ANGINA PECTORIS

INTRODUCTION:
Angina pectoris is commonly known as chest pain due to ischemia of the heart muscle and
general obstruction or spasm of the coronary artery.

DEFINITION:
Angina pectoris is a clinical syndrome usually characterized by episodes or paroxysms of
pain or pressure in the anterior chest. It occurs when the heart muscle does not get as much as
blood.

CLASIFICATION:
1. STABLE ANGINA OR EFFORT ANGINA:
A typical presentation of stable angina is that of chest discomfort and associated
symptoms precipitated by some activity (running, walking, after taking a heavy meal
etc.) with minimal symptoms at rest or after administration of nitroglycerin.
2. UNSTABLE ANGINA OR CRESCENDO ANGINA:
Symptoms increase in frequency and severity may not be relieved with rest and
nitroglycerin. It is lasting more than 10 minutes and longer than stable angina. It may
occur unpredictably at rest, which may be a serious indicator of an impending heart
attack.
3. VARIANT ANGINA OR PRINZMETAL’S ANGINA:
A spasm in coronary artery causes this type of angina. It is rare seen in people. It
usually occurs at rest and pain can be severe. It happens between midnight and early
morning.
RISK FACTORS:
MODIFIABLE RISK FACTORS:
 Tobacco use
 High blood cholesterol
 Lack of exercise
 Obesity
 Stress
 Eating a heavy meal
NONMODIFIABLE RISK FACTORS:
 History of heart disease
 history Family Old age (>45 yrs for men, > 55 yrs for women)
 Diabetes mellitus
 High blood pressure

ETIOLOGY:
 Coronary artery spasm
 Hypertrophic cardiomyopathy
 Atherosclerosis
 Valvular heart disease like aortic stenosis

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PATHOPHYSIOLOGY:

Due to etiological factor

Increase oxygen demand in body

When oxygen demand increases, increase

heart work load and heart needs more blood supply .

Then coronary artery dilate and supply more blood to heart.

When there is blockage in coronary

artery blood flow cannot be increased.

Decreases oxygen level in heart and ischemia occurs.

Starts angina (pain) in pectoris (heart muscles)

CLINICAL MANIFESTATION:
 Tightness in upper chest
 Discomfort
 Pain in neck, jaw, shoulders, and inner aspects of the upper arms.( left arm)
 Weakness
 Chest pain
 Diaphoresis
 Dizziness
 Indigestion
 Nausea
 Vomiting
 Shortness of breath
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DIAGNOSTIC EVALUATION:
 History collection
 Physical examination
 ECG (may show changes indicative of ischemia, such as T-wave inversion)
 Chest X-RAY
 Echocardiogram
 Stress test(treadmill test)
 Coronary angiography

MANAGEMENT:
MEDICAL MANAGEMENT:
 Vasodilators - Improves blood flow to the heart muscle and relieves pain.
Ex: Nitroglycerin
 Beta-Adrenergic blocking agents - Reduces myocardial oxygen consumption by
blocking the sympathetic stimulation to the heart.
Ex: Metoprolol, Atenolol
 Calcium channel blocking agents - Decreases the strength of myocardial contraction
that relax the blood vessel and reduce blood pressure and increase coronary artery
perfusion.
Ex: Amlodipine, Diltiazem
 Antiplatelet and Anticoagulant medications – To prevent platelet aggregation and
subsequent thrombosis which impedes blood flow through coronary artery.
Ex: Aspirin, Heparin
 Oxygen therapy is usually initiated at the onset of chest pain because to fulfill the
demand of oxygen and to reduce pain.
SURGICAL MANAGEMENT:
 Coronary Artery Bypass Graft (to give proper blood supply)
 Percutaneous Transluminal Coronary Angioplasty (to open blocked and narrowed
coronary artery.
 Intra coronary Stent (to dilate the blood vessel)
 Atherectomy (to remove the deposition present in the coronary artery)
NURSING MANAGEMENT:
 Collect patient history and physical examination.
 Provide proper position to reduce the level of pain.
 Assess the angina condition if the patient having angina then give semi-fowler’s
position to reduce the oxygen requirement of myocardium.
 Continuous assess the condition and measure the vital signs.
 Monitor ECG and note the ST- segment changes.
 Teach the patient not to do any heavy work and stressful work.
 Diet should be given to the patient that contain no fatty food.
 Advice the patient don’t to take tobacco, smoking and alcohols.

