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 Transient, paroxysmal chest pain produced

by insufficient blood flow to the myocardium

resulting in myocardial ischemia.
 Angina pectoris is a chest pain due to
transient myocardial ischemia without
development of myocardial necrosis.
 Chest pain due to imbalance between
myocardial oxygen supply and demand.
 Angia pectoris is associated with
atherosclerotic lesions and is a manifestation
of CHD.
 Angina can be caused either by chronic or
acute blockage of a coronary artery or by
coronary artery spasm.
 Chronic blockages are associated with fixed
calcified or fibrotic atherosclerotic lesions
that occlude more than 75% of the vessel
 When fixed blockages are present in the
coronary arteries, conditions that increase
myocardial oxygen demand (eg: physical
exertion, emotion, exposure to cold) may
precipitate episodes of angina.
1. Modifiable risk factors
a) Major
 Hyperlipidemia
 Hypertension
 Smoking
 Physical inactivity
b) Minor
 Obesity
 Stressful lifestyle and type A personality
2. Non modifiable
 Hereditary
 Age
 Gender
 Race
3. Contributing risk factors
 Obesity
 DM
 Stress/ type A personality
 Emotional pattern
Etiological/risk factors

Formation of thrombus

Presence of atherosclerosis
1. Eating heavy meals
(Increases flow in the mesentric region)
2. Exposure to cold, emotional stress, smoking
3. Physical exertion
( increases myocardial oxygen demand)
Reduced coronary tissue perfusion

Decrease myocardial oxygenation

Myocardial ischemia
 Stable angina
 Unstable angina
 Intractable or refractory angina
 Variant angina
 Nocturnal angina
 Angina decubitus
 Post infarction angina
 Silent ischemia
 Angina pectoris produces transient
paroxysmal attacks of substernal or
precordial pain with the following
1. Onset
 Angina develops quickly and slowly.
2. Location
 Nearly 90% of clients experience the pain as
retrosternal or slighlty to the left of the sternum.
3. Radiation
 The pain usually radiates to the left shoulder and
upper arm and may then travel down the inner
aspect of the left arm to the elbow, wrist and
fourth and fifth fingers.
 The pain may also radiate to the right shoulder,
neck, jaw or epigastric region.
4. Duration
 Angina usually lasts less than 5 min.
 Attacks precipitated by a heavy meal or
extreme anger may last 15 to 20 minutes.
5. Sensation
 Clients describe the pain of angina as
squeezing, burning, pressing, choking,
aching or bursting pressure.
6. Associated characteristics
 Includes dyspnea, pallor, sweating, faintness,
palpitations, dizziness and digestive
7. Atypical presentation
 It may be manifested as epigastric pain,
backpain, dyspnea, fatigue and syncope.
8. Relieving and aggravating factors
 It is aggravated by continued activity.
 Subside with administration of nitroglycerin
and rest.
 History collection
 Physical examination
 Radioisotope imaging
 Electron Beam Computed Tomography
 Coronary Angiography
 Chest X-ray
 Opiate analgesics
 Vasodilators: nitroglycerin
 Beta-Adrenergic blockers: Metoprolol,
 Calcium channel blockers: Amlodipine,
 Antiplatelet and anticoagulant medications
 Oxygen administration
 If the arteries are critically blocked:
angiography, coronary artery angioplasty or
even coronary artery bypass surgery.
 M-Morphine sulphate
 O-oxygen
 N-Nitrates
 A-Aspirin
 Ineffective tissue perfusion related to
thrombus in coronary artery, resulting in
altered blood flow to myocardial tissue.
 Acute pain related to myocardial ischemia
resulting from coronary artery occlusion.
 Anxiety related to cardiac symptoms.
 Risk for activity intolerance related to an
imbalance between oxygen supply and