Angina Pectoris | Angina Pectoris | Coronary Artery Disease

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ANGINA PECTORIS Characterized by episodes or paroxysms of chest pain caused by temporary myocardial ischemia where oxygen demand exceeds supply. Myocardial cells become ischemic within 10 seconds of coronary artery occlusion -> decrease pumping action of heart (after several minutes) -> decrease blood supply (glucose & oxygen) -> decrease ATP production -> anaerobic metabolism -> production of lactic acid (acidosis) -> PAIN

Clinical Manifestations:  Chest pain (assumes Levine Position – closed fist over chest) that feels like squeezing, pressing, & burning @ left retrosternal or substernal area radiating to arms and shoulder lasting 3 – 5 mins. relieve by nitroglycerine and rest.  Associated Symptoms: weakness or numbness (arms, wrists, hands), SOB, pallor, diaphoresis, dizziness, n/v, severe apprehension, feelings of impending death TYPES: a. Stable Angina – follows an event with predictable severity, pattern & duration, and relieving factors are present. b. Unstable/Pre-Infarction/Crescendo Angina/Intermittent Coronary Syndrome – occurs at rest or minimal exertion with increasing severity (threshold of pain is lower). Rest & Nitroglycerine do not relieve attacks. This has similar manifestations with MI but has no ECG changes & requires medical intervention. c. Intractable/Refractory Angina – severe incapacitating chest pain. d. Prinzmetal/Variant Angina – not cause by atherosclerotic plaque but with coronary spasm, which occurs at rest with longer duration and usually in the cold mornings (12am-8am). May be associated with ST segment elevation. e. Silent Angina – with signs of ischemia (like ECG changes) but the patient reports no symptoms. f. Nocturnal Angina – associated with rapid eye movement (REM) sleep during dreaming. g. Angina Decubitus – paroxysmal & occurs when client reclines; lessens when the client sits or stands up. h. Post-Infarction Angina – occurs after MI; residual ischemia may cause episodes of angina. ANGINAL Management: A – spirin, anticoagulant, & oxygen therapy N – itroglycerine (max of 3doses 5mins. interval; should be carried @ all times) G – ive appropriate diet (small frequent, high fiber, no gas forming)& weight management I – ncrease patient knowledge (education) N – ormalize BP (Beta & Calcium Channel Blockers) A – void cigarettes and control cholesterol and DM L – ifestyle changes (stress reduction & exercise) Special Considerations: 1. The elderly may not exhibit the typical pain profile since neurotransmitter response diminishes due to aging. Dyspnea is the most often presenting symptom and pain may radiate to both arms rather than left arm alone. Sometimes there are no symptoms. 2. Patients with DM may not have severe pain caused by angina because diabetic neuropathy can blunt noriceptors and thus decreasing pain perception. 3. A woman may have different symptoms than a man since CAD in women is diffuse and affects long segments of the artery (discrete segments in men).

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