Angina Pectoris

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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

• Physical exertion (increase myocardial o2
  demand).
• Exposure to cold ( cause elevation of BP increase
  oxygen demand )
• Eating heavy meals
• Stress or any emotion-provoking situation

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Type of angina

• Stable angina predictable consistent pain that
  occurs on exertion and relieved by rest.
• Unstable angina or preinfarction or cresendo
  angina symptoms occur more frequently and longer
  than stable angina.
• Intractable or refractory angina sever
  incapacitating chest pain.

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Type of angina

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

1. Pallor, Diaphoresis
2. Dizziness or lightheadedness
3. Nausea and vomiting

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Diagnostic findings

• Often made by evaluating the clinical
  manifestations of ischemia and the pts history
• 12-Lead ECG and blood laboratory
  values help in making diagnosis
• C-reactive protein ( CRP) is a marker for
  inflammation of vascular endothelium which caused
  by CAD

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Diagnostic findings

1. 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 exercise
• Cut down on fatty foods
• Eat 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

• Ineffective myocardial tissue
• perfusion secondary to CAD as
• evidence by chest pain or equivalent
• symptoms
• Anxiety related to fear of death

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Diagnosis

• 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

• Treating angina when pt experiences angina the
  nurse should direct pt to stop activities and sit
  or rest in bed in semi-fowler position
• 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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• 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
• Reports that pain is relieved promptly
• Reports decreased anxiety

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• Understands ways to avoid complications and
  demonstrates freedom from complications
• Adheres to self-care program

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