MDC week 8

Chronic Stable Angina

R A S S M U S S E N U N I V E R S T I Y M E D C I C A L C E N T E R

What is angina and why does it occur?

Angina is discomfort in the chest that occurs by temporary imbalance between the blood supply and the cardiac muscle's demand for oxygen. The lack of oxygen that happens with angina does not cause permanent damage to the heart's tissue. The cause of angina is typically due to atherosclerotic plaque (Ignatavicius & Workman, 2021).

Angina is a symptom common symptom of CAD and the artery is only partially occluded. With myocardial infarction, there is a complete blockage of an artery (Angina , Heart Foundation, 2021).

Angina Vs. Coronary Artery Disease

and Myocardial Infarction

Diagnosis

Electrocardiogram: Leads are placed on the chest to monitor electrical impulse patterns of the hears. Trained professionals will be able to see abnormalities.

Stress Test: angina is easier to diagnos when is it working hard. During this test, the patient will exercise BP and ECG will be monitored.

Imaging Angiography (visualize the inside of the vessels) , CT scan (visualize narrowing of the arteries), MRI (to visualize the heart's striation and vessels), and X-Ray (can see if heart is enlarged).

Labs: to test for elevated troponin

(Angina, Mayo, 2021)

E.g., nitroglycerin tablets , to relats and widen the blood vessles.

Nitrates

Anti-platelet- Reduces the bloods ability to clot making it mov through the arteries easier.

Asprin

Cholesterol lowering-help reduce further blockage in the arteries byreducing cholesterol and through blocking and reabsorbing.

Statins

Treatment

Pharmacological Blocks effects of epinephrine, which results in reduced heart rate and blood pressure. Also helps vessels relax.

Beta- Blockers

Relaxes and widens the veslses, which increased the blood flow to the heart.

Calcium channel blockers

Anti-anginal may work by inhibitong portal fatty-acid oxidation

(Angina Treatment, 2021)

Ranolazine

A tiny balloon in inserted, then inflated to widen the artery at the narrowing. A small wire mesh is inserted with the ballon and will remain in the place to widen the artery.

Angioplasty & stenting

Coronary attery bypass surgery used if other treatments fail. A vein or artery from somewhere else in the body is surgericaly attached, so blood can bypass the narrowed or blocked artery.

Bypass surgery

External counter pulsation is done is multiple sessions. It involves blood- pressue like cuffs that are placed around calves, pelvis, ansd thighs to increase blood flow to the heart.

(Story, 2018)

ECP

Treatment

Procedures Surgery

Diet

Smoking cessation

Exercise

Treatment

Lifestyle

Stress can trigger sympathetic nervous system causing the heart to work harder. Practicing relaxing techniques is good for the heart.

(Story, 2018)

Stress

Following a heart health diet, including low sodium and saturated fats will redcue the risk of heart disease.

Smoking can lead to CAD, stroke, and myocradio infarction.

At least 30 Minutes a day, 5 days a week to improve heart health.

Manage weight

Excess weight contributes strongly to heart disease.

Multidimensional Care

Risk Reduction & Health Promotion

The provider will discuss the benefits an risk for each treatment option. Medication will be ordered by the provider to mange and reduct the risk of future occurrences. A dietitian will work with the patient to create a heart healthy diet plan based on the patient's preferences. Physical therapy will determine the level of indecent mobility to develop a save excersise plan for the patient. Utilize inpatient smoking cessation programs which include patient education and concealing provided by the provider and counselors. The nurse will assess the level of understanding the patint has on risk reduction and provide insight where needed. The nurse will teach the patient to listen to their body and know what activities have triggered angina in the past (Ignatavicius et al., 2021).

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Multidimensional Care

Nursing Interventions.

Treat the chest pain- The nurse will instruct the patient to stop activity and rest in bed in semi-fowlers position and administer nitroglycerin. Prevent pain - The nurse should assess the level of activity that causes the chest pain and plan the patient's activities accordingly. Decrease oxygen demand- The nurse can provide education on the importance of balancing activity and rest. Assess for knowledge deficits- Assess the patients ability and willingness to learn and participate in health related care. Reduce anxiety- The nurse can provide education on the diagnosis, treatments, and ways to prevent future occurrences and progression. This will help the patient to have autonomy of their care (Ignatavicius et al., 2021).

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References: Angina (2021). Heart Foundation. https://www.heartfoundation.org.nz/your- heart/heart-conditions/angina

Angina. (2021) Mayo Clinc. https://www.mayoclinic.org/diseases- conditions/angina/diagnosis-treatment/drc-20369378 Angina Treatment (2021. Mayo 4.

Ignatavicius., D. D., & Workman, L. M. (2021). Medical-Surgical Nursing. Concepts for Interprofessional Collaborative Care (10th. ed). Elsevier. https://ambassadored.vitalsource.com/reader/books/9780323654050/epubcfi/6/12[%3 Bvnd.vst.idref%3DB9780323612425120019]!/4/4/4[CN]

Story, L. (2018) Pathophysiology. A Practical Approach (3rd ed). https://ambassadored.vitalsource.com/#/books/9781284142983/cfi/6/96!/4/2/2/2@0:0. 00

Thank you!