angina

1. Angina pectoris

3. DEFINITION
Angina pectoris is chest pain or
discomfort that occurs when the heart
muscledoesn’tgetenoughblood.
Angina pectoris is chest pain resulting
from myocardial ischemia (inadequate
bloodsupplytothemyocardium).

4. TYPES OF ANGINA
1. Stable angina
2. Unstable angina
3. Variant angina
4. Nocturnal angina
5. Angina decubitus
6. Intractable angina
7. Post infarction angina

5. • Stable angina
characterized by chest discomfort
or anginal equivalent that is provoked with
exertion and alleviated at rest or with
nitroglycerin.
Unstable angina,
one of several acute coronary syndromes,
causes unexpected chest pain, and usually
occurs while resting.

6. Prinzmetal angina (vasospastic angina or
variant angina)
characterized by chest discomfort or pain at
rest with transient electrocardiographic
changes in the ST segment, and with a
prompt response to nitrates.
The pain from variant angina is caused by a
spasm in the coronary arteries, which supply
blood to the heart muscle

7. nocturnal angina
• Unstable angina
A more unpredictable and/or severe pattern, where
chest pain may occur while resting or even
sleeping
Angina decubitus
is a variant of angina pectoris that occurs at night
while the patient is recumbent. Some have
suggested that it is induced by an increase in
myocardial oxygen demand caused by expansion
of the blood volume with increased venous return
during recumbency.

8. Intractable angina
a condition in which patients of heart disease
continue to suffer from recurrent restricting angina,
even though they are following the right medication
plan
Postinfarction angina
recurrence of typical anginal chest pain greater
than. 24 h following an acute myocardial infarction.

10. ETIOLOGY
Supply-demand mismatch
Factors that decrease supply
 Coronary vessel
disorders
Atherosclerosis
Arterial spasm
Coronary arteritis

11.  Circulatory disorders
Hypotension
Aortic stenosis
Aortic insufficiency
 Blood disorders
Anemia
Hypoxemia
Polycythemia

12. Factors that increase demand
 Increased cardiac output
Exercise
Emotion
Digestion of a large meal
 Increased myocardial need for oxygen
Damaged myocardium
Myocardial hypertrophy

13. CLINICAL FEATURES
Chest pain
Manifest as
heaviness, tightness,
aching, fullness, or
burning of the chest,
epigastrium, and/or
arm or forearm
(usually the left).

14. Characteristics of angina
includes
Onset :- Develop quickly or slowly.
Location :- Slightly to the left of
sternum.
Radiation :- Left shoulder and upper
and may then travel down the inner
aspect of the left arm to the elbow,
wrist, fourth and fifth fingers, radiate
to right shoulder, neck, jaw, epigastric
region.

15. Duration :- Less than 5 minutes.
Sensation :- Like squeezing, burning,
pressing , chocking, aching , pain feels
like gas, heartburn.
Severity :- Usually mild or moderate
in severity.
Treatment :- The client treated the
pain with nitroglycerin. Angina should
subside after nitroglycerin use.

16. DIAGNOSTIC MEASURES
History
Physical
examination
ECG
Laboratory studies
Serial cardiac
biomarkers
Hemoglobin
Serum chemistry
Lipid profile
Chest Radiography
Angiography
Radioisotope
Imaging
Exercise Testing

19. MANAGEMENT
A for aspirin and anti anginaltherapy
B for beta-blocker therapy and blood
pressure control
C for cigarettes and
cholesterol
D for diet and diabetes
E for education & exercise

20. PHARMACOLOGICAL
MANAGEMENT
Opioid analgesics
Antiplatelet agents
Beta-adrenergic blocking agents
Vasodilators
Calcium channel blockers

21. Cardiac catheterization
Revascularization
Nutritional management
Rehabilitation

22. REHABILITATION PROCESS
Smoking cessation
Lipid lowering
Control of hypertension

23. Diabetes mellitus
management
Weight management
and nutritional
counseling

24. Psychosocial management
Activity management

25. Nursing Diagnosis
Anxiety related to diagnosis of cardiac
disorder as evidenced by restlessness,
tachycardia, and frequently asking
questions regarding prognosis.
Acute chest pain related to decreased
blood supply to myocardium as evidenced
by distraction behaviors such as
restlessness, discomfort and fatigue.

26. Impaired gas exchange related to
decrease cardiac output as evidenced by
dyspnea, pallor and fatigue.
Risk for bleeding related to
coagulopathiesassociated with
thrombolytic therapy or arterial
puncture after angiography.