Coronary Heart Disease. Raja Nursing Instructor RN, DCHN, Post RN. BSc.N

Size: px

Start display at page:

Download "Coronary Heart Disease. Raja Nursing Instructor RN, DCHN, Post RN. BSc.N"

Blaise Waters
5 years ago
Views:

1 Coronary Heart Disease Raja Nursing Instructor RN, DCHN, Post RN. BSc.N 31/03/2016

2 Objectives Define coronary heart disease (CHD). Identify the causes and risk factors of CHD Discuss the pathophysiological changes and clinical manifestation in patient with CHD. Myocardial Ischemia (Angina & its types) Myocardial infarction Discuss the medical, surgical and nursing management of patients suffering from CHD.

3 Coronary Heart Disease Coronary Heart Disease (CHD) describes heart disease caused by impaired coronary blood flow. CHD is mostly caused by atherosclerosis. Angina Pectoris and Myocardial Infarction are the most common diseases of coronary artery.

4 Global Burden of CHD CHD is the most common type of heart disease. Globally, and also leading cause of death. Each year, approximately 3.8 million men and 3.4 million women die from CHD. In 2020, it is estimated that this disease will be responsible for a total of 11.1 million deaths globally ( WHO, 2008)

5 Branches of Coronary Artery

6 Causes and Risk Factors Atherosclerosis Hyperlipidemia Hypertension Smoking Overweight/Obesity Diabetes Mellitus. Family History Not getting enough exercise. Gender Heredity Age

8 Normal and Plaque formed artery

12 Myocardial Ischemia Myocardial ischemia occurs when ability of coronary arteries to supply blood is inadequate to meet the metabolic demands of the heart.

13 Angina Pectoris Chest pain caused by transient myocardial ischemia due to an imbalance between myocardial oxygen supply and demand. Angina is a cardinal sign of coronary artery disease (ischemic heart disease). Angina is caused by an imbalance of O2 supply vs. demand, resulting in myocardial ischemia. If the supply of oxygen to the heart muscle is decreased, the demand for oxygen by the heart muscle is increased, or both, then angina (chest pain) results.

15 Types of Angina 1. Stable Angina. 2. Unstable Angina. 3. Variant Angina.

16 Stable Angina Stable angina occurs when the heart has to work harder than normal Sub sternal pain (area of chest) Pain duration is less than 15 minutes the most common form of angina Predisposing factors Exertion Heavy meal Exposure to cold weather

17 Pain Relieving factors Rest Sublingual Nitroglycerin Nursing management Smoking cessation Stress reduction Wight reduction Limiting dietary intake of cholesterol

18 Unstable Angina Increased frequency, severity and duration of pain in a patient of unstable angina Pain is severe more than 20 minutes Pain occurs with less exertion or at rest Myocardial infarction may occur in 10-20% of patients.

19 Variant Angina Is also known as Prinzmetal s angina or Vasospastic Angina. Chest pain at rest due to coronary artery spasm It may be associated with rapid eye moments stage of sleep cycle. Reduced prostaglandin i2 (Prostacyclin) Acute elevation of ST segment Dysrhythmias often occur due to sever pain

21 The underlying cause is Fissuring of atheroscelerotic plaques Platelet aggregation Thrombosis Coronary artery spasm Atheroscelerotic changes

22 Symptoms of angina Pain that begins in the mid of chest and spreads to left arm, back, neck or jaw. Not a sharp pain, but a dull one A feeling of pressure, tightness or squeezing in chest Feeling of persistent indigestion Numbness

23 Remember, unstable angina differs from a myocardial infarction (heart attack) only in that the extent of ischemia (inadequate oxygen supply to the heart muscle) is not sufficient to produce death of heart muscle cells. However, it is considered a medical emergency because it can rapidly evolve into a full heart attack! Unstable angina is a medical emergency.

24 Myocardial infarction Acute myocardial infarction (MI) is defined as death or necrosis of myocardial cells. Most cases from occlusive coronary thrombus at the site of preexisting atherosclerosis plaque. Rarely infarction results from prolonged vasospasm, inadequate blood flow to myocardium (i.e. Hypotension). Rarely infarction results due to embolic occlusion.

26 Cont. Cocaine may cause MI It is also known as heart attack If blood flow is not restored to the heart muscle within 40 minutes, irreversible death of the heart muscle will begin to occur. Approximately 30% to 50% of person with AMI die of ventricular fibrillation.

27 Myocardial Infarction

29 Cont. Myocardial cells that undergo necrosis are gradually replaced with scar issues. An acute inflammatory response develops in area of necrosis approximately 2 to 3 days after infarction

30 Clinical features Chest pain described as a pressure sensation, fullness, or squeezing in the mid portion of the thorax. Pain is usually substernal. Radiation of chest pain into the jaw/teeth, shoulder, left arm, and back Dyspnea or shortness of breath Epigastric discomfort with or without nausea and vomiting

31 Cont. Diaphoresis or sweating Hypotension Syncope or near-syncope without other cause Tachycardia Anxiety Restlessness

32 Prevention Healthy diet Exercise Quitting smoking Managing stress Reduce obesity Maintain blood pressure

33 Beta blockers Medications to treat CHD Nitroglycerine and other nitrates Calcium-channel blockers Aspirin Cholesterol-lowering drugs ACE inhibitors Diuretics

34 Surgical Management

36 References Porth, MC. (2002). Pathophysiology. (6th Ed:). Philadelphia. USA. Lippincott Willams & Willkins, A Wolters Kluwer Company McPhee, J. S., & Papadakis, A. M. (2011). Current Medical Diagnosis and Treatment. (50 th Ed:). Chicago. USA: Mc Graw Hill

Heart disease remains the leading cause of morbidity and mortality in industrialized nations. It accounts for nearly 40% of all deaths in the United

Heart disease remains the leading cause of morbidity and mortality in industrialized nations. It accounts for nearly 40% of all deaths in the United States, totaling about 750,000 individuals annually