Angina pectoris is chest pain or discomfort caused by insufficient blood flow to the heart muscle. It is usually characterized by transient episodes of chest pain or pressure that is precipitated by physical exertion or emotional stress. There are different types of angina including stable angina, unstable angina, and variant angina. Common causes of angina include physical exertion, strong emotions, temperature extremes, cigarette smoking, sexual activity, and stimulant use. Angina pain typically feels squeezing, burning, or pressing and radiates to the left arm. Attacks usually last less than 5 minutes.

3. Definition:
Angina pectoris is a clinical syndrome, usually
characterized by episodes or paroxysms of pain or pressure in
the anterior chest. The cause is causually insufficient coronary
blood flow.
• Angina is a common manifestation of CHD.
• Angina can also occur in clients with normal-coronary
arteries, but it is less common.
• Clients with aortic stenosis, hypertension, and
hypertropic cardiomyopathy can also have Angina
pectoris

4. Types of Angina:
• Stable Angina
• Unstable Angina
• Intractable or refractory angina.
• Variant Angina.
• Silent ischemia.

5. Etiology:
1) Physical exertion :
Walking outdoors is the most common form of
the exertions, that produce an attack.
Isometric exertion of the arms as on raking
leaves, painting of lifting heavy objects also
causes exertional angina
2) Strong emotions:
Stimulate the sympathetic nervous system
and increase the work of the heart. This result
in an increase in HR, BP and myocardial
contractility.

6. 3) Temperature extremes:
It may be either hot or cold, increases the
workload of the heart.
• Blood vessels constricts  in Response to cold climate.
• Blood vessel dilate  hot stimulus
Cold weather also cause increased
metabolism to maintain internal temperature
regulation.
4) Cigarette Smoking: causes vasoconstruction
and an increased HR because of nicotine
stimulations of the catecholamine releases. It
also diminishes available oxygen by
increasing level of carbon monoxide

7. 5) Sexual Activity: increase the work load and
sympathetic stimulation. In a person with
severe CAD, the resulting extra workload of
the heart may precipitate angina
6) Stimulants: Such as cocaine, cause increased
HR and subsequent myocardial demand.
Stimulation of catecholamine release is the
precipitating Factor

8. Clinical Manifestations:
Characteristics of Angina:
Angina is a clinical syndrome characterized by
discomfort in the chest, Jaw, shoulder, back
or arm. Angina pectoris produce transient
paroxysmal attacks of substernal or precordial
pain with the following characteristics.
Onset – Angina can develop quickly or slowely.
Location: Nearly 90% of clients experience the
pain as retrosternal or slightly to the left of the
sternum

9. Radiation: The pain usually radiates to the left
shoulder and upper arm, and may then travel
down the inner aspect of the left arm to the
elbow, wrist and Fourth and Fifth fingers. The
pain may also radiate to the right
shoulder, neck, Jaw or epigastric region.
Duration: Angina usually last less than 5 minutes.
However, attack precipitated by a heavy meal or
extreme angor may last 15 to 20 minutes.

10. Sensation: Clients describe the pain of angina as
squeezing, burning, pressing, choking, aching or
bursting pressure. The clients often says the pain
feels like gas, heart burn, or indigestion.
Severity: The pain of angina is usually mild or
moderate in severity. It is often called
“discomfort”, not “pain”. Rarely is the pain
described as “severe”

11. Associated characteristics: other manifestation
that may accompany the pain includes:
• Dyspnea.
• Pallor
• Sweating
• Faintness
• Palpitations.
• Dizziness.
• Digestive disturbances.