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  Advice the patient to take medications in right time and right dose.
NURSING DIAGNOSIS -1:
Impaired gas exchange related to decreased blood flow as evidenced by breathlessness.
GOAL:
Improve breathing pattern.
INTERVENTION:
 Provide adequate oxygen therapy.
 Administer medication as prescribed by physician.
 Provide adequate rest.
NURSING DIAGNOSIS -2:
Acute pain related to disease condition as evidence by chest pain, restlessness, dyspnea.
GOAL:
Reduce pain.
INTERVENTION:
 Assess pain score.
 Administer analgesics as prescribed by physician.
 Provide comfort position.
NURSING DIAGNOSIS -3:
Ineffective cardiac tissue perfusion related to decrease coronary blood flow as evidence by
chest pain, dizziness.
GOAL:
Relief of chest pain or discomfort.
INTERVENTION:
 Assess vital signs of the patient.
 Obtain 12- lead ECG recording during symptomatic events, as prescribed, to assess
for ongoing ischemia.
 Ensure physical rest: head of bed elevated to promote comfort, provide restful
environment, diet as tolerated.
 Provide oxygen therapy to the patient.
NURSING DIAGNOSIS -4:
Anxiety related to underlying pathological responses as evidenced by increased tension and
restlessness.

GOAL:

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Decrease anxiety and increase sense of self control.
INTERVENTION:
 Use calm, reassuring approach so as not to increase patient’s anxiety.
 Instruct patient in use of relaxation therapies. (Breathing exercises, imagery to
enhance self control)

COMPLICATIONS:
 Heart attack
 Heart failure
EVIDENCE BASED PRACTICE:
A clinic pathologic study of angina pectoris was carried out in a group of 848 cases in which
the coronary arteries were injected and dissected by the Schlesinger technique. The group
consisted of 177 patients with angina pectoris of one month duration or longer and 671
control patients without cardiac pain. All angina patients had either coronary, valvular or
hypertensive heart disease; 90% of them had coronary narrowing of occlusion. The serious
prognostic import of angina pectoris in this series is evident from the mortality figures.

SUMMARY:
I am summarizing my topic regarding introduction and definition of angina pectoris, types ,
risk factor , etiology, pathophysiology, clinical manifestation, diagnostic evaluation, and
management of angina pectoris.

CONCLUSION:
Angina pectoris is a heart disease in which due to obstruction or spasm of coronary artery
ischemia occurs in heart muscle. Main sign and symptoms are chest pain, dyspnea, tightness
in chest etc. It is treated by medications like nitroglycerin, oxygen therapy, mainly for pain
aspirin used. Surgical managements are CABG, angioplasty etc.

BIBLIOGRAPHY:
 Black M. joyce, Hwks hokanson jane, medical surgical nursing, 8 th edition, volume 2,
New delhi; Reed Elsevier India private limited: 2009. P1411-1426.
 Suddarth’s and brunner, Hinkle L.Janice, Cheever H. Kerry. Text book of medical
surgical nursing. 13th edition. Volume 1, New delhi: wolters kluwer india Pvt
ltd;2014. P729- 759.
 http://www.webmed.com/heart disease/guide.
 en.m.wikipedia.org
 http://www.heart.org/en/health topics/consumer health care.

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 CLASS TEACHING ON: ANGINA PECTORIS

SUBMITTED BY: SUBMITTED TO:

MS PADMINI PANDA MRS RENUKA DASH
MSC NURSING 1ST YEAR VICE PRINCIPAL
ROLL NO:10 CON, VIMSAR ,BURLA

SUBMITTED ON:
24/03/2021

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 CONTENT

SL CONTENT PAGE NO.

NO. DESCRIPTION
1 INTRODUCTION 1
2 DEFINITION 1
3 CLASSIFICATION 1
4 RISK FACTOR 1
5 ETIOLOGY 1-2
6 PATHOPHYSIOLOGY 2
7 CLINICAL MANIFESTATION 2-3
8 DIAGNOSTIC EVALUATION 3
9 MANAGEMENT 3-4
10 NURSING DIAGNOSIS 4-5
11 COMPLICATIONS 5
12 EVIDENCE BASED PRACTICE 5
13 SUMMARY 5
14 CONCLUSION 5
15 BIBLIOGRAPHY 5