This document summarizes a seminar presentation on angina pectoris. It defines angina pectoris as chest pain caused by reduced oxygen to the heart muscle. It discusses the different types of angina including stable, unstable, variant, and refractory angina. Risk factors, symptoms, diagnostic evaluations, complications, treatment options including medications, angioplasty and bypass surgery, and nursing management are outlined. The last section summarizes a research article on developing evidence-based nursing guidelines for patients with angina pectoris.

1. VIVEKANANDA COLLEGE OF NURSING
SEMINAR ON;
PRESENTED BY- APURVA DWIVEDI [M.Sc. Nsg. 2st Yr.]

2. ANGINA PECTORIS

3. DEFINITION
A disease marked by brief sudden attacks of
chest pain or discomfort caused by deficient
oxygenation of the heart muscles usually due
to impaired blood flow to the heart.
Acc. 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.”

4. INCIDENCE
An estimated 10 million people in the US
suffer from angina. According to the
Framingham heart study, an estimated
500,000 new cases of stable angina occur
each year.

5. TYPES
Stable
Angina
Unstable
Angina
Variant
Angina
Pectoris
Refractory
Angina

6. STABLE ANGINA
• Is the most common form of angina. It usually
happens during activity (exertion) and goes
away with rest or angina medication. For
example, pain that comes on when you're
walking uphill or in the cold weather may be
angina.
• Stable angina pain is predictable and usually
similar to previous episodes of chest pain. The
chest pain typically lasts a short time, perhaps
five minutes or less.

7. UNSTABLE ANGINA (A MEDICAL
EMERGENCY)
• Unstable angina is unpredictable and occurs at rest, Or the
angina pain is worsening and occurs with less physical effort.
• It's typically severe and lasts longer than stable angina, maybe
20 minutes or longer.
• The pain doesn't go away with rest or the usual angina
medications.
• If the blood flow doesn't improve, the heart is starved of
oxygen and a heart attack occurs.
• Unstable angina is dangerous and requires emergency
treatment.

8. VARIANT ANGINA (PRINZMETAL ANGINA)
• Variant angina caused by a spasm in the heart's arteries
that temporarily reduces blood flow.
• Severe chest pain is the main symptom of variant angina.
• It most often occurs in cycles, typically at rest and
overnight.
• The pain may be relieved by angina medication.

9. REFRACTORY ANGINA
Angina episodes are frequent despite a combination of medications and
lifestyle changes.

10. RISK FACTORS

11. Modifiable Risk
Tobacco
Use
High Blood
Cholesterol
Or
Triglyceride
Levels
Lack Of
Exercise
Obesity Stress

12. Non-modifiable Risk
Family
History Of
Heart
Disease
Older Age Diabetes
High Blood
Pressure

13. PATHOPHYSIOLOGY
Atherosclerotic disease
Significant obstruction of major coronary artery
Insufficient blood flow
Decreased oxygen supply
Anginal pain

14. SYMPTOMS
CARDIOVASCULAR
• Angina pectoris: it is sensation of chest pain, pressure or squeezing often
due to insufficient blood flow to the heart muscle as a result of obstruction.
• Ischemia: ischemia is a restriction in blood supply to tissues, causing a
shortage of oxygen
• Low cardiac output
• Chest pain: chest pain occurs suddenly, severe immobilizing chest pain that
not relieved by rest, position change and medications.

15. CONTI.
• Decrease pulse rate
• BP may be elevated because of sympathetic stimulation or decreased
bp because of decreased contractility, development if cardiogenic shock
• Myocardial infarction: when the blood flow decreases or stop to apart
of the heart , causing damage to the heart muscle.
• Diaphoresis: excessive sweating
• ECG changes: ST segment and T wave changes, also show
tachycardia, bradycardia, or dysrhythmias.
• Dysarthria

