4. BROAD OBJECTIVE
At the end of this presentation, learners
should be able to manage the patient with
angina pectoris.
5. OUTLINE
1. Define and describe the classification of angina pectoris
2. Explain the etiology and pathophysiology of angina
pectoris
3. Describe the clinical manifestation of angina pectoris
4. Describe the diagnostic evaluation of the angina
pectoris
5. Explain the nursing assessment and its diagnosis
6. Explain the nursing management of angina pectoris
7. Explain the medical/ surgical management of angina
pectoris
8. Outline the complications of angina pectoris
6. Definition
It is commonly called “angina”
It is the chest pain that is due to ischemia of
the heart muscle, generally due to obstruction
or spasm of the coronary arteries
7. TYPES OF ANGINA PECTORIS
The most three types of angina include:
Stable angina
- It is triggered by a predictable degree of physical exertion
or motion but can be improved after rest.
- It is the most common type of angina
Unstable angina
- It is triggered by unpredictable degree which may occur at
night
- It is more dangerous and requires emergency treatment
and is often a sign that heart attack can occur soon
Variant angina
- this is a rare form that is caused by a spasm in coronary
artery
8. ETIOLOGY AND PATHOPHYSIOLOGY
Angina pectoris is as a result of ischemia of
the heart which is due to antherosclerosis of
the coronary arteries which restricts blood
flow to the myocardium.
Due to myocardium ischemia, the myocardial
tissues are deprived of oxygen and nutrients
for the aerobic metabolism.
As a result there is an inclusion of anaerobic
metabolism which leads to accumulation of
lactic acid
9. Due to increase of lactic acid, myocardial
nerve fibers are irritated and this transmit a
pain message to the cardiac nerves and
upper thoracic posterior nerve roots
And all this leads to cardiac pain which is the
angina pectoris
11. DIAGNOSTIC EVALUATION
Electrocardiography (ECG)
- an ECG recorded in the presence of pain may
record transient ischemic attacks.
- it also suggest coronary artery’s involvement and
the extent of the myocardium affected by the
ischemic event
Exercise electrocardiography
- This involves the client exercising on a treadmill or
stationery bicycle until reaching a maximum of 85%
heart rate.
If any change in the ECG or vital signs may indicate
the presence of ischemia
12. Radioisotope
- this involves the use of different nuclear imaging
techniques to evaluate heart muscles.
- regions of ischemia appear as areas of
diminished activity
Ultrafast computed tomography
- it enables detection of the amount of calcium in
the coronary arteries. High coronary calcium
rate is associated with obstructive coronary
disease.
13. Coronary angiography
- it detect the percentage of blockage in
coronary artery
- it remains the most accurate test
Chest x-ray
- it allows the detection of cardiomegaly and
non cardiac causes of chest pain e.g
pneumonia
14. NURSING ASSESSMENT
SUBJECTIVE DATA
Past health history
- previous history of cardiac artery
disease, angina, myocardial infarction, anemia and heart
failure
Medications
- use of aspirin, calcium channel blockers and
antihypertensive
Family history
- history of heart disease, tobacco use
Nutritional history
- heart burn, nausea, vomiting
Coping stress mechanism
- anger, anxiety, depression and stressful life style
15. OBJECTIVE DATA
General
- anxiety, fear, restlessness
Integumentary
- cool, clammy, pale skin
Cardivascular
- tachycardia or bradycardia, dysrhythmias, low Bp or hypertension
Possible findings
- increase in white blood cell count, positive exercise stress test, ST
segment and T wave abnormalities on ECG, cardiac
enlargement, pulmonary congestion on chest x-ray and positive
coronary angiography.
16. NURSING DIAGNOSIS
Acute pain related to myocardial ischemia as
evidenced by severe chest pain and tightness
Ineffective tissue perfusion related to myocardial
injury as evidenced by dyspnea, decrease in Bp.
Anxiety related to perceived or actual threat of death,
pain and possible life style changes as manifested by
restlessness and patient asking too much questions
Activity intolerance related to fatigue secondary to
decreased cardiac output and poor lung and tissue
perfusion as manifested by increased heart rate
17. Ineffective therapeutic regimen management
related to lack of knowledge of disease
process as evidenced by frequent
questioning about the illness and
management after discharge
18. NURSING MANAGEMENT
- evaluate chest pain e.g location in order to
accurately evaluate, treat and prevent further
ischemia
- promote bed rest in semi fowlers position, it
relaxes the muscles of the chest cavity
- monitor vital signs after every 5 minutes on
each attack to review the effectiveness of the
care given
19. - Monitor fluid balance (e.g. monitor input and
output, daily weight ) to monitor renal
perfusion and observe for fluid retention
- Provide factual information concerning the
disease process to decrease fear of the
unknown
- administer prescribed medication to relieve
pain and ischemia to decrease anxiety and
cardiac workload e.g. Nitroglycerin-which
dilates the coronary arteries and increases
the supply of oxygen to the myocardium
20. MEDICAL MANAGEMENT
It focuses on three goals
1. Relief of the acute pain. The major drugs
used to reduce acute pain are opioid
analgesics e.g nitroglycerin
2. Restore coronary blood flow. Administer
vasodilators e.g propanolol, calcium channel
blockers such as felodipine.
3. Prevent further attacks-this is done through
education and counselling regarding
modification of risk factors of the disease.
22. Complications of Angina Pectoris
Angina pectoris can lead to:-
• Heart failure
• Acute renal failure
• Myocardial infarction
• Cardiac arrest
• Death
23. References
1. Black J. M. and Hawks J (2009) Medical –
surgical Nursing, Clinical Management for
positive outcomes (8th edition) saunders,
Elsevier
2. Lewis S. M., Heitkemper M. M and Dirksen S.
R (2007) Medical /Surgical Nursing.
Assessment and management of clinical
problems. (7th edition) St Louis: C.V. Mosby
3. http://www.servier.co.uk
