Angina pectoris, causes, risk factors, medical management, nursing management, prevention and complications.

1. n
Presentation
on
Angina Pectoris
By
Chimankpam Sarimazinuchi Kaycey
Bruce Maruam-Enaan Hearty
Dagogo Lolia Dadokiye

2. INTRODUCTION
• Angina pectoris is the result of myocardial
ischemia caused by an imbalance between
myocardial blood supply and oxygen demand.
• It is a common presenting symptom (typically,
chest pain) among patients with coronary artery
disease (CAD).

3. Epidemiology
• Angina pectoris is more often the presenting
symptom of coronary artery disease in women than
in men, with a female- to- male ratio of 1.7:1.
• It has an estimated prevalence ratio of 4.6 milion in
women and 3.3 million in men.
• Approximately 9.8 million Americans are estimated
to experience angina annually with 500, 000 new
cases of angina occurring every year.

4. Epidemiology
• The annual rates per 1000 population of new
episodes of angina for those aged 45-54 years are;
8.5 for black men, 10.6 for black women, 11.8 for
nonblack women and 20.8 for black women.
• For those aged 55-64 years; 10.6 for black men,
11.9 for non black men, 19.3 for black women and
11.2 for non black women.

5. Epidemiology
• For those aged 65-744years; 8.8 for black men, 10.0
for black women, 13.7 for nonblack women and
13.1 for nonblack men (Jamshid, 2018).

6. Types of angina
1. Stable angina. There is predictable and
consistent pain that occurs on exertion and is
relieved by rest and/or nitroglycerin. This type of
attack, lasts for about 0.5 to 3 minutes.
2. Unstable angina. The symptoms increase in
frequency and severity and may not be relieved
with rest or nitroglycerin.

7. Types of angina
3. Intractable or refractory angina. There is severe
incapacitating chest pain.
4. Variant angina. There is pain at rest, with
reversible ST-segment elevation and thought to
be caused by coronary artery vasospasm.
5. Silent ischemia. There is objective evidence of
ischemia but the patient reports no pain.

8. Causes
• Underlying coronary artery disease,
• Damage to the arteries and smoking,
• Narrowing of the arteries.

9. Risk factors
• Stress
• An overuse of alcohol or recreational drugs
• Smoking
• Exposure to particle pollution, for example, at work
• Low physical activity
• An unhealthy diet

10. Risk factors cont.
• High cholesterol levels
• Overweight or obesity
• Genetic factors
• Conditions such as heart disease, diabetes, low
blood pressure, metabolic syndrome, and anemia
• An age of over 45, for males, or 55, for females

11. Clinical manifestations
• Chest pain and discomfort,
• A pressing, squeezing, or crushing pain, usually
under the breastbone,
• Pain in the arms, neck jaw, ear lobes, shoulder or
back,
• Dizziness,
• Fatigue,
• Nausea,
• Shortness of breath,
• Sweating.

12. Pathophysiology
• Angina results when there is an imbalance
between the heart's oxygen demand and supply.
• This imbalance can result from an increase in
demand (e.g., during exercise) without a
proportional increase in supply (e.g., due to
obstruction or atherosclerosis of the coronary
arteries).

13. Pathophysiology cont’d
• Oxygen demands are not met. Normally, the
myocardium extracts a large amount of oxygen
from the coronary circulation to meet its
continuous demands.
• Increased demand. When there is an increase in
demand, flow through the coronary arteries needs
to be increased.
• Ischemia.

14. Figure 1: Pathophysiology of Angina Pectoris. Retrieved from
https://www.slideshare.net/aishuanju/angina-pectoris-45012725

15. Diagnostic Tests
• Electrocardiogram (ECG): used to diagnose heart
abnormalities such as arrhythmias or to show
ischemia (lack of oxygen and blood) to the heart.
• Stress test without imaging: This heart-
monitoring test is used to help evaluate how well
the heart performs with activity.

16. • Blood tests: The tests can identify certain
enzymes such as troponin that leak into the
blood after your heart has suffered severe
angina or a heart attack.

17. Diagnostic Tests Cont’d
• Chest x-ray
• CT of the chest
• Magnetic resonance (MR) imaging
• Catheter angiography
• Myocardial Single Photon Emission Computed
Tomography (SPECT)

18. Medical management
• The objectives of the medical management of
angina are to decrease the oxygen demand of the
myocardium and to increase the oxygen supply.
• Treatment options include lifestyle modification,
pharmacologic agents, cardiac procedures, and
cardiac rehabilitation.

