This document discusses angina pectoris, including its definition, risk factors, types, pathophysiology, signs and symptoms, diagnostic procedures, and treatment. Angina pectoris is a clinical syndrome characterized by chest pain or pressure due to insufficient blood flow to the heart. It discusses the three main types of angina - stable, unstable, and variant angina - and their distinguishing features. Treatment focuses on reducing oxygen demand on the heart and includes medications like nitroglycerin, beta blockers, and calcium channel blockers. Nursing care involves health education regarding medication administration and lifestyle modifications.

1. DECREASE CARDIAC OUTPUT
ANGINA PECTORIS
NURSING CARE II: CARDIOVASCULAR
AND HAEMOPOIETIC SYSTEM
MDM ROZILA IBRAHIM
Jully 2022

2. Learning Outcome
At the end of the session, student would be able to:
• To identify the definition, risk factors, type of angina,
pathophysiology, sign and symptom and treatment related
to angina pectoris.
• To describe the role of medication in treating angina such
as nitro glycerine (GTN), beta blocker, calcium channel
blocker and ranolazine
• To elaborate the nursing intervention and management
patient related to angina pectoris.
• Explain the health education to patient with angina
pectoris.
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3. Heart disease related to decrease
cardiac output
• Angina pectoris
• Acute myocardial infarction (MI)
• Congestive Cardiac Failure (CCF)
• Cor Pamonale
• Acute Pulmonary Edema
• Cardiogenic Shock
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4. Definition Angina Pectoris
• Is a clinical syndrome usually characterized by episodes of
chest pain or pressure in the anterior chest due to the
insufficient coronary blood flow which results in a
decreased oxygen supply (myocardial ischemial) to meet an
increased myocardial demand.
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5. Risk factors/ Etiology
• Arteriosclerosis (thickening of the walls arteries & loss of
elasticity) eg: Artherosclerosis plaques (progressive disease
characterized by formation in arteries walls.
• Chronic disease : Chronic heart disease, DM, HPT, kidney
failure, pulmonary disease
• Trauma of the heart/artery coronary
• Narrowing or constriction of the coronary artery due to
spasm.
• Lifestyle (smoking, obesity: high cholesterol, lack of
exercise, stress)
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6. Cont.. Etiology
• Hypermetabolic condition – exercises, thyrotoxicosis,
hyperthyroidism, stress, stimulation abuse drug eg cocaine
• Chronic disease – anemia, heart failure, pulmonary disease
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7. Risk
factors
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8. Pathophysiology
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9. Cont.. pathophysiology
• When myocardial oxygen needs are greater than partially
occluded vessels can supply, myocardial cells become
ischemic and shift to anaerobic metabolism.
• Anaerobic metabolism produces lactic acid that stimulates
nerve endings in the muscle, causing pain. Pain subsides
when the oxygen supply again meets myocardial demand.
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10. Type of Angina
1. Stable Angina
2. Unstable Angina
3. Variant Angina (prinzmetal’s angina)
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11. 1. Stable Angina
• Most common
• It occur usually when heart is working harder than usual.
• Predictable & consistent pain that occurs on exertion and
relieve by rest and nitrates
• Regular pattern
• Pain will relieve after a few minute
• Not a heart attack
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12. Cont.. Stable angina
risk factors:
• Expose to cold
• Stress
• Physical exertion
• Smoking
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13. 2. Unstable angina
• Required emergency treatment and high risk for myocardial
infarct.
• Increasing in frequency, severity and duration.
• Unpredictable – occurs with decrease with activity or stress or
during rest.
• Clinical manifestation:
- Not follow pattern
- Not relieve by rest or medication
- Sign that a heart attack could occur soon
- Symptom occur more frequently and
longer.
• Potential T wave inversion and ST depression due to the ischemic
with negative cardiac bio markers.
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14. 3. Variant or prinzmetal’s angina
• Prinzmetal angina is also called variant angina or
vasospastic angina or inversa angina
• Unpredictable. Not related with activity.
• Rarely occur, but it happen during the night while sleeping
or early morning when you’re at rest
• Due to Spasm at coronary artery.
• It is relieved by the medication
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16. Clinical manifestation
• Strangulated chest
• Tightness or squeezing,
discomfort, burning sensation,
sweating, pressure, heaviness,
sharp pain
• Location: Radiate to neck,
chin, jaw, left arm, epigastric
region or back
• Shortness of breath.
