Download Ignatavicius: Medical-Surgical Nursing, 7th Edition

Ignatavicius: Medical-Surgical Nursing, 7th Edition
Chapter 40: Care of Patients with Acute Coronary Syndromes
Key Points PATHOPHYSIOLOGY & MANAGEMENT
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Coronary artery disease, also called coronary heart disease or simply heart disease is the
single largest killer of American men and women in all ethnic groups.
It is also the leading cause of premature, permanent disability in the United States.
When the arteries that supply the myocardium are diseased, the heart is unable to pump blood
effectively to adequately perfuse vital organs and peripheral tissues.
The incidence has declined over the past decade due to increasingly effective treatment and
increased emphasis on reducing major cardiovascular risk factors.
Atherosclerosis is the primary factor in the development of coronary disease.
Assess the patient for risk factors of coronary artery disease (CAD), such as obesity,
smoking, positive family history, cholesterol management, and the diagnosis and treatment of
hypertension.
Nonmodifiable risk factors are personal characteristics that cannot be altered or controlled
such as age, gender, family history, and ethnic background.
Teach patients about the importance of decreasing their risk for CAD.
Teach patients that angina is the pain associated with decreased blood flow to the heart
muscle. An MI indicates necrosis of heart muscle tissue.
Health promotion efforts are directed toward controlling or altering modifiable risk factors,
including smoking, inactivity, hypertension, diabetes mellitus, obesity, excessive alcohol
consumption, cholesterol management, and stress.
Coronary artery disease, chronic stable angina, and acute coronary syndromes affect
arteries providing blood, oxygen, and nutrients to the myocardium.
When blood flow through the coronary arteries is partially or completely blocked, ischemia
and infarction of the myocardium may result.
Ischemia occurs when insufficient oxygen is supplied to meet the requirements of the
myocardium.
Infarction, which is necrosis or cell death, occurs when severe ischemia is prolonged and
decreased perfusion causes irreversible damage to tissue.
Chronic stable angina is chest discomfort that occurs with moderate to prolonged exertion in a
frequency, duration, and intensity that remain the same over time.
o It results in only slight limitation of activity, is usually associated with a fixed
atherosclerotic plaque, is relieved by nitroglycerin or rest, is managed with drug therapy,
and rarely requires aggressive treatment.
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New-onset angina describes the patient who has his or her first angina symptoms, usually
after exertion or other increased demands on the heart.
Variant angina is chest pain or discomfort resulting from coronary artery spasm and
typically occurs after rest.
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Key Points - Print
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Women of any age may experience atypical angina, often misdiagnosed, and manifesting as
indigestion, pain between the shoulders, an aching jaw, or a choking sensation that occurs with
exertion..
Patients with diabetes mellitus and CAD (coronary artery disease) may not experience chest
pain or pressure due to diabetic neuropathy.
Angina pain is ischemic pain, so it usually improves when the imbalance between oxygen
supply and demand is resolved.
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.