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Angina Pectoris

Prepared by : Ansam Sharef Ahmad Aswad

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Angina Pectoris

Definition : Angina pectoris is a clinical syndrome usually

characterized by episodes of pain or pressure in the anterior chest . The cause is usually insufficient coronary blood flow which results in a decreased oxygen supply to meet an increased myocardial demand for oxygen in response to physical exertion or emotional stress.

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Pathophysiology

Myocardial ischemia can result from:

• A reduction of coronary blood flow caused by fixed &\or dynamic epicardial artery stenosis.

• Abnormal constriction or deficient relaxation of coronary artery.

• Reduce O2-carrying capacity of the blood .

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Factors are associated with typical angina pain

1. Physical exertion (increase myocardial o2 demand).

2. Exposure to cold ( cause elevation of BP increase oxygen demand )

3. Eating heavy meals4. Stress or any emotion-provoking

situation

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Type of angina

1. Stable angina: predictable & consistent pain that occurs on exertion and relieved by rest.

2. Unstable angina or preinfarction or cresendo angina: symptoms occur more frequently and longer than stable angina.

3. Intractable or refractory angina: sever incapacitating chest pain.

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Type of angina

4. Variant angina or prinzmetals angina : pain at rest with reversable ST-segment elevation, caused by coronary artery vasospasm.

5. Silent ischemia: objective evidence of ischemia (as ECG changes with a test), but pt report no symptom.

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Risk Factors for atherosclerosis

1. Family history of premature coronary artery disease.

2. DM, systemic HTN.3. Cigarette smoking.4. Hypercholesterolemia.5. Others as obesity, increase levels

of lipoprotein,fibrinogen, s.triglycerides.

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Clinical manifestations

1. May produce pain vary in severity from feeling of indigestion to chocking in retrosternal area , radiate to neck , jaw shoulders , inner aspects of upper arms

2. Feeling of weakness or numbness in the arms , wrists and the hands

3. Shortness of breath

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Clinical manifestations

4. Pallor, Diaphoresis

5. Dizziness or lightheadedness

6. Nausea and vomiting

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Diagnostic findings

Often made by evaluating the clinical manifestations of ischemia and the pts history

1. 12-Lead ECG and blood laboratory values help in making diagnosis

2. C-reactive protein ( CRP) is a marker for inflammation of vascular endothelium which caused by CAD

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Diagnostic findings

3. An elevated blood level of homocysteine ,an amino acid proposed as an independent risk factor for cardiovascular disease , but no studies supported the relationship between elevation of homocysteine and atherosclarosis

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Medical management for the pt with angina pectoris

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• The objective is to decrease oxygen demand of myocardium and to increase oxygen supply

• 1.Nitroglycerin : administered to

reduce myocardial oxygen consumption

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2.Beta-adrenergic blocking agents : ( propranolol ,metoprolol , atenolol)

appear to reduce myocardial oxygen consumption, result in a reduction in heart rate, decreased BP , and reduced myocardial contractility .

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3-Calcium channel blocking agents : some decrease sinoatrial node automaticity and node conduction ,resulting in slower heart rate

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4- Antiplatelet and anticoagulent medications

Aspirin: prevents platelet

activation and reduces the incidence of MI and death with CAD

Heparin : prevents the formation of new blood clots

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• Oxygen administration :

usually initiated at the onset of chest pain to increase the amount of oxygen delivered to the myocardium and to decrease the pain.

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Prevention

Self care action plan changing habits.

Stop smoking Increase level of exerciseCut down on fatty foodsEat more oats, which decrease

cholesterol

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Lose wt if u DR. thinks you are overweight.

Make sure your BP is not high by regular check

Consider another method of contraceptive if you take pill

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Nsg process for pt with Angina pectoris

Assessment

The nurse gather information about the pts symptoms and activities . The nurse may ask about the period that angina last , and if any medication relieve the angina.

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Diagnosis

1. Ineffective myocardial tissue perfusion secondary to CAD as evidence by chest pain or equivalent symptoms

2. Anxiety related to fear of death

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Diagnosis

3. Noncompliance , ineffective

management of therapeutic regimen related to failure to accept necessary lifestyle changes

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Planning and goals

The major goal include immediate treatment when angina occur , preventing of angina , reduction of anxiety and absence of complications

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NSG interventions

1. Treating angina : when pt experiences angina the nurse should direct pt to stop activities and sit or rest in bed in semi-fowler position

2. Reducing anxiety : The nurse should explore and implicate that the diagnosis has for the pt providing information about the illness , treatment and methods of preventing its progression

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3. Preventing pain : when the pt has pain with minimal activity , the nurse alternates the pts activities with rest periods

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Evaluation

expected pts outcomes may include

1. Reports that pain is relieved promptly 2. Reports decreased anxiety

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3. Understands ways to avoid complications and demonstrates freedom from complications

4. Adheres to self-care program

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