DRUG THERAPY

PERCUTANEOUS CORONARY INTERVENTION

US TRANSLUMINAL ANGIOPLASTY
NITRATES
d catheter is placed in a coronary causes
vessel narrowed bygeneralized
plaque vasodilation
Can be administered orally, sublingually,
nflated and deflated to stretch the vessel wall and flatten the plaque transdermally, or IV
ARY ATHERECTOMY Provide short or long-lasting effects
Short-acting
catheter is guided into a coronary nitrates
vessel to the site ofprovide immediate relief or prophylaxis (15 MINUTES EFFECT)
the plaque
Long-acting
r cut, shaved, or pulverized then removed nitrates prevent anginal episodes and/or reduce severity and frequency of attacks
vessels BETA-ADRENERGIC BLOCKERS inhibit SYMPATHETIC stimulation of receptors of the heart and heart muscle
ARY STENT Non-selective BAB also inhibit stimulation of the lungs. Contraindicated for patients with COPD or ASTHMA because it c
sh tubular device is placed in theCALCIUM CHANNEL BLOCKERS inhibit movement of calcium within the heart muscle and coronary vessels; promote
coronary vessel
nosis ACE INHIBITORS have therapeutic effects on the vascular endothelium and have show to REDUCE RISK of worsening
ents contain an anti-inflammatoryANTILIPIDS
drug, which decrease
reduce cholesterol and triglyceride
the inflammatory responselevels
NARY ARTERY BYPASS GRAFT)ANTIPLATELET
SURGERY AGENTS decrease platelet aggregation to inhibit thrombus formation
FOLIC
cally attached to the aorta, and the otherACID
end AND
of theB-COMPLEX VITAMINS
graft is attached treat
to a distal increased
portion of the homocysteine levels
coronary vessel
ARDIAL REVASCULARIZATION
mall channels are formed in the myocardium
 CLINICAL MAN

CA

CHRONIC STABLE ANGINA PECTORIS

UNSTA

Chest pain occurring at REST, no OXYGEN

Coronary artery spasm
Chest pain or discomfort provoked by EXERTION or EMOTIONAL STRESS. Relieved by REST
Presence of an enlarge plaque
Characteristics
Hemorrhage / ulceration of a complicated l
substernal chest pain, pressure, heaviness or discomfort
Critical narrowing of the vessel lumen occu
pain may be mild or severe
A change in FREQUENCY, DURATION, an
gradual buildup of discomfort and subsequent gradual fading
Pain lasts longer than 10 MINUTES
numbness or weakness in arms, wrists, or hands
DIAGNOSTIC EVALUATIONS diaphoresis
Pain UNRELIEVED by rest or Nitroglycerine
Mimics S&S of MI
tachycardia
CAN CAUSE SUDDEN DEATH OR RESULT IN
increased BP
Location
Behind middle or upper third of sternum
st pain and clinical history + Levine Sign
relief of pain. Radiation
lobin, fasting blood glucose, fasting lipid panel, coagulationRadiates
studies, to
CRP, homocysteine,
neck, lipoprotein).
jaw, shoulders, arms, hands, and posterior intracapsular area
show LVH, ST-T wave changes, arrhythmias, and Q waves. Duration
progressive increases of speed and elevation walking on 2-15a treadmill
minutesincrease the workload
(after stopping of the heart. ST-T wave changes occur if myocardial ischem
activities)
ing a radioisotope, thallium 201, injected during exercise 1isminute
imagedafter
by aNITROGLYCERINE
camera. Low uptake of the isotope by heart muscle indicates regions of ischem
riculography (gated blood pool scanning) red blood cellsOther taggedPrecipitating
with a radioisotope
Factorare imaged by camera during exercise and at rest. Wall motion ab
ation coronary angiography performed during the procedure determines
Exposure to hot the presence,
or cold weather location, and extent ofAbsence
coronaryoflesion.
chest pain with documented e
ssion Tomography) cardiac perfusion imaging with high Eating resolution to detect
heavy meal very small perfusion differences caused
CIRCADIANby stenotic(occurs
EVENT arteries.
during the first
detects coronary calcium, which is found in most, but not Coitus
all, atherosclerotic plaque.ofLow
(increase workload thespecificity. Increase
heart, increase oxygen heart rate
demand)
Increase BP
Increase coronary vessel tone
Increase blood viscosity
 PRIMARY PREVENTION FOR CAD

STOP SMOKING

FBS < 110 mg/dL

CONTROL!!!

<100 mg/dL

<40 mg/dl (m) IDEAL BODY WEIGHT

<50 mg/dl (f)

<150 mg/dl

<300 mg/day
 NURSING ASSESSMENT
1. Ask patient to DESCRIBE anginal attacks.
WHEN do attacks tend to occur?
WHERE is the pain located? Does it RADIATE?
Was the onset of pain SUDDEN or GRADUAL?
How LONG did it LAST?
Was the pain STEADY and UNWAVERING in quality?
Was the discomfort accompanied by other symptoms?
o SWEATING
o LIGHT-HEADEDNESS
o NAUSEA
o PALPITATIONS
o SHORTNESS OF BREATH
How is the pain RELIEVED?