19. Lifestyle changes
• Quit smoking
• Manage weight
• Regularly check cholesterol levels
• Rest when necessary
• Regular exercise
• Learn how to handle or avoid stress
• Consume diets that are rich in fruits, vegetables,
whole grains, low-fat or no-fat dairy products, and
lean sources of protein

20. Pharmacological management
A. Nitroglycerin:
• Nitroglycerin is administered to reduce myocardial
oxygen consumption, which decreases ischemia
and relieves pain.
B. Beta-Adrenergic Blocking Agents
• Beta-blockers such as metoprolol (Lopressor,
Toprol) reduce myocardial oxygen consumption by
blocking beta-adrenergic sympathetic stimulation
to the heart. This helps control chest pain and
delays the onset of ischemia during work or
exercise.

21. Pharmacological management cont’d
C. Calcium Channel Blocking Agents:
• Decrease sinoatrial node automaticity and
atrioventricular node conduction, resulting in a
slower heart rate and a decrease in the strength of
myocardial contraction (negative inotropic effect).
• Relax the blood vessels

22. Pharmacological management cont’d
D. Antiplatelet and Anticoagulant Medications:
• Antiplatelet medications are administered to
prevent platelet aggregation and subsequent
thrombosis, which impedes blood flow.
•
E. Oxygen Administration:
• Oxygen therapy is usually initiated at the onset of
chest pain in an attempt to increase the amount of
oxygen delivered to the myocardium and to
decrease pain.

23. Figure 2: Drugs used in the pharmacologic management of angina

24. Alternatives to surgery
Figure 3: Cardiac enhanced external counterpulsation
Retrieved from
https://upload.wikimedia.org/wikipedia/commons/2/26/Blausen_0161_Cardiac_E
nhanced_External_Counterpulsation.png

25. Figure 4: Spinal cord stimulator
Retrieved from
https://www.wsj.com/articles/SB10001424052702304512504579493843647492538

26. Figure 5. Transmyocardial laser therapy
Retrieved from: https://thvmg.com/wp-
content/uploads/2018/08/tmlr-fact-sheet.jpg
• Transmyocardial laser
therapy:
• This stimulates the
growth of new blood
vessels or otherwise
enhances blood flow in
the heart.

27. Surgical procedures
• Figure 6. Angioplasty
• Retrieved from: https://www.azuravascularcare.com//assets/illustration-of-what-is-an-angioplasty.jpg

28. Figure 7. coronary artery bypass grafting
Retrieved from: https://www.allinahealth.org/-/media/allina-
health/content/health-conditions-and-treatments/health-
library/patient-education/helping-your-heart/resources/heart-
surgery/coronary-artery-bypass-surgery-
graphic.jpg?la=en&hash=0061147BBC351209C69E2AF7C67180D3
• coronary artery bypass
grafting:
• A healthy artery or vein
from another part of the
body is used to bypass
narrowed arteries in the
heart.

29. Nursing management
• Immediate management
1. Assess pain.
2. Provide bed rest.
3. Administer oxygen at 3 L/min by nasal cannula as
prescribed.

30. Nursing management
4. Administer nitroglycerin as prescribed. to dilate
the coronary arteries, reduce the oxygen
requirements of the myocardium and relieve the
chest pain.
5. Continue patient monitoring.

31. Nursing management
• Following acute episode:
1) Instruct the client regarding the purpose of
diagnostic medical and surgical procedures and
the preprocedure and postprocedure
expectations.
2) Assist the client to identify angina precipitating
events.
3) Instruct the client to stop activity and rest if
chest pain occurs and to take nitroglycerin as
prescribed.

32. Nursing management
4) Instruct the client to seek medical attention if pain
persists.
5) Instruct the client regarding prescribed medications.
6) Provide dietary instructions to the client, stressing
that dietary changes are not temporary and must be
maintained or life.
7) Assist the client to identify risk factors that can be
modified.

33. Nursing management
8) Assist the client to identify barriers to compliance
with therapeutic plan and to identify methods to
overcome barriers.
9) Assist the client to set goals that will promote
changes in lifestyle to reduce the impact of risk
factors.

