Chapter

28:
Management
Patients with CVD

of

e) Silent ischemia ECG changes with

a stress test, no reports of pain

Coronary Artery Disease (CAD)

Angina Pectoris

Most
prevalent
type
of
cardiovascular disease in adults
It is important for nurses to be
familiar with various manifestations
of coronary artery conditions

The need of O2 exceeds that of

what the body has
Characterized by episodes or
paroxysms of pain or pressure in
the anterior chest
Factors causing pain:
Physical exertion
Exposure to cold
Eating a heavy meal
Stress or any emotion-provoking
situation
Mild indigestion to choking or
heavy sensation on upper chest
that ranges from discomfort to
agonizing pain accompanied by
severe apprehension and feeling of
impending death
Pain may radiate to neck, jaw,
shoulders, or inner aspects of
upper arms usually left arm
Weakness or numbness in the
arms, wrists hands, SOB, pallor,
diaphoresis,
dizziness/lightheadedness,
N/V,
anxiety
Increased O2 demand O2 therapy
Nitroglycerin

to
reduce
myocardial
O2
consumption,
decreases ischemia and relieves
pain
adrenergic blocking agents (olol)reduce myocardial O2
consumption by blocking
adrenergic sympathetic stimulation
to the heart
Calcium channel blocking agents
(amlodipine) - decrease workload
of the heart
Anti-platelet and anti-coagulant
meds

prevent
platelet
aggregation
Aspirin
Clopidogrel
Heparin prevents formation of
new blood clots
Glycoprotein 2B/3A agents
bleeding is the major side effects

Coronary Atherosclerosis
Abnormal accumulation of lipid
(fatty substances) and fibrous
tissue in the lining of arterial blood
vessel walls; these block and
narrow the coronary vessels and
reduces
blood
flow
to
the
myocardium
Impediment to blood flow is usually
progressive, causing an inadequate
blood supply that deprives cardiac
muscle cells of O2 (ischemia)
Risk Factors:
Hyperlipidemia
Smoking, tobacco use
HPN
DM
Metabolic Syndrome
Obesity
Physical inactivity
Prevention:
Controlling
cholesterol
abnormalities
Dietary measures
Physical activity
Medications (-statins, nicotinic
acids,
fibrates,
bile
acid
sequestrants,
cholesterol
absorption inhibitor, omega-3acid-ethyl esters)
Promoting cessation of tobacco
use
Managing HPN
Controlling DM
Types of Angina:
a) Stable angina occurs on exertion,
relieved by rest
b) Unstable angina (preinfarction or
crescendo angina) symptoms
increase in intensity and severity,
may not be relieved by rest
c) Intractable or refectory angina
severe incapacitating chest pain
d) Variant
angina
(Prinzmetals
angina) pain at rest, caused by
coronary artery vasospasm

Myocardial Infarction (MI)

Irreversible cardiac damage from
occlusion of one or more arteries
Also
called
coronary
artery
occlusion/thrombosis

 Chest pain that occurs suddenly

and continuous despite rest and
meds
SOB, indigestion, nausea, anxiety,
cool, pale, moist skin
Assessment:
Patient
Hx

presenting
symptoms, Hx of previous cardiac
and other illnesses, family Hx
ECG,
2D-Echo,
lab
tests
(creatinine kinase, myoglobin,
troponin)
Analgesics,
ACE-inhibitors,
thrombolytics
Cardiac Rehab
Phase
1

diagnosis
of
atherosclerosis
Phase 2 after patient has been
discharged
Phase 3 long-term outpatient
program, maintaining CV stability
and long-term conditioning

Chapter 32: Assessment

and
Management of Patients with HPN
Primary HPN high BP from an
unknown cause
Secondary HPN high BP r/t
identified cause
Accompanies other risk factors:
atherosclerotic
heart
disease
(dyslipidemia abnormal fat level),
obesity, DM, metabolic syndrome,
sedentary lifestyle
Hemorrhages, exudates, arteriolar
narrowing,
cotton-wool
spots,
papilledema (in severe HPN), left
ventricular hypertrophy, alterations
in vision or speech, dizziness,
weakness, a sudden fall, or
transient or permanent paralysis
on one side (hemiplegia)
Ax: ECG; renal damage maybe
suggested by elevations of BUN
and creatinine levels or by
microalbuminuria
or
macroalbuminuria
Risk factors:
Smoking
Dyslipidemia
DM
Impaired renal fxn
Obesity
Physical inactivity
Age (older than 55 for men, 65
for women)
Family Hx
Management:

Pharmacologic Tx:
Thiazide diuretics
Loop diuretics (-anides)
K-sparing diuretics
Aldosterone receptor blockers
Central 2 agonists and
other centrally acting drugs
-blockers
1-blockers
Combined - and -blockers
Vasodilators
ACE inhibitors
Angiotensin
2
receptor
blockers
CCB
Dihydropyridines
Direct renin inhibitors
Step 1:
S-top smoking
C-ontrol weight
I-nvolve your doctor
E-at right
N-ote your med intake
Cut down your salt
E-xercise
Step 2 continue lifestyle
modification,
single
med
is
prescribed and started at low
dose
Step 3 increase drug dose or
substitute another drug if no
response or side effects become
apparent; add a 2nd drug if
diuretic is not used
Step 4 add a 2nd or 3rd drug
Hypertensive crisis: hypertensive
emergency
and
hypertensive
urgency
Hypertensive emergency BP is
extremely elevated (more than
180/120 mmHg); there is an
actual or developing clinical
dysfunction of the target organ;
acute,
life-threatening
BP
elevations that require prompt Tx
in an ICU because of the serious
target organ damage that may
occur
Hypertensive urgency BP is very
elevated but there is no evidence
of impending or progressive
target organ damage

*LDL: Normal Adult Range: 62 130 mg/dl

Optimal Adult Reading: 81 mg/dl
HDL: Normal Adult Range: 35 - 135 mg/dl

Optimal Adult Reading: +85 mg/dl

Various things that can affect normal HDL
and LDL levels.:
1- Weight

2345-

Physical activity
Diet strategy
Genetic factor
Age and sex