1. D. Safaa eid
Medical surgical and critical care nursing
department

2. function of the
heart
•circulate blood throughout the
body
•Pumping blood through the lungs
removes carbon dioxide and
refreshes the blood with oxygen
•The coronary arteries are the
blood vessels that supply blood
and oxygen to the heart muscle.

3. Coronary Circulation

4. Definition:
is an abnormal accumulation of lipid, or fatty
substances in the vessel wall.
These substances create blockages or narrow
the vessel in a way that reduces blood flow to the
myocardium.

5. Risk factors

7. Risk Factors
Uncontrollable Controllable
•Sex •High blood pressure
•Hereditary •High blood cholesterol
•Age •Smoking
•Physical activity
•Obesity
•Diabetes
•Stress and anger

8. Pathophysiology :
•Atherosclerosis begins as fatty streaks, lipids that
are deposited in the intima of the arterial wall.

9. • T lymphocytes and monocytes infiltrate the area to
ingest the lipids and then die
• a fibrous cap is formed over the dead fatty core.
• These deposits, called atheromas or plaques,
protrude into the lumen of the vessel, narrowing it
and obstructing blood flow.
• plaques are made up of cholesterol particles, fat,
calcium, cellular waste and other substances.

10. Clinical manifestations
Chest
None Pain
Signs &
Symptoms
Shortness Heart
Of Breath Attack

11. • symptoms similar to those of a heart
attack, such as chest pain (angina).
• If you have atherosclerosis in the arteries
leading to your brain, symptoms such as
sudden numbness or weakness in your
arms or legs, difficulty speaking .
• If you have atherosclerosis in the arteries
in your arms and legs, symptoms such as
leg pain when walking (intermittent
claudication).

12. Diagnostic studies
• ECG
• cardiac enzymes

13. •Get regular medical checkups.
•Control your blood pressure.
•Check your cholesterol.
•Don’t smoke.
•Exercise regularly.
•Maintain a healthy weight.
•Eat a heart-healthy diet.
•Manage stress.

14. Treatment
• Lifestyle changes: Reducing the lifestyle risk factors
• Medication: Taking drugs for high cholesterol and
high blood pressure
• Anti-platelet medications. such as aspirin, to reduce
the likelihood that platelets will clump in narrowed
arteries, form a blood clot and cause further
blockage.
• Beta blocker medications. They lower heart rate and
blood pressure.

15. • Angiotensin-converting enzyme (ACE)
inhibitors
• slow the progression of atherosclerosis by
lowering blood pressure and reduce the risk of
recurrent heart attacks.
• Calcium channel blockers.
• These medications lower blood pressure
• Diuretics, lower blood pressure.

16. • Angiography and stenting:
- Cardiac catheterization with angiography of the
coronary arteries .
- Using a thin tube inserted into an artery in the
leg or arm, doctors can access diseased
arteries. Blockages are visible on a live X-ray
screen.

17. • Angioplasty
• (catheters with balloon tips) and stenting
can often open up a blocked artery.
• Bypass surgery: Surgeons "harvest" a
healthy blood vessel (often from the leg or
chest). They use the healthy vessel to bypass
a segment blocked by atherosclerosis.

19. Treatment (continued)
1) Stenting
• a stent is introduced into a blood vessel on a balloon
catheter and advanced into the blocked area of the artery
• the balloon is then inflated and causes the stent to expand
until it fits the inner wall of the vessel, conforming to
contours as needed
• the balloon is then deflated and drawn back
•The stent stays in place permanently, holding the vessel
open and improving the flow of blood.

20. Treatment (continued)
2) Angioplasty
• a balloon catheter is passed through the guiding catheter to the
area near the narrowing. A guide wire inside the balloon catheter is
then advanced through the artery until the tip is beyond the
narrowing.
• the angioplasty catheter is moved over the guide wire until the
balloon is within the narrowed segment.
• balloon is inflated, compressing the plaque against the artery wall
• once plaque has been compressed and the artery has been
sufficiently opened, the balloon catheter will be deflated and
removed.

