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Acute Ischemic Heart Disease, Study Guides, Projects, Research of Nursing

Central Mindanao University (CMU)Nursing

Have you ever felt a tightness, pressure, or pain in your chest? It could be a sign of Acute Ischemic Heart Disease (AIHD), a serious condition where blood flow to your heart muscle is reduced. This can lead to damage and even heart attack.

Typology: Study Guides, Projects, Research

2022/2023

Available from 05/12/2024

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ACUTE ISCHEMIC HEART DISEASE
Often referred to as acute coronary
syndrome (ACS), is a serious
cardiovascular condition that occurs
when there is a sudden decrease in
blood flow to the heart muscle due to a
blockage in one or more of the
coronary arteries. This can lead to
insufficient oxygen supply to the heart
muscle, resulting to tissue damage or
cell death (MI/HEART ATTACK).
Acute ischemic heart disease (AIHD)
refers to a group of conditions that
occur when the heart muscle does not
receive enough oxygen-rich blood,
leading to damage or death of the
heart muscle cells.
There are 3 main types of AIHD:
1. ST-segment elevation
myocardial infarction (STEMI):
most severe type, characterized by
a complete blockage of a coronary
artery, resulting in permanent
damage to the heart muscle.
2. Non-ST-segment elevation
myocardial infarction (NSTEMI):
This type occurs when there is a
partial blockage of a coronary
artery, resulting in less damage to
the heart muscle compared to
STEMI.
3. Unstable Angina: occurs when
there is a temporary blockage or a
coronary artery, resulting in chest
pain that can resolve with rest or
medication.
Etiology:
AIHD is typically caused by a
blockage in the coronary arteries,
which supply blood to the heart
muscle. The blockage is often due to:
Atherosclerosis: the primary
cause, involving the gradual
build-up of atherosclerotic
plaques in coronary arteries.
Plaque Rupture: plaque
destabilization can lead to
rupture, exposing thrombogenic
material.
Thrombus Formation: platelet
aggregation and fibrin formation
result in clot formation.
Coronary Artery Spasm:
Vasospasm may cause
temporary reduction of blood
flow.
Emboli: Dislodged clots or debris
can obstruct coronary arteries.
Risk Factors:
Age
Male sex
Family History
Genetics
Smoking
Hypertension
Diabetes
Hyperlipidemia
Obesity
Drug use
Physical exertion
Emotional stress
Electrolyte imbalances
Assessment:
Subjective Data:
a. Nursing History:
Chest pain description
(quality, location, radiation,
duration)
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ACUTE ISCHEMIC HEART DISEASE

Often referred to as acute coronary syndrome (ACS), is a serious cardiovascular condition that occurs when there is a sudden decrease in blood flow to the heart muscle due to a blockage in one or more of the coronary arteries. This can lead to insufficient oxygen supply to the heart muscle, resulting to tissue damage or cell death (MI/HEART ATTACK). Acute ischemic heart disease (AIHD) refers to a group of conditions that occur when the heart muscle does not receive enough oxygen-rich blood, leading to damage or death of the heart muscle cells. There are 3 main types of AIHD:

  1. ST-segment elevation myocardial infarction (STEMI): most severe type, characterized by a complete blockage of a coronary artery, resulting in permanent damage to the heart muscle.
  2. Non-ST-segment elevation myocardial infarction (NSTEMI): This type occurs when there is a partial blockage of a coronary artery, resulting in less damage to the heart muscle compared to STEMI.
  3. Unstable Angina: occurs when there is a temporary blockage or a coronary artery, resulting in chest pain that can resolve with rest or medication.

Etiology: AIHD is typically caused by a blockage in the coronary arteries, which supply blood to the heart muscle. The blockage is often due to:  Atherosclerosis: the primary cause, involving the gradual build-up of atherosclerotic plaques in coronary arteries.  Plaque Rupture: plaque destabilization can lead to rupture, exposing thrombogenic material.  Thrombus Formation: platelet aggregation and fibrin formation result in clot formation.  Coronary Artery Spasm: Vasospasm may cause temporary reduction of blood flow.  Emboli: Dislodged clots or debris can obstruct coronary arteries. Risk Factors:  Age  Male sex  Family History  Genetics  Smoking  Hypertension  Diabetes  Hyperlipidemia  Obesity  Drug use  Physical exertion  Emotional stress  Electrolyte imbalances Assessment: Subjective Data: a. Nursing History:  Chest pain description (quality, location, radiation, duration)

