Transcript Medical management for the pt with angina pectoris

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.
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Pathophysiology
Myocardial ischemia can result from:
•
A reduction of coronary blood flow
caused by fixed &\or dynamic
epicardial artery stenosis.
•
Abnormal constriction or deficient
relaxation of coronary artery.
•
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
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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.
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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.
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Risk Factors for
atherosclerosis
1. Family history of premature
2.
3.
4.
5.
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
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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
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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 supported the relationship
between elevation of
homocysteine and atherosclarosis
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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 : administered to
reduce myocardial oxygen
consumption
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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
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•
Oxygen administration :
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
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 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
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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
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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
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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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