ANGINA PECTORIS

• is chest pain or discomfort that occurs

when an area of your heart muscle
doesn't get enough oxygen-rich blood.
• is a clinical syndrome usually
characterized by episodes or
paroxysms of pain or pressure in the
anterior chest.
• Angina itself isn't a disease. Rather, it's
a symptom of an underlying heart
problem. Angina is usually a symptom
of coronary artery disease (CAD), the
most common type of heart disease.
• The severity of angina is based on the
precipitating activity and its effect on
the activities of daily living
Risk factors

• Major risk factors for Coronary Artery Disease (CAD)

include the following:
* Male gender
* Advancing age
* Strong family history of heart disease
* Obesity and overweight
* Smoking
* High blood pressure
• Sedentary lifestyle
• High blood cholesterol
• Diabetes
• Stress
• Excessive Alcohol Intake
 Precipitating factors
• Eating
• Emotion
• Effort
• Extreme temperature
 Signs and Symptoms

• An uncomfortable pressure, fullness, squeezing, or pain in the

center of the chest

• It may also feel like tightness, burning, or a heavy weight.

• The pain may spread to the shoulders, neck, or arms.

• It may be located in the upper abdomen, back, or jaw.

• The pain may be of any intensity from mild to severe.

 Other symptoms may occur with an
angina attack:

• Shortness of breath
• Lightheadedness
• Fainting
• Anxiety or nervousness
• Sweating or cold, sweaty skin
• Nausea
• Rapid or irregular heart beat
• Pallor (pale skin)
 Types of Angina

• Knowing how the types are different is

important. This is because they have
different symptoms and require different
treatment.
Types of Angina

• Stable angina: predictable and

consistent pain that occurs on exertion
and is relieved by rest
– Occurs when the heart must work harder,
usually during physical exertion.
– Last 1 – 15 minutes.
• Unstable angina (also called
preinfarction angina or crescendo
angina):
– symptoms occur more frequently and last
longer than stable angina. The threshold for
pain is lower, and pain may occur at rest.
– Is more severe and lasts longer (as long as
30 minutes) than episodes of stable angina
– Comes as surprise.
• Variant angina (also called Prinzmetal’s
angina)
– Usually occurs at rest and during the night or
early morning hours
– Tends to be severe
– Is relieved by medicine
– thought to be caused by coronary artery
vasospasm
• Silent ischemia:
• objective evidence of ischemia (such
as electrocardiographic changes with a
stress test), but patient reports no
symptoms
Complication
• Untreated chronic stable angina may progress
to unstable angina, an acute coronary syndrome
that requires immediate medical attention to
prevent the development of:
– severe arrhythmias (i.e., irregular heart rhythm),
– heart attack, or
– sudden cardiac death—due to cardiac arrest with
loss of consciousness within 1 hour of the onset of
acute symptoms
• Possible complications of variant angina include
the following:
– Atrioventricular block (i.e., absence of electrical
conduction between the atrium and ventricle)
– Episodes of disabling pain
– Heart attack
– Severe arrhythmias
– Sudden cardiac death (sudden cardiac arrest [SCA])
Diagnostic Test

• Blood pressure measurement

• Blood test
• Exercise tolerance test (stress test or treadmill
test)
• Stress echocardiogram – may reveal problems
with the heart’s ability to pump blood.
• Coronary angiography - is done to find a blockage
in the coronary arteries, which can lead to heart
attack.
 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.
• Nitroglycerin. (Nitrostat, Nitrol,
Nitrobid IV)

– is administered to reduce myocardial

oxygen consumption, which decreases
ischemia and relieves pain.
• Beta-Adrenergic Blocking Agents.
– Propranolol (Inderal), metoprolol (Lopressor,
Toprol), and atenolol(Tenormin)
– helps to control chest pain and delays the
onset of ischemia during work or exercise.
– Slow the heart rate.
• Calcium Channel Blocking Agents.
– most commonly used are amlodipine
(Norvasc), verapamil (Calan, Isoptin,
Verelan), and diltiazem (Cardizem,
Dilacor, Tiazac)
– relax the blood vessels, causing a
decrease in blood pressure and an
increase in coronary artery perfusion.
• Antiplatelet and Anticoagulant
Medications
– administered to prevent platelet
aggregation, which impedes blood flow.
– e.g: Aspirin, Heparin
Medical Procedures

• Angioplasty
– opens blocked or narrowed coronary
arteries.
Coronary artery bypass grafting(CABG)

• healthy arteries or veins taken from

other areas in your body are used to
bypass (that is, go around) your
narrowed coronary arteries. Bypass
surgery can improve blood flow to your
heart, relieve chest pain, and possibly
prevent a heart attack.
Nursing management

• Major nursing diagnoses may include:

– Ineffective myocardial tissue perfusion secondary to CAD,
evidenced by chest pain or equivalent symptoms.
– Anxiety related to fear of death
– Deficient knowledge about the underlying disease and
methods for avoiding complications.
– Noncompliance, ineffective management of therapeutic
regimen related to failure to accept necessary lifestyle
changes.
Nursing intervention

• TREATING ANGINA
– When a patient experiences angina, the nurse should
direct the patient to stop all activities and sit or rest in
bed in a semi-Fowler position to reduce the oxygen
requirements of the ischemic myocardium.
– Nitroglycerin is administered sublingually, and the
patient’s response is assessed (relief of chest pain and
effect on blood pressure and heart rate).
• REDUCING ANXIETY
– Various stress reduction methods should be explored
with the patient
– For example, music therapy, has been shown to
reduce anxiety in patients who are in a coronary care
unit
– Addressing the spiritual needs of the patient and
family may also assist in allaying anxieties and fears.
• PREVENTING PAIN
– Balance of activity and rest is an important
aspect of the educational plan for the
patient and family.
Outcome

• Reports that pain is relieved promptly

• Reports decreased anxiety
• Understands ways to avoid complications and
demonstrates freedom from complications
• Adheres to self-care program
– a. Takes medications as prescribed
– b. Keeps health care appointments
– c. Implements plan for reducing risk factors