Page 4 - Lippincott's Visual Nursing_ A Guide to Diseases, Skills, and Treatmentspo_Neat

LWBK942-C02[11-76].qxd 6/27/11 8:39 PM Page 23

Coronar y ar ter y disease 23

Stable angina

Angina is the classic sign of coronary artery
disease. There are three forms of stable
angina: chronic stable angina, microvascular
(cardiac syndrome X) angina, and Prinzmetal’s
(variant) angina.

Chronic stable angina
◗ Characterized by exertional, rest-
relieved discomfort, located any-
where between the umbilicus and
the ears that may be associated with
numbness of the arms or hands Partially blocked
◗ Doesn’t increase in frequency or artery, causing
chronic stable
severity over time angina
◗ Generally caused by fixed obstruc-
tive atheromatous lesions
◗ Treated with rest and nitrates
during attacks, and beta-adrenergic Capillary constriction,
blockers for prevention causing microvascular
angina without
blockage of coronary
arteries

Area of vasospasm,
Microvascular causing Prinzmetal’s
(cardiac syndrome X) angina angina
◗ Characterized by stable angina-like chest pain
◗ Caused by impairment of vasodilator reserve
◗ Poses no risk of cardiac ischemia because the Prinzmetal’s (variant) angina
capillaries are too small to block oxygenation ◗ Characterized by resting discomfort, which can cause
of cardiac cells the patient to awaken at night and persists for hours
◗ Treated with nitrates, beta-adrenergic block- ◗ Caused by coronary artery vasospasm
ers, or calcium channel blockers ◗ Causes reversible ST-segment elevation during event
◗ Treated with calcium channel blockers and nitrates,
possibly beta-adrenergic blockers, or coronary stent-
ing if intractable
LESSON
PLANS

Teaching about CAD

◗ If the patient is scheduled for sur- ◗ Stress the need to follow the pre- rehabilitation center or cardiovas-
gery, explain the procedure, pro- scribed drug regimen. cular fitness program near his
vide a tour of the intensive care ◗ Encourage the patient to maintain home or workplace.
unit, introduce him to the staff, the prescribed low-sodium diet ◗ Reassure the patient that he can
and discuss postoperative care. and start a low-calorie diet as well. resume sexual activity and that
◗ Help the patient determine which ◗ Explain that recurrent angina modifications can allow for sexual
activities precipitate episodes of symptoms after PTCA or rotational fulfillment without fear of overex-
pain. Help him identify and select ablation may signal reobstruction. ertion, pain, or reocclusion.
more effective coping mechanisms ◗ Encourage regular, moderate exer- ◗ Refer the patient to a smoking
to deal with stress. cise. Refer the patient to a cardiac cessation program.