16. RESPIRATORY
• Shortness Of Breath
• Pulmonary Edema
• Chest Heaviness
• Dyspnea
• Fatigue

17. GENITOURINARY
Decreased Urinary Output May Indicate Cardiogenic Shock.

18. GASTROINTESTINAL
Nausea And Vomiting

19. SKIN
• Cool
• Clammy
• Diaphoretic And Pale

20. DIAGNOSTIC EVALUATION

21. Physical Examination

22. History Collection

23. Stress Test

24. Chest X-ray

25. Electrocardiogram (ECG)

26. ECHOCARDIOGRAM

27. Cardiac Catheterization (Angiogram)

28. COMPLICATIONS
Abnormal
Heart Rhythm
(Arrhythmia)
Heart
Failure
Heart
Attack

29. PREVENTION
• Quitting Smoking
• Monitoring And Controlling Other Health
Conditions, Such As High Blood
Pressure, High Cholesterol And
Diabetes
• Eating A Healthy Diet And Maintaining A
Healthy Weight
• Reducing Your Stress Level
• Increasing Physical Activity. Aim For 150
Minutes Of Moderate Activity Each Week.
Plus, It's Recommended That Person Get
10 Minutes Of Strength Training Twice A
Week And To Stretch Three Times A Week
For 5 To 10 Minutes Each Time
• Limit Alcohol Consumption To Two Drinks
Or Fewer A Day For Men, And One Drink
A Day Or Less For Women

30. MEDICAL MANAGEMENT
Vasodilators (These Drugs Acts As Blood Vessel Dilator)
Ex; Nitrates
Beta-blockers (Decrease Work Load In Heart)
Ex; Propranolol 20-40 Mg
Calcium Channel Blocker (They Improve Coronary Blood Flow)
Ex; Nifedipine, Verapamil
Anticoagulant Drugs
Ex; Heparin

31. CONTI.
Opiate Analgesic (For Reduce Pain)
Ex; Morphine Sulphate
Thrombolytic Drugs
Ex; Streptokinase, Urokinase
Antihypertensive Medicines
Ex; Methydopa, Amlodipine, Sodium Nitroprusside

32. SURGICAL
MANAGEMENT

33. Angioplasty

34. Coronary Artery Bypass Surgery

36. NURSING MANAGEMENT
• Instruct The Client Regarding The Purpose Of Diagnostic Medical & Surgical
Procedures And The Pre- & Post Procedure Expectations.
• Assist The Client To Identify Risk Factors That Can Be Modified, And Set Goals
That Will Promote Change In Lifestyle To Reduce The Impact Of Risk Factors.
• Instruct Client Regarding A Low-calorie, Low-sodium, Low-cholesterol, Low-fat Diet
With A Increase In Dietary Fiber. Stress That Dietary Changes Are Not Temporary
And Must Be Maintained For Life.
• Provide Community Resources To Client Regarding Exercise, Smoking Cessation
And Stress Reduction.

37. NURSING DIAGNOSIS
• Impaired gas exchange related to decreased blood flow as evidenced by breathlessness.
• Acute pain related to disease condition as evidenced by patient verbalization
• Impaired physical mobility related to weakness as evidenced by patient is unable to perform
daily activity.
• Imbalanced nutrition less than body requirement related to less intake of food as evidenced by
weight loss
• Disturbed sleep pattern related to hospitalization as evidenced by patient verbalization
• Anxiety related to hospitalization as evidenced by patient asking too many question
• Knowledge deficit related to disease process and treatment as evidenced by patient is having
many doubts

38. RESEARCH ARTICLES
Design Of Guidelines Evidence-based Nursing Care In Patients
With Angina Pectoris
Maryam Nezamzadeh1 , Seyed Mohammad Khademolhosseini1* ,
Jamileh Mokhtari Nouri1 , Abbas Ebadi1
Faculty Of Nursing, Baqiyatallah University Of Medical Sciences,
Tehran, Iran

39. ABSTRACT
AIMS: Evidence-based clinical guidelines effectively guide medical teams and nurses to increase the quality of clinical
work. Designing evidence-based guidelines in critical care units, especially in cardiac care unit is much more needed.
Therefore, this study was conducted to design evidence-based nursing care guidelines for patients with angina
pectoris.
METHODS: This descriptive-comparative study was conducted in two cardiac care units in baqiyatallah hospital in
tehran in 2011. First, the quality of 30 available care guidelines was investigated via a checklist designed by the
researcher in three levels: good, average and poor. Then nursing care guidelines were designed based on stetler
model with an evidence-based approach and their quality was re-investigated. Finally, the collected data was analyzed
by the help of descriptive statistics and using SPSS 17 software.
RESULTS: Quality of 26.7 % of the available guidelines was found out to be poor and 73.3 % was proven to be
average. After designing the guidelines, this number increased to 100 %. finally, an eight evidence-based nursing care
guideline was designed for patients with angina pectoris.
CONCLUSION: Since the available guidelines are of low quality, designing evidence-based care guidelines can
improve nursing care.

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41. THANK YOU..