dr. hana omer. angina pectoris :is a clinical syndrome characterized by paroxysmal chest pain due...
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ANGINA AND AMI DR. HANA OMER
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ANGINA PECTORIS
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DEFINITION
ANGINA PECTORIS :is a clinical syndrome characterized by paroxysmal chest pain due to transient myocardial ischemia.
It may be occur whenever there is imbalance between myocardial oxygen supply and demand .
The most common cause is atherosclerosis , aortic stenosis, and hypertrophic cardiomyopathy .
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TYPES OF ANGINA
Stable angina . Unstable angina .
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STABLE ANGINA
is the angina that occurs when coronary perfusion is impaired by fixed or stable atheroma of coronary arteries i-e patient has fixed capacity of exertion after that he starts feeling chest pain .
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UNSTABLE ANGINA
is the angina that is characterized by rapidly worsening chest pain, pain on minimal exertion or pain at rest .
It is carachterized by :- More serious, higher level of obstruction Changes in frequency, severity, duration May begin during sleep or at rest Warning of impending MI
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Angina Pectoris
Prinzmetal angina Caused by coronary artery vasospasm Causes chest pain at rest Increased risk of: ▪ Ventricular dysrhythmias▪ Myocardial infarction▪ Heart block▪ Sudden death
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DIAGNOSIS
Usually diagnosis is clinically, by present of these symptoms :-
1. Chest pain increase with exertion .2. Typical chest pain .3. Releaved by Nitroglycerin . all 3 ₌ stable angina , 2 ₌ unstable angina 1 ₌ no angina .
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MYOCARDIAL INFARCTION
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DEFINITION
Acute ischemic necrosis of an area of myocardium is known as myocardial infarction , OR myocardial necrosis occurring as a result of critical imbalance between coronary blood supply and myocardial demand is called myocardial infarction .
It has the the same symptoms and signs, etiology , as angina pectoris .
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Acute Coronary Syndrome
Any group of clinical symptoms consistent with acute MI Patients should receive a 12-lead ECG.▪ ST-segment elevation: “Q-wave AMI” ▪ No ST-segment elevation: unstable angina or
a non-ST-segment elevation (UA/NSTEMI) we find inverted T .
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Acute Myocardial Infarction (AMI)
Symptoms Chest pain is the most common
symptom.▪ Patient often clenches fist when describing ▪ May radiate to arms, fingers, neck, jaw, upper
back, or epigastrium.▪ Sometimes mistaken for indigestion▪ Not influenced by body movements
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Acute Myocardial Infarction (AMI)
Other symptoms include: Diaphoresis Dyspnea Anorexia, nausea, vomiting, belching,
hiccups Profound weakness, dizziness,
palpitations Feeling of impending doom
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Acute Myocardial Infarction (AMI)
Symptoms (cont’d) Patients with silent MI may present with:▪ Sudden dyspnea▪ Rapid progress to pulmonary edema▪ Sudden loss of consciousness ▪ Unexplained drop in blood pressure▪ Apparent stroke or simply confusion
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Acute Myocardial Infarction (AMI)
Symptoms (cont’d) Women more likely to present with:▪ Nausea▪ Lightheadedness▪ Epigastric burning▪ Sudden onset of weakness or tiredness▪ Pain radiating down right side
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Acute Myocardial Infarction (AMI)
Assessment For history, ask usual questions, but also
if any pain medication has helped.
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Acute Myocardial Infarction (AMI)
Take note of: Patient’s general appearance Patient’s state of consciousness Pale, cold, and clammy skin Vital signs Left-sided heart failure signs Right-sided heart failure signs
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Acute Myocardial Infarction (AMI)
Typical signs include: Ashen-gray pallor Cold, wet skin Rapid pulse rate Decreased blood pressure from
decreased CO Increased blood pressure from pain and
anxiety
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Management of AMI and Suspected AMI in the Field
Treatment goals: Limit size of infarct. Decrease fear and pain. Prevent serious cardiac dysrhythmias.
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Management of AMI and Suspected AMI in the Field
Place patient at physical and emotional rest. Stress response can make damaged
heart race Can place peripheral circulation in a
state severe vasoconstriction
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Management of AMI and Suspected AMI in the Field
To begin treatment, place patient in a semi-Fowler position. Do not allow patient to get on stretcher
alone.
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Management of AMI and Suspected AMI in the Field
Treat (MONA) in following order: Oxygen Aspirin Nitroglycerine Morphine
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Management of AMI and Suspected AMI in the Field
Give nitroglycerin if BP is adequate. Do not mix with PDE-5 inhibitors. Place 0.4-mg under tongue. Do not give with hypotension or
bradycardia. Repeat every 3 to 5 minutes, up to three
doses.
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Management of AMI and Suspected AMI in the Field
Morphine sulfate may be given by IV. 2- to 4-mg doses as needed Do not give if patient has/is: ▪ Low blood pressure▪ Dehydrated▪ AMI involving the heart’s inferior wall
Some protocols prefer fentanyl.
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Management of AMI and Suspected AMI in the Field
Perform cardiac monitoring. Document the initial rhythm. Place anterior chest leads. Keep cardiac drugs close at hand.
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Management of AMI and Suspected AMI in the Field
Record vital signs. Measure blood pressure at least every
5 minutes. Measure pulse rate.
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Management of AMI and Suspected AMI in the Field
History and secondary assessment Find out if patient:▪ Has history of cardiac disease▪ Takes any heart medications▪ Has had a previous heart attack or heart
surgery Obtain more details about current
symptoms and any relevant past medical history.
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Management of AMI and Suspected AMI in the Field
Transport the patient. Once stable, transport in semi-Fowler
position Use safe and appropriate transport. If serious dysrhythmia develops,
consider stopping and treating immediately.