AnginaPectoris - ANGINA(CORONARY ARTERY DISEASE The classic...

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ANGINA (CORONARY ARTERY DISEASE) The classic symptom of coronary artery disease (CAD) is angina—pain caused by loss of oxygen and nutrients to the myocardial tissue because of inadequate coronary blood flow. In most but not all patients presenting with angina, CAD symptoms are caused by significant atherosclerosis. Unstable angina is sometimes grouped with MI under the diagnosis of acute coronary syndrome. Angina has three major forms: (1) stable (precipitated by effort, of short duration, and easily relieved), (2) unstable (longer lasting, more severe, may not be relieved by rest/nitroglycerin; may also be new onset of pain with exertion or recent acceleration in severity of pain), and (3) variant (chest pain at rest with ECG changes due to coronary artery spasm). The AHCPR guidelines of May 1994 state that unstable angina is a transitory syndrome that causes significant disability and death in the United States. CARE SETTING Patients judged to be at intermediate or high likelihood of significant CAD are often hospitalized for further evaluation and therapeutic intervention. Classification of angina (provided by Canadian Cardiovascular Society Classification [CCSC]) aids in determining the risk of adverse outcomes for patients with unstable angina and, therefore, level of treatment needs. Class III angina is identified as occurring if the patient walks less than two blocks and normal activity is markedly limited, and class IV angina occurs at rest or with minimal activity and level of activity is severely limited. These two classes may require inpatient evaluation/therapeutic adjustments. RELATED CONCERNS Cardiac surgery: postoperative care Dysrhythmias Heart failure: chronic Myocardial infarction Psychosocial aspects of care Patient Assessment Database ACTIVITY/REST May report: Sedentary lifestyle, weakness Fatigue, feeling incapacitated after exercise Chest pain with exertion or at rest Awakened by chest pain May exhibit: Exertional dyspnea CIRCULATION May report: History of heart disease, hypertension, obesity in self/family May exhibit: Tachycardia, dysrhythmias Blood pressure normal, elevated, or decreased Heart sounds: May be normal; late S 4 or transient late systolic murmur (papillary muscle dysfunction) may be evident during pain Moist, cool, pale skin/mucous membranes in presence of vasoconstriction EGO INTEGRITY May report: Stressors of work, family, others May exhibit: Apprehension, uneasiness FOOD/FLUID May report: Nausea, “heartburn”/epigastric distress with eating Diet high in cholesterol/fats, salt, caffeine, liquor May exhibit: Belching, gastric distension PAIN/DISCOMFORT May report: Substernal or anterior chest pain that may radiate to jaw, neck, shoulders, and upper
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extremities (to left side more than right) Quality: Varies from transient/mild to moderate, heavy pressure, tightness, squeezing, burning Duration: Usually less than 15 min, rarely more than 30 min (average 3 min)
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AnginaPectoris - ANGINA(CORONARY ARTERY DISEASE The classic...

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