Also called as Heart Attack Terminal stage of CAD Characterized by necrosis & scarring due to permanent mal-occlusion

TYPES Transmural MI- most dangerous MI (Mal occlusion of both R & L coronary artery Sub-endocardial MI-mal-occlusion of either R & L coronary artery

MOST CRITICAL PERIOD UPON DX of MI- 48-72 hrs - Majority of pt suffers from PVC

Gender- MALE Hyperlipidemia Smoking Hypertension DM Obesity Sedentary lifestyle Diet

 Chest pain- excruciating, located substernal or precodial area -radiates back, arm, shoulders, axilla, jaw and abdominal muscles -not usually relieved by rest or NTG Dyspnea Erthermia Initial increase in BP Restlessness & apprehension

Cardiac enzymes Troponin test ECG tracing Serum cholesterol and uric acid CBC

Narcotic analgesics- Morphine SO4 (vasodilation) Administer O2 inhalation Enforce CBR w/o BP Avoid valsalva maneuver Semi fowler General liquid to soft diet Monitor VS, I & O, ECG tracings Take 20-30 ml/week- wine, whisky, brandy Assist in surgery Provide Health teaching Strict Compliance to Meds PTCA CABG

 A clinical syndrome characterized by paroxysmal chest pain usually relieved by REST or NTG, resulting from temporary myocardial ischemia.

STABLE ANGINA- also known as effort angina, this refers to the more common understanding of angina related to myocardial ischemia.

UNSTABLE ANGINA- also known as crescendo angina

Gender- Male Black Raise Hyperlipidemia Smoking HPN Sedentary Lifestyle Obesity hypothyroidism

Excessive physical exertion Exposure to cold environment Extreme emotional response Excessive food intake of food- saturated fats

 Initial symptoms Levines Sign Chest pain- sharp, stabbing excruciating pain. Loc. (substernal), radiates back, shoulders, axilla, arms & jaw muscles, relieve by rest or NTG. Dyspnea Tachycardia Palpitation Diaphoresis

History taking & P.E. ECG tracing Stress test Serum cholesterol & uric acid

Enforce CBR Administer medication-NTG - keep in dry place. Avoid moisture and heat - Monitor S/E: Orthostatic Hypotension Transient Headache Dizziness Rise slowly from sitting position Assist in ambulation If giving NTG via patch: -avoid placing near hairy areas -avoid rotating transdermal patches - avoid placing near microwave oven or during defibrillation Beta blockers ACE inhibitors CA antagonist