Angina pectoris is a clinical syndrome characterized by chest pain or pressure due to insufficient blood flow to the heart. It occurs when oxygen demand of the heart exceeds the oxygen supply. The main causes are atherosclerosis and coronary artery spasm. Diagnosis is made based on symptoms, ECG, stress test, and coronary angiography. Treatment involves lifestyle changes, medications to reduce oxygen demand or increase supply like nitroglycerin, beta blockers, and calcium channel blockers. The goal is to manage symptoms and prevent further heart issues.

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ANGINA PECTORIS
PREPARED BY :
OM VERMA
ASSISTANT PROFESSOR
RELIANCE INSTITUTE OF NURSING

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4. • Definition:
• Angina: Choking or suffocation.
• Pectoris: Chest.Angina pectoris, is
the medical term used to describe
acute chest pain or discomfort.
Angina occurs when the heart’s need
for oxygen increases beyond the
Level of oxygen available from the
blood nourishing the heart.
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5. • DEFINITION :-
• ACCORDING TO BRUNNER AND
SUDDHARTH –,Angina Pectoris is
severe chest pain due to ischemia
(a lack of blood, thus a lack of
oxygen supply) of the heart muscle,
generally due to obstruction or
spasm of the coronary arteries (the
heart's blood vessels).
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6. • ACCORDING TO LIPPINCOTT :-
Chest pain that is typically
severe and crushing with a
feeling just behind the
breastbone (the sternum) of
pressure and suffocation, due to
an inadequate supply of oxygen
to the heart muscle.
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Angina Pectoris
Definition :
Angina pectoris is a clinical syndrome
usually characterized by episodes of pain
or pressure in the anterior chest . The
cause is usually insufficient coronary
blood flow which results in a decreased
oxygen supply to meet an increased
myocardial demand for oxygen in
response to physical exertion or
emotional stress.

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• a condition marked by severe pain
in the chest, often also spreading
(radiate ) to the shoulders, arms,
and neck, cause to an inadequate
blood supply to the heart.

9. ETIOLOGY
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10. • ETIOLOGY
• Supply-demand mismatch
• Factors that decrease supply
• Coronary vessel
• disorders
• Atherosclerosis
• Arterial spasm
• Coronary arteritis
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11. •Polycythemia ( abnormal
increased concentration of
haemoglobin in the blood
and reduction plasma
volume or increased red
cell number.
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12. • Angina Causes
• Angina usually happens because of heart disease. A fatty
substance called plaque builds up in your arteries, blocking
blood flow to your heart muscle. This forces your heart to
work with less oxygen. That causes pain. You may also
have blood clots in the arteries of your heart, which can
cause heart attacks.
• Less common causes of chest pain include:
• A blockage in a major artery of your lungs (pulmonary
embolism)
• An enlarged or thickened heart (hypertrophic
cardiomyopathy)
• Narrowing of a valve in the main part of your heart (aortic
stenosis)
• Swelling of the sac around your heart (pericarditis)
• Tearing in the wall of your aorta, the largest artery in your
body (aortic dissection)
•
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13. Tobacco use. Chewing tobacco, smoking and long-term
exposure to secondhand smoke damage the interior walls of
arteries — including arteries to your heart — allowing deposits
of cholesterol to collect and block blood flow.
Diabetes. Diabetes increases the risk of coronary artery
disease, which leads to angina and heart attacks by speeding
up atherosclerosis and increasing your cholesterol levels.
High blood pressure. Over time, high blood pressure damages
arteries by accelerating hardening of the arteries.
High blood cholesterol or triglyceride levels. Cholesterol is a
major part of the deposits that can narrow arteries throughout
your body, including those that supply your heart. A high level of
low-density lipoprotein (LDL) cholesterol, also known as "bad"
cholesterol, increases your risk of angina and heart attacks. A
high level of triglycerides, a type of blood fat related to your
diet, also is unhealthy. 13

