Angina pectoris is a clinical syndrome of chest pain due to transient myocardial ischemia without infarction. It occurs when oxygen demand of the heart exceeds its supply, usually due to coronary artery disease. There are four main types of angina - stable angina, unstable angina, variant angina, and microvascular angina. Diagnosis involves symptoms, ECG, and imaging. Treatment focuses on pain relief, slowing disease progression, and reducing future cardiac events through medications, lifestyle changes, and procedures like angioplasty. Complications can include heart attack, heart failure, and cardiac arrest if not properly managed.

2. ANGINA PECTORIS
ST. FRANCIS HOSPITAL NSAMBYA SNM
MEDICINE I
CN22
MARK

5. Definition and Overview
• This is chest pain/discomfort that occurs when there isn’t enough blood going to
the heart to meet the metabolic demands.
OR
• Angina pectoris is a clinical syndrome of precordial discomfort or pressure due to
transient myocardial ischemia without infarction.
• It occurs due to imbalance between oxygen demand and supply; i.e. increased
oxygen demand with reduction in oxygen supply due coronary artery disease.
• It is typically precipitated by exertion or psychologic stress and relieved by rest or
sublingual nitroglycerin.
• Diagnosis is by symptoms, ECG, and myocardial imaging.
• Treatment may include nitrates, β-blockers, Ca channel blockers, and coronary
angioplasty or coronary artery bypass graft surgery.

6. Pathophysiology of Angina
• When myocardial oxygen demand exceeds supply, ischemia occurs
• Major cause of ischemia is coronary artery occlusion
• 75% occlusion/stenosis of coronary arteries
• Following occlusion, the myocardium becomes hypoxic within the first 10secs
• With total occlusion, myocytes cease to contract thus decreasing cardiac output
• Ischemia also causes conduction abnormalities leading to ECG changes i.e.
dysrhythmias
• Anaerobic processes take over resulting in lactic acid accumulation
• Lactic acid and abnormal stretching of ischemic myocardium irritates myocardial
nerve fibers and transmits pain impulse to cardiac nerves and afferent
sympathetic fibers entering spinal cord at C3 to T4 (thus the variation in location
and radiation)

7. Pathophysiology cont’d
• Cardiac cells remain viable for 20 mins in ischemic conditions
• When blood flow is restored, aerobic metabolism resumes, contractility is
restored and cellular repair begins
• If coronary occlusion persists beyond 20 mins, myocardial infarction (MI) occurs
• The prolonged ischemia causes irreversible damage to myocytes

8. Types of angina
• Four types:
Stable angina
Unstable angina
Microvascular angina
Prinzmetal’s angina

9. Type of Angina Causes/triggers symptoms Treatment options
1. Stable Angina or Angina
Pectoris
• Physical activity or
emotional stress
• Exposure to very cold
or hot temperature
• Heavy meals
• Smoking
• Pain often lasts 5
minutes or less
• Pain may feel like
indigestion or gas
• Pain may feel like it
spreads to the arms,
back or other areas
• Rest
• Medication (e.g.,
nitroglycerin
2. Variant (Prinzmetal's)
Angina or Angina Inversa
• Spasm in the coronary
arteries caused by
stress, smoking,
cocaine use or
exposure to cold
weather.
• Medications that
narrow or tighten blood
vessels
• Usually occurs in
younger patients
• Severe chest pain or
discomfort that occurs
while resting, at night
or early in the morning
• Medications (e.g.,
calcium antagonists and
nitrates)

10. Type of Angina Causes/triggers symptoms Treatment options
3. Unstable Angina or
Acute Coronary
Syndrome
 Also called
“Crescendo
angina”
• Coronary arteries
narrowed by fatty
buildups
(atherosclerosis)
• Fatty buildups may
rupture and cause
injury to the coronary
blood vessel, lead to
blood clotting and
block the blood flow
to the heart
• Note: Unstable angina
requires emergency
care.
• Unexpected pain that
occurs during physical
activity or when
resting or sleeping
• Pain that may last
longer than stable
angina
• Pain that may get
worse over time
• Pain that doesn’t go
away with rest or
medication
• Chest pain or
discomfort that may
lead to a heart attack
• Cardiac
catheterization
• Percutaneous
coronary intervention
(PCI)
• Coronary artery
bypass graft surgery

