Acute Coronary Heart Disease - Copy

7/29/2019 Acute Coronary Heart Disease - Copy

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Cardiovascular

system

ACUTE CORONARY

SYNDROME

Reported by:

Nashraifar A. Jahiron



system

ACS

Is an emergent situation characterized

by an acute onset of myocardial

ischemia that result in myocardial

death if definitive intervention do not

occur promptly.



Causes: hypertension

smoking

DMOBESITY

high cholesterol level 240 mg/dl

Risk factor: age >55

males

family history

hereditary



Heart with ischemia that leads to ACS

NORMAL HEART



Pathophysiology RF

Atherosclerotic plaque partially obstruct coronary blood flow

Stable plaqueUnstable plaque with ulceration or rupture and thrombosis

Transient ischemia Sustained ischemia

Unstable angina

Myocardial infarction

Myocardial inflammation

And necrosis

Injury of the vascular endothelium



CLINICAL MANIFESTATION

Chest pain

Shortness of breath

Indigestion

Nausea Anxiety

Cool, pale and moist skin

Fast heart rate and respiratory



DIAGNOSTIC TEST

Physical exam

Patient history

Electrocardiogram

Echocardiogram To determine cardiac activity

Laboratory test

Cardiac enzymes and biomarkers

Creatine kinase and its isoenzymes Myoglobin

troponin



Patients with ACS are, for the most part, dichotomized

by whether significant ST elevation is present or not.

On the basis of serial enzymatic measurements,

patients without ST elevation can subsequently be categorized

to have unstable angina or non-ST elevation myocardial

infarction (NSTEMI.



MEDICAL MANAGEMENT

Pharmacologic therapy

Aspirin

Nitroglycerin

IV beta blockers

Unfractionated heparin

• Analgesics

• Angiotensin converting enzyme inhibitor

• Thrombolytics

Alteplase

Reteplase

tPA(tissue plasminogen activator)



Nitrates -

• indications: to prevent anginal attacks, reduce myocardial ischemia

• contraindications: marked hypotension, increased ICP, severeanemia

Beta-Blockers- these are drugs that is more useful in treating stable angina

• indications: antiarrhythmic, anti anginal, antihypertensive

• contraindications: clients who has decreased HR and BP, Clients

who have 2nd or 3rd degree AV block, pregnancy, bronchial asthma,

COPD.

Calcium channel blockers-

• indications: treatment of stable and variant angina, certain

dysrhythmias, hypertension

• contraindications: pregnant, hypotension



Nursing responsibilities

Anti anginals:

• Before giving the drug- obtain VS ,health hx, & drug hx

• upon giving: offer sips of water before giving SL Nitrates,

• monitor VS & effects of IV Nitroglycerin. Report angina that persists.

• client teaching: a SL Nitroglycerin tablet is used if chest pain occurs. Repeat in 5mins

if pain has not subsided & again in another 5mins if pain persists. If pain still has not

subsided immediate medical help is necessary• -show client how SL nitro glycerin are taken. Inform that a stingin & biting sensation

indicates the tablet is fresh

• - meds bottle should be kept dry & away from sunlight.

• - instruct client taking Transdermal patch to apply it OD, usually in the morning,

Beta Blockers & Ca channel blockers- do not discontinue these drugswithout the health care client’s approval. Withdrawal symptoms

(reflex tachycardia& pain) may be severe



SURGICAL MANAGEMENT

Emergent percutaneous Coronary Intervention(PCI)

Used to open the occluded coronary artery and promote

reperfusion to the area that has been deprived of

oxygen.

Cardiac catheterization laboratory and staff nurseshould be available if an emergent PCI is to be

performed.

Coronary artery bypass surgery



NSG. DIAGNOSIS

Ineffective cardiac tissue perfusion related to

reduced coronary blood flow

Risk for imbalanced fluid volume

Risk for ineffective peripheral tissue perfusionrelated to decreased cardiac output.

Death anxiety related to cardiac event



COMPLICATIONS

Acute Pulmonary Edema

Heart failure

Cardiogenic shock

Dysrhytmias and cardiac arrest Pericardial effusion and cardiac tamponade



NURSING MANAGEMENT

Relieving pain and other signs and symptoms.

Administer medication as prescribed

Administer oxygen with medication by nasal cannula 2-4 Lpm.

Monitor vital signs frequently

Bedrest with the backrest elevated or in a supported chair

helps to decrease chest discomfort.



1. Promoting adequate tissue perfusion

• Bed or Chair rest high 30 degrees during the initial

phase of treatment helps myocardial oxygen

consumption.• Limitation on mobility

• Check skin temperature and peripheral pulses frequently

to monitor tissue perfusion.

2.Reducing anxiety

• Provide information to the patient ad family in an honest

and supportive manner.

• Ensuring a quiet environment.

• Preventing interventions that disturb sleep.

• Teaching relaxation techniques• Music therapy



MONITORING AND MANAGING POTENTIAL

COMPLICATIONS

Monitor the patient closely and report promptly for changes of:

Cardiac rate and rhythm

Heart sounds

Blood pressure Chest pain

Respiratory status

Urinary output

Skin color

Temperature

ECG changes

Sensorium

Laboratory values



1. Which risk factor for coronary artery

disease is non-modifiable?

a. Cigarette smoking

b. Diabetes mellitus

c. hereditary

d. Hypertension



2. Exceeding which SERUM

CHOLESTEROL level significantly increase

the risk of coronary artery syndrome?

a. 100 mg/dl

b.150 mg/dl

c. 175 mg/dld. 240 mg/dl



3. Which condition most commonly causeof acute coronary artery syndrome?

a. Atherosclerosis

b. Diabetes mellitusc. Myocardial infarction

d. Renal failure



4. A nurse describes atherosclerosis for client education.

which of the following statements if made by the client ,

requires additional teaching?a. Plaques obstruct the coronary artery

b. Plaques obstruct the coronary vein

c. Hardened vessels can’t dilate to allow

d. Atherosclerosis can cause angina

5. Which action is the first priority of care for a client

exhibiting signs and symptoms of coronary artery syndrome?

a. Decrease anxiety

b. Enhance myocardial oxygenation

c. Administer sublingual nitroglycerin

d. Educate the client about his symptoms



6. Medical treatment of coronary artery disease includes the ff invasive

procedure except?

a. Cardiac catheterization

b. Coronary artery bypass surgeryc. Oral medication administration

d. Percutaneous coronary intervention(PCI

7. In caring the client with cardiac problem , the nurse must know that the

condition most likely responsible for myocardial infarction is which of thefollowing?

a. Aneurysm

b. heart failure

c. coronary artery thrombosis

d. renal failure



8. What is the most common complication of acute coronary artery

syndrome?

a. Cardiogenic shock

b. Heart failure

c. Arrhythmiasd. Pericarditis

9. In what position should the nurse place the head of the bed to obtain

the most accurate?

a. High fowlersb. Raised 10 degrees

c. Raised 30 degrees

d. Supine

10. What is the drug of choice in treating acute coronary artery

disease in preventing angina attacks?

a. nitroglycerin

b. methotrexate

c. antipyretics

d. opioids

Acute Coronary Heart Disease - Copy

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