Angina pectoris
Binu BabuAsst. ProfessorM.Sc. (N)
Jincy BinuLecturerM.Sc. (N)
DEFINITION Angina pectoris is chest pain or
discomfort that occurs when the heart muscle doesn’t get enough blood.
Angina pectoris is chest pain resulting from myocardial ischemia (inadequate blood supply to the myocardium).
TYPES OF ANGINA1. Stable angina2. Unstable angina3. Variant angina4. Nocturnal angina5. Angina decubitus6. Intractable angina7. Post infarction angina
ETIOLOGYSupply-demand mismatchFactors that decrease supply Coronary vessel disorders
Atherosclerosis Arterial spasmCoronary arteritis
Circulatory disordersHypotension Aortic stenosisAortic insufficiency
Blood disordersAnemia HypoxemiaPolycythemia
Factors that increase demand Increased cardiac output
ExerciseEmotionDigestion of a large meal
Increased myocardial need for oxygen
Damaged myocardiumMyocardial hypertrophy
CLINICAL FEATURES Chest pain
Manifest as heaviness, tightness,aching, fullness, or burning of the chest, epigastrium, and/or arm or forearm (usually the left).
Characteristics of angina includes
Onset :- Develop quickly or slowly.
Location :- Slightly to the left of sternum.
Radiation :- Left shoulder and upper and may then travel down the inner aspect of the left arm to the elbow, wrist, fourth and fifth fingers, radiate to right shoulder, neck, jaw, epigastric region.
Duration :- Less than 5 minutes.Sensation :- Like squeezing,
burning, pressing , chocking, aching , pain feels like gas, heartburn.
Severity :- Usually mild or moderate in severity.
Treatment :- The client treated the pain with nitroglycerin. Angina should subside after nitroglycerin use.
DIAGNOSTIC MEASURESHistoryPhysical
examinationECGLaboratory
studiesSerial cardiac biomarkersHemoglobin
Serum chemistryLipid profile
Chest Radiography
Angiography Radioisotope
ImagingExercise Testing
MANAGEMENTA for aspirin and anti anginal therapyB for beta-blocker therapy and blood
pressure controlC for cigarettes and cholesterolD for diet and diabetesE for education & exercise
PHARMACOLOGICAL MANAGEMENT
Opoid analgesics Antiplatelet agentsBeta-adrenergic blocking agentsVasodilatorsCalcium channel blockers
Cardiac catheterizationRevascularizationNutritional managementRehabilitation
REHABILITATION PROCESS
Smoking cessation
Lipid loweringControl of hypertension
Diabetes mellitus management
Weight
management and nutritional counseling
Psychosocial managementActivity management
NURSING MANAGEMENT
Nursing DiagnosisAnxiety related to diagnosis of cardiac
disorder as evidenced by restlessness, tachycardia, and frequently asking questions regarding prognosis.
Acute chest pain related to decreased blood supply to myocardium as evidenced by distraction behaviors such as restlessness, discomfort and fatigue.
Ineffective tissue perfusion related to decreased oxygenation of myocardium as evidenced by chest pain, shortness of breath and tachycardia.
Decreased cardiac output related to negative ionotropic changes in the heart secondary to decreased oxygenation of myocardium as evidenced by chest pain, tachycardia and fatigue.
Impaired gas exchange related to decrease cardiac output as evidenced by dyspnea, pallor and fatigue.
Risk for bleeding related to coagulopathies associated with thrombolytic therapy or arterial puncture after angiography.