Question

explain the difference between stable angina and myocardial infarction

explain treatments for each.

explain teaching interventions (what will you do) to client, provide rationale also

Answer 1

1.differences between stable angina and myocardial infarction :

A myocardial infarction is a serious condition where there is complete blockage of blood supply to the heart. In contrast, stable angina is chest pain or discomfort that usually occurs with activity or stress resulting from poor blood flow through the blood vessels in the heart.

COMMONLY CALLED :

stable angina - chest pain with activity or stress.

Myocardial infarction - heart attack

CAUSES :

stable angina -Decrease in blood supply to heart muscle. This leads to myocardial ischemia.

Myocardial infarction - Complete blockage of blood supply to heart muscle. Secondary to sudden and extended obstruction of the myocardial blood supply

OCCURENCE OF PAIN :

stable angina -Occurs when engaged in physical activity or due to emotional stress

Myocardial infarction - Can occur at any time

SYMPTOMS :

Stable angina -Chest pain with no damage to the heart. Pain is described as a tightness or pressure in the chest, and may radiate to the neck, lower jaw, left arm and left shoulder.

Myocardial infarction - Chest pain with damage to the heart. Pain is sudden substernal chest pain radiates to left neck and usually described as severe, steady, and crushing. Hypotension, weak rapid pulse and low grade fever.

SEVERITY :

Stable angina - Usually no permanent damage to heart muscle. If blood flow is restored, no permanent damage.

Myocardial infarction - Serious condition. May cause permanent damage. If blood supply can be restored in the first 20 min irreversible damage may be prevented.

RELIEVING FACTORS :

stable angina -Symptoms relieved by rest or nitro within 10-15 minutes. Lack of relief indicates an individual may be developing infarction.

Myocardial infarction - Symptoms persists after 15 minutes and not relieved by rest or nitro.

2.TREATMENT OF STABLE ANGINA :stable angina can be controlled with lifestyle changes and medicines.

Aspirin and other anti-platelet medications reduce the ability of your blood to clot, making it easier for blood to flow through narrowed heart arteries.

Nitrates-Often used to treat angina, nitrates relax and widen your blood vessels, allowing more blood to flow to your heart muscle. Nitrates in pills or sprays act quickly to relieve pain during an event.

Beta blockers-these block the effects of the hormone epinephrine, also known as adrenaline. They help your heart beat more slowly and with less force, decreasing the effort your heart makes and easing the angina pain.

Statins-Statins lower blood cholesterol by blocking a substance your body needs to make cholesterol. They might also help your body reabsorb cholesterol that has accumulated in the buildup of fats (plaques) in your artery walls, helping prevent further blockage in your blood vessels.

Calcium channel blockers-Also called calcium antagonists, these drugs relax and widen blood vessels by affecting the muscle cells in the arterial walls. This increases blood flow in your heart, reducing or preventing angina.

Ranolazine (Ranexa)-This anti-angina medication might be prescribed with other angina medications, such as beta blockers. It can also be used as a substitute if your symptoms don't improve with the other medications.

TREATMENT OF MYOCARDIAL INFARCTION :

As a general rule initial therapy for acute MI is directed toward restoration of perfusion as soon as possible to salvage as much of the jeopardized myocardium as possible. This may be accomplished through medical or mechanical means such as percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery.

Treatment ranges from lifestyle changes and cardiac rehabilitation to medication, stents and bypass surgery.

The pain of myocardial infarction is usually severe and requires potent opiate analgesia. Intravenous diamorphine 2.5–5 mg (repeated as necessary) is the drug of choice and is not only a powerful analgesic but also has a useful anxiolytic effect..

Blood thinners, such as aspirin, are often used to break up blood clots and improve blood flow through narrowed arteries.

Thrombolytics are often used to dissolve clots

3.TEACHING INTERVENTIONS :

Stable angina - Nursing interventions for a patient with angina pectoris include:

Treating angina,the nurse should instruct the patient to stop all activities and sit or rest in bed in a semi-Fowler's position when they experience angina and administer nitroglycerin sublingually. Reducing anxiety.

Myocardial infarction - Administer oxygen along with medication therapy to assist with relief of symptoms. Encourage bed rest with the back rest elevated to help decrease chest discomfort and dyspnea. Encourage changing of positions frequently to help keep fluid from pooling in the bases of the lungs.The nursing management involved in MI is critical and systematic. efficiency is needed to implement the care for a patient with MI.