1. Angina Pectoris
Prepared by :
Ansam Sharef
Ahmad Aswad

2. 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.

3. 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 .

5. 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

6. 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.

7. 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.

8. 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.

9. 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

10. Clinical manifestations
Pallor, Diaphoresis
Dizziness or lightheadedness
Nausea and vomiting

11. 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

13. 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

14. Medical management for the pt with angina pectoris

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

16. 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 .

17. 3-Calcium channel blocking agents : some decrease sinoatrial node automaticity and node conduction ,resulting in slower heart rate

18. 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

19. 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.

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

21. 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

22. 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.

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

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

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

26. 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

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

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

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

30. THANK YOU