Chapter 23 Management of Patients with Coronary Vascular Disorders
Potassium:
• Signs of hypokalemia include muscle weakness, fatigue, muscle cramps, constipation and
inverted T waves and a u wave on an EKG (Thread).
Angina:
• Unstable angina increases in severity and may not be resolved with rest or nitroglycerine.
• Instruct patients that angina could be triggered if they eat a heavy meal, blood is shunted to the
gastrointestinal area which decreases blood availability to the myocardium.
• Chest pain is typically felt behind the sternum (retrosternum) and may radiate to the neck, jaw,
shoulders, or along the inner aspect of the left arm.
• A classic finding with angina is that it is relieved with rest or nitroglycerine.
• Decrease oxygen demand and increase oxygen supply with angina.
• Nitroglycerine should be kept in a dark bottle, renewed every 6 months, placed under a moist
tongue and never swallowed and taken q 5 minutes up to 3 doses (call 911 if not effective after
3rd dose) Current practice states to call 911 after the first dose if pain is not relieved.
• Instruct patients that nitroglycerine may cause headache, hypotension, flushing and tachycardia
and they should sit down for several minutes when taking this medication.
• Worsening angina or myocardial infarction could occur if beta blockers are stopped abruptly.
• Inverted t ways are a sign of ischemia while ST elevations is a sign of infarct.
Cardiac Output:
• Assess patients for cardiac tamponade following cardiac surgery.
• A decrease in pulse pressure (< 30 mm Hg) suggests a decrease in stroke volume and cardiac
output while an increase in pulse pressure increases stroke volume and cardiac output.
• Disorders that impair the heart rate or stroke volume will affect cardiac output.
• A weak thready pulse typically suggests a decrease in cardiac output.
Cardiovascular Disease:
• Atherosclerosis impedes blood flow to the myocardium and increases the risk for coronary artery
occlusion.
• Atherosclerosis increases the risk of narrowing of the vessel lumen and thrombus occlusion
which could lead to a reduction in tissue perfusion.
• Modifiable risk factors for coronary artery disease include diabetes, hyperlipidemia, metabolic
syndrome, obesity, physical inactivity and tobacco use.
Potassium:
• Signs of hypokalemia include muscle weakness, fatigue, muscle cramps, constipation and
inverted T waves and a u wave on an EKG (Thread).
Angina:
• Unstable angina increases in severity and may not be resolved with rest or nitroglycerine.
• Instruct patients that angina could be triggered if they eat a heavy meal, blood is shunted to the
gastrointestinal area which decreases blood availability to the myocardium.
• Chest pain is typically felt behind the sternum (retrosternum) and may radiate to the neck, jaw,
shoulders, or along the inner aspect of the left arm.
• A classic finding with angina is that it is relieved with rest or nitroglycerine.
• Decrease oxygen demand and increase oxygen supply with angina.
• Nitroglycerine should be kept in a dark bottle, renewed every 6 months, placed under a moist
tongue and never swallowed and taken q 5 minutes up to 3 doses (call 911 if not effective after
3rd dose) Current practice states to call 911 after the first dose if pain is not relieved.
• Instruct patients that nitroglycerine may cause headache, hypotension, flushing and tachycardia
and they should sit down for several minutes when taking this medication.
• Worsening angina or myocardial infarction could occur if beta blockers are stopped abruptly.
• Inverted t ways are a sign of ischemia while ST elevations is a sign of infarct.
Cardiac Output:
• Assess patients for cardiac tamponade following cardiac surgery.
• A decrease in pulse pressure (< 30 mm Hg) suggests a decrease in stroke volume and cardiac
output while an increase in pulse pressure increases stroke volume and cardiac output.
• Disorders that impair the heart rate or stroke volume will affect cardiac output.
• A weak thready pulse typically suggests a decrease in cardiac output.
Cardiovascular Disease:
• Atherosclerosis impedes blood flow to the myocardium and increases the risk for coronary artery
occlusion.
• Atherosclerosis increases the risk of narrowing of the vessel lumen and thrombus occlusion
which could lead to a reduction in tissue perfusion.
• Modifiable risk factors for coronary artery disease include diabetes, hyperlipidemia, metabolic
syndrome, obesity, physical inactivity and tobacco use.
