angina

1. Angina pectoris

2. DEFINITION
 Angina pectoris is chest pain or
discomfort that occurs when the heart
muscle doesn’t get enough blood.
 Angina pectoris is chest pain resulting
from myocardial ischemia (inadequate
blood supply to the myocardium).

3. TYPES OF ANGINA
1. Stable angina
2. Unstable angina
3. Variant angina
4. Nocturnal angina
5. Angina decubitus
6. Intractable angina
7. Post infarction angina

7. ETIOLOGY
Supply-demand mismatch
 Factors that decrease supply
 Coronary vessel
disorders
Atherosclerosis
Arterial spasm
Coronary arteritis

8.  Circulatory disorders
Hypotension
Aortic stenosis
Aortic insufficiency
 Blood disorders
Anemia
Hypoxemia
Polycythemia

9.  Factors that increase demand
 Increased cardiac output
Exercise
Emotion
Digestion of a large meal
 Increased myocardial need for oxygen
Damaged myocardium
Myocardial hypertrophy

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

11. Characteristics of angina
includes
 Onset :- Develop quickly or slowly.
:- Slightly to the left of
 Location
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.

12.  Duration :- Less than 5 minutes.
 Sensation :- Like squeezing, burning,
pressing , chocking, aching , pain feels
like gas, heartburn.
 Severity :- Usually mild or moderate
in severity.
 Treatment :- The client treated the
pain with nitroglycerin. Angina should
subside after nitroglycerin use.

13. DIAGNOSTIC MEASURES
 History
 Physical
examination
 ECG
 Laboratory studies
Serial cardiac
biomarkers
Hemoglobin
Serum chemistry
Lipid profile
 Chest Radiography
 Angiography
 Radioisotope
Imaging
 Exercise Testing

14. MANAGEMENT
 A for aspirin and anti anginal therapy
 B for beta-blocker therapy and blood
pressure control
 C for cigarettes and
cholesterol
 D for diet and diabetes
 E for education & exercise

15. PHARMACOLOGICAL
MANAGEMENT
 Opoid analgesics
 Antiplatelet agents
 Beta-adrenergic blocking agents
 Vasodilators
 Calcium channel blockers

16.  Cardiac catheterization
 Revascularization
 Nutritional management
 Rehabilitation

17. REHABILITATION PROCESS
 Smoking cessation
 Lipid lowering
 Control of hypertension

18.  Diabetes mellitus
management
Weight management
and nutritional
counseling

19.  Psychosocial management
 Activity management

20. NURSING MANAGEMENT

21. Nursing Diagnosis
 Anxiety related to diagnosis of cardiac
disorder as evidenced by restlessness,
tachycardia, and frequently asking
questions regarding prognosis.
 Acute chest pain related to decreased
blood supply to myocardium as evidenced
by distraction behaviors such as
restlessness, discomfort and fatigue.

22.  Ineffective tissue perfusion related to
decreased oxygenation of myocardium as
evidenced by chest pain, shortness of
breath and tachycardia.
 Decreased cardiac output related to
negative ionotropic changes in the heart
secondary to decreased oxygenation of
myocardium as evidenced by chest pain,
tachycardia and fatigue.

23.  Impaired gas exchange related to
decrease cardiac output as evidenced by
dyspnea, pallor and fatigue.
 Risk for bleeding related to
coagulopathies associated with
thrombolytic therapy or arterial
puncture after angiography.