34. Complications
• Myocardial infarction
• Cardiac arrest
• Cardiogenic shock.

35. Preventive measures
• Eat varied, nutritious, “heart-healthy” diet,
• Avoid or quit smoking,
• Get regular exercise,
• Practice ways to manage stress and
• People should receive consistent, effective treatment
for cardiovascular disease and other aspects of
metabolic syndrome, such as high blood cholesterol,
high blood pressure, diabetes, and obesity.

36. Conclusion
• In conclusion, angina pectoris is the result of
myocardial ischemia caused by an imbalance
between myocardial blood supply and oxygen
demand, It is a common presenting symptom
(typically, chest pain) among patients with
coronary artery disease.
• Its management includes lifestyle changes,
pharmacological, surgical non surgical
management, and nursing management.

37. References
• Allina Health's Patient Education Department. (2017).
Coronary artery bypass surgery (CAB). Allinahealth.
Retrieved from https://www.allinahealth.org/-
/media/allina-health/content/health-conditions-and-
treatments/health-library/patient-education/helping-
your-heart/resources/heart-surgery/coronary-artery-
bypass-surgery-
graphic.jpg?la=en&hash=0061147BBC351209C69E2AF7C
67180D3
• Azura Vascular Care. (2019). Angioplasty. Retrieved from
https://www.azuravascularcare.com//assets/illustration-
of-what-is-an-angioplasty-768x426.jpg

38. References
• Bainey, K. R.,Welsh, R. C., Alemayehu, W., Westerhout, C.
M., Traboulsi, D., Anderson, T., & Kaul, P. (2018).
Population-level incidence and outcomes of myocardial
infarction with non-obstructive coronary arteries
(MINOCA): Insights from the Alberta contemporary acute
coronary syndrome patients invasive treatment strategies
(COAPT) study. International journal of cardiology, 264,
12-17.
•
• Crosta, P. (2020). Everything you need to know about
angina. MedicalNewsToday. Retrieved from
https://www.medicalnewstoday.com/articles/8886

39. References
• Gillen, C., & Goyal, A. (2020). Stable Angina. StatPearls
[Internet].
• Jamshid, A. (2018). Angina Pectoris: Practice Essentials,
Background, Pathophysiology. Accessed at
https://emedicine.medscape.com/article/150215-
overview#a1 on 2nd May, 2021
• Mayoclinic. (2019). Angina treatment: Stents, lifestyle
changes — What’s best?
https://www.mayoclinic.org/diseases-
conditions/coronary-artery-disease/in-depth/angina-
treatment/art-20046240-angina-pectoris

40. References
• Mohammed, H. A. (2017). The Relation between Life
Quality and Angina Pectoris Patients in Hospitals in Kirkuk
City ‫ةقالعالنيبةيعون‬. Kufa Journal for Nursing Sciences, 7(1).
• Nurses Labs. (2021). Angina Pectoris (Stable Angina)
Nursing Care Management: Study. Accessed at
https://nurseslabs.com/angina-pectoris/
• Radiological Society of North America. (2019). Angina
Pectoris. Accessed at
https://www.radiologyinfo.org/en/info/anginapectoris?go
ogle=amp on 2nd May, 2021
• Shao, C., Wang, J., & Tian, J. (2020). Coronary artery
disease: from mechanism to clinical practice. Coronary
Artery Disease: Therapeutics and Drug Discovery, 1-36.

41. References
• Texas Heart & Vein Multispecialty Group and Houston
Cardiothoracic and Vein Surgeons. (2018). Transmyocardial Laser
Revascularization. Retrieved from https://thvmg.com/wp-
content/uploads/2018/08/tmlr-fact-sheet.jpg
• Walker, J. (2014). Spinal-Cord Simulators. Wall Street Journal.
Retrieved from https://s.wsj.net/public/resources/images/MK-
CL609A_SPINE_G_20140415154204.jpg
• Wikipedia. (n.d).
Blausen_0161_Cardiac_Enhanced_External_Counterpulsation.png.
Retrieved from
https://upload.wikimedia.org/wikipedia/commons/thumb/2/26/Bl
ausen_0161_Cardiac_Enhanced_External_Counterpulsation.png/28
0px-
Blausen_0161_Cardiac_Enhanced_External_Counterpulsation.png