11. Type of Angina Causes/triggers symptoms Treatment options
4. Microvascular Angina
 Also called
Syndrome X
• Micro-Vascular
Disease
• Spasms within the
walls of tiny arteries
that reduce blood
flow to the heart
• More common in
women
• Pain may be more
severe than other
types of angina
• Pain that may come
with shortness of
breath, fatigue, sleep
problems or lack of
energy
• Pain may be noticed
when experiencing
mental stress or
during routine daily
activities
• Medications
• Medical strategies
that increase blood
flow and reduce
workload in the heart

12. General Causes of Angina
• Coronary artery disease
• Coronary arterial spasms
• Severe anaemia
• Hypertrophic cardiomyopathy
• Aortic valve stenosis and regurgitation
• Arteriosclerosis
• Pericarditis(swelling of the sac around the heart)
• Aortic dissection
• Pulmonary embolism
• Physical exertion
• stress

13. General Precipitating factors for Angina
• Physical exertion
• Heavy meals
• Lying flat
• Cold weather
• Sexual excitement
• Emotional disturbances
• Vivid dreams

14. Signs an symptoms
• Chest pain (the major symptoms)
Squeezing and crushing pain under the chest
Sometimes pain occurs in the upper back, earlobes and neck.
Pain radiates to the shoulder, jaw neck and back
• Dyspnea
• Fatigue
• Shortness of breath
• Palpitations
• Anxiety
• Sweating
• Numbness
• pallor

15. Diagnosis of angina
• Physical examination and detailed history of the disease
• Electrocardiogram to investigate heart rhythms
• Coronary angiography
• MRI, CT, Chest x-ray
• Cardiac biomarkers e.g. troponin1,troponin 2
• Cardiac catheterization
• Stress tests
• Cardiac enzymes (AST,CPK,CK,and CK-MB;LDH and isoenzymes LD1,LD2)

16. Treatment:
•Aims:
Relief of symptoms
Slowing progression of the disease
Reduction of future events like myocardial infarction

18. Treatment of angina
• Morphine; for pain
• Oxygen
• Lipid lowering drugs (Statins)
• Aspirin (cardiac aspirin 75mg OD noct)
• Angioplasty
• Nitroglycerin
• Percutaneous coronary interventions (PCI)

19. Percutaneous coronary intervention

21. Preventing/lowering the risk of Angina
• Being physically active
• Eating healthy; avoiding eating processed foods, eating foods low in
cholesterol, fruit juice and vegetables.
• Limiting alcohol intake
• Lowering blood cholesterol levels (if needed); diet and anti-cholesterol drugs
• Lowering high blood pressure (if needed)
• Managing diabetes (if needed); complying to anti-diabetic treatment
• Quitting smoking
• Stress management; joining social groups
• Weight loss or maintaining a healthy weight

22. Possible nursing diagnoses
• Ineffective myocardial tissue perfusion related to CAD, as evidenced by chest
pain or equivalent symptoms
• Anxiety related to fear of death
• Deficient knowledge about the underlying disease and methods for avoiding
complications.
• Noncompliance, ineffective management of therapeutic regimen related to
failure to accept necessary lifestyle changes

23. Possible nursing management for a patient
with Angina
• Find out the intensity of anginal pain
• Provide fowler’s position to the patient to promote ventilation.
• Encourage the patient to take deep breaths, it may reduce infarct size, decrease
anxiety and resolve chest pain.
• Provide reassurance to the client to decrease anxiety.
• Administer nitroglycerine sublingually as prescribed: check vital signs especially
blood pressure.
• Administer oxygen, if required.
• Take vital signs in every 10 to 15 minutes, till anginal pain subsides.
• Advice the patient to inform nursing staff if pain occurs.
• Morphine for pain

24. Complications of Angina
• Myocardial infarction
• Acute pulmonary edema
• Congestive heart failure
• Cardiogenic shock
• Dysrhythmias and cardiac arrest
• Myocardial rupture
• Pericardial effusion and cardiac tamponade