• Diaphoresis(excessive or
abnormal sweating).
• Nausea and vomiting
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17. Conti…manifestation
• Symptom ‘crescendo-decrescendo’ pattern- increasing to a
peak, then gradually decreasing. Lasting 2-5 minutes.
• Dyspnea
• Pallor
• tachycardia
• Great anxiety and fear
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18. Grading of severity of angina
• Class I – not occur with ordinary physical activities. But in
strenuous activity or prolonge physical activity.
• Class II – Occur with prolong walking or stair climbing
• Class III- significantly limits ordinary physical activity
• Class IV- Occur at rest, as well as during activity.
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19. Interdisciplinary Care
• Management focus on maintaining coronary blood flow and
cardiac function
• Stable angina – often can manage by medical therapy
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20. Diagnostic procedure
• ECG – Electrocardiography : usually focus on ST and T wave
. Potential T wave inversion and ST depression due to the
ischemic with negative cardiac bio markers.
• Stress electrocardiography; exercise stress test uses ECG to
monitor cardiac response to increase workload during
progressive exercise.
• Nuclear medicine studies ;(radionuclide testing); use
radioisotope injected intravenously, heart is scan with
radiation detector.
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21. Cont..diagnostic procedure
• Echocardiography (ultrasound) –evaluate cardiac function
and structure.
• Coronary angiography – Catheter introduce into artery
threaded into the coronary artery. Dye is injected guided
with fluoroscopy. Allow visualize main coronary branches
for any abnormality eg obstruction or stenosis.
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23. Stress ECG
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24. Nuclear medicine studies
;(radionuclide testing)
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25. Echocardiography (ultrasound)
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26. Coronary angiography
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28. Pharmacology Treatment
Goal: To reduce oxygen demand and increase oxygen supply to
myocardium.
1. NITRATES
 Nitroglycerin (GTN)
 Route: sublingual (SL)
 Act: 1-2 minutes
 Decrease myocardial work & oxygen demand through
venous and arterial vasodilatation, which is turn reduce
preload and afterload.
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29. CONT..nitrates
• Available = oral tablet,
ointment, transdermal
patches
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30. Pharmacology Treatment
2. BETA BLOCKERS
 Eg: propanalol, metaprolol,nadolol & atenolol
 Block cardiac stimulating affects of noradrenaline and
epinephrine, prevent anginal attacks and reduce heart rate,
myocardial contractility & blood pressure thus reducing
myocardial demand
 * Not use to treat Prinzmetal’s angina
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31. Pharmacology Treatment
3. CALCIUM CHANNEL BLOCKER
 Reduce myocardial demand & increase oxygen supply
 Verapamil, diltiazem, nifedipine
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32. Pharmacology Treatment
4. ASPIRIN
 Low dose aspirin 80 to 325 mg/day
 To reduce risk of platelet aggregation and thrombus
formation
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33. Health education for patient and
family
1. Use only SL, buccal and spray forms of nitrates to treat
acute angina
 If the 1st nitrates dose not relieve within 5 minute take
2nd dose
 After 5 minutes 2nd dose if not relieve take 3rd dose
 If pain not relieve or lasts for 20 minutes seek Doctor
immediately.
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34. Health education for patient and
family
2. Carry nitroglycerin tablet with you, dissolve under the
tongue until completely dissolve
3. Keep tightly in original amber glass bottle to protect from
heat, light and moisture.
4. Get the continuous supply.
5. You may have burning or tingling sensation under the
tongue and develop headache when taken this drug. Headache
will diminish over time.
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35. Health education for patient and
family
6. Caution when standing from sitting position: nitroglycerine
may make you lightheaded
7. Rotate ointment or transdermal patch application sites.
Apply at hairless area: spread ointment without rubbing or
massaging. Remove patch or residual ointment at bedtime .
Apply fresh dose in the morning.
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36. Cont..Diagnostic
• Identify from the sign and symptoms
• Symptomatic treatment eg short of breath: administer an
oxygen, rest, positioning
• Perform ECG – 12 lead
• Blood laboratory eg C-reaction protien (CRP)maker for
inflammation
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37. THANK YOU
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