NLE Cardiovascular Nursing — Coronary Artery Disease, Angina and Myocardial InfarctionConcept Map

Concept

Pathophysiology of CAD

Sub Concepts

• Atherosclerosis and plaque formation
• Endothelial injury and inflammation
• LDL deposition in arterial intima
• Progressive luminal narrowing
• Myocardial ischemia when demand exceeds supply
• Plaque rupture and thrombosis

Relationship To Central

Foundation of disease process

Concept

Risk Factors

Sub Concepts

• Non-modifiable: age, sex, family history, ethnicity
• Modifiable: hypertension, dyslipidemia, diabetes mellitus, smoking
• Lifestyle factors: obesity, physical inactivity, stress
• DOH PhilPEN screening targets
• Prevention as pillar of NCD program

Relationship To Central

Modifiable and non-modifiable causes

Concept

Angina Pectoris

Sub Concepts

• Stable angina: exertional, predictable, relieved by rest and nitroglycerin
• Unstable angina: at rest, frequent, not relieved by rest, form of ACS
• Variant angina: coronary spasm, nocturnal
• Normal cardiac biomarkers
• Clinical presentation: substernal pressure, radiation to arm/jaw/back

Relationship To Central

Reversible myocardial ischemia presentation

Concept

Myocardial Infarction

Sub Concepts

• Complete coronary occlusion
• Prolonged ischemia leading to permanent damage
• STEMI: ST-segment elevation, full-thickness injury
• NSTEMI: ST depression or T-wave inversion, partial occlusion
• Elevated troponin and CK-MB
• Severe, crushing chest pain lasting over 20 minutes
• Atypical presentations in women, elderly, diabetics
• Silent MI in diabetics due to neuropathy

Relationship To Central

Irreversible myocardial necrosis

Concept

Acute Coronary Syndrome Management

Sub Concepts

• MONA framework with modern nuance
• Aspirin: chewable 160-325 mg, first-priority drug
• Nitroglycerin: sublingual, up to 3 doses, contraindications
• Oxygen: only for hypoxia, SpO2 below 90-94%
• Morphine: reserved for pain unrelieved by nitroglycerin
• Reperfusion therapy: PCI vs thrombolytics
• Adjunct pharmacology: antiplatelets, anticoagulants, beta-blockers, ACE inhibitors, statins

Relationship To Central

Treatment and intervention strategies

Concept

Reperfusion Therapy

Sub Concepts

• PCI: preferred first-line, door-to-balloon under 90 minutes
• Thrombolytic therapy: alteplase, reteplase, tenecteplase, streptokinase
• Door-to-needle time under 30 minutes
• Time window: ideally within 6 hours, up to 12 hours
• Bleeding risk and absolute contraindications
• Reperfusion signs and dysrhythmias

Relationship To Central

Critical for restoring coronary blood flow

Concept

Nursing Management and Priorities

Sub Concepts

• Pain relief and anxiety reduction
• 12-lead ECG within 10 minutes
• IV access and cardiac marker draw
• Continuous cardiac monitoring for dysrhythmias
• Position upright to reduce oxygen demand
• Bed rest and workload reduction
• Vital signs and rhythm monitoring
• Patient reassurance

Relationship To Central

Evidence-based nursing interventions

Concept

Complications

Sub Concepts

• Dysrhythmias: ventricular fibrillation (leading cause of early death)
• Cardiogenic shock
• Heart failure and pulmonary edema
• Pericarditis and Dressler's syndrome
• Papillary muscle rupture
• Ventricular aneurysm
• Cardiac rupture

Relationship To Central

Adverse outcomes requiring intervention

Concept

Cardiac Rehabilitation and Patient Teaching

Sub Concepts

• Structured, progressive exercise programs
• Phases: inpatient, early outpatient, long-term maintenance
• Nitroglycerin use and storage
• Warning signs recognition and response
• Risk factor modification: smoking cessation, BP control, diabetes management
• Heart-healthy diet: low-saturated fat, low-sodium
• Sexual activity and driving resumption
• Medication adherence

Relationship To Central

Long-term recovery and prevention

Concept

Diagnostic Tools

Sub Concepts

• 12-lead ECG: ST elevation, ST depression, T-wave inversion, Q waves
• Troponin: most specific and sensitive cardiac biomarker
• CK-MB: rises in myocardial necrosis
• Serial biomarker measurement
• Angiography for determining anatomy and stenosis severity

Relationship To Central

Confirmation and assessment methods

Concept

Angina vs MI Differentiation

Sub Concepts

• Cause: reversible ischemia vs irreversible necrosis
• Duration: under 15 minutes vs over 20-30 minutes
• Relief: rest/nitroglycerin responsive vs non-responsive
• Cardiac markers: normal vs elevated troponin/CK-MB
• ECG changes: transient vs persistent ST-T changes

Relationship To Central

Clinical distinction for management decisions

To

Myocardial Ischemia

From

Atherosclerosis

Strength

strong

Relationship

Progressive atherosclerotic plaque narrows coronary artery lumen, reducing blood flow and oxygen supply to myocardium

To

Atherosclerosis

From

Risk Factors

Strength

strong

Relationship

Modifiable and non-modifiable risk factors accelerate atherosclerotic plaque formation and progression

