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Angina Pectoris

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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 ST-
segment 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


coronary artery disease.
2. DM, systemic HTN.
3. Cigarette smoking.
4. Hypercholesterolemia.
5. 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
its progression 26
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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