Angina Pectoris

Learning Objective:

 Define Angina Pectoris

 Listnthe etiogy of angina pectoris
 State the type of angina pectoris
 List the clinical manisfestation for angina
 List the investigation
 Medication used to treat angina
 Nursing management for angina pectoris
 Health education given to angina patient
 Identify nursing problem for angina
 Nursing intervention for the identified problem

WHAT IS ANGINA PECTORIS

Definition:

 Referring to acute chest pain or discomfort resulting from decreased blood supply to
the heart muscle (Myocardial Ischemia).
 Occurs due to imbalance between myocardial blood supply and demand

Etiology:

1. Physical exertion → increased oxygen demand → chest pain

2. Exposure to cold → vasoconstriction → increased blood pressure → increased
oxygen demand → chest pain
3. Eating a heavy meal → increased blood flow to mesenteric area for digestion →
reduced blood flow to heart muscle → chest pain
4. Stressful or emotional situation → release of adrenaline → increase blood
pressure → increase cardiac workload → increase oxygen demand → chest
pain

Type of Angima Pectoris

1. Stable Angina
 Most common and predictable angina
 The pain occurs with physical exertion ,sress, exposure to cold
 Relieved by rest and nitrates

2. Unstable Angina
 Brought on by minimal exertion as well as at rest
 Occurs more frequent ,more severe and last longer
 Not relieved with GTN promptly

3. Variant or Prinzmetal Angina

 Caused by coronary vasospam
 Unpredictable and occur often at night

4. Nocturnal Angina
 Occurs only during the night and associated with the REM (Rapid Eye
Movement)

5. Angina Decubitus
 Occurs when the client reclines and lessens when the client sits or
stands up.

6. Intractable Angina
 Is chronic incapacitating angina unresponsive to intervention

7. Post Infarction Angina

 Occurs after MI, when residual ischemia may cause episodes of angina

8. Silent Ischemic
 Objectives evidence of ischemia, but the patient reports no symptoms

Manifestation
  Cardinal sign – chest pain
 The pain can be described – tight ,squeenzing ,heavy pressure or
constricting pain
 Begins at sternum and may radiate to jaw ,neck ,or arm
 Feeling of weakness and numbness in the arm ,wrists ,and hand
accompany the pain
 Additional manisfestion – dyspnea ,pallor ,tachycardia ,diaphoresis
,dizziness ,lightheadedness ,nausea ,vomiting ,anxiety and fear
 Last less than 15 minute and relieved by rest ,position and nitrates

Investigation

 ECG (Electrocardiogram)
 Echocardiogram
 Stress Test
 Nuclear Scan
 Coronary Angiogram
 Cardiac Catheterization
 Blood Test – Lipid Profile ,glucose level ,cardiac enzyme

Medication

 Analgesic – to reduce or relieve acute pain e.g. Morphine

 Nitrates – vasodilators that reduce pain and prevent further attack by widening the
arteries e.g. GTN
 Beta blockers – to reduce the workload of the heart e.g. Propranolol ,Atenolol
 CA channel blocker – to dilate the coronary arteries e.g. Diltiazem ,Nifedipine
 Anti – platelet e.g. Aspirin ,clopidogrel (Plavix)

Management

 Assessment of patient – general condition ,severity of pain ,location of pain

  Vital sign (B/P, Pulse rate, Tempreture, Spo2)
 Obtain ECG reading
 Medication – GTN and Morphine
 Oxygen (O2) therapy – to ensure adequate oxygenation

Health Education

 Educate the client to avoid activities or habit that precipitate angina attack
 Medication – on how to take anti – angina medication (e.g. GTN)
 Management of hypertension – control with medication
 Reduce weigth for obese client
 Stop smoking
 Adjust to avoid stressful activity

GLYCERIN TRINITRATES (GTN)

 Is a vasodilators
 Help to reduce acute pain and prevent further attacks by widening the diameter of
coronary arteries and increase the supply of O2 to the myocardium
 Can be given S/L (Sublingual) ,oral tablet or translingual spray
 Reduce angina pain within 1-2 min
 3 pills can be taken at 5 minute interval
 Can be taken prior to heavy activity
 If not relieved ,to seek Doctors treatment

Nursing Problem

 Chest pain related to decreased blood supply to heart muscle

 Anxiety due to chest pain or knowledge deficit
 Difficulty I compliance to medication therapy and change of lifestyle
 Potential for deterioration in condition