Cardiac

1. CONTENT
What is angina
Causes of angina pectoris
Pathophysiology
Classification of angina pectoris
Clinical Manifestations
Risk factors for angina
Medical Management and treatment
Nursing intervention & responsibility

2. Angina pectoris
Definition :- Is clinical syndrome
characterized by pain in anterior
chest(usually characterized by episodes
or paroxysms of pain or pressure in the
anterior chest) produced as a result of
insufficient coronary blood flow &
myocardial hypoxia

3. Several factors are associated with typical anginal pain:
1. • Physical exertion, which can precipitate an attack by
increasing myocardial oxygen demand
2. • Exposure to cold, which can cause vasoconstriction
and an elevated blood pressure, with increased oxygen
demand
3. • Eating a heavy meal, which increases the blood flow to
the mesenteric area for digestion
4. • Stress or any emotion-provoking situation, causing the
release of adrenaline and increasing blood pressure,
which may accelerate the heart rate and increase the
myocardial workload

4. Pathophysiology
Narrowing in the coronary
artery , which results from
plaque accumulation in the
intima lining
obstruction of blood flow ,
which diminish myocardial
oxygen supply .

6. Classification
1. Stable angina.
Also known as 'effort angina', this refers to the classic
type of angina related to myocardial ischemia. A typical
presentation of stable angina is that of chest
discomfort and associated symptoms precipitated by
some activity (running, walking, etc.) with minimal or
non-existent symptoms at rest or after administration
of sublingual nitroglycerin.[

7. Classification
2. Unstable angina .
Unstable angina (UA) (also "crescendo angina"; this is a
form of acute coronary syndrome) is defined as angina
pectoris that changes or worsens .

8. Unstable angina is different. The pain or
discomfort
1. • often happens when you are sleeping or resting
2. • takes you by surprise
3. • might last as long as 30 minutes and might become
progressively worse
4. • cannot be relieved with rest or medication
5. • might be a sign of a heart attack that will happen
soon

9. Clinical Manifestations

12. Assessment and Diagnostic
Findings
1. The diagnosis of angina is often made by evaluating the clinical
manifestations of ischemia and the patient’s history
2. A 12-lead ECG
3. blood laboratory
4. patient may undergo an exercise or pharmacologic stress test in which
the heart is monitored by ECG
5. Echocardiogram
6. cardiac catheterization and coronary artery angiography)
7. CAD is believed to result from inflammation of the arterial
endothelium. C-reactive protein (CRP) is a marker for inflammation of
vascular endothelium.

13. Medical Management
The objectives of the medical management of angina are to decrease the
oxygen demand of the myocardium and to increase the oxygen supply.
intracoronary stents, and atherectomy
CABG
Atherectomy
Percutaneous transluminal coronary angioplasty (PTCA)

14. PHARMACOLOGIC THERAPY
1. Nitroglycerin ( Angised)
2. beta-adrenergic blocking agents(Beta-blockers such as
propranolol(Inderal), metoprolol.
3. calcium channel blockers such as amlodipine , verapamil, and
diltiazem.
4. Antiplatelet agents (Aspirin.) Clopidogrel (Plavix) Heparin.
5. Oxygen Administration.

15. Nursing intervention & responsibility
1. Diet
2. I.V therapy
3. oxygen therapy
4. monitor & record VS , I/O
5. advice patient to rest if pain is begin
6. obtain an ECG reading during & acute attack
7. keep the patient in semi- fowler’s position

16. REFERENCES
Juan Carlos Kaski, Guy D. Eslick, C. Noel Bairey Merz · 2013
·
 Institute of Medicine, Board on the Health of Select
Populations, Committee on Social Security Cardiovascular
Disability Criteria · 2010
Majid Maleki, Azin Alizadehasl, Majid Haghjoo · 2017 ·
Alice P. Gallo, Margaret L. Jones · 2008
James T. Willerson, David R. Holmes, Jr. · 2015

17. THANKS