Review On Cardiovascular Diseases: BY: Fidel G. Yongque III, RN

Review on
Cardiovascular
z
Diseases
BY: Fidel G. Yongque III, RN
z
MANAGEMENT OF CLIENTS WITH
MYOCARDIAL INFARCTION
 Coronary Artery Disease (CAD) – OBSTRUCTION
 Causes:
1. Atherosclerosis
2. Clot formation
3. Vasospasm
z
RISK FACTORS
PRECIPITATING FACTORS: 4E’S
EXERCISE
EMOTIONAL EXTREMES
EATING A HEAVY MEAL
ENVIRONMENTAL – cold (promotes vasoconstriction)
z
Signs and Symptoms of CAD
1. ANGINA PECTORIS – chest pain
PATTERNS:
a. STABLE ANGINA – predictable chest pain; relieved by rest or
nitroglycerine or both.
b. UNSTABLE ANGINA – paroxysmal chest pain triggered by an
unpredictable degree of exertion or emotion, which
may occur at night. It must be treated as a medical
emergency with the client receiving immediate medical
attention
z
c. VARIANT/PRINZMETAL’S ANGINA – longer duration, may occur while

the client is at rest. It results from coronary artery spasm
and may be associated with elevation of ST segment on
ECG.
d. NOCTURNAL ANGINA – REM sleep during dreaming
e. ANGINA DECUBITUS – paroxysmal chest pain that occurs when the

client reclines and lessens when the client sits
or stands up.
z
f. INTRACTABLE ANGINA – chronic, incapacitating angina;

unresponsive to intervention.
g. POST INFARCTION – pain occurs after MI, when residual ischemia

may cause episodes of angina.
z
Diagnostic Tools
 ECG – ST elevation or ST depression
 Fasting Lipid Profile – elevated cholesterol level, elevated LDL
Normal Total cholesterol level: less than 200mg/dL

 Coronary Angiography/Angiogram/Cardiac Catheterization –
most accurate test
z
General Management for CAD
 AHA recommends that people with angina control their modifiable

risk factors and seek prompt treatment for episodes of chest pain:
ABCDE
 A for aspirin & antianginal therapy
 B for beta-blocker therapy & BP control
 C for cigarette & cholesterol
 D for diet & diabetes
 E for education & exercise

z
Lifestyle Modification
 LOW FAT, LOW CHOLESTEROL DIET
(+) HDL (polyunsaturated fat) – ex. Vegetable oil (olive oil,

corn oil, sunflower & safflower oil)
(-)LDL (saturated fat) – animal oil

z
ANTICHOLESTEROL OR
ANTILIPEMICS
 Fibrates – Fenofibrate, Gemfibrozil (Lopid)
 Statins: Atorvastatin (Lipitor), Simvastatin (Zocor), Rosuvastatin

(Crestor)
*AVOID fibrates & statins taken together – prevent rhabdomyolysis

(rupture of muscle fibers)
z
Medications – Relieve Acute Pain and
Restore Coronary Artery Flow
 Opiate analgesics
 Vasodilators
 Beta-adrenergic Blockers
 Calcium-channel Blockers
 Antiplatelets
z
Nitrates
 Nitroglycerine – photosensitive = use dark-colored containers
a. Sublingual – normal: tingling, fizzling = potent. After 3-6mos

(potency)
b. Transdermal patch – anterior chest wall
Protection: 24 hours
Placement: 12 hours = nitrate-free periods
Swim/shower? = yes – water resistant
c. Dosing: Maximum of 3 doses with 5 mins interval for each dose
d. HEADACHE is expected signs and symptoms
z
2. MYOCARDIAL INFARCTION – prolonged ischemia, endpoint of

CHD
Signs & Symptoms:

a. Atypical chest, abdominal, back or stomach pain
b. Nausea or dizziness
c. Shortness of breath and DOB
d. Unexplained anxiety, weakness or fatigue
e. Palpitations, cold sweat or paleness

z
Diagnostic Tests for MI
 Increase WBCs (leukocytosis) -10,000mm3 to 20,000mm3
 Increased ESR – inflammation
 (+) cardiac enzymes: CPK-MB
 (+) cardiac proteins: Troponin I & T
 ECG Changes: Pathologic Q wave
ST elevation
T inversion
z
z
Management for MYOCARDIAL
z
INFARCTION
PLEASE REMEMBER MONAF!!!
 MORPHINE – decreased cardiac workload = O2 demand =
relieved of pain
 OXYGEN
 NITRATES – dilate coronary artery
 ASA – platelet aggregator inhibitor = prevent clot formation
 FIBRINOLYTIC/THROMBOLYTIC AGENT – dissolve clot
formation. Ex: streptokinase, urokinase or tPA (tissue
plasminogen activator)
z
Surgery
 PTCA (Percutaneous Transluminal Coronary Angioplasty)

 CABG (Coronary Artery Bypass Graft)
z
Common Complications of
MYOCARDIAL INFARCTION
 CARDIOGENIC SHOCK
 DYSRHYTHMIAS
 HEART FAILURE
 PULMONARY EDEMA
 PULMONARY EMBOLISM
 RECURRENT MI
Change in
z condition of Activation of Formation of a
plaque in the platelets thrombus
coronary artery
Ischemia of
Coronary blood
Myocardial Cell tissue in the
supply less than
Death region supplied
demand
by the artery

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Review on

 Coronary Artery Disease (CAD) – OBSTRUCTION

PRECIPITATING FACTORS: 4E’S

c. VARIANT/PRINZMETAL’S ANGINA – longer duration, may occur while

d. NOCTURNAL ANGINA – REM sleep during dreaming

e. ANGINA DECUBITUS – paroxysmal chest pain that occurs when the

f. INTRACTABLE ANGINA – chronic, incapacitating angina;

g. POST INFARCTION – pain occurs after MI, when residual ischemia

 ECG – ST elevation or ST depression

 Fasting Lipid Profile – elevated cholesterol level, elevated LDL

Normal Total cholesterol level: less than 200mg/dL

 AHA recommends that people with angina control their modifiable

 B for beta-blocker therapy & BP control

 C for cigarette & cholesterol

 D for diet & diabetes

 E for education & exercise

 LOW FAT, LOW CHOLESTEROL DIET

(+) HDL (polyunsaturated fat) – ex. Vegetable oil (olive oil,

(-)LDL (saturated fat) – animal oil

 Fibrates – Fenofibrate, Gemfibrozil (Lopid)

 Statins: Atorvastatin (Lipitor), Simvastatin (Zocor), Rosuvastatin

*AVOID fibrates & statins taken together – prevent rhabdomyolysis

a. Sublingual – normal: tingling, fizzling = potent. After 3-6mos

2. MYOCARDIAL INFARCTION – prolonged ischemia, endpoint of

Signs & Symptoms:

c. Shortness of breath and DOB

d. Unexplained anxiety, weakness or fatigue

e. Palpitations, cold sweat or paleness

 Increase WBCs (leukocytosis) -10,000mm3 to 20,000mm3

 Increased ESR – inflammation

 (+) cardiac enzymes: CPK-MB

 (+) cardiac proteins: Troponin I & T

 ECG Changes: Pathologic Q wave

 PTCA (Percutaneous Transluminal Coronary Angioplasty)

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