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.