Angina Pectoris
Prepared by :
E.JYOTHIRMAI
M.Sc (N)
1
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.
2
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 .
3
4
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 meals
4. Stress or any emotion-provoking
situation
5
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.
6
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.
7
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.
8
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
9
Clinical manifestations
4. Pallor, Diaphoresis
5. Dizziness or
lightheadedness
6. Nausea and vomiting
10
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
11
12
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
13
Medical management for
the pt with angina pectoris
14
• The objective is to decrease
oxygen demand of myocardium
and to increase oxygen supply
• 1.Nitroglycerin : administered to
reduce myocardial oxygen
consumption
15
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 .
16
3-Calcium channel blocking
agents : some decrease
sinoatrial node automaticity and
node conduction ,resulting in
slower heart rate
17
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
18
• 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.
19
Prevention
Self care action plan changing habits.
Stop smoking
Increase level of exercise
Cut down on fatty foods
Eat more oats, which decrease
cholesterol
20
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
21
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.
22
Diagnosis
1. Ineffective myocardial tissue
perfusion secondary to CAD as
evidence by chest pain or equivalent
symptoms
2. Anxiety related to fear of death
23
Diagnosis
3. Noncompliance , ineffective
management of therapeutic
regimen related to failure to
accept necessary lifestyle changes
24
Planning and goals
The major goal include
immediate treatment when
angina occur , preventing of
angina , reduction of anxiety
and absence of complications
25
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
26
3. Preventing pain : when the pt has
pain with minimal activity , the
nurse alternates the pts activities
with rest periods
27
Evaluation
expected pts outcomes may include
1. Reports that pain is relieved
promptly
2. Reports decreased anxiety
28
3. Understands ways to avoid
complications and demonstrates
freedom from complications
4. Adheres to self-care program
29
30
