms/neck/jaw/intrascapular/epigastric
2. SOB
3. cold sweat
4. fatigue
5. light-headedness/dizziness
etiology
1. life style
  1. obisity
  2. smoking
  3. physical activity
2. health problems
  1. HTN
  2. hyperlipidemia
  3. DM and metabolic syndrome
  4. homocysteine
3. pshycological states
  1. type A personality
  2. perfectionism
  3. hardworking
  4. driving personality
4. age > 55 yrs
5. gender
6. ethnicity
7. family history
8. genetic predisposition
pathophysiology
diagnostic studies
1. physical exam
2. chest X-Ray
  1. normal
3. 12-lead ECG
  1. done at rest or when the pt is pain free
  2. ST depression or T wave inversion
  3. dysrhythmias and heart block may be present
  4. significant Q waves = prior MI
4. laboratory studies
  1. serum lipids elevated
  2. cardio enzymes normal/elevation indicates myocardial damage (CKMB, troponin)
5. exercise stress test
  1. positive
6. echocardiography
  1. possible abnormal valvular action
7. nuclear tests
  1. ischemic regions
  2. evaluation of wall motion and ejection fraction
8. coronary angiography
  1. definitive test
  2. artery involvement
collaborative care of stable angina
1. drug therapy/pt education
  1. A. antipletelet agent (aspirin); abtianginal agent (nitro spray); ACEIs (captopril)
  2. B. B adrenergic blockers (bisoprolol.nutropolol)
  3. C. cigarette smoking cessation; cholesterol control (statin therapy - Rosuvastatin/atorvastatin
  4. D. diet, DM control
  5. E. education; exercise
  6. F. flue vaccination
2. procedures
  1. PCI
  2. CABG
nursing management
1. Assessment
  1. Subjective/Objective data from patient
2. Plan
  1. relief of pain
  2. reservation of myocardium
  3. immediate/appropriate Tx of ischemia
  4. effective cooping
  5. participation in rehab plan
  6. reduction of risk factors
3. Intervention
  1. health promotion
  2. acute intervention
    1. O2 administration
    2. vital signs
    3. prompt pain relief with nitro, followed by opioids
    4. auscultation of heart sounds
    5. comfortable position of patient
    6. pain assessment
  3. ambulatory and home care
4. Evaluation
  1. pain relief
  2. decreased anxiety
  3. avoidance of complications
  4. self-care program

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coronary artery disease/CAD

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	Created by tansha almost 9 years ago