Treatment Of Chronic Stable Angina Pectoris -Myassignmenthelp.Com

Question: Discuss About The Treatment Of Chronic Stable Angina Pectoris? Answer: Introduction Arteriosclerosis is the condition leading to hardening of the arterial wall and restriction of the blood flow to different organs and tissues (Kuro-o, 2017). In contrast, atherosclerosis is a condition which leads to narrowing of arteries due to plaque buildup on the artery walls. Atherosclerosis can be regarded as a form of arteriosclerosis where elasticity of arteries are lost due to deposition of fatty plaques and other substance on the artery walls (Stone et al., 2014). The main pathophysiological difference between both the conditions is related to narrowing and hardening of arterial walls in respective conditions. NSTEMI (Non-segmented elevation myocardial infarction) and STEMI (ST-segment elevation myocardial infarction) are two common types of heart attacks where difference is found on the nature of waves detected in electrocardiogram (ECG) (Fanaroff et al., 2016). The difference in ECG characteristics for NSTEMI and STEMI are as follows: Depressed ST wave is found in NSTEMI and in STEMI, elevated ST waves are formed. No progression to Q wave is seen in NSTEMI, however progression to Q wave is seen STEMI condition The ECG characteristics of NSTEMI shows partial blockage of the coronary artery and in case of STEMI, full blockage in the coronary artery is found (Fanaroff et al., 2016). NSTEMI is the least commonly occurring heart attack compared to STEMI (McManus et al., 2011). Angina pectoris is a clinical term given for chest pain in patients with coronary heart disease. It occurs due to blockage of arteries and lack of appropriate blood flow to the heart muscle (Tarkin Kaski, 2013). The main difference between signs and symptoms of myocardial infarction and angina pectoris are as follows: Angina pectoris consists of many types such as stable angina, unstable angina, microvascular angina and Prinzmetals angina (Iqbal et al., 2016). In contrast, myocardial infarction consists of two types including NSTEMI and STEMI (Ludka et al., 2015). The main problem or sign in case of angina pectoris is intermittent chest pain (Katzung Chatterjee, 2012) and the main problem in myocardial infarction is tightness in the chest (Canto et al., 2012). The difference in symptoms of myocardial infarction and angina pectoris is that in case of angina pectoris, patients have pressing chest pain in the left side (Katzung Chatterjee, 2012). In myocardial infarction, the crushing chest pain is on the lower sternum (Canto et al., 2012). Preload and afterload are two terms used in cardiac physiology. Preload or left ventricular end-diastolic pressure is the end-diastolic volume found at the end of diastole. In contrast, afterload or systemic vascular resistance is the amount of resistance needed by heart to push the blood into systemic circulation. Preload is an event that occurs after the end of diastole whereas afterload is a condition that occurs during systole (Lao et al., 2015). One long term effect of hypertension includes increase in risk of stroke due to weakening of the arterial walls and blood vessels. The increased risk of cardiovascular disease occurs in patient with high blood pressure due to increase in pressure of blood flowing through the arteries. It damages the inner lining of the arterial walls (Mahmood et al., 2014). Hence, elasticity of arterial wall is lost creating conditions for development of stroke or other cardiovascular disease. Irregular blood flow to the heart due to narrowing down of arteries leads to chest pain and heart attack in patients (Dawber, Moore Mann, 2015). The artrioventricular node abnormalities are defined as the abnormalities in atrioventricular node leading to interruptions in the electrical conduction from atria to the ventricles (Temple et al., 2016). There are three degrees of atrioventricular blocks which are as follows: First degree block: It results in elongation of PR intervals and delay in atrial impulse. Here PR interval excess by 0.20 seconds Second degree block: It is associated with single non conduction of P wave or repetition of non conduction after PR interval Third degree block: No AV conduction occurs and atrial and ventricular impulses are not synchronous with each other (Luik et al., 2016). The main difference between left sided and right sides heart failure are as follows: In case of left sided heart failure, straining of left ventricle muscles is the reason for heart attack (Rosenkranz et al., 2015). However, in case of right sided heart failure, straining of the right ventricle is the main cause of heart attack (Melenovsky et al., 2014). Left sided failure is associated with severe breathlessness, anxiety, sweating and frothy sputum in cough (Rosenkranz et al., 2015). In case of right sided heart failure, nausea, vomiting, oedema and abdominal pain are the main symptoms (Melenovsky et al., 2014). Drug card for Nitroglycerin: Classification: Anti-anginal and nitrates Pharmacology and actions: It is a vasodilator, hence used for dilating coronary arteries and reducing preload and afterload. It also minimizes the myocardial oxygen demand. Indications: Oral and transdermal mainly used for acute angina and IV used for treatment of acute myocardial infarction Contraindications: