Angina pectoris presented by akash bhagwat

1. GOOD MORNING
AND
WELCOME TO ALL

2. ANGINA PECTORIS
IN THIS PRESENTATIN WE WILL DISCUSS
THE ANGINA PECTORIS WITH NURSING
MANAGEMENT

3. 1. DEFINTION OF ANGINA
12 CONTENTS
2. INCIDENCE OF ANGINA
3. RISK FACTORS OF ANGINA
4. PATHOPHYSIOLOGY OF ANGINA
5. TYPES OF ANGINA

4. 7. CLINICAL FEATURES OF ANGINA
8. DIAGNOSTIC EVALUATION
9. MEDICAL MANAGEMENT
10. NURSING MANAGEMENT
11. NURSING DIAGNOSIS
12. NURSING INTERVENTIONS

5. 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.
The insufficient blood flow in coronary artery
resulting in a decreased oxygen supply and
increased myocardial demand.
The severity of angina is based on the chest
pain and its effect on the activities of daily
living.

6. INCIDENCE
 Angina pectoris is more often the
presenting symptom of coronary artery
disease in women more than men.
It has an estimated prevalence of 4.6
million in women and 3.3 million in men.
(Jul 19, 2019)

7. MODIFIABLE RISK
FACTOR :
NON-MODIFIABLE RISK
FACTORS :
CLASSIFICATION OF THE RISK FACTORS
01 02

8. 1. MODIFIABLE RISK FACTOR :
Tobacco use and smoking
High blood cholesterol or triglyceride
level
Lack of exercise
Obesity
Stress

9. 2. NON-MODIFIABLE RISK
FACTORS :
Family history of the heart
disease.
Older age
Diabetes
High blood pressure

10. PATHOPHYSIOLOGY
Due to etiological factors
Obstruction in coronary artery
Ischemia to heart muscles
Hypoxia

11. CONTI….
Reduced oxygen demand
Thrombolysis
Angina

12. THE 5 TYPES OF ANGINA PECTORIS
1. Stable angina:
Predictable and consistent pain that occurs on
exertion and is relieved by rest.
2. Unstable angina :
Is also as called Preinfarction angina. The pain
occur is lower chest, not relief by rest or
nitroglycerine.
3. Intractable or refractory angina:
Severe incapacitate chest pain may present.

13. CONTI….
4. Variant angina :
Is also called Prinzmetal’s angina. Pain at rest with
ST-segment elevation; caused by coronary artery
vasospasm. (CAV)
5. Silent ischemia or silent angina:
Objective evidence of ischemia such as
electrocardiographic changes with but patient
reports no chest pain.

14. CLINICAL MANIFESTATION
Ischemia of the heart muscle may produce
chest pain and chest discomfort with feeling of
the indigestion.
The pain is often felt deep in the chest behind
the upper or middle of the sternum
(Retrosternal area).
Typically, the pain or chest discomfort is
poorly localized and may radiate to the neck,
jaw, shoulders, and inner aspects of the upper
arms, usually the left arm.

15. CONTI….
The patient often feels chest tightness or a
heavy, choking, or strangling sensation (Due to
neck pain).
A feeling of weakness or some time numbness
in the arms, wrists, and hands.
Patient may have shortness of breath, pallor,
diaphoresis, dizziness or lightheadache, nausea
and vomiting.
Anxiety may also present in angina. (Impending
doom)

16. DIAGNOSTIC EVALUATION
The diagnosis of angina is often made by
evaluating the clinical manifestations of
ischemia and the patient’s complaints.
A 12-lead ECG and blood laboratory
values help in making the diagnosis.
The patient may undergoing several
diagnostic test in which the heart is
monitored by ECG, echocardiogram, or
both.

17. CONTI….
The patient may also be referred for an
echocardiogram or invasive cardiac
procedures such as cardiac catheterization
and coronary artery angiography.
There is also monitoring CRP (C-reactive
protein) (Increased CRP level is harmful for
heart health) blood levels which is
additional risk factor for cardiovascular
disease.

18. MEDICAL
MANAGEMENT

19. OBJECTIVES OF MANAGEMENT
The objectives of the medical management of
angina are following :
To decrease the oxygen demand of the
myocardium and to increase the oxygen supply.
Medically, these objectives are met through the
pharmacologic therapy especially oxygen
therapy.
To prevent the complication of the angina
pectoris for example M.I. etc.
To minimized the sign and symptoms of the

20. PHARMACOLOGIC THERAPY
Nitroglycerin :
 Nitrates remain the mainstay for
treatment of angina pectoris. Nitroglycerin is
administered to reduce myocardial oxygen
consumption (Myocardial damage) which
decreases ischemia and relieves pain.
 Nitroglycerin dilates primarily the veins
and, in higher doses, also dilates the arteries.