 Risk factors (smoking, HTN, diabetes, family history)  Previous cardiac history/interventions  Medication history Objective Data: a. Physical Assessment (Clinical Manifestations):  Chest discomfort/pain  Diaphoresis (profuse sweating)  Pallor and cool, clammy skin  Dyspnea & tachypnea  Abnormal heart sounds (e.g., murmurs)  Changes in blood pressure, HR, & rhythm.  Decreased LOC Diagnostic Assessment a. Non-invasive Tests:  Electrocardiogram (ECG): to identify any abnormal rhythms or ST Segment changes indicative of MI.  Cardiac enzyme tests/biomarkers (troponin or creatinine kinase): to confirm myocardial cell damage.  Echocardiography: to evaluate cardiac function and identify any regional wall motion abnormalities.  Stress test: to assess cardiac function and coronary blood flow during exercise.  Coronary Computed Tomography Angiography (CTA): uses an injection of iodine-containing contrast material and CT scanning to examine the arteries that

supply blood to the heart and determine whether they have been narrowed. b. Invasive Tests:  Coronary Angiography: to visualize the coronary arteries and identify any

obstructions or stenosis.  Percutaneous Coronary Intervention (PCI): to open up blocked coronary

Implementation Medical/Surgical Management:Coronary Artery Bypass Grafting (CABG): a surgical procedure that involves creating new pathways for blood to flow around blocked or narrowed coronary arteries.

Traditional Coronary Artery Bypass Graft: the surgeon performs a median sternotomy and connects the patient to the

cardiopulmonary bypass (CPB) machine.  Transmyocardial Laser Revascularization (TMR): a surgical procedure that uses laser technology to create small channels within the heart muscle to improve blood flow.  Off-Pump Coronary Artery Bypass (OPCAB): a variation of CABG where the surgery is performed without the use of a heart-lung machine (cardiopulmonary bypass).  Percutaneous transluminal coronary angioplasty (PTCA): a balloon tipped catheter is used to open blocked coronary vessels and resolve ischemia.  Oxygen Therapy: increases oxygen delivery to the heart muscle and alleviate symptoms of oxygen deprivation.  Coronary Artery Stent: release of mediators that leads to vasoconstriction, clotting, and scar tissue formation.  Bed rest and continuous cardiac monitoring. Medications:  Thrombolytic: drugs that dissolve blood clots.

  • Tenecteplase
  • Streptokinase
  • Alteplase  Antiplatelets: agents that inhibit platelet aggregation
  • Aspirin
  • Clopidogral
  • Prasugrel
  • Ticagrelor  Beta Blockers: medications that reduce the hearts workload and decrease the demand for oxygen.
  • Metoprolol
  • Atenolol  Statins: drugs that lower cholesterol levels and reduce inflammation.
  • Simvastatin
  • Artorvastatin  Nitroglycerin: a medication that dilates coronary arteries and reduces the workload on the heart.  Anticoagulant agents: these medications, prevent the formation of new blood clots and are often used in combination with antiplatelet agents.
  • Heparin
  • Low molecular weight heparin  Angiotensin-converting enzyme (ACE) inhibitors or Angiotensin receptor blockers (ARBs): these medications lower blood pressure and reduce the workload on the heart.  Nitrates: these medications relax and widen blood vessels, allowing for increased blood flow to the heart muscle.  Inotropes: these medications increase the contractility of the heart muscle, helping to compensate for reduced function caused by AIHD.  Morphine: for pain management. Nutritional and Diet Therapy:  Promote a heart healthy diet low in saturated fats, cholesterol, and sodium  Encourage a diet rich in fruits, vegetables whole grains, and lean proteins.

 Monitor electrolyte levels, especially potassium and magnesium. Client Education:  Educate the client about risk factor modification (smoking cessation, diet, exercise).  Medication management and adherence.  Recognition of s&s of AIHD.  Stress management and coping strategies.  Importance of follow-up care and cardiac rehabilitation. Evaluation: Assess the client’s response to interventions, including pain relief, improved cardiac function, and reduced anxiety. Monitor for potential complications and adjust the care plan accordingly. Evaluate the clients understanding of AIHS management and lifestyle changes.