Used cautiously when suffering from hypersensitivity, severe anemia, liver impairment, hypovolemia and patients with alcohol intolerance Precautions and side effects: Dizziness, weakness, hypotension and dry mouths are side effects of drugs. Interactions: It has interaction with nitrates in any form Administration: IV dose must be diluted in glass bottles. It must be diluted in 0.9% NaCl and in case of using in concentrated form, it must not exceed 400 mcg/ml. Use topically too. Consideration for drug use: Patients must be instructed about dosage and gradual reduction in dose instead of abrupt discontinuation of drug. Patient must be advised to change position slowly and report about any adverse side effects of the drug (Vallerand, Sanoski Deglin, 2016). Drug card for Digoxin (Lanoxin) Classification: Antiarrhythmics, inotropics Pharmacology and actions: It increased cardiac output by prolonging refractory period of AV node and increasing myocardial contraction. Indications: It is used for treatment of heart failure and atrial tachycardia Contraindications: Contraindicated in AV block, alcohol intolerance and uncontrolled ventricular arrhythmias. Precautions and side effects: Fatigue, weakness, blurred vision, arrhthymias and vomiting are some of the side effect of the drugs. Interactions: It has interaction with thiazide and loop diuretics, beta blockers and thyroid hormones Administration: The dose may vary for children of different age and adults. The dose also differs based on use for inotropic effect and atrial arrhythmias. Consideration for drug use: Apical pulse should be monitored before administration and consider use of digoxin at different heart rates for children (Vallerand, Sanoski Deglin, 2016). Reference Canto, J. G., Rogers, W. J., Goldberg, R. J., Peterson, E. D., Wenger, N. K., Vaccarino, V., ... NRMI Investigators. (2012). Association of age and sex with myocardial infarction symptom presentation and in-hospital mortality.Jama,307(8), 813-822. Dawber, T. R., Moore, F. E., Mann, G. V. (2015). II. Coronary heart disease in the Framingham study.International journal of epidemiology,44(6), 1767-1780. Fanaroff, A. C., Navar, A. M., Clare, R., Lokhnygina, Y., Roe, M., Giugliano, R., ... Blazing, M. (2016). Association of Type of Presentation, STEMI vs NSTEMI/UA, With the Relative Long-Term Incidence of Cardiovascular and Non-Cardiovascular Mortality. Iqbal, M. N., Ashraf, A., Muhammad, A., Alam, S., Xiao, S., Ali, S., Irfan, M. (2016). Prevalence of Angina Pectoris in relation to various risk factors.PSM Biological Research,1(1), 6-10. Katzung, B. G., Chatterjee, K. (2012). Vasodilators and the treatment of angina pectoris.Basic and clinical pharmacology,7, 20-25. Kuro-o, M. (2017). Development of identification and the new treatment of the novel therapeutic target of arteriosclerosis.Impact,2017(6), 53-55. Lao, Y., Ji, H., Huang, Y., Liang, J., Huang, Y., Li, Y., ... Huang, Z. (2015, October). Effects of preload, after-load and myocardial contractility on pressure-volume loop of the cardiovascular system model. InBiomedical Engineering and Informatics (BMEI), 2015 8th International Conference on(pp. 291-295). IEEE. Ludka, O., Stepanova, R., Sedova, P., Kara, T., Spinar, J. (2015). Long term prognosis of patients with different types of myocardial infarction (nstemi and Stemi) with similar left ventricular systolic function and moderate to severe sleep apnea: Supported by European Regional Development Fund-Project Fnusa-icrc (no. Cz. 1.05/1.1. 00/02.0123).European Journal of Heart Failure,17, 436. Luik, A., Mignanelli, L., Kroschel, K., Schmitt, C., Rembe, C., Scalise, L. (2016). Laser Doppler vibrometry as a noncontact method to detect various degrees of atrioventricular block: A feasibility study.Future cardiology,12(3), 269-279. Mahmood, S. S., Levy, D., Vasan, R. S., Wang, T. J. (2014). The Framingham Heart Study and the epidemiology of cardiovascular disease: a historical perspective.The Lancet,383(9921), 999-1008. McManus, D. D., Gore, J., Yarzebski, J., Spencer, F., Lessard, D., Goldberg, R. J. (2011). Recent trends in the incidence, treatment, and outcomes of patients with STEMI and NSTEMI.The American journal of medicine,124(1), 40-47. Melenovsky, V., Hwang, S. J., Lin, G., Redfield, M. M., Borlaug, B. A. (2014). Right heart dysfunction in heart failure with preserved ejection fraction.European heart journal,35(48), 3452-3462. Rosenkranz, S., Gibbs, J. S. R., Wachter, R., De Marco, T., Vonk-Noordegraaf, A., Vachiery, J. L. (2015). Left ventricular heart failure and pulmonary hypertension.European heart journal,37(12), 942-954. Stone, N. J., Robinson, J. G., Lichtenstein, A. H., Merz, C. N. B., Blum, C. B., Eckel, R. H., ... McBride, P. (2014). 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.Journal of the American College of Cardiology,63(25 Part B), 2889-2934. Tarkin, J. M., Kaski, J. C. (2013). Pharmacological treatment of chronic stable angina pectoris.Clinical medicine,13(1), 63-70. Temple, I. P., Logantha, S. J. R., Absi, M., Zhang, Y., Pervolaraki, E., Yanni, J., ... Drinkhill, M. (2016). Atrioventricular node dysfunction and ion channel transcriptome in pulmonary hypertension.Circulation: Arrhythmia and Electrophysiology,9(12), e003432. Vallerand, A. H., Sanoski, C. A., Deglin, J. H. (2016).Davis's Canadian Drug Guide for Nurses. FA Davis.