Coronary Artery Disease
Diseases concerning any of the coronary arteries (LADA, RDA, Circumflex Branch, etc.) that supply oxygen to the heart. These diseases result in progression into myocardial ischemia, myocardial injury, and myocardial infarction.
Atherosclerosis
The narrowing of the lumen of any blood vessel by plaques, fat or lipid deposition, and fibrous tissue formation from vascular damage.
Atherosclerosis, Arteriosclerosis, and Arteriolosclerosis
Arteriosclerosis is the hardening of the blood vessel due to any cause. If caused by plaque/fatty deposits, it becomes atherosclerosis. Arteriolosclerosis is the thickening of the blood vessel walls, implicitly causing hardening of the blood vessel walls (Arteriosclerosis).
Pathophysiology
- Vascular Damage (Vasculitis)
- Fatty Streak Development (in the Intimal Layer)
- Plaque Formation
- Complications e.g. calcifications, ulcerations, thrombosis
Angina Pectoris
Paroxysms of pain or a feeling of pressure in the anterior chest caused by insufficient coronary blood flow. It is usually a result of atherosclerosis.
- Clinical Manifestations: poorly localized retrosternal pain, apprehension, impending feeling of death, weakness/numbness of extremities, LOC changes, diaphoresis, pallor. An important characteristic is the relief of pain when the precipitating factor or nitroglycerin is used.
- Diagnostics: ECG changes, Blood Tests (Cardiac Biomarkers), ECHO/Catheterization/Angiography
- Medical Management: PCI procedures (PTCA, Intracoronary Stents, Atherectomy) and pharmacologic therapy.
- Pharmacologic Management: nitroglycerin, beta-blockers (-olols), calcium channel blockers (-dipines), anticoagulants/thrombolytics, oxygen
- Nursing Diagnoses:
- Ineffective cardiac tissue perfusion secondary to CAD as evidenced by chest pain or other prodromal symptoms.
- Death anxiety
- Deficient knowledge about underlying disease and methods for avoiding complications.
- Noncompliance, ineffective management of therapeutic regimen to failure to accept necessary lifestyle changes.
- Complications: Acute Coronary Syndrome, Myocardial Infarction, Heart Failure, Cardiogenic Shock
- Nursing Interventions:
- Treating Angina: immediate bed rest in semi-fowler’s position, SL nitroglycerin, oxygen therapy, monitor for MI and complications
Myocardial Infarction
Myocardial death resulting from an imbalance between myocardial oxygen supply and demand.
- Clinical Manifestations: chest pain similar to AP, but one that does not cease when rest and medication are implemented. Decreased perfusion of the skin results in cool skin and pallor. SNS stimulation from heart failure results in tachycardia and tachypnea.
- Diagnostics: ECG within 10 minutes of pain onset (Inverted T, Elevated ST, then Abnormal Q) and ECHO for assessment of ventricular function; Cardiac biomarkers (CK-MB, Myoglobin, Troponin)
- Medical Management: thrombolytics (TPA, Streptokinase), PCIs (PTCA, CABG, MIDCAB), bed rest, oxygenation
- Pharmacologic Therapy: nitrates, anticoagulants/thrombolytics, analgesics, ACE inhibitors, beta-blockers. (MONA → Morphine, Oxygenation, Nitroglycerin, Aspirin)
- Nursing Assessment: baseline data, LOC, chest pain, heart rate and rhythm, organ function, blood pressure, skin color and temperature.
- Nursing Diagnoses
- Ineffective cardiac tissue perfusion related to reduced coronary blood flow
- Risk for imbalanced fluid volume
- Risk for ineffective peripheral tissue perfusion related to decreased cardiac output from left ventricular dysfunction
- Death anxiety
- Deficient knowledge about post-ACS self-care
- Complications: acute pulmonary edema, heart failure, cardiogenic shock, dysrhythmias and cardiac arrest, pericardial effusion and cardiac tamponade.
- Nursing Management: relieve pain (MONA, cardiac chair) and improve respiratory function (assess for early signs).