Angina Pectoris 4n3b6n

Angina Pectoris Prepared by : Ansam Sharef Ahmad Aswad

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Angina Pectoris Definition : Angina pectoris is a clinical syndrome usually characterized by episodes of pain or pressure in the anterior chest . The cause is usually insufficient coronary blood flow which results in a decreased oxygen supply to meet an increased myocardial demand for oxygen in response to physical exertion or emotional stress. 2

Pathophysiology Myocardial ischemia can result from: •

A reduction of coronary blood flow caused by fixed &\or dynamic epicardial artery stenosis.

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Abnormal constriction or deficient relaxation of coronary artery.

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Reduce O2-carrying capacity of the blood .

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Factors are associated with typical angina pain 1. Physical exertion (increase myocardial o2 demand). 2. Exposure to cold ( cause elevation of BP increase oxygen demand ) 3. Eating heavy meals 4. Stress or any emotion-provoking situation 5

Type of angina 1. Stable angina: predictable &

consistent pain that occurs on exertion and relieved by rest.

2. Unstable angina or preinfarction or

cresendo angina: symptoms occur more frequently and longer than stable angina.

3. Intractable or refractory angina: sever incapacitating chest pain. 6

Type of angina 4. Variant angina or prinzmetals angina : pain at rest with reversable STsegment elevation, caused by coronary artery vasospasm. 5. Silent ischemia: objective evidence of ischemia (as ECG changes with a test), but pt report no symptom. 7

Risk Factors for atherosclerosis 1. Family history of premature 2. 3. 4.

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coronary artery disease. DM, systemic HTN. Cigarette smoking. Hypercholesterolemia. Others as obesity, increase levels of lipoprotein,fibrinogen, s.triglycerides.

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Clinical manifestations 1. May produce pain vary in severity from feeling of indigestion to chocking in retrosternal area , radiate to neck , jaw shoulders , inner aspects of upper arms 2. Feeling of weakness or numbness in the arms , wrists and the hands 3.

Shortness of breath 9

Clinical manifestations 4. Pallor, Diaphoresis 5. Dizziness or lightheadedness 6. Nausea and vomiting

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Diagnostic findings Often made by evaluating the clinical manifestations of ischemia and the pts history 1. 12-Lead ECG and blood laboratory values help in making diagnosis

2. C-reactive protein ( CRP) is a marker for inflammation of vascular endothelium which caused by CAD 11

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Diagnostic findings 3. An elevated blood level of homocysteine ,an amino acid proposed as an independent risk factor for cardiovascular disease , but no studies ed the relationship between elevation of homocysteine and atherosclarosis 13

Medical management for the pt with angina pectoris

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• The objective is to decrease oxygen demand of myocardium and to increase oxygen supply • 1.Nitroglycerin : istered to reduce myocardial oxygen consumption 15

2.Beta-adrenergic blocking agents : ( propranolol ,metoprolol , atenolol) appear to reduce myocardial oxygen consumption, result in a reduction in heart rate, decreased BP , and reduced myocardial contractility .

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3-Calcium channel blocking agents : some decrease sinoatrial node automaticity and node conduction ,resulting in slower heart rate

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4- Antiplatelet and anticoagulent medications Aspirin: prevents platelet activation and reduces the incidence of MI and death with CAD

Heparin : prevents the formation of new blood clots 18

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Oxygen istration : usually initiated at the onset of chest pain to increase the amount of oxygen delivered to the myocardium and to decrease the pain.

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Prevention Self care action plan changing habits.

 Stop smoking  Increase level of exercise  Cut down on fatty foods  Eat more oats, which decrease cholesterol 20

 Lose wt if u DR. thinks you are overweight.  Make sure your BP is not high by regular check  Consider another method of contraceptive if you take pill 21

Nsg process for pt with Angina pectoris Assessment The nurse gather information about the pts symptoms and activities . The nurse may ask about the period that angina last , and if any medication relieve the angina.

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Diagnosis

1. Ineffective myocardial tissue perfusion secondary to CAD as evidence by chest pain or equivalent symptoms

2. Anxiety related to fear of death 23

Diagnosis 3. Noncompliance , ineffective management of therapeutic regimen related to failure to accept necessary lifestyle changes

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Planning and goals

The major goal include immediate treatment when angina occur , preventing of angina , reduction of anxiety and absence of complications

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NSG interventions 1. Treating angina : when pt experiences angina the nurse should direct pt to stop activities and sit or rest in bed in semi-fowler position 2. Reducing anxiety : The nurse should explore and implicate that the diagnosis has for the pt providing information about the illness , treatment and methods of preventing 26 its progression

3. Preventing pain : when the pt has pain with minimal activity , the nurse alternates the pts activities with rest periods

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Evaluation

expected pts outcomes may include 1. Reports that pain is relieved promptly

2. Reports decreased anxiety

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3. Understands ways to avoid complications and demonstrates freedom from complications 4. Adheres to self-care program

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