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Prepared by: Aminath Nahooda (RN, RM, BN, MN)

 A clinical syndrome usually
characterized by:
 Episodes or paroxysms of pain or
pressure in the anterior chest.

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 Insufficient coronary blood flow.
 The need for oxygen exceeds the
supply.
 The severity of the symptoms of
angina is based on the magnitude of
the precipitating activity and its effect
on activities of daily living.
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 Usually caused by atherosclerotic
disease.
 Associated with a significant
obstruction of at least one major
coronary artery.

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 Myocardium extracts a large amount
of oxygen from the coronary
circulation to meet its continuous
demands.
 When demand increases , flow
through the coronary arteries need to
be increased.
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 Block in the
coronary artery

Flow cannot
increase

Ischemia
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results
 Stable angina
 Predictable and consistent pain on
exertion (rest/NTG)
 Unstable angina (also called preinfarction
angina or crescendo angina)
 Symptoms increase in frequency and
severity; may not be relieved with rest or
nitroglycerin
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Intractable or refractory angina
 Severe incapacitating chest pain
 Variant angina
 Also called Prinzmetal’s angina
 Pain at rest with reversible ST-segment
elevation
 Thought to be caused by coronary artery
vasospasm
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Silent ischemia
 Objective evidence of ischemia (such as
electrocardiographic changes with a
stress test), but patient reports no pain

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 Physical exertion
 Exposure to cold
 Eating a heavy meal
 Stress or any emotion-provoking situation
 Unstable angina is not associated with
these listed factors. It may occur at rest.
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 Pain and other symptoms varying in severity
from mild indigestion to a choking or heavy
sensation in the upper chest
 Ranges from discomfort to agonizing pain
 Accompanied with severe apprehension and
feeling of impending death

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 Person with DM may not have severe pain
Women may have different symptoms than men
Accompanying the pain may be:
 Feeling of weakness or numbness of arms, wrists,
hands
 SOB
 Pallor
 Diaphoresis
 Dizziness
 Light-headedness 13

 Nausea & vomiting

 An important characteristic of angina is that it
subsides with rest or administering
nitroglycerin. In many patients, anginal
symptoms follow a stable, predictable pattern.
 Unstable angina is characterized by attacks that
increase in frequency and severity and are not
relieved by rest and administering nitroglycerin.
 Patients with unstable angina require medical
intervention.
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The elderly person with angina may not exhibit
the typical pain profile due to diminished
responses of neurotransmitters that occur with
aging.

 Often presents with dyspnea.

Sometimes there are no symptoms (“silent”

CAD), making recognition and diagnosis a 15
clinical challenge.
 Begins with history related to the clinical
manifestations of ischemia
 12- lead ECG (T-wave inversion)
CRP and cardiac biomarkers
 Exercise of pharmacologic stress test
 nuclear scan
Invasive procedures
Cardiac catheterization
Coronary angiography 16
 Medical / pharmacological / surgical
management
 Nursing management
Nursing care plan
Health education

HF/ Angina pectoris/ MI / HTN

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