21. CONTI….
 Nitroglycerin may be given by several
routes: sublingual tablet or intravenous
administration.
 Sublingual nitroglycerin is generally placed
under the tongue or in the cheek and reducing
the pain of ischemia within 3 minutes.
 Topical nitroglycerin is also fast acting and
is a convenient way to administer the
medication. Both routes are suitable for
patients.

22. CONTI….
Beta-Adrenergic Blocking Agents :
 Beta-blockers such as propranolol,
metoprolol, and atenolol reduce sympathetic
stimulation to the heart and prevent the
damage of myocardium.
Calcium Channel Blocking Agents :
 Calcium channel blockers increase
myocardial oxygen supply by dilating the
smooth muscle wall of the coronary arteries.

23. CONTI….
 The calcium channel blockers most commonly
used are amlodipine, verapamil, and diltiazem.
 They may be used by patients who cannot take
beta-blockers. (significant side effects from beta-
blockers or nitrates).
Antiplatelet and Anticoagulant Medications :
Antiplatelet medications are administered to
prevent platelet aggregation, which obstruct in
blood flow. The following drugs may used :
“Aspirin, Clopidogrel & Ticlopidine, Heparin”

24. NON-PHARMACOLOGICAL
MANAGEMENT
As Per Myocardial Infarction……...

25. NURSING
MANAGEMENT

26. NURSING ASSESSMENT
The nurse gathers information about the
patient’s symptoms and activities,
especially those that precede and precipitate
attacks of angina pectoris.
The information about the patient’s gathers
by questions format.
In this format there is asking the same
questions regarding history of patient’s
diseases condition.

27. ASSESSMENT OF PAIN BY
QUESTIONS
Where is the pain? Can you point it
now?
Can you feel the pain anywhere else?
How you describe the pain?
It is like the pain you had before?
You can rate the pain on 0 to 10 scale?

28. CONTI….
When did the pain begin?
How long does it last?
Any other symptoms except pain? Or
with pain?
What helps the pain go away?

29. NURSING DIAGNOSIS
The nursing diagnosis are based on the assessment
of data, major nursing diagnosis for the patient may
include:
Acute chest pain related to coronary obstruction.
Ineffective myocardial tissue perfusion related to
CAD.
Fear & Anxiety related to hospitalization fear of
death.
Knowledge deficit related to lack of information of
post recovery self care activities.

30. GOALS
The major patient goals include immediate
and appropriate treatment when angina
occurs.
Prevention of angina.
Reduction of anxiety.
Awareness of the disease process and
understanding of the prescribed care
Adherence to the self-care program
Absence of complications.

31. NURSING INTERVENTION
If the patient reports pain the nurse takes
immediate action.
Proper assessment of the pain is mandatory to
analyses the severity of angina.
When a patient experiences angina, the nurse
should direct the patient to stop all activities and
sit or rest in bed in a semi-fowler position to
prevent the myocardial ischemia & take easy to
breath.
The nurse should monitor the vital sign of the

32. CONTI….
The nurse assesses the patient’s angina by asking
questions to determine whether the angina is the
same as the patient typically experiences.
The nurse then continues to assess the patient,
measuring vital signs and observing for signs of
respiratory distress.
If the patient is in the hospital, then 12-lead ECG
is usually obtained and analyzing for ST-
segment and T-wave changes.

33. CONTI….
Nitroglycerin is administered sublingually, and
the patient’s response is assessed. (Relief of
chest pain and effect on blood pressure and heart
rate).
If the chest pain is unchanged, then administer
the nitroglycerin repeated up to three doses.
Each time, blood pressure, heart rate, and the ST
segment are assessed to prevent the farther
complications
The nurse administers oxygen therapy if the
patient’s respiratory rate is increased or the
oxygen saturation level is decreased.

34. CONTI….
Patient and there family may be fearful that the
pain may lead to an MI or death. Hence, the
nurse providing information about the illness,
its treatment to reduce and minimized the
anxiety of patient and family.
The nurse identifies the level of the pain, and
plans the patient’s activities accordingly.
The nurse administer the analgesics to
minimized the pain. E.g. Inje. Morphine sulfate
or Voveron.

35. ANY
QUESTIONS

36. THANK YOU!!!