14. Family history of heart disease. If a family member has coronary
artery disease or has had a heart attack, you're at a greater risk
of developing angina.
Older age. Men older than 45 and women older than 55 have a
greater risk than do younger adults.
Lack of exercise. An inactive lifestyle contributes to high
cholesterol, high blood pressure, type 2 diabetes and obesity.
However, it is important to talk with your doctor before starting
an exercise program.
Obesity. Obesity
is linked with high blood cholesterol levels, high blood pressure
and diabetes, all which increase your risk of angina and heart
disease. If you're overweight, your heart has to work harder to
supply blood to the body.
Stress. Stress can increase your risk of angina and heart
attacks. Too much stress, as well as anger, also can raise your
blood pressure. Surges of hormones produced during stress can
narrow your arteries and worsen angina. 14

15. C.M
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16. General Symptoms
• Severe chest discomfort (heaviness,
pressure, tightness, choking,
squeezing) (suffocation )
• The pain may radiate to the
shoulders, arms, back,
neck, or jaw.
• Palpitations
• Sweating
• Dizziness
• Dyspnea

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

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• 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. Duration :- Less
than 5 minutes. Sensation :- Like
squeezing, burning, pressing ,
chocking, aching , pain feels like gas,
heartburn

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• Associated: Dyspnea, Sweating,
faintness ( behoshi ) , palpitation,
dizziness ect.
• Relieving: GTN and rest.
• Aggravating: exertion, exercise,
heavy meal, emotional upset, and
anger

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Pathophysiology
• Due to etiological factors
• A reduction of coronary blood flow
caused by fixed &or dynamic
epicardial artery stenosis.
• Abnormal constriction or deficient
relaxation of coronary artery.
• Reduce O2-carrying capacity of the
blood .

21. • Atherosclerosis Arterial spasm
Atherosclerosis+Plaque
split+Thrombus
Obstruction sudden reversible
occlusion obstruction
• ISCHAEMIA (Hypoxia)
Reduced oxygen demand Angina
Thrombolysis -
Unstable angina 21

22. • imbalance between the heart's
oxygen demand
• This imbalance can result from
an increase in demand (e.g.,
during exercise)
Lead to angina pectoris
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23. • TYPES OF ANGINA PECTORIS
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1. STABLE ANGINA:
• predictable (STABLE) & consistent pain
• Predictable
• Occurs on exercise, emotion or eating.
• Caused by increase demand of the
heart and by a fixed
• narrowing of coronary vessels, almost
always by atheroma.
• Coronary obstruction is ‘fixed’
• relieved by rest.

25. • 2. Intractable or refractory angina:
sever incapacitating chest pain.
refractory angina pectoris (chest
pain) is a sensation of pressure
or pain in the chest that is the
result of insufficient blood flow to
the heart muscle and in which
treatment with medication
and heart surgery is either
insufficient or no longer effective.
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26. 3.Unstable angina or preinfarction or
cresendo angina:
• symptoms occur more frequently and
longer ( PROLONGATE )than stable
angina. Dangerous and requires
emergency treatment.
• It is the rupture of the fibrous cap,
leading to the blockage of
• the artery by clotted blood.
• • Occurs with increasing frequency
(progression) • Affects the patient's
life by not being able to work. 26

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4. Variant angina or prinzmetals angina :
secondary epicardial coronary artery
spasm. pain at rest with reversable ST-
segment elevation, caused by coronary
artery vasospasm.
5. Silent ischemia: objective evidence of
ischemia in absence of chest
discomfort (as ECG changes with a
test), but pt report no symptom.

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• ANGINA: SILENT ISCHEMIA
• Very Common
• More episodes of Silent than
Painful angina in the
• same patient.
• Difficult to diagnose
• Gnerally Exercise testing.

