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Chapter 2
•
Cardiovascular Care
31
as arterial spasm, aortic stenosis,
cardiomyopathy, or uncontrolled
hypertension. Noncardiac causes
include anemia, fever, thyrotoxicosis,
and anxiety/panic attacks.
Clinical Manifestations
of Angina Pectoris
•
Chest pain or discomfort induced
by physical exertion or emotional
stress which is relieved by rest and
nitroglycerin
•
Mild or severe pain which
crescendos in discomfort and then
decrescendos to relief
•
Substernal chest pain, pressure,
heaviness, or discomfort such as
a squeezing, aching, burning,
choking, strangling, and/or
cramping pain
•
Exertional shortness of breath
•
Nausea
•
Diaphoresis
•
Fatigue
•
Numbness or weakness in arms,
wrists, or hands
•
Women are more likely to have
“atypical” symptoms such as
dyspnea and fatigue
•
Diabetics may have atypical,
minimal or no symptoms
Patterns of Angina Pectoris
—
are
caused by varying combinations
of increased myocardial demand,
decreased myocardial perfusion, and
coronary arterial pathology identified as:
•
Stable or Typical Angina
—imbalance
in coronary perfusion demand
•
Prinzmetal Variant Angina
—
coronary artery spasm
•
Unstable Angina (UA)
—pattern
of increasing pain, prolonged
duration of pain, or pain
occurring at rest
TIP:
Early recognition and treat-
ment of UA is imperative to prevent
complication such as sudden death.
ACUTE CORONARY
SYNDROME
Acute coronary syndrome (ACS)
is a term used to describe a group
of clinical symptoms which result
ACS Tissue Destruction
Arch of aorta
Pulmonary trunk
Left atrial auricle
Circumflex
branch of left
coronary artery
Left anterior
descending
artery
Papillary muscle
Damaged muscle
from myocardial
infarction
ZONES OF MYOCARDIALINFARCTION
Reversible
ischemia
Severe ischemia
(recovery possible
with revascularization)
Necrosis (damage irreversible)
Superior vena
cava
Right atrial
auricle
Right coronary
artery
from underlying acute myocardial
ischemia. ACS includes UA, non-ST
elevation myocardial infarction
(NSTEMI), and ST-elevation
myocardial infarction (STEMI),
depending on the degree of
coronary artery occlusion. These
conditions are characterized
by differences in severity, risk,
etiology, pathophysiology,
presentation, and management.
Angina is considered unstable when
a patient experiences prolonged
symptoms at rest.
CAUSES OF UNSTABLE
ANGINA OR NSTEMI
•
Thrombus or thromboembolism,
usually arises from disrupted or
eroded plaque
•
Occlusive thrombus, usually
with collateral vessels
•
Subtotal occlusive thrombus on
pre-existing plaque
•
Distal microvascular
thromboembolism from plaque-
associated thrombus
•
Thromboembolism from plaque
erosion
•
Nonplaque-associated coronary
thromboembolism
•
Dynamic obstruction (coronary
spasm or vasoconstriction)
of epicardial and/or
microvascular vessels
•
Progressive mechanical
obstruction to coronary flow
•
Coronary arterial inflammation
•
Secondary UA
•
Coronary artery dissection
Treatment of UA/NSTEMI
•
Oxygen
•
Nitrates
•
Morphine
•
Beta blockers
•
Heparin
Clinical Manifestations of Acute Coronary Syndrome
•
Chest pain
•
Pressure
•
Tightness or heaviness
•
Pain that radiates to neck, jaw,
shoulders, back, or one or both
arms
•
Indigestion or heartburn
•
Nausea and/or vomiting associated
with chest discomfort
•
Persistent shortness of breath
•
Weakness
•
Dizziness
•
Lightheadedness
•
Loss of consciousness