Angina Pectoris: Symptoms, Causes & Treatment

Angina Pectoris: Symptoms, Causes & Treatment


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

  1. Stable angina pectoris.
  2. Unstable angina pectoris.
  3. 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

  1. The most common cause of angina pectoris – Coronary atherosclerosis.
  2. Ischemic chest pain less than 5 minutes – Angina.
  3. Drug of choice for angina pectoris – Nitrate.
  4. Most common angina pectoris – Stable angina.
  5. Which angina pectoris occurs during rest – Variant Angina.
  6. Classical angina pectoris also known – Stable Angina Pectoris.
  7. ECG finding in angina pectoris – ST-segment depression.
  8. A common route of nitrate administration – Sublingually.
  9. Angina occurs due to coronary artery spasm – variant angina.
  10. More dangerous angina pectoris – Unstable angina.
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