Pennsylvania Nurse, Front Page 2017 Issue 1 | Page 21

needs to educate patients on ex-
ercising to an intensity that does
not impede their ability.
The healthcare community has a
duty to educate the patient popu-
lation on their modifiable risk
factors for heart disease. Patients
who perceive their modifiable risk
factors and understand that they
can influence risk factors may be
more likely to positively alter be-
haviors. Compliance in a health-
care regime requires a balanced
teamwork between the healthcare
team and the patient.
Pathophysiology
All muscles in the body require
a constant blood supply. A heart
muscle will receive an inadequate
blood supply due to fat and cho-
lesterol narrowing clogs the coro-
nary arteries. When an athero-
sclerotic plaque ruptures, fissures,
or ulcerates, it can cause a partial
and/or occlusive thrombus disrup-
tion of blood flow to the muscle.
Clinical manifestations of CAD
produce symptoms and complica-
tions arising from the location
and degree of the narrowing of
the arterial lumen, thrombus
formation, and obstruction of
blood flow to the myocardium (or
heart muscle). This obstruction
of blood flow is usually progres-
sive. It will cause an insufficient
blood supply to the myocardium
and a deprivation of oxygen.
If this lack or decrease in blood
supply is great enough and/or of
long enough duration, permanent
damage and death to the myo-
cardial cells occurs. Over time,
damaged myocardial tissue dete-
riorates and is replaced by scar
tissue. This will cause varying
amounts of myocardial dysfunc-
tion. Results include persistent
low cardiac output and heart
failure when the body’s need for
blood supply cannot be main-
tained. This decrease in blood
supply may give rise to an abrupt
cessation of the heart known as
sudden cardiac death.
Individuals with myocardial
ischemia present with a range of
symptoms other than chest pain.
Heart disease in women develops
differently than in men and often
progresses over a longer period
of time. The symptoms of heart
disease in women may be more
subtle. For this reason, women
tend to attribute their symptoms
to another cause. It is important
for all women to be aware of the
differences in symptoms. Prodro-
mal symptoms may manifest or
a major cardiac event may be the
first evidence of coronary athero-
sclerosis.
Angina (chest pain) is often de-
scribed as a tightness in the chest,
which at times radiates down the
left arm or into the jaw. Other
symptoms are chronic breathless-
ness or waking up and finding it
difficult to catch one’s breath.
Overwhelming and unusual
fatigue is also associated with
heart disease in women. Dizzi-
ness, unexplained lightheaded-
ness, and blackouts are signs that
women experience with heart
disease. Edema (particularly in
the lower legs and ankles), profuse
sweating, and vague abdominal
discomfort, including nausea or
vomiting, may occur.
Angina in men is notably differ-
ent. Men describe their pain as
sudden pressure, fullness, squeez-
ing, or pain in the center of the
chest. This pain lasts more than a
few minutes or will go away and
return. Pain radiates from the
center of the chest to the shoul-
der, neck, or arms. Chest dis-
comfort may be accompanied by
fainting, lightheadedness, profuse
sweating, nausea, or shortness of
breath. A sudden onset of a rapid
heartbeat may also be noted, as
well as an impending sense of
doom.
Further complicating the presen-
tation of cardiac events is the age
of an individual. Typical pain
for a male or a female decreases
with age, which results in a
delay of treatment. Older adults
commonly present with dyspnea
(shortness of breath). However,
they are less likely to present with
precordial pain due to a decrease
in pain perception. This makes
older adults more prone to pain-
less acute coronary syndromes.
Additionally, neurological symp-
toms (confusion and weakness)
and worsening heart failure are
common in the elderly. Comorbid-
ities are common in older adults,
which makes diagnosis difficult
and EKG findings atypical.
Healthcare providers must re-
member that the older adult, who
typically has multiple comor-
bidities, has an increased risk of
a silent myocardial infarction.
Increasing a healthcare provider’s
knowledge on the atypical signs
and symptoms of CHD presenta-
tion in a woman and the older
adult populations can increase
treatment time and outcomes.
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