21. Treatment (continued)
3) Bypass surgery
• healthy blood vessel is removed from leg, arm or chest
• blood vessel is used to create new blood flow path in your heart
• the “bypass graft” enables blood to reach your heart by flowing
around (bypassing)
the blocked portion
of the diseased
artery. The
increased blood
flow reduces angina
and the risk of heart
attack.

22. Angina Pectoris
• Angina pectoris is a clinical syndrome
usually characterized by episodes of pain
or pressure in the anterior chest.

23. Causes
• insufficient coronary blood flow.
• Aortic stenosis
• Pulmonary hypertension
• Congenital disease

24. Types of Angina
• Stable angina: pain that occurs on
exertion and is relieved by rest
• Unstable angina (also called
preinfarction angina : symptoms occur
more frequently and last longer than
stable angina. pain may occur at rest.

25. • Intractable or refractory angina: severe
chest pain
• Variant angina pain at rest with reversible
ST-segment elevation; thought to be caused
by coronary artery vasospasm
• Silent ischemia: objective evidence of
ischemia, but patient reports no symptoms

26. Clinical Manifestations
• Chest pain

27. • The patient often feels tightness or a
heavy, choking, or strangling sensation.
• The patient with diabetes mellitus may not
have severe pain with angina because the
neuropathy
• A feeling of weakness or numbness in the
arms, wrists, and hands may accompany the
pain

28. • Shortness of breath, pallor, diaphoresis,
dizziness , nausea and vomiting.
• Anxiety may accompany angina. An
important characteristic of angina is that it
subsides with rest or nitroglycerin

29. Factors are associated with
typical angina pain:
• Physical exertion
• Exposure to cold,
• Eating a heavy meal,
• Stress .

30. Diagnostic Findings
• Noninvasive tests
– Chest x-ray
– [ECG]
– Exercise ECG (stress test)
– Echocardiography at rest
– Ambulatory ECG (Holter monitor)

32. Invasive tests
– Coronary arteriography
– Intravascular ultrasound
– Fasting lipid profile including total
cholesterol (TC), low density lipoprotein
(LDL), high density lipoprotein (HDL), and
triglycerides

33. – C-reactive protein (CRP) is a marker for
inflammation of vascular endothelium.
– High CRP is associated with increased
coronary artery calcification and risk of
an acute cardiovascular event (eg, MI)

34. Medical Management
A- Pharmacologic Therapy
1-Nitroglycerin reduce myocardial oxygen
consumption, which decreases ischemia
and relieves pain
2- Beta-Adrenergic Blocking Agents.
• as (Inderal) reduce myocardial oxygen
consumption

35. • Calcium channel blockers relax the blood
vessels, causing a decrease in blood
pressure and an increase in coronary
artery perfusion.
• Antiplatelet medications are administered
to prevent platelet aggregation
• Heparin prevents the formation of new
blood clots. reduces the occurrence of MI.

36. B- Oxygen Administration.
• increase the amount of oxygen delivered
to the myocardium and to decrease pain.

37. Nursing Interventions
• Help the patient to sit or rest in bed in a semi-
Fowler position .
• Measuring vital signs and observing for signs
of respiratory distress.
• The patient is placed on cardiac monitoring .
• a 12-lead ECG is usually obtained, the ST
segment is assessed for changes.
• Nitroglycerin is administered sublingually,

38. • nitroglycerin administration is repeated up to
three doses.
• Each time, blood pressure, heart rate, and the
ST segment are assessed.
• Assess and document pain characteristics
• The nurse administers oxygen therapy if the
patient’s respiratory rate is increased or
decreased.

39. • oxygen is usually administered at 2 L/min by nasal
cannula.
• Maintain activity restrictions based on the
patient’s activity tolerance to reduce myocardial
oxygen demands.
• Begin the patient on a low-cholesterol, low-sodium
diet to alleviate the modifiable risk factors

40. Patient Teaching for Patients with
Angina Pectoris
• Activity and Exercise
• Diet
• Smoking
• Cold Weather
• Medications