Angina Pectoris Prepared by : Ansam Sharef Ahmad Aswad

Angina Pectoris Definition : Angina pectoris is a clinical syndrome usually characterized by episodes of pain or pressure in the anterior chest . The cause is usually insufficient coronary blood flow which results in a decreased oxygen supply to meet an increased myocardial demand for oxygen in response to physical exertion or emotional stress.

Pathophysiology Myocardial ischemia can result from: A reduction of coronary blood flow caused by fixed &\or dynamic epicardial artery stenosis. Abnormal constriction or deficient relaxation of coronary artery. Reduce O2-carrying capacity of the blood .

Factors are associated with typical angina pain Physical exertion (increase myocardial o2 demand). Exposure to cold ( cause elevation of BP increase oxygen demand ) Eating heavy meals Stress or any emotion-provoking situation

Type of angina Stable angina: predictable & consistent pain that occurs on exertion and relieved by rest. Unstable angina or preinfarction or cresendo angina: symptoms occur more frequently and longer than stable angina. Intractable or refractory angina: sever incapacitating chest pain.

Type of angina Variant angina or prinzmetals angina : pain at rest with reversable ST-segment elevation, caused by coronary artery vasospasm. Silent ischemia: objective evidence of ischemia (as ECG changes with a test), but pt report no symptom.

Risk Factors for atherosclerosis Family history of premature coronary artery disease. DM, systemic HTN. Cigarette smoking. Hypercholesterolemia. Others as obesity, increase levels of lipoprotein,fibrinogen, s.triglycerides.

Clinical manifestations May produce pain vary in severity from feeling of indigestion to chocking in retrosternal area , radiate to neck , jaw shoulders , inner aspects of upper arms Feeling of weakness or numbness in the arms , wrists and the hands Shortness of breath

Clinical manifestations Pallor, Diaphoresis Dizziness or lightheadedness Nausea and vomiting

Diagnostic findings Often made by evaluating the clinical manifestations of ischemia and the pts history 12-Lead ECG and blood laboratory values help in making diagnosis C-reactive protein ( CRP) is a marker for inflammation of vascular endothelium which caused by CAD

Diagnostic findings An elevated blood level of homocysteine ,an amino acid proposed as an independent risk factor for cardiovascular disease , but no studies supported the relationship between elevation of homocysteine and atherosclarosis

Medical management for the pt with angina pectoris

The objective is to decrease oxygen demand of myocardium and to increase oxygen supply 1.Nitroglycerin : administered to reduce myocardial oxygen consumption

2.Beta-adrenergic blocking agents : ( propranolol ,metoprolol , atenolol) appear to reduce myocardial oxygen consumption, result in a reduction in heart rate, decreased BP , and reduced myocardial contractility .

3-Calcium channel blocking agents : some decrease sinoatrial node automaticity and node conduction ,resulting in slower heart rate

4- Antiplatelet and anticoagulent medications Aspirin: prevents platelet activation and reduces the incidence of MI and death with CAD Heparin : prevents the formation of new blood clots

Oxygen administration : usually initiated at the onset of chest pain to increase the amount of oxygen delivered to the myocardium and to decrease the pain.

Prevention Self care action plan changing habits. Stop smoking Increase level of exercise Cut down on fatty foods Eat more oats, which decrease cholesterol

Lose wt if u DR. thinks you are overweight. Make sure your BP is not high by regular check Consider another method of contraceptive if you take pill

Nsg process for pt with Angina pectoris Assessment The nurse gather information about the pts symptoms and activities . The nurse may ask about the period that angina last , and if any medication relieve the angina.

Diagnosis Ineffective myocardial tissue perfusion secondary to CAD as evidence by chest pain or equivalent symptoms Anxiety related to fear of death

Diagnosis Noncompliance , ineffective management of therapeutic regimen related to failure to accept necessary lifestyle changes

Planning and goals The major goal include immediate treatment when angina occur , preventing of angina , reduction of anxiety and absence of complications

NSG interventions Treating angina : when pt experiences angina the nurse should direct pt to stop activities and sit or rest in bed in semi-fowler position Reducing anxiety : The nurse should explore and implicate that the diagnosis has for the pt providing information about the illness , treatment and methods of preventing its progression

Preventing pain : when the pt has pain with minimal activity , the nurse alternates the pts activities with rest periods

Evaluation expected pts outcomes may include Reports that pain is relieved promptly Reports decreased anxiety

Understands ways to avoid complications and demonstrates freedom from complications Adheres to self-care program

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