Definition: Angina pectoris is a clinical syndrome, usuallycharacterized by episodes or paroxysms of pain or pressure inthe anterior chest. The cause is causually insufficient coronaryblood flow. • Angina is a common manifestation of CHD. • Angina can also occur in clients with normal-coronary arteries, but it is less common. • Clients with aortic stenosis, hypertension, and hypertropic cardiomyopathy can also have Angina pectoris
Etiology: 1) Physical exertion : Walking outdoors is the most common form of the exertions, that produce an attack. Isometric exertion of the arms as on raking leaves, painting of lifting heavy objects also causes exertional angina 2) Strong emotions: Stimulate the sympathetic nervous system and increase the work of the heart. This result in an increase in HR, BP and myocardial contractility.
3) Temperature extremes: It may be either hot or cold, increases the workload of the heart. • Blood vessels constricts in Response to cold climate. • Blood vessel dilate hot stimulus Cold weather also cause increased metabolism to maintain internal temperature regulation.4) Cigarette Smoking: causes vasoconstruction and an increased HR because of nicotine stimulations of the catecholamine releases. It also diminishes available oxygen by increasing level of carbon monoxide
5) Sexual Activity: increase the work load and sympathetic stimulation. In a person with severe CAD, the resulting extra workload of the heart may precipitate angina6) Stimulants: Such as cocaine, cause increased HR and subsequent myocardial demand. Stimulation of catecholamine release is the precipitating Factor
Clinical Manifestations: Characteristics of Angina: Angina is a clinical syndrome characterized by discomfort in the chest, Jaw, shoulder, back or arm. Angina pectoris produce transient paroxysmal attacks of substernal or precordial pain with the following characteristics. Onset – Angina can develop quickly or slowely. Location: Nearly 90% of clients experience the pain as retrosternal or slightly to the left of the sternum
Radiation: The pain usually radiates to the left shoulder and upper arm, and may then travel down the inner aspect of the left arm to the elbow, wrist and Fourth and Fifth fingers. The pain may also radiate to the right shoulder, neck, Jaw or epigastric region.Duration: Angina usually last less than 5 minutes.However, attack precipitated by a heavy meal orextreme angor may last 15 to 20 minutes.
Sensation: Clients describe the pain of angina assqueezing, burning, pressing, choking, aching orbursting pressure. The clients often says the painfeels like gas, heart burn, or indigestion.Severity: The pain of angina is usually mild ormoderate in severity. It is often called“discomfort”, not “pain”. Rarely is the paindescribed as “severe”
Associated characteristics: other manifestationthat may accompany the pain includes:• Dyspnea.• Pallor• Sweating• Faintness• Palpitations.• Dizziness.• Digestive disturbances.