Angina Pectoris

Syndrome characterized by episodes of pain or pressure in anterior chest Caused by insufficient coronary blood flow, resulting in decreased oxygen supply when there is increased myocardial demand for oxygen Severity depends on the magnitude of precipitating activity and its effect on activities of daily living

Types of Angina Pectoris Stable predictable and consistent pain that occurs on exertion relieved by rest and!or nitroglycerin "nstable preinfarction or cresendo angina may not be relieved with rest or nitroglycerin #ntractable or $efractory severe incapacitatin chest pain

%ariant prinzmetal&s angina pain at rest and thought to be caused by coronary artery vasospasm Silent #schemia no pain but there is ob'ective evidence of ischemia

(actors asso) with typical anginal pain* Physical exertion increased myocardial oxygen demand +xposure to cold causes vasoconstriction, increased ,P which increases also oxygen demand +ating heavy meal increased blood flow to mesenteric area for digestion which reduces the blood supply availble to the heart muscle Stress releases catecholamine which increases blood pressure, heart rate and myocardial wor-load

Clinical .anifestations Pain /eavy cho-ing 0ea-ness or numbness in the arms, wrists, and hands S1, Pallor 2iaphoresis 2izziness, 3ight headedness 4!%

5erontologic Considerations (re6uently chec- patient 7dyspnea8 +ncourage them to recognize their chest pain9li-e symptom 7wea-ness8 Proving palliative and spiritual care

.anagement 4itrates 7 nitroglycerin 8 9 vasodilation ,eta9Adrenergic ,loc-ing Agents 7 metoprolol, atenolol 8 9 bloc-s the beta9 adrenergic stimulation of the heart Calcium #on Antagonists 7 amlodipine, felodipine 8 9 treatment for vasospasm Antiplatelet .edications 7 clopidogrel, aspirin 8 9 prevention for platelet aggregation Anticoagulants 7 heparin, dalteparin 8 9 prevention of thrombus formation direct patient to stop all activities and sit or rest in bed in semi9fowlers position to reduce the oxygen re6uirements if pain occurs Continue monitoring vital signs and observing for signs of respiratory distress Administer oxygen therapy as ordered when respiratory rate is increased or if oxygen saturation level is decreased $educing anxiety of patient by using various stress reduction methods such as using guided imagery or music therapy