ANGINA PECTORIS  By Charmaine Sta Ana

ETIOLOGY  Chest pain or discomfort due to decreased oxygen or lack of oxygen of the myocardium

 Atherosclerosis of the coronary arteries is the common cause  Arteries are blocked or narrowed  Ischemia of the heart muscle occurs

pATHOPHYSIOLOGY  Angina occurs with increased cardiac workload due to  Intense cold  Exercise  Unusually heavy meals  Emotional stress  Any strenuous activity

Stable Angina  Predictable chest pain  Occur on exertion or stress  Relieved with rest, nitroglycerin, or both

Unstable Angina  Unexpected chest pain  Occurs at rest  Mimics MI (red flag that MI will occur)

Variant Angina (Prinzmental’s Angina)  Occurs spontaneously  Occurs at rest  Does not follow exertion or stress  Painful  Happens between midnight and 8 a.m.

CLINICAL MANIFESTATION  Pain  Tightness or heaviness of chest chest  Mistaken for indigestion  Pain often below or behind sternum behind sternum  Pain radiates down the left inner arm to the left inner arm to the little finger and up to little finger and up to the shoulder and jaw the shoulder and jaw

Other symptoms  Chest pain  Dyspnea (shortness of breath)  Anxiety  Apprehension  Diaphoresis (sweating)  Nausea

ASSESSMENT  Note pt. statement regarding location, intensity, radiation, and duration of pain  Determine relief measured used  Note any changes in frequency or severity of symptoms  Note pt. behavior, such as rubbing the left arm or a fist against sternum  Note any diaphoresis or anxiety  Monitor vital signs

DIAGNOTIC TESTS  ECG (electrocardiogram) is a graphic study of the electrical activities of the myocardium to determine transmission of cardiac impulses through the muscles/conduction tissue  Holter monitoring is a monitor that is worn at home that records the heart during daily activities in a 24 hour period  Stress test is a test the heart is monitored while using a treadmill,exercising,or climbing the stairs to evaluate if the heart is lacking O2 or having any abnormal rhythym  Thallium 201 is a radioisotope, which is an intracellular ion that is actively transported into normal cells, that is injected intravenously while the patient is on a treadmill. If the cell is ischemic or infarcted, the thallium will not be picked up and a “cold spot” image is produced.

Which one are you?

Diagnostics cont…  PET (positron emission tomography)is a computerized radiographic technique that uses radioactive substances to examine the metabolic activity of various body structures. A biochemical radioactive substance is inhaled or injected and specific color-coded images reveal organs’ metabolic function. It can detect a cardiac disease.  Angiography is a passage of a catheter into the heart chambers through a peripheral vessel which is used to measure pressure within the heart and blood-volume relationship to cardiac competence. A contrast dye is injected to allow better heart and vessel visualization.

MEDICAL MANAGEMENT  Reducing cardiac ischemia by controlling symptoms.  Correcting cardiovascular risk factors: strenuous exercise, smoking, heavy meals, emotional stress, cold weather are avoided  Antiplatelet aggregation therapy (Aspirin) help decrease platelet adhesion and decrease thrombosis formation  Vasodilators (Nitroglycerin) reduces cardiaac oxygen demand by relaxing vascular smooth muscle and dilating coronary vessels  Beta-adrenergic blocking agents (Lopressor) block Beta- adrenergic stimulation and decrease myocardial oxygen demand, thus decreasing myocardial damage.

Medical management cont…  Calcium channel blockers (Cardizem) dilate blood vessels, increase coronary artery blood supply and decrease myocardial oxygen demand.

Surgical intervention  CABG (coronary artery bypass graft) is when sections of the saphenous veins in the legs or the internal mammary artery is used as a graft. Blood flow to the myocardium through the grafts and bypasses the occluded coronary arteries.  PTCA (percutaneous transluminal coronary angioplasty) is an invasive procedure performed in the cardiac catherization lab where a a balloon is inflated in the occluded artery to help dilate the narrowed wall of the artery. A fluoroscopy is used to guide a catheter from the femoral or brachial artery to the coronary arteries to be treated.

Surgical cont…  Stent replacement are performed to treat abrupt or threatened vessel closure following PTCA. Stents are expandable, meshlike structures designed to maintain vessel patency by compressing the arterial walls and resisting vasoconstriction. Stents are placed over the angioplasty site to hold the vessel open.

NURSING INTERVENTION/ PATIENT TEACHING Promote comfort by providing rest periods,a calm environment, and prescribed medications. (Help with anxiety and help decrease oxygen demand) Promote tissue perfusion by instructing the patient to stop activity immediately in the presence of chest pain, dyspnea, syncope, or vertigo (indicators of low tissue perfusion). (Help promote better blood flow through the tissues, thus decreasing oxygen demand) Promote activity and rest by avoiding exertion and only performing mild activities. (Help to decrease chest pain) Promote relief of anxiety and feeling of well being by providing relaxation therapy or support group therapy. (An optimistic outlook helps to relieve the work of the heart)  Teaching patient and family about medication and treatments. (Helps with reduction of myocardial oxygen needs and workload of the heart)

Do the right thing for the ones you love