Angina Pectoris: Blood Vessel Changes in Heart Disease – Atherosclerosis (Nursing)

00:00 Now that we've clarified that topic.

00:02 Let's take a look at the blood vessels and the changes that happen in heart disease.

00:07 Now we've covered this in detail in other areas, but I want to give you a quick review.

00:12 This is a beautiful drawing and it's worth just hanging out here for a little bit so you can make sense of all that we have here.

00:19 I'll help you with your learning.

00:20 Now first let's look at the key.

00:22 I want to orient you, see the endothelial cells and what they look like.

00:27 So look at the normal vessel farthest on the left, endothelial cells, see those all the way around.

00:34 Then look at the structures that are the neutrophils.

00:36 Found them? Cool! Now look for the platelets.

00:41 I want you to look through each one of these five drawings and see where you see them present.

00:48 Now note the red blood cells or those biconcave disc their job is to carry hemoglobin and therefore oxygen to the tissues look for them in all four, and five of the drawings.

01:03 Now lastly, you've got a thrombus so you don't see that in the first one not in the second one, not in the third, but look at what's going on in that fourth and fifth one.

01:16 Yeah those both have thrombi.

01:19 They both have a clot.

01:21 But I want you to notice the difference between 4 and 5.

01:25 Okay, it's clearly much bigger in the fifth one or infarct.

01:31 So see that's what happens in these blood vessels as they change.

01:35 Let's start back at the normal one.

01:36 Now you've been introduced to all the players.

01:38 So, you know what those are.

01:39 Look at the normal vessel.

01:41 Everybody's there.

01:42 Everything's moving freely.

01:44 That's a good blood supply.

01:46 Now someone who has that.

01:48 What is that yellow stuff on the top for the roof of their vessel there? That's atherosclerotic plaque.

01:55 So this likely happened over a period of time.

01:57 There's some type of initial injury, fatty substances and the inflammatories responded, the platelets put out that growth factor, then you got all that stuff trapped in there and it eventually became hardened tough fibrous plaque that's made the vessel smaller.

02:13 Now that's why you can have exertional angina.

02:16 That means if I'm at rest with exertional angina, I'm fine.

02:20 My heart muscle, I shouldn't have any chest pain because there's still enough blood scooting by there to be okay, but if I do something that requires the heart to need more oxygen, I work hard, I do some heavy lifting, I do something that makes my heart pump harder and faster.

02:37 Now I'm going to...

02:39 it's not going to be adequate oxygen supply to my heart because of the exertion because I'm asking more of my heart.

02:46 It's wanting more oxygen delivered and because that vessel has been narrowed from plaque just can't provide it.

02:54 That's what causes exertional angina.

02:57 These patients, if we have them rest or maybe take a little nitroglycerin.

03:01 It should go away and they know what starts the angina, they know it starts the chest pain because they were out shoveling something or running or doing some type of exercise or activity that exerted them.

03:13 So if you're helping a patient with exertional angina, we likely know they have it.

03:18 They know this brings it on.

03:20 They've been diagnosed with this before then they have a plan.

03:23 They know what to do.

03:24 Now look at the the next one.

03:27 Vasospastic angina.

03:29 What's different about that vessel compared to the first two? It's a lot smaller.

03:35 You got it.

03:36 That's because, its kind of clamping down so you can see we've got much less area for the blood to be delivered to you, right? That pipe is much much smaller because of the vasospasm.

03:49 Now remember what's all the way around that vessel right, smooth muscle.

03:55 So that's why I can clamp down like that.

03:59 So you liked it a normal vessel.

04:01 We've looked at why people with exertional angina can be fine if they're at rest, but if they do something that raises their heart rate or elevates that then we know that's why they can have chest pain.

04:12 Vasospastic means they didn't wasn't because they were doing exercise.

04:15 It can just randomly happen and with that smooth muscle all the way around.

04:20 It's no problem for it to clamp down in a spasm.

04:23 Here's the last two that It's really important you understand.

04:27 This is much different.

04:30 Okay with unstable angina or what's the difference between unstable and exertional? Will see what's going on here.

04:39 We have narrowing of the arteries.

04:41 Yeah, both pictures have atherosclerotic plaque.

04:45 That's the same both pictures of red cells still got those players there but introduction, right there.

04:54 You've got a thrombus.

04:56 So this is what can happen in unstable angina.

05:00 This is why it's a medical emergency.

05:03 See it's narrower now that clot, that thrombus that's developed from many places have no idea right now where it's coming from.

05:11 That's not the most important point.

05:13 Let's just say you've got a clot, a thrombus.

05:15 It's broken off, it traveled around and it got caught in an area where the artery had narrowed.

05:22 And now that thrombus is a problem.

05:24 Is there any blood flow? Yes, that's why it's unstable see how we have some of those red cells there for you, you can see they're still getting through, we've got platelets there, The red cells are still there, but move over to infarct.

05:39 Yeah, you can see there's some very tiny spaces but not enough that's really going to be able to make a difference for the heart.

05:46 So that's when we're at infarct.

05:50 Unstable angina is much much closer to infarct than exertional angina when it becomes unstable angina, our next step and it might not be very long is when it turns into infarcted tissue.

06:03 So that's why you need to recognize the signs and symptoms intervene as quickly as possible and help that patient move on to a healthier next step.

06:13 It's not just us who are important piece of the puzzle.

06:16 The patient also needs to recognize when their angina is different because unstable angina will present differently than exertional.

06:23 But now that you've got a picture in your mind, I'd pause for a minute go back and spend some time just on your own without listening to my voice and look at the differences and the similarities on how the vessels look and each one of these five states.

06:41 Okay, welcome back.

06:43 Now that you've got a really clear picture in your mind of what's going on in these vessels.

06:47 It's going to make understanding the treatment plan for each one of these much simpler.

06:51 Now prinzmetal angina, that's a vasospasm.

06:55 Now while you're picturing in your mind.

06:56 Yeah that really small artery, cool.

07:00 It's a vasospasm.

07:01 There's really not a lot of rhyme or reason sometimes on way it happens.

07:05 So we treat that one a little differently.

07:07 Now chronic stable angina.

07:10 That's because there's a fixed stenosis.

07:13 Not a clot that's blocking everything off but there's a fixed stenosis.

07:18 It's also called demand ischemia or exertional ischemia.

07:22 Think back to the picture we just talked about.

07:25 Okay.

07:26 So which one of those pictures represented chronic stable angina? How did it look different from unstable angina or infarct? Great! Thanks for hanging with us and doing the work as we walk through it.

07:39 We're going to save you time and studying I promise.

07:43 Now last one unstable angina.

07:46 What was different about this one? You've got that thrombus.

07:49 It's blocked it off right now there's no blood or very limited blood being supplied to the heart.

07:54 So this one is the medical emergency.

07:57 This is a crisis because we don't want unstable angina to become infarct.

08:04 Okay, so you've got the three types of angina here before you go on, pause for just a minute, play with these concepts, make sure your very clear on the difference of these names that we use and you can picture what the artery looks like in each one of these states.