Transcript Angina Pectoris File

ANGINA PECTORIS
Prepared by
Miss Fatima Hirzallah
DEFINITION
Angina pectoris is a clinical syndrome usually
characterized by episodes or paroxysms of pain
or pressure in the anterior chest.
 The cause is insufficient coronary blood flow,
resulting in a decreased oxygen supply when
there is increased myocardial demand for
oxygen in response to physical exertion or
emotional stress

PATHOPHYSIOLOGY
Angina is usually caused by atherosclerotic
disease. Almost invariably, angina is associated
with a significant obstruction of a major coronary
artery.
 Normally, the myocardium extracts a large amount
of oxygen from the coronary circulation to meet its
continuous demands. When there is an increase in
demand, flow through the coronary arteries needs
to be increased. When there is blockage in a
coronary artery, flow cannot be increased, and
ischemia results.

RISK FACTORS ARE ASSOCIATED WITH TYPICAL
ANGINAL PAIN:
Physical exertion, which can precipitate an
attack by increasing myocardial oxygen
demand
 Exposure to cold, which can cause
vasoconstriction and elevated blood pressure,
with increased oxygen demand

Eating a heavy meal, which increases the blood
flow to the mesenteric area for digestion, thereby
reducing the blood supply available to the heart
muscle. In a severely compromised heart, shunting
of blood for digestion can be sufficient to induce
anginal pain.
 Stress or any emotion-provoking situation, causing
the release of catecholamines, which increases
blood pressure, heart rate, and myocardial
workload

RISK FACTORS

1.
2.
3.
4.
Nonmodifiable Risk Factors for CAD
Family history of coronary heart disease
Increasing age
Gender (heart disease occurs three times more often in
men than in women)
Race (higher incidence of heart disease in African
Americans than in Caucasians)
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RISK FACTORS

1.
2.
3.
4.
5.
6.
Modifiable Risk Factors for CAD
High blood cholesterol level
Cigarette smoking, tobacco use
Hypertension
Diabetes mellitus
Lack of estrogen in women
Obesity
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TYPES OF ANGINA

Stable angina: predictable and consistent pain that
occurs on exertion and is relieved by rest
 Unstable angina (also called preinfarction angina
symptoms occur more frequently and last longer than
stable angina. The threshold for pain is lower, and
pain may occur at rest.
 Intractable or refractory angina: severe
incapacitating chest pain
 Silent ischemia: objective evidence of ischemia
(such as ECG changes with a stress test), but patient
reports no symptoms
CLINICAL MANIFESTATIONS
The pain is often felt deep in the chest behind
the sternum (retrosternal area).
 Typically, the pain or discomfort is poorly
localized and may radiate to the neck, jaw,
shoulders, and inner aspects of the upper
arms, usually the left arm. The patient often
feels tightness or a heavy choking .

CLINICAL MANIFESTATIONS
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A feeling of weakness or numbness in the
arms, wrists, and hands, as well as shortness
of breath, pallor, diaphoresis
 dizziness or lightheadedness
 nausea and vomiting, may accompany the pain.
Anxiety may occur with angina.
 An important characteristic of angina is that it
subsides with rest or nitroglycerin.

ASSESSMENT AND DIAGNOSTIC FINDINGS
history related to the clinical manifestations of
ischemia.
 A 12-lead electrocardiogram (ECG)
 blood laboratory values

IMPORTANT CARDIAC LABS


Enzymes – CK, CK-MB, LDH
Other important cardiac biomarkers that are
assessed include the myoglobin and troponin T or I.
Myoglobin

The patient may undergo an exercise or
pharmacologic stress test in which the heart is
monitored by ECG, echocardiogram, or both.
The patient may also be referred for invasive
procedure (eg, cardiac catheterization,
coronary artery angiography).
MEDICAL MANAGEMENT
pharmacologic therapy and control of risk
factors.
 Alternatively, reperfusion procedures may be
used to restore the blood supply to the
myocardium.
 These include: PCI procedures (eg,
percutaneous transluminal coronary
angioplasty [PTCA], intracoronary stents, and
atherectomy) and CABG.

PHARMACOLOGIC THERAPY
Aspirin
 Nitroglycerin
 Oxygen Administration
 Morphine
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PHARMACOLOGIC THERAPY
Nitroglycerin
 Nitrates remain the mainstay for treatment of
angina pectoris. A vasoactive agent,
nitroglycerin is administered to reduce
myocardial oxygen consumption, which
decreases ischemia and relieves pain.
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PHARMACOLOGIC THERAPY

Nitroglycerin dilates primarily the veins and, in
higher doses, also the arteries. Dilation of the
veins causes venous pooling of blood
throughout the body. As a result, less blood
returns to the heart, and filling pressure
(preload) is reduced.
PHARMACOLOGIC THERAPY
Oxygen Administration
 Oxygen therapy is usually initiated at the onset
of chest pain in an attempt to increase the
amount of oxygen delivered to the myocardium
and to decrease pain.
 The therapeutic effectiveness of oxygen is
determined by observing the rate and rhythm of
respirations.

PHARMACOLOGIC THERAPY
Antiplatelet and Anticoagulant Medications
 Antiplatelet medications are administered to
prevent platelet aggregation and subsequent
thrombosis, which impedes blood flow

PHARMACOLOGIC THERAPY
Aspirin
 Aspirin prevents platelet activation and reduces
the incidence of MI and death in patients with
CAD. A 160- to 325-mg dose of aspirin should
be given to the patient with angina as soon as
the diagnosis is made (eg, in the emergency
department or physician's office) and then
continued with 81 to 325 mg daily.
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PHARMACOLOGIC THERAPY
Clopidogrel and Ticlopidine
 Clopidogrel (Plavix) or ticlopidine (Ticlid) is
given to patients who are allergic to aspirin or
given in addition to aspirin in patients at high
risk for MI.

PHARMACOLOGIC THERAPY
Heparin
 IV unfractionated heparin prevents the
formation of new blood clots. Treating patients
with unstable angina with heparin reduces the
occurrence of MI.
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PHARMACOLOGIC THERAPY
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Beta-Adrenergic Blocking Agents
Beta-blockers such as metoprolol (Lopressor, Toprol)
and atenolol
reduce myocardial oxygen consumption by blocking
beta-adrenergic sympathetic stimulation to the heart.
The result is a reduction in heart rate, slowed
conduction of impulses through the conduction system,
decreased blood pressure, and reduced myocardial
contractility (force of contraction) to balance the
myocardial oxygen needs (demands) and the amount of
oxygen available (supply).
PHARMACOLOGIC THERAPY
Calcium Channel Blocking Agents.
(calcium ion antagonists) have different effects.
Some decrease sinoatrial node automaticity and atrioventricular
node conduction, resulting in a slower heart rate and a
decrease in the strength of the heart muscle contraction.
 The calcium channel blockers most commonly used are
amlodipine (Norvasc), verapamil (Calan, Isoptin, Verelan), and
diltiazem (Cardizem, Dilacor, Tiazac).
They may be used by patients who cannot take beta-blockers.

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NURSING DIAGNOSES
Based on the assessment data, major nursing
diagnoses may include:
 Ineffective cardiac tissue perfusion secondary to
CAD, as evidenced by chest pain or equivalent
symptoms
 Death anxiety
 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