2. Obtain BASELINE ECG.

3. Assess patient and familys KNOWLEDGE of disease.

4. Identify patient and familys level of anxiety and use appropriate coping mechanism.

5. Gather information about the patients cardiac risk factors.

Age
Total cholesterol level
HDL level
Systolic BP
Smoking status
10-year risk for development of CHD according to Framingham scoring method

6. Medical history
Diabetes
Heart failure
Previous MI
COPD

7. Identify factors that may contribute to NONCOMPLIANCE with prescribed drug therapy.

8. Review RENAL and HEPATIC STUDIES and CBC.

9. Discuss patient current ACTIVITY LEVELS.

10. Discuss patients BELIEFS about modification of risk factors and WILLINGNESS TO CHANGE.

FRAMINGHAM SCORING METHOD

Determine the 10-year risk of development of coronary heart disease (CHD) in men and women
based on:
AGE CHOLESTER HDL BP HYPERTENSI SMOKING
OL ON
 NURSING INTERVENTIONS

RELIEVING PAIN MAINTAINING CARDIAC OUTPUT

Monitor response to therapy.

BP and PR (provides baseline data for orthostatic hypotension)
f patients angina. Recheck VS as indicated by ONSET of action of drug and at time of drugs PEAK effect.
ed in the past. Note changes in BP of more than 10 mmHg and changes in heart rate of more than 10 beats/min.
and symptoms (diaphoresis, sob,complaints
Note protective body posture, dusky
of headache (esp.facial color,
use of changes
Nitrates) in LOC.
and dizziness.
FOWLERs promotes ventilation.
Analgesics for headache
Supine position to relieve dizziness (associated with hypotension, PRELOAD is enhanced, thereby increasing BP)
until angina subsides) Institute continuous or PRN ECG.
Beta-adrenergic blockers and calcium channel blockers can cause significant bradycardia and varying degrees of heart block.
N) Evaluate for development of heart failure.
ain and note duration of anginal
Beta episode
adrenergic blockers and calcium channel blockers DECREASE CONTRACTILITY, increasing the likelihood of heart failure.
on from stable to unstable angina
Obtain daily weight and IO.
ities the patient may engage in that
Auscultate lungare below
fields the level at which angina pain occurs.
for CRACKLES.
ina pain is experienced.Monitor for presence of EDEMA.
Remove previous nitrate patch or paste before applying new paste or patch.
Prevents HYPOTENSION.
To decrease nitrate tolerance transdermal nitroglycerin may be worn only in the daytime hours and taken off at night when phy
Be alert to ADVERSE REACTION related to ABRUPT DISCONTINUATION of beta-adrenergic blockers and calcium ch
Prevent rebound phenomenon.
Tachycardia
Hypertension
DECREASNG
Chest pain ANXIETY
Discuss use of CHROMOTHERAPEUTIC therapy with health care provider.
Tailoring of anginal drug therapy to the timing of circadian events.
Report adverse drug effects.

ANTI-ANGINA MEDICATIONS AND ADVERSE EFFECTS

ogies for increasing anxiety before administering PRN sedatives.
ns of HYPOPERFUSION.
unds
NITROGLCERIN
Carry it at all times.
Keep in original dark container.
findings, healthShould
care cause
providera slight burning orand
notification stinging sensation
response, andunder the tongueand
interventions when potent.
response.
Place under tongue at
alization, diagnostic tests, and therapies. first sign of chest discomfort.
alize fears andStop all effort
concerns or activity,
about illnesssit and takefrequent
through tabletrelief should be after a few minutes.
conversations.
s. Bite tablet between front teeth and slip under tongue for quick action.
edication (PRN).Repeat dosage in a few minutes (3x) if relief is not obtained.
Taketo
anxiety reduction prophylactically
assist in controlto avoid pain known to occur with certain activities.
of angina.
Remove
ased stress on the heart, previous
requiring paste before
the heart applying
to use morenew one (same with patch).
oxygen.
Do not remove patch when swimming or bathing.
VERAPAMIL
ken when an anginal episode(CALAN)
occurs. constipation
anxiety. NIFEDIPINE (PROCARDIA) ankle edema
escribe angina. BEETA-ADRENERGIC BLOCKERS / CALCIUM CHANNEL BLOCKERS heart failure, shortness of breath, weight gain, REBOUND EFFEC
VASODILATORS, ANTIHYPERTENSIVES dizziness

Others:
CAFFEINE increases heart rate and produce angina
DIET PILLS, NASAL DECONGESTANTS increases heart rate and stimulate high BP
ALCOHOL increase hypotensive adverse effect of drugs