Question

• How the nurse would compare and contrast the symptoms and diagnostic evaluation between angina and myocardial infarction?
• What would be the RN’s priority action when caring for a client with ACS? 

Answer 1

Angina is chest pain that occurs because the heart muscle is not receiving enough blood. When the heart is at rest, it may receive enough blood despite the atherosclerosis. ... When the coronary arteries become blocked or severely narrowed by a blood clot, this causes a myocardial infarction, or heart attack.

angina is medical term for chest pain. The heart is not only the pump for the blood of our body but it is also a muscle. Just like all muscles in the body it requires blood to provide oxygen and nutrients to maintain the health and function of the muscle.

The coronary arteries are the arteries that provide blood to the heart muscle. If the arteries are narrowed, the heart muscle is at risk for not receiving enough blood. Atherosclerosis is a plaque build-up that causes narrowing in the arteries.

Patients are likely to be anxious and frightened. Nurses should be calm and reassuring, and ensure pain and other symptoms are well controlled. They play a central role in providing psychosocial sup- port; when possible, they should give patients a chance to speak about their experiences, address their concerns and relay these to the multidisciplinary team.

At rest, the heart muscle requires less oxygen and nutrients than with activity. Think of your car. When driving at a slow rate, it requires less gas to fuel it. But when the car is performing at high speeds, it requires increased gas to fuel it. The same applies to your heart.

Therefore, when a person has atherosclerosis of the coronary arteries, they may not experience any problems when at rest. But when the person becomes active, causing the heart to work harder, there is not enough blood flow to keep up with the increased workload. When a muscle doesn't receive enough oxygen and nutrients, it causes pain in that muscle. It can also cause other symptoms such as feeling lightheaded and short of breath. This is why angina occurs and it can indicate that a more serious event may occur.

Myocardial Infarction

If the narrowed arteries that feed the heart muscle become blocked or severely narrowed, it is called a myocardial infarction, commonly known as a heart attack. The blockage is often due to a blood clot. When the heart muscle doesn't receive oxygen and nutrient-rich blood, it results in cell damage and death in the heart. This results in permanent damage to the heart muscle.

Time is important when experiencing a heart attack. The longer the blockage occurs, the more damage that can be done.

It is recommended to take aspirin if experiencing signs and symptoms of a heart attack. The aspirin works to prevent any further clotting. In the emergency room, they will administer oxygen. They may also administer nitroglycerin, which dilates the blood vessels and allows increased blood flow to the heart. Morphine is used for pain. It may be necessary to have a stent placed to open up the artery and resume normal blood perfusion.

nursing care of patient with ACS:

Keeping clear and comprehensive notes is crucial to ensure all nurses caring for patients with ACS know the patients’ clin- ical status, areas of concerns and manage- ment plan. Nurses caring for patients who recently had coronary angiography should monitor radial or femoral access sites and be able to recognise complications. Close communication with cardiac catheterisa- tion laboratory staff and the coronary care unit is crucial. Nurses receiving these patients need clear information about the type of procedure they had, any complica- tions, medications and IV uids, and whether they have received anticoagulants or GPIs, which will put them at greater risk of bleeding.

General priorities for patients with ACS are haemodynamic monitoring and close observation of vital signs. A review of uid status can provide information about renal perfusion, as some patients may present with, or develop, heart failure. In patients with diabetes, capillary blood glucose levels should be regularly checked; some may be put on IV insulin if their blood glu- cose is >11mmol/L. Patients recently diag- nosed with diabetes should be referred to the diabetes specialist nurse.

Symptom monitoring is important to achieve pain relief with GTN or morphine. Swift recognition of any cardiac changes on the serial ECGs is also a key aspect of nursing care. Patients considered at high risk should be managed where continuous cardiac monitoring is available as they are at risk of arrhythmias, which can precede a cardiac arrest. Patients at intermediate risk may be managed in a medical assess- ment unit, where they are likely to receive serial ECGs. Nurses caring for patients with ACS should have ECG interpretation skills, as ECG changes or arrhythmias are signs of potential deterioration.

Other elements of nursing care include ongoing management of IV cannulas, cen- tral venous pressure lines, urinary cathe- ters and wounds and dressings.