CH 21 Occlusive Disorders & Heart Failure

Title Pathophysiology Signs & Symptoms Diagnosis Treatment

Coronary Artery
Disease CAD
(Any disorder that
causes narrowing or
occlusion in Coronary
artery).
** Leading cause of
death in the US.
Q25seconds someone
in the US has a CAD
related incident.
Risk Factors:
NONMODIFIABLE: age,
gender, heredity, &
race. MODIFIABLE:
hypertension, tobacco
smoking, Type 2
diabetes, obesity,
sedentary lifestyle,
stress, drug use (esp.
cocaine).
Smoking Cessation &
avoid 2
nd
hand smoke.
BP less than 140/90.
LDL less than or = to
100mg/dL. HDL
greater than or =
40mg/dL. 30 mins
physical activity 3-
4x/week.
Arteriosclerosis
(Narrowing &
hardening of arteries)
A buildup of lipids,
collagen, & smooth
muscle cells narrows
the lumen of the vessel.
3 types:
atherosclerosis, calcific
sclerosis, & arteriolar
sclerosis.
ATHEROSCLEROSIS is
fatty deposits on inner
lining of vessel wall.
Fat deposits (plaque)
accumulate in the
vessel as person ages.
Foam cells- large
amounts of lipids.

Angina Pectoris
(Chest pain, Most
common symptom of
Myocardial ischemia is
temporary inadequate
blood & oxygen supply
Squeezing pain under
sternum radiates to left
shoulder. (Pain may
Patients with
hypertension or
Diabetes mellitus have
Increase blood supply
to affected area.
Administer oral dose of
CH 21 Occlusive Disorders & Heart Failure

CAD) to the myocardial
tissues. Angina occurs
when this is temporary
and is known as stable.
Unstable angina is part
of a condition called
acute coronary
syndrome. Stable
angina occurs during
exertion and less with
rest.
radiate to right
shoulder, jaw, or ear).
If client experiences an
ischemic attack with no
angina it is called
SILENT MI. These
symptoms include
chest pressure,
restlessness, shortness
of breathe, numbness
or tingling in arms or
shoulders, fatigue, &
dizziness. Person may
state they feel funny.
Prinzmetals angina
caused by coronary
artery spasms that
occurs at rest.
higher risk. Dx based
on health Hx, lab tests,
and stress test.
Thallium scan, or
coronary arteriogram.
162-325mg crushed
aspirin or aspirin to be
chewed because it
prevents platelet
aggregation or
vasoconstriction. O2
@2-4L/min. Nitro tabs
to increase O2 supply.
If pain is not relieved
by nitroglycerin then
give morphine sulfate
2-4mg IV push.
Morphine can be
repeated every 5-15
mins until pain is
under control. **Side
effect of nitroglycerin
is hypotension (patient
should be sitting or
lying down when
medication is given) &
headaches. PTCA can
be done if only one
artery is involved.
**Intracoronary Stent
(tiny metal tube with
holes in it) implanted
into vessel to prevent
vessel from collapsing
and keep plaque
CH 21 Occlusive Disorders & Heart Failure

against vessel wall.
Acute Coronary
Syndrome
(term for all signs &
symptoms of sudden
myocardial ischemia)
The more susceptible p
to myocardial
infarction & sudden
death.
Unstable Angina occurs
at rest or with minimal
exertion.
Tachycardia,
diaphoresis, nausea, &
dizziness. Pt. may have
Tachycardia,
tachypnea,
hypertension or
hypotension,
decreased O2, cardiac
dysrhythmias. Women
with ACS may
experience indigestion,
palpations, nausea,
numbness in hands,
fatigue rather than
chest pain.
Cardiac biomarkers,
ECG recordings.
Myoglobin is first
biomarkers to rise with
myocardial damage.
Abnormal Q wave
indicates MI or past MI.
MONA: Morphine
Sulfate, Oxygen,
Nitroglycerin, and
Aspirin.
Myocardial Infarction
(Obstruction in
coronary artery,
resulting in necrosis
(death) to tissues
supplied by the artery)
** Most common cause
is atherosclerosis.
Obstruction usually
caused by plaque,
thrombus, or
embolism. Area most
commonly affected is
the left ventricle. HF or
Stroke by also occurs.
Great anxiety,
Impending Doom.
Frequently cold &
clammy. MEN: feelings
of chest heaviness or
tightness that progress
to a severe gripping
pain in lower sternal
area. Pain occurs in
arm, neck, back, and
epigastric area. The
rest or nitroglycerin
does not relieve pain
and client becomes
ECG tracings, Cardiac
biomarkers values, &
radioactive isotope
scan, ECG Stress test
has less diagnostic
value with women than
men. ** Cardiac
troponin I &
myoglobin. Troponin
found in cardiac cells,
when cells are
damaged they show
elevated level.
O2 via Venturi Mask or
nasal cannula.
Morphine Sulfate IV for
Pain. Nitrates IV or
Sublingual for pain. SL
may provide
immediate relief. One
tab SL nitro given
Q5mins up to 3xs.
Thrombolytic therapy
is sometimes used
within 3-6 hours of MI
to dissolve clot-
blocking artery. Bed
CH 21 Occlusive Disorders & Heart Failure

short of breath,
diaphoretic, and
anxious. Pulse
irregular rapid and
weak with low B/P.
skin pale & turns
cyanotic. WOMEN:
Upper abdominal pain,
heartburn, nausea,
dyspnea, lethargy,
fatigue, dull pain,
anxiety, chest pain.
Women may have
symptoms on the back
or left side of chest
with numb, tingling,
burning, stabbing, and
sensation.
Rest for 24 hours,
progress to chair. Diet
of less than 30 grams
of fat/day. Regular
exercise, 30 mins 5
days/week.


** Carry nitroglycerin at all times, 0.4mg q5 mins (up to 3) in 15 minutes. Call 911.
** African American men & women ages 45-74 have higher rate of CAD deaths, than men or women of other races.
** Beta Blockers: (Lopressor, Toprol, Metoprolol) Increase diastolic time, & increase coronary perfusion.
** Calcium Channel Blockers: (Cardizem & Norvasc) coronary artery dilation, & prevent vasospasm.
** Antiplatelet agents: (Aspirin, Plavix) Decrease preload & afterload.
** Lipid Altering Agents (Zocor, Lipitor, Crestor) Monitor liver function test.
** Niacin: Hot flashes & pruritus; take aspirin 30 mins- one hour before drug & after food.
** Giving Meds IM increases CK blood levels. Therefore IM meds are usually not given to patients with angina, ACS, or an MI.