ANGINA PECTORIS

is chest pain or discomfort that occurs

when an area of your heart muscle
doesn't get enough oxygen-rich blood.
is a clinical syndrome usually
characterized by episodes or
paroxysms of pain or pressure in the
anterior chest.
 Angina itself isn't a disease. Rather, it's
a symptom of an underlying heart
problem. Angina is usually a symptom
of coronary artery disease (CAD), the
most common type of heart disease.
The severity of angina is based on the
precipitating activity and its effect on
the activities of daily living
Risk factors

Major risk factors for Coronary Artery Disease (CAD)

include the following:
* Male gender
* Advancing age
* Strong family history of heart disease
* Obesity and overweight
* Smoking
* High blood pressure
 Sedentary lifestyle
High blood cholesterol
Diabetes
Stress
Excessive Alcohol Intake
 Precipitating factors
Eating
Emotion
Effort
Extreme temperature
 Signs and Symptoms

An uncomfortable pressure, fullness, squeezing, or pain in

the center of the chest

It may also feel like tightness, burning, or a heavy weight.

The pain may spread to the shoulders, neck, or arms.

It may be located in the upper abdomen, back, or jaw.

The pain may be of any intensity from mild to severe.

 Other symptoms may occur with an
angina attack:

Shortness of breath
Lightheadedness
Fainting
Anxiety or nervousness
Sweating or cold, sweaty skin
Nausea
Rapid or irregular heart beat
Pallor (pale skin)
 Types of Angina

Knowing how the types are different is

important. This is because they have
different symptoms and require different
treatment.
Types of Angina

Stable angina: predictable and

consistent pain that occurs on exertion
and is relieved by rest
Occurs when the heart must work harder,
usually during physical exertion.
Last 1 15 minutes.
 Unstable angina (also called
preinfarction angina or crescendo
angina):
symptoms occur more frequently and last
longer than stable angina. The threshold for
pain is lower, and pain may occur at rest.
Is more severe and lasts longer (as long as
30 minutes) than episodes of stable angina
Comes as surprise.
 Variant angina (also called
Prinzmetals angina)
Usually occurs at rest and during the night
or early morning hours
Tends to be severe
Is relieved by medicine
thought to be caused by coronary artery
vasospasm
 Silent ischemia:
objective evidence of ischemia (such
as electrocardiographic changes with a
stress test), but patient reports no
symptoms
Complication

Untreated chronic stable angina may

progress to unstable angina, an acute
coronary syndrome that requires
immediate medical attention to prevent the
development of:
severe arrhythmias (i.e., irregular heart
rhythm),
heart attack, or
sudden cardiac deathdue to cardiac arrest
with loss of consciousness within 1 hour of the
onset of acute symptoms
 Possible complications of variant angina
include the following:
Atrioventricular block (i.e., absence of electrical
conduction between the atrium and ventricle)
Episodes of disabling pain
Heart attack
Severe arrhythmias
Sudden cardiac death (sudden cardiac arrest
[SCA])
Diagnostic Test

Blood pressure measurement

Blood test
Exercise tolerance test (stress test or
treadmill test)
Stress echocardiogram may reveal
problems with the hearts ability to pump
blood.
Coronary angiography - is done to find a
blockage in the coronary arteries, which can
lead to heart attack.
 Medical Management

The objectives of the medical

management of angina are to decrease
the oxygen demand of the myocardium
and to increase the oxygen supply.
 Nitroglycerin. (Nitrostat, Nitrol,
Nitrobid IV)

is administered to reduce myocardial

oxygen consumption, which decreases
ischemia and relieves pain.
 Beta-Adrenergic Blocking Agents.
Propranolol (Inderal), metoprolol (Lopressor,
Toprol), and atenolol(Tenormin)
helps to control chest pain and delays the
onset of ischemia during work or exercise.
Slow the heart rate.
 Calcium Channel Blocking Agents.
most commonly used are amlodipine
(Norvasc), verapamil (Calan, Isoptin,
Verelan), and diltiazem (Cardizem, Dilacor,
Tiazac)
relax the blood vessels, causing a
decrease in blood pressure and an
increase in coronary artery perfusion.
 Antiplatelet and Anticoagulant
Medications
administered to prevent platelet
aggregation, which impedes blood flow.
e.g: Aspirin, Heparin
Medical Procedures

Angioplasty
opens blocked or narrowed coronary
arteries.
Coronary artery bypass grafting(CABG)

healthy arteries or veins taken from

other areas in your body are used to
bypass (that is, go around) your
narrowed coronary arteries. Bypass
surgery can improve blood flow to your
heart, relieve chest pain, and possibly
prevent a heart attack.
Nursing management

Major nursing diagnoses may include:

Ineffective myocardial tissue perfusion secondary
to CAD, evidenced by chest pain or equivalent
symptoms.
Anxiety related to fear of death
Deficient knowledge about the underlying
disease and methods for avoiding complications.
Noncompliance, ineffective management of
therapeutic regimen related to failure to accept
necessary lifestyle changes.
Nursing intervention

TREATING ANGINA
When a patient experiences angina, the nurse
should direct the patient to stop all activities and
sit or rest in bed in a semi-Fowler position to
reduce the oxygen requirements of the ischemic
myocardium.
Nitroglycerin is administered sublingually, and
the patients response is assessed (relief of
chest pain and effect on blood pressure and
heart rate).
 REDUCING ANXIETY
Various stress reduction methods should
be explored with the patient
For example, music therapy, has been
shown to reduce anxiety in patients who
are in a coronary care unit
Addressing the spiritual needs of the
patient and family may also assist in
allaying anxieties and fears.
 PREVENTING PAIN
Balance of activity and rest is an important
aspect of the educational plan for the
patient and family.
Outcome

Reports that pain is relieved promptly

Reports decreased anxiety
Understands ways to avoid complications and
demonstrates freedom from complications
Adheres to self-care program
a. Takes medications as prescribed
b. Keeps health care appointments
c. Implements plan for reducing risk factors