Medical surgical nursing

1. By : Malak Tagaldeen
Aisha Al-mogamer
Supervised by :Dr. Om Alkher

2. • Also called angina pectoris
•Definition: is a clinical syndrome characterized by episodes of pain
or pressure in the anterior chest usually caused by reduced blood
flow to the heart .
• The reduce in blood flow results in a decreased oxygen supply to
meet an increased myocardial demand for oxygen in response to
physical exertion or emotional stress. => (myocardial ischemia ).
• Angina is a symptom of coronary artery disease.

3. Myocardial ischemia result from :
• Coronary atherosclerosis .
• Coronary artery spasm.
• Thrombosis and embolisms.
• Aortic stenosis.
• Hypertrophic cardiomyopathy.
• Ventricular hypertrophy .
• Anemia.

4. • Increase age.
• Family history of coronary artery disease.
• Hypertension , DM.
• Tobacco use / smoking .
• Hypercholesterolemia or triglyceride .
• Lack experience .

5. • Obesity.
• Emotional stress.
• Cold temperature .
• Certain Medication.
• Drug misuse.
• Other health conditions such as CKD, peripheral artery disease
,history of stroke increase the risk of angina .

6. • Chest pain and discomfort described as squeezing ,pressure ,
tightness, burning.
• The pain may felt in the arms , neck , jaw,shoulder or back.
• Shortness of breath.
• Pallor.
• Diaphoresis .
• Dizziness .
• Neasea.
• Fatigue .

7. • Physical exertion (increase myocardial demand )
• Exposure to cold ( cause elevation of BP increase oxygen demand)
• Eating heavy meals.
• Intense emotion.
• Typical angina pain usually within minutes and relieved with rest or
glycerylnitirate.

8. • Stable angina : predictable , usually occur on exertion and
relieve with rest or angina medication , lasts a short time
(five minutes or less(
• Unstable angina : unpredictable, symptoms occurs more
frequent with less physical effort , lasts longer than stable
angina (20 min or longer ) doesn’t go away with rest or usual
angina medications. It is dangerous and requires emergency
treatment .

9. • Variant angina (Prinzmetal angina) : Pain occur at rest or
overnight caused by coronary artery spasm , relieved by
angina medication.
• Refractory angina : patients with severe coronary disease in
whom revascularization is not possible and angina is not
controlled by medical therapy .

10. • Resting ECG
• Exercise ECG ( treadmill ECG)
• Imaging test ( chest X-R , CT , MRI )
• Blood test for ( cholesterol , sugar , protein , CRP , cardiac
enzyme )
• Echocardiogram
• Myocadiuminal perfusion scaning ( nuclear stress test)
• Cornonary angiography .

11.  Life –style change.
 Medical ( pharmacological treatments )
 Surgical ( non pharmacological ( invasive) treatments )

12.  Antiplatelet and anticoagulant .
• Aspirin , Clopidegel , Heparin -> prevent formation of clot .
 Statin –reduce high cholesterol .
 Antianginal therapies :
• Nitrate ( reduce myocardial oxygen demand and increase
myocardial oxygen supply )
• Beta blockers (propranolol, metoprolol, atenolol) reduce
myocardial oxygen demand by dereseae HR, BP , myocardial
contractility .

13.  Cont. antianginal therapies
• Calcium channel blockers (relax blood vessels to improve
blood flow)
• Angiotensin –converting enzyme inhibitors ( ACE( lower
blood pressure.
• Potassium channel activators -> vasodilators (nicorandil )
 Oxygen administration .

14.  Percutaneous coronary intervention (PCI) —a tiny balloon
is inserted into the narrowed artery .
• The balloon is inflated to widen the artery, and then a small
wire mesh coil (stent) is usually inserted to keep the artery
open.
 Coronary artery bypass surgery (CABG ) a vein or artery
from somewhere else in the body is used to bypass a blocked
or narrowed heart artery.

15. Nursing intervention
• Treating angina : when pt experiences angina the nurse should direct
pt to stop activities and sit or rest in bed in semi-fowler position
• Reducing anxiety : The nurse should explore and implicate that the
diagnosis has for the pt providing information about the illness ,
treatment and methods of preventing its progression
• Preventing pain : when the pt has pain with minimal activity , the
nurse alternates the pts activities with rest periods

16. • Stop smoking.
• Eating healy diet ( cut down fatty foods and eat more oats
which decrease cholesterol )
• Exercising regularly .
• Maintain healthy weight.
• Reducing stress.
• Maintain normal BP and blood sugar.
• Avoid alcohol.