To

Stable Angina

From

Myocardial Ischemia

Strength

strong

Relationship

Transient reversible ischemia triggered by exertion or stress results in anginal chest pain

To

Thrombosis

From

Plaque Rupture

Strength

strong

Relationship

Rupture of atherosclerotic plaque exposes thrombogenic material, triggering platelet aggregation and thrombus formation

To

Myocardial Infarction

From

Thrombosis

Strength

strong

Relationship

Complete coronary artery occlusion by thrombus causes prolonged myocardial ischemia leading to irreversible necrosis

To

Myocardial Infarction

From

Unstable Angina

Strength

strong

Relationship

Unstable angina is a form of ACS that signals impending MI; biomarkers remain normal but tissue damage may occur

To

Reperfusion Therapy

From

STEMI

Strength

strong

Relationship

ST-elevation MI requires immediate reperfusion via PCI or thrombolytics to minimize myocardial damage and mortality

To

Medical Therapy

From

NSTEMI

Strength

strong

Relationship

NSTEMI is managed initially with aggressive medical therapy including dual antiplatelets and anticoagulation before angiography

To

Antiplatelet Effect

From

Aspirin

Strength

strong

Relationship

Aspirin irreversibly inhibits platelet aggregation, reducing thrombus formation and improving outcomes in ACS

To

Symptom Relief

From

Nitroglycerin

Strength

strong

Relationship

Nitroglycerin causes vasodilation, reduces preload, and relieves ischemic chest pain in angina

To

Right Ventricular MI

From

Contraindications to Nitroglycerin

Strength

strong

Relationship

RV MI patients are preload-dependent; nitroglycerin-induced vasodilation can cause profound hypotension

To

Bleeding Risk

From

Thrombolytic Therapy

Strength

strong

Relationship

Thrombolytic agents dissolve fibrin clots but carry significant risk of hemorrhage including intracranial bleeding

To

Dysrhythmia Detection

From

Continuous Cardiac Monitoring

Strength

strong

Relationship

Continuous monitoring enables early detection and treatment of potentially fatal dysrhythmias like VF occurring in MI

To

MI Complications

From

Dysrhythmias

Strength

strong

Relationship

Ventricular dysrhythmias are the leading cause of death in the early hours of MI

To

Risk Factor Modification

From

Cardiac Rehabilitation

Strength

moderate

Relationship

Structured rehabilitation includes patient teaching and supervised exercise to modify cardiovascular risk factors

To

Medication Adherence

From

Patient Teaching

Strength

moderate

Relationship

Education on nitroglycerin use, antiplatelet therapy, and long-term medications improves compliance and outcomes

To

MI Diagnosis

From

Troponin

Strength

strong

Relationship

Elevated troponin is the most specific and sensitive marker for myocardial necrosis and confirms MI diagnosis

To

STEMI vs NSTEMI

From

ECG Changes

Strength

strong

Relationship

ST elevation indicates full-thickness transmural MI; ST depression or T-wave inversion suggests subendocardial or partial MI

To

Myocardial Salvage

From

Door-to-Balloon Time

Strength

strong

Relationship

Rapid PCI within 90 minutes of arrival maximizes myocardial salvage and reduces infarct size and mortality

To

Thrombolytic Efficacy

From

Door-to-Needle Time

Strength

strong

Relationship

Thrombolytic administration within 30 minutes of arrival improves clot dissolution and clinical outcomes

To

Women and Elderly

From

Atypical MI Presentations

Strength

moderate

Relationship

Women, older adults, and diabetics often present with fatigue, dyspnea, or indigestion rather than classic chest pain

To

Diabetics

From

Silent MI

Strength

moderate

Relationship

Diabetic neuropathy masks typical MI pain symptoms, leading to delayed recognition and treatment

To

Ventricular Remodeling

From

ACE Inhibitors

Strength

moderate

Relationship

ACE inhibitors reduce afterload and prevent pathologic ventricular remodeling following MI

To

Myocardial Oxygen Demand

From

Beta-blockers

Strength

strong

Relationship

Beta-blockers decrease heart rate, blood pressure, and contractility, reducing myocardial oxygen consumption

To

Plaque Stabilization

From

Statins

Strength

moderate

Relationship

Statins lower LDL cholesterol and stabilize atherosclerotic plaques, reducing rupture risk

To

MI Mortality

From

Cardiogenic Shock

Strength

strong

Relationship

Cardiogenic shock develops when MI damages a large area of myocardium, impairing cardiac output and perfusion

To

Acute MI

From

Papillary Muscle Rupture

Strength

strong

Relationship

Acute MI can cause necrosis of papillary muscles, leading to acute mitral regurgitation and pulmonary edema

To

Post-MI Inflammation

From

Pericarditis

Strength

moderate

Relationship

Post-MI pericarditis and Dressler's syndrome occur as inflammatory responses to myocardial necrosis

To

MI Complications

From

Heart Failure

Strength

strong

Relationship

Systolic heart failure develops when MI impairs left ventricular contractility and ejection fraction

To

Oxygen Therapy

From

Oxygen Saturation Monitoring

Strength

strong

Relationship

Supplemental oxygen is indicated only when SpO2 falls below 90-94%, reflecting current evidence-based practice