Definition of Angina Pectoris
- Angina pectoris is a clinical syndrome of ischemic heart disease characterized by ischemic chest pain due to myocardial ischemia.
- Angina pectoris is a severe chest pain caused by an imbalance between the supply and demand of oxygen in myocardial tissue.
Cause of Angina Pectoris
- Coronary artery atherosclerosis.
- Coronary artery spasm.
- Obstruction in coronary artery blood flow.
- Thrombosis and embolism in the coronary artery.
- Coronary artery disease.
Etiology of Angina pectoris
- Obesity
- Age, sex
- Smoking
- Hypertension
- Use of cocaine
- Diabetes
- Sedentary lifestyle
- Diet
- Renal dysfunction
- Mental stress
- Physical exertion.
Types of Angina Pectoris
- Stable angina pectoris.
- Unstable angina pectoris.
- Variant angina pectoris.
Stable angina pectoris
Also known as – exertional angina
- Classic angina
- Effort angina.
- Stable angina is the most common angina.
- Stable angina occurs due to emotional stress, heavy exercise, and increased cardiac workload.
- Stable angina is resolved by rest and nitro-glycerine.
Unstable Angina pectoris
- Also known as preinfarction angina.
- Unstable angina is more severe than stable angina.
- Unstable angina occurs due to plaque formation in the coronary artery.
- Unstable angina is more dangerous and requires emergency treatment and is not resolved by nitro-glycerine.
Variant Angina pectoris
- Also known as prinzmetal angina, vasospastic angina.
- Variant angina rarely occurs due to spasms in the coronary artery.
- The most common cause is vasospasm.
- Variant angina occurs during rest.
Pathophysiology of Angina pectoris
Causes / etiology / risk factor
↓
Myocardial tissue damage
↓
Increase oxygen demand and less supply
↓
Myocardial ischemia and necrosis
↓
Ischemic chest pain
↓
Angina pectoris.
Clinical manifestation of Angina pectoris
- Mild to moderate crushing, squeezing chest pain.
- Pain may radiate to the shoulder, arm, jaw, neck, or back.
- Pain duration less than 5 minutes.
- Pain intensity develops slowly.
- Pain relief by adequate rest and nitro-glycerine.
- Tachycardia and palpitation
- Dyspnoea
- Hypertension
- Sweating
- Chest discomfort
- Fatigue
- Anxiety
- Dizziness
- Pallor.
Diagnostic examination of Angina pectoris
- History collection and physical examination.
- ECG – ST-segment depression
- T – Wave inversion.
- Exercise ECG.
- Chest X-ray.
- Angiography of the coronary artery.
- ECHO – determine anatomy.
- CBC, urine test, LFT, RFT.
- Lipid profile test.
- Ultrafast computed tomography.
Medical management of Angina pectoris
- The drug of choice for angina – is nitrate.
- Nitrate is administered through a sublingual route.
- Other drugs are –
- B – Blocker
- Calcium channel blockers.
- Antiplatelet medication.
- Anticoagulants agents.
- Proton pump inhibitors.
- Antiemetic.
- Vasodilators.
- Administer oxygen.
- Provide adequate rest to prevent cardiac workload.
Surgical management of Angina pectoris
- Median Sternotomy (open heart surgery).
- Percutaneous Transluminal coronary artery angioplasty (PTCA).
- Coronary artery bypass grafting (CABG).
Complication of angina
- Heart failure.
- Myocardial infarction.
- Acute renal failure.
- Heart block.
- Death.
Nursing management of Angina pectoris
- Monitor patient vital signs and general appearance.
- Evaluate the intensity of chest pain and duration.
- Provide a semi-Fowler position and adequate bed rest to relieve the cardiac workload.
- Administer nitrate drug in severe angina pectoris.
- Administer oxygen according to the demand or supply.
- The nurse administered the prescribed medication.
- Provide physiological and emotional support to relieve anxiety.
- Encourage patients to improve their lifestyles.
- Educate the patient about the cessation of smoking and avoiding alcohol.
- A reminder of patient vital signs.
- Suggest modifiable risk factors.
Key Points
- The most common cause of angina pectoris – Coronary atherosclerosis.
- Ischemic chest pain less than 5 minutes – Angina.
- Drug of choice for angina pectoris – Nitrate.
- Most common angina pectoris – Stable angina.
- Which angina pectoris occurs during rest – Variant Angina.
- Classical angina pectoris also known – Stable Angina Pectoris.
- ECG finding in angina pectoris – ST-segment depression.
- A common route of nitrate administration – Sublingually.
- Angina occurs due to coronary artery spasm – variant angina.
- More dangerous angina pectoris – Unstable angina.
