I am attaching ppt on angina pectoris

1. ANGINA PECTORIS
 Definition :
Angina pectoris
is a clinical
syndrome
usually
characterize by
episodes or
paroxysm of
pain or pressure
in anterior

2. TYPES
1. Stable angina: Predictable and
consistent pain that occurs on exertion
and it usually last for 5-10 minutes and
relieved by rest or nitrate.
2. Unstable angina: Also called crescendo
angina- symptoms occurs more frequently
and last longer than stable angina. The
threshold for pain is lower, and pain
occurs at rest.

3. 3. Intractable or refractory angina:
Sever incapacitating chest pain.
4. Variant angina: Also called
prinzmetal’s angina- pain at rest with
reversible ST- segment elevation.
5. Silence ischemia: Objective evidence
is ischemic but patient reports no
symptoms.

4. CAUSES:
1. Acute blockage of a coronary
artery or coronary artery spasm
2. Physical exertion, which can
precipitate an attack by increasing
myocardial oxygen demand.
3. Exposure to cold which can cause
vasoconstriction and elevated
blood pressure.

5. 4. Eating a heavy meal
5. Stress or any emotion provoking
situation.

6. Pathophysiology:
Coronary artery occlusion
Myocardial cells become ischemic
Pumping flow of heart is reduced

7. Deprives the ischemic cells of
needed O2 and glucose
Cells covert to anaerobic metabolism
Leaves lactic acid as a waste
products

8. Lactic acid accumulates
Pain occurs

9. Clinical manifestation
1. Chest pain: pain varying in severity
from a feeling of indigestion to a
choking of heaviness sensation.
2. Diaphoresis
3. Decrease pulse rate

10. 4. Tachycardia
5. Shortness of breaths
6. Chest heaviness
7. Fatigue.

11. 8. Decrease urinary output
9. Nausea and vomiting
10. Cool and pale appearance on
skin.
11. Tightness of a heavy chocking
feeling.
12. Feeling of numbness in the arm,
wrist and hands.

12. Diagnostic test
1. History and physical examination
2. ECG: suggests transient ischemic attacks
with ST segment elevation or depression
and coronary artery involvement.

13. 3. Exercise ECG: During a stress test,
client exercise on treadmill or
stationary bicycle until reaching
85% of maximal heart rate.
4. Radioisotope imaging: regions of
poor perfusion or ischemia
appears areas of diminished or
absent or absent activity.

14. 5. Coronary angiography: To
visualize the patency of
coronary artery and to
determine the extent of
blockage.

15. MANAGEMENT
 The main goal of treatment is to balance
myocardial oxygen demand.
 Medical management
 Opiate analgesic:
 Vasidilators:
 Β- adrenergic blockers: help to reduce the
workload of heart

16.  Calcium channel blockers: Used t o
dilate coronary arteries there by
increasing oxygen supply to
myocardium.
Eg: Nifedipine, Verepamin

17.  Antiplatelet agents: inhibits platelet
aggrigation and reduce coagulation
thus preventing clot formation
Eg: aspirin and ticlopidine
 Heparin: prevents formation of new
blood cloths

18.  Oxygen administration: it is usually
initiated at the onset of chest pain in an
attempt to increase the amount of
oxygen delivered to the myocardium
and to decrease pain.