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Diagnostic findings
Often made by evaluating the
clinical manifestations of ischemia
and the pts history

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DIAGNOSTIC FINDINGS

31. • DIAGNOSTIC TESTS :-
• Electrocardiogram (EKG) - records electrical
activity of the heart and can detect when the
heart is starved for oxygen
•
• Stress test - blood pressure readings and an
EKG while the patient is increasing physical
activity
• Chest X-ray - to see structures inside the chest
• Coronary angiography - dye and special X-rays
to show the inside of coronary arteries (dye is
inserted using cardiac catheterization)
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• Blood tests - to check levels of fats,
cholesterol, sugar, and proteins 31

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Medical management for
the pt with angina pectoris

33. • MANAGEMENT :- Treatment will depend on the
severity of the symptoms, severity of the
underlying disease, and extent of damage to the
heart muscle, if any Simple rest and observation,
an aspirin, breathing oxygen, and sublingual
nitroglycerin may be all that the patient needs, if it
is only angina.
• Medication may be administered to reduce anxiety.
• Medication may be administered to lower blood
pressure or heart rate.
• Medication may be administered to reduce the risk
of having a blood clot or to prevent further clotting.
• If the healthcare provider believes the chest pain
actually represents a heart attack, the patient may
be given a fibrinolytic (apowerful clot-buster
medication).
• Lifestyle changes recommended to treat angina33

34. • Regularly checking cholesterol
levels
• Resting and slowing down
• Avoiding large meals
• Learning how to handle or avoid
stress
• Eating fruits, vegetables, whole
grains, low-fat or no-fat diary
products, and lean meat and
fish
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• The objective is to decrease
oxygen demand of myocardium
and to increase oxygen supply
• 1.Nitroglycerin : administered to
reduce myocardial oxygen
consumption

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2.Beta-adrenergic blocking agents :
( propranolol ,metoprolol , atenolol)
appear to reduce myocardial oxygen
consumption, result in a reduction in
heart rate, decreased BP , and
reduced myocardial contractility .

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3-Calcium channel blocking
agents : some decrease
sinoatrial node automaticity and
node conduction ,resulting in
slower heart rate

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4- Antiplatelet and
anticoagulent
medications
Aspirin: prevents platelet
activation and reduces the
incidence of MI and death with
CAD
Heparin : prevents the
formation of new blood clots

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• Oxygen administration :
usually initiated at the onset of
chest pain to increase the amount
of oxygen delivered to the
myocardium and to decrease the
pain.

40. Angioplasty
• is a treatment used for people whose angina does not get
better with medication and/or who are at high risk of having a
heart attack.
• Before angioplasty can be done, the area(s) of coronary
artery narrowing is located with coronary arteriography.
• A thin plastic tube called a catheter is inserted into
an artery in the arm or groin with local sedation.
The catheter has a tiny balloon attached to the
end.
• The catheter is threaded through the arteries and
into the artery where the narrowing is.
• The balloon on the catheter is inflated, opening up
the narrowing.
• Following ballon treatment, many patients require
placement of a "stent," a small metal sleeve that is
placed in the narrowed artery. The stent holds the40

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Prevention
Self care action plan changing habits.
 Stop smoking
 Increase level of exercise
 Cut down on fatty foods
 Eat more oats, which decrease
cholesterol

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 Lose wt if u DR. thinks you are
overweight.
 Make sure your BP is not high by
regular check
 Consider another method of
contraceptive if you take pill

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Nsg process for pt with
Angina pectoris
Assessment
The nurse gather information about
the pts symptoms and activities .
The nurse may ask about the period
that angina last , and if any
medication relieve the angina.

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Diagnosis
1. Ineffective myocardial tissue
perfusion secondary to CAD as
evidence by chest pain or equivalent
symptoms
2. Anxiety related to fear of death

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Diagnosis
3. Noncompliance , ineffective
management of therapeutic
regimen related to failure to
accept necessary lifestyle changes

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Planning and goals
The major goal include
immediate treatment when
angina occur , preventing of
angina , reduction of anxiety
and absence of complications

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NSG interventions
1. Treating angina : when pt
experiences angina the nurse should
direct pt to stop activities and sit or
rest in bed in semi-fowler position
2. 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

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3. Preventing pain : when the pt has
pain with minimal activity , the
nurse alternates the pts activities
with rest periods

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Evaluation
expected pts outcomes may include
1. Reports that pain is relieved
promptly
2. Reports decreased
3. anxietyUnderstands ways to avoid
complications and demonstrates
freedom from complications

50. • Complications:
• Myocardial infarction
• Cardiac Arrhythmias
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