young adults. It is most often a result of hemolytic streptococcal infection and is the most common precursor to heart disease in people under the age of 50. Repeated attacks lead to chronic rheumatic heart disease thay may cause mitral or aortic stenosis or insufficiency.
SYMPTOMS—Normally there is a history of URI within the last 3 weeks. Fever, tachycardia, rapid respiration, joint pain, and swelling are common. The sedimentation rate is markedly increased, and the patient may suffer frequent epistaxis. There may be precordial or abdominal pain, malaise, anorexia, chores (involuntary muscle tics or jerking), and diaphoresis.
TREATMENT—General measures consist of bed rest, aspirin, high caloric soft diet, and support and protection for the affected joints. Use penicillin to combat existing infections. Order bed rest until the acute stages of the disease have passed. Return to full activity may take months.
Angina Peetoris
It is a characteristic, usually substernal, thoracic pain caused by a mild coronary insufficiency (normally arteriosclerotic heart disease) and is precipitated by exertion. Attacks are frequently experienced when mounting inclines or stairways. Angina always occurs during exertion and subsides promptly if the patient stands or sits quietly. The patient will usually prefer to stand or sit rather than to lie down.
SYMPTOMS—Chest pain is the chief complaint. Usually it is located behind or slightly to the left of the sternum and frequently radiates to the left shoulder and arm. Occasionally the pain may be located at the base of the neck, lower jaw, axilla, or epigastrium. Rarely is it referred to the right side of the body. The pain is usually described as squeezing, crushing, or viselike as opposed to sharp or stabbing. The intensity varies from mild to severe and may be incapacitating. Episodes normally last from 1 to 3 minutes. The patient may experience palpation, faintness, sweating, dyspnea, and digestive disturbances.
TREATMENT—Rest! Nitroglycerine is the drug of choice. Amyl nitrite is sometimes used.
Atherosclerosis (Hardening of the Arteries)
This is the most serious form of arteriosclerosis because of its tendency to affect coronary, cerebral, and peripheral arteries.
TREATMENT—Because of its insidious nature, the best treatment is prevention. Techniques of prevention and management include treating the underlying cause, weight reduction, exercise, discontinuance of smoking habits, and reducing the fat and cholesterol intake.
Myocardial Infarction (MI)
Damage to a portion of the heart muscle is caused by myocardial ischemia. It is most often caused by blockage of one or more of the branches of the coronary arteries.
SYMPTOMS—This disease may be preceded by a history of angina, and the symptoms may begin at any time. The major complaint is severe squeezing or crushing substernal pain. The location of the pain is similar to angina, but is markedly more persistent. It does not subside with rest. Dyspnea, severe anxiety, and shock are common.
TREATMENT—The primary objective of treatment is to minimize heart damage and to sustain life. If the MI causes cardiac/pulmonary arrest, CPR is of primary importance. The patient should be administered Demerol® or morphine for pain and to help relieve apprehension. Oxygen therapy is essential and sedation is appropriate. In all cases, transfer the patient to the cardiac care unit (CCU) as soon as possible.
Congestive Heart Failure
This condition is due to the failure of the heart to maintain an adequate flow of blood to the tissues. The pulmonary or systemic circulation becomes congested, often resulting in left ventricular failure.
SYMPTOMS—The patient’s chief complaint is dyspnea and often a gradual loss of energy. The ankles are often swollen and markedly edematous. The blood pressure may or may not be increased.
