WHAT IS IT

·        Chest pain caused by reduced myocardial blood flow and oxygenation

·        Classic symptom of coronary artery disease

TYPES

·        Stable

o   Occurs during physical exertion

o   Predictable

o   Relieved with nitrates & rest

·        Unstable (MEDICAL EMERGENCY)

o   Occurs at rest & more frequently

o   Usually not relieved with nitrates & rest

·        Prinzmetal/Variant

o   Caused by coronary vasospasm

o   Occurs at rest

o   Relieved by nitro & calcium channel blockers

·        Microvascular

o   Spasms of microvascular arteries

o   Pain usually lasts >20 min

Can be stable or unstable

COMMON TRIGGERS

·        Physical exertion (Shovelling snow, strenuous exercise)

·        Extreme cold (causes vasoconstriction)

·        Extreme heat (can lead to heat exhaustion)

·        Stress (increases myocardial demand)

·        Eating a large meal (increases O₂ demand for digestion)

·        Smoking

SYMPTOMS

·        Chest Pain

·        Feeling tight/ dull/ heavy

·        May radiate to arms, neck, jaw, or back

·        Shortness of breath

·        Weakness & fatigue

·        Dizziness

·        Pallor

·        Diaphoresis

TREATMENT

MEDICATIONS

·        Antiplatelets: prevent clots from forming

·        Calcium Channel Blockers: relax blood vessels

·        Beta blockers: reduces O₂ demand of heart

·        Nitrates: for episodes of angina (dilates vessels)

·        Administering nitro-glycerine

o   Administered sublingually every 5 minutes up to 3 doses max

o   Do not take if Sildenafil (Viagra) taken within 24 hrs

o   Call 911 if pain not relieved 5 minutes after 1st dose

PROCEDURES

·        Percutaneous Coronary Intervention (PCI): catheter inserted into arteries with possible stent placement to restore blood flow

·        Coronary Artery Bypass Surgery (CABG): vein or artery used to bypass a blocked or narrowed heart artery

NURSING INTERVENTIONS

·        Vital signs & EKG

·        Administer oxygen

·        Nitroglycerin

·        Semi-fowler's position

·        Maintain calm & quiet environment

·        Encourage rest Monitor pain

·        Lifestyle Modifications

o   Smoking cessation

o   Moderate exercise 3-4 times/week

o   Stress management

o   Weight management

o   Monitor heart rate & blood pressure

·        Diet

o   ↓ sodium ↓ saturated fat

o   ↓ alcohol

o   ↑ fibre ↑ fruits & vegetables