ANGINA PECTORIS

OBJECTIVES
1. To review the anatomy and physiology of the
cardiovascular system.
2. To define angina pectoris and its clinical
manifestations.
3. To discuss the factors that evoke chest pain.
4. To explain the pathophysiology of angina
pectoris.
5. To determine the different types of angina.
6. To ascertain the different diagnostic
examinations.
7. To be able to understand the different medical
and nursing management.
Anatomy Review
 ANGINA PECTORIS

 A clinical syndrome characterized episodes of pain or

pressure in the anterior chest.

 CAUSE: insufficient coronary blood flow

(Demand<Supply)

 The severity is based on the precipitating activity and

its effect on the ADL.
CLASS EVOKING ACTIVITY LIMITS TO
ACTIVITY
I Prolonged exertion None
II Walking >2 blocks Slight
III Walking <2 blocks Marked
IV Minimal or rest Severe

CANADIAN CARDIOVASCULAR SOCIETY

CLASSIFICATION OF ANGINA
 FACTORS THAT EVOKE
TYPICAL CHEST PAIN

 Physical Exertion
 Exposure to cold
 Eating a heavy meal
 Stress or any emotion-provoking situation
PATHOPHYSIOLOGY

INC. MYOCARDIAL TEMPORARY

CAUSES
OXYGEN DEMAND CESSATION

LACTIC ACID
CHEST PAIN
PRODUCTION
CLINICAL MANIFESTATIONS

o Chest pain
 Retrosternal pain
 Compressing, burning, squeezing, crushing
heaviness
 Radiates to left arm, jaw, neck, and back
 5-10 minutes
o Feeling of indigestion to a choking
o Numbness
o Severe apprehension
o Feeling of impending death
o May accompany diaphoresis, pallor, dizziness or
lightheadedness, and NV
CLINICAL MANIFESTATIONS

o Be alert to those patients who are:

Diabetic (Diabetes mellitus
 Elderly patients

o May be relieved by rest and NTG

 TYPES OF ANGINA

1. STABLE ANGINA
 Identifiable cause of pain (exertion)
 Predictable
 Relieved by rest

2. UNSTABLE
 Pain lasts longer than stable
 May occur at rest
 TYPES OF ANGINA

3. VARIANT/PRINZMETAL ANGINA
 CAUSE: vasospasm
 Pain at rest

4. SILENT ISCHEMIA
 No symptoms
 Objective evidence of ischemia
 DIAGNOSTICS

11. Clinical manifestations

2. Echocardiogram

3. ECG

4. Stress test

5. Cardiac enzymes
 MEDICAL MANAGEMENT

GOAL:

 the myocardial oxygen demand

 oxygen supply
 PHARMACOLOGICAL
THERAPHY

1. NITROGLYCERIN (Nitrostat, Nitrol, Nitrobid IV)

 Mainstay for treating angina pectoris
 Dilates veins (higher doses, arteries) – decrease
preload
 Prevent vasospasm and increase perfusion
through the collateral vessels
 SL or spray, topical agent, and IV
 S/E: HPO (and other accompanied signs of it)
 PHARMACOLOGICAL
THERAPHY

2. BETA-ADRENERGIC BLOCKING AGENTS (-olol)

 Blocks the beta-adrenergic receptors in the
heart
 S/E: HPO, bradycardia, AV block, and heart
failure
 C/I: asthma
 Instruct patient not to stop abruptly but
decrease gradually
 PHARMACOLOGICAL
THERAPHY

3. CALCIUM CHANNEL BLOCKING AGENTS

(Iodipine, verapamil, and diltiazem)
 Decrease nodal automaticity and
conductivity = (-) inotropic effect
 Relax the blood vessel
 Dilates the coronary arterioles
 S/E: AV blocks, bradycardia, and HPO
 PHARMACOLOGICAL
THERAPHY

4. ANTIPLATELET (Aspirin, Clopidogrel)

 Prevents platelet activation and reduces the
incidence of MI
 Given immediately once angina is diagnosed
 If concurrently under NSAIDs, patient may be
treated with H2 blockers.
 S/E: Bleeding
 PHARMACOLOGICAL
THERAPHY

5. OXYGEN ADMINISTRATION
 Given immediately
 O2 saturation and respiratory rate and
rhythm
 NURSING MANAGEMENT

Treating Angina
1. Assess pain or other signs and symptoms
using the PQRST format.
2. If patient reports pain, instruct patient, place
patient in SEMI-FOWLER’S POSITION.
3. Measure vital signs.
4. 12-Lead ECG
5. NTG. Assess pain and vital signs.
6. Oxygen administration. 2 L/M.
 NURSING MANAGEMENT

Reducing Anxiety
1. Providing information about the illness, its
treatment, and methods of preventing its
progression.
2. Stress reduction (music therapy,
aromatherapy, etc.)
3. Addressing the spiritual needs of the patient
and family
 NURSING MANAGEMENT

Preventing Pain
1. Identify the level of activity that causes pain.
2. Plan the patient’s activities
3. May alternate patient’s activities with rest
periods.
4. Balance of activity and rest.
Thank You!