ANGINA PECTORIS

BY: YASIERAH K. AGALIN

 OVERVIEW
Angina pectoris Angina pectoris is a
clinical syndrome usually characterized by
episodes of pain or pressure in the
anterior chest caused by insufficient
coronary blood flow.

RISK FACTORS:
History of heart Tobacco use.
disease.
Diabetes.
Men older than 40
High blood
and women older
pressure.
than 55
Lack of exercise.
Afro-Americans

Obesity.
High blood
cholesterol or
Stress. triglyceride levels.
 PATHOPHYSIOLOGY
Angina is usually caused by atherosclerotic Narrowing of the coronary artery
disease causing a significant obstruction of a
major coronary artery.
Factors that can precipitate angina: Insufficient blood flow

Physical exertion
Exposure to cold
Lack of oxygen to myocardial cells
Eating a heavy meal (increases the blood
flow to the mesenteric area for digestion,
thereby reducing the blood supply
Anaerobic metabolism with lactic acid stimulation
available to the heart muscle)
Stress or any emotion-provoking
situation
Irritation of myocardial nerve fibers
 TYPES OF ANGINA
TYPES OF ANGINA

1. Stable angina: predictable and consistent pain 4. Variant angina (also called Prinzmetals
that occurs on exertion and is relieved by rest angina): pain at rest with reversible ST-

2. Unstable angina (also called pre-infarction segment elevation; thought to be caused by

angina or crescendo angina): symptoms occur coronary artery vasospasm

more frequently and last longer than stable 5. Silent ischemia: objective evidence of
angina. The threshold for pain is lower, and ischemia (such as electrocardiographic
pain may occur at rest. changes with a stress test), but patient

3. Intractable or refractory angina: severe reports no symptoms

incapacitating chest pain

 Signs and symptoms
Chest pain
o Type: squeezing, pressing, burning.
The Canadian Cardiovascular Society grading
of angina pectoris (sometimes referred to as
o Location: retrosternal, substernal, the CCS Angina Grading Scale or the CCS
left of sternum, radiates to left arm Functional Classification of Angina) is a
o Duration: short, usually 3 to 5 minutes, classification system used to grade the severity
less than 15 minutes. of exertional angina.

o Relief: rest, nitroglycerin

Nausea
Fatigue
Shortness of breath
Sweating
Dizziness
Tachycardia
 Diagnostic tests
Blood chemistry shows increased
cholesterol levels.
Cardiac enzymes are within normal limits.
Coronary arteriography shows plaque
accumulation.
ECG shows ST-segment depression and
T-wave inversion during anginal pain.
Holter monitoring reveals ST-segment
depression and T-wave inversion.
Stress test results include abnormal ECG
findings and chest pain
 Medical management
Semi-Fowlers position
Oxygen therapy (typically 2 to 4 L)
Diet: low fat, low sodium, and low
cholesterol (low calorie if necessary)
SUGRICAL MANAGEMENT
Coronary artery bypass grafting
Percutaneous transluminal coronary
angioplasty (PTCA)
stent placement
DRUG THERAPY
Anticoagulants: heparin, aspirin
Beta-adrenergic blockers: propranolol
(Inderal), nadolol (Corgard), atenolol (Tenormin),
metoprolol (Lopressor)
Calcium channel blockers: verapamil (Calan), diltiazem
(Cardizem), nifedipine (Procardia), nicardipine (Cardene)
Low-dose aspirin therapy
Nitrates: nitroglycerin, isosorbide dinitrate (Isordil), topical
nitroglycerin, transdermal nitroglycerin (Transderm-Nitro)
 Medical management
Percutaneous transluminal coronary angioplasty (PTCA)

Coronary artery bypass grafting

 Nursing management
1. Identify precipitating factors for angina
1. Acute Pain related to 2. assess cardiovascular status, hemodynamic variables, and vital signs to
myocardial ischemia
detect evidence of cardiac compromise and response to treatment.

2. Activity intolerance 3. Administer oxygen to increase oxygenation supply.

related to onset of pain
4. Assess for chest pain and evaluate its characteristics. Assessment allows
3. Fear and anxiety related for care plan modification as necessary.

to possible death 5. Administer medications, as prescribed, to increase oxygenation and to

reduce cardiac workload. Hold nitrates and notify physician for systolic
blood pressure less than 90 mm Hg.

6. Hold beta-adrenergic blocker and notify the physician for heart rate less
than 60 beats/ minute to prevent complications that can occur
as a result of therapy.
 Cont. Nursing management
7. Advise the client to rest if pain begins to reduce 12. Encourage the client to express anxiety,
cardiac workload. fears, or concerns because anxiety can

8. Obtain 12-lead ECG during an acute attack to assess increase oxygen demands.

for ischemic changes. 13. Maintain the clients prescribed diet (low-

9. Keep the client in semi-Fowlers position to promote fat, low-sodium, and low-cholesterol; low-

chest expansion and ventilation. calorie, if necessary) to reduce risk of CAD.

10. Monitor and record intake and output to monitor 14. Teach about Taking sublingual nitroglycerin

fluid status. for acute attacks and prophylactically to

prevent anginal episodes

11. Encourage weight reduction, if necessary, to reduce

risk of CAD.
.
THANK YOU FOR LISTENING!!