Angina pectoris is defined as chest pain due to inadequate oxygen supply to the heart muscle. It is caused by conditions that block or narrow the coronary arteries like high cholesterol or hypertension. Symptoms include chest pressure or squeezing pain that can radiate to the arms or other areas. There are different types of angina that vary in timing and triggers. Diagnosis involves health history, physical exam, ECG, cardiac enzymes and other tests. Treatment focuses on risk factor modification, medications like nitrates and calcium channel blockers, and procedures like angiography. A study found that low-dose testosterone treatment for 12 weeks in men with stable angina reduced exercise-induced ischemia and improved quality of life measures of pain and
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Angina pectoris
1.
2. Angina pectoris is defined as
an inadequate supply of
oxygen to the heart muscle
which is typically severe and
crushing and is
characterized by feeling of
pressure and suffocation
just behind the breast bone.
3. High cholesterol level
High blood pressure
Smoking
Uncontrolled diabetes mellitus
Obesity
Metabolic syndrome
Lack of physical activity
Age
Cold climate
5. Due to etiological and risk factors
Blockage of coronary artery
Imbalance between myocardial oxygen demand
and supply
Myocardial ischemia
Deprived glucose in myocardial cell for aerobic
metabolism
Production of lactic acid and its accumulation
Lactic acid irritates myocardial nerve fiber
Transmits pain message to cardiac nerve and
upper thoracic posterior root
Angina pectoris
6. Substernal/ precordial pain
ONSET: quickly/slowly
LOCATION: retrosternal/ slightly left to
sternal
RADIATION: Left shoulder , upper arm
and may travel down the inner aspect of
left arm to the elbow wrist and 4th or 5th
finger. May radiate to right shoulder, neck,
jaw or epigastric region.
DURATION: Last less than 5 minutes.
Attacks precipitated by heavy meal /
extreme anger may last 15-20 minutes.
10. STABLE ANGINA:
Chest pain occurs intermittently
Over a long period
Triggered by: exertion, emotion
Same pattern of onset, duration and intensity of
symptoms
UNSTABLE ANGINA
Paroxysmal chest pain
Occurs even on rest/ sleep
Attacks characteristically increases in number, duration
and severity
Triggered by: unpredictable degree of exertion, emotion.
Requires immediate hospitalisation
11. PRINZMETAL ANGINA:
Occurs at rest as a response to spasm of major
coronary artery
Rare form
Can occur during rapid eye movement sleep when
myocardial oxygen consumption increases.
It may relieve by rest
12. ANGINA DECUBITUS
Occurs when person is lying down
Occurs because gravity redistributes fluids in body
which makes heart work harder
Relieved by sitting or standing
NOCTURNAL ANGINA
Occurs at night
INTRACTABLE ANGINA: chronic incapacitating
angina that does not response to interventions
POST INFARCTION ANGINA: pain occurs after MI
when residual ischemia may cause episodes of
angina
15. Cardiac enzyme
ENZYME NORMAL VALUE
CK-MB 5 to 25 IU/L Rise in 3-12 hours
Peaks 24 hours
Normalizes in 48-72
hours
MYOGLOBIN Doubles in value
within 2 hours of MI
0 to 85 ng/mL
Rise in 1-4 hours
Peaks 6-7 hours
Normalizes in 24
hours
Troponin T Greater than 2ng/
ml
Rise in 3-12 hours
Peaks 12-48 hours
Normalizes in 14
days
Troponin I >0.03mcg/l Rise in 3-12 hours
Peaks 24 hours
Normalizes in 5-10
days
21. Presentation with chest pain
Assess nature, characteristics, location and
quality
Angina unlikely angina likely
Avoid unnecessary test primary
secondary
Manage risk able to exercise investigate
normal resting ECG
treat
22. Yes no
Exercise ECG Myocardial perfusion
imagining
High risk low risk
Angiography medical treatment
28. Establish and maintain airway
Anticipate need for intubation
Administer oxygen
Start 2 IV lines
Loosen clothes
Monitor cardiac rate and rhythm
29. Monitor vital signs
Take 12 lead ECG
Be prepared to perform CPR
Assess severity and location of pain
Obtain past heath history
Assess indication and contraindication of
thrombolytic therapy
30. Acute pain related to oxygen supply and demand imbalance
as evidenced by pain score
Decreased cardiac output related to decrease cardiac
contractility and dysrhythmias as evidenced by ECG
monitoring
Activity intolerance related to cardiac dysfunction, changes
in oxygen supply and consumption as evidenced by
shortness of breath
Anxiety related to chest pain, fear of death as evidenced by
facial expression
31.
32. A pilot project was done to examine the clinical
effects of long-term low-dose androgens in men with
angina. Forty-six men with stable angina completed
a 2-week, single-blind placebo run-in, followed by
double-blind randomization to 5 mg testosterone
daily by transdermal patch or matching placebo for
12 weeks, in addition to their current medication.
Time to 1-mm ST-segment depression on treadmill
exercise testing and hormone levels were measured
and quality of life was assessed by SF-36 at baseline
and after 4 and 12 weeks of treatment.
33. Active treatment resulted in a 2-fold increase in
androgen levels and an increase in time to 1-mm ST-
segment depression from 309±27 seconds at baseline to
343±26 seconds after 4 weeks and to 361±22 seconds
after 12 weeks.
This change was statistically significant compared with
that seen in the placebo group; P=0.02 .
The magnitude of the response was greater in those with
lower baseline levels of bioavailable testosterone
(r=−0.455, P<0.05).
There were significant improvements in pain perception
(P=0.026) and role limitation resulting from physical
problems (P=0.024) in the testosterone-treated group.
Low-dose supplemental testosterone treatment in men
with chronic stable angina reduces exercise-induced
myocardial ischemia.