8/8/2019 Angina Pectoris Demo

http://slidepdf.com/reader/full/angina-pectoris-demo 1/23

ANGINA PECTORIS

8/8/2019 Angina Pectoris Demo

http://slidepdf.com/reader/full/angina-pectoris-demo 2/23

1. To review the anatomy and physiology of the

cardiovascular system.

2. To define angina pectoris and its clinical

manifestations.3. To discuss the factors that evoke chest pain.

4. To explain the pathophysiology of angina

pectoris.

5. To determine the different types of angina.

6. To ascertain the different diagnosticexaminations.

7. To be able to understand the different medical

and nursing management.

8/8/2019 Angina Pectoris Demo

http://slidepdf.com/reader/full/angina-pectoris-demo 3/23

8/8/2019 Angina Pectoris Demo

http://slidepdf.com/reader/full/angina-pectoris-demo 4/23

8/8/2019 Angina Pectoris Demo

http://slidepdf.com/reader/full/angina-pectoris-demo 5/23

8/8/2019 Angina Pectoris Demo

http://slidepdf.com/reader/full/angina-pectoris-demo 6/23

CLASS EVOKING ACTIVITY LIMITS TO 

ACTIVITY

I Prolonged exertion None

II Walking >2 blocks Slight

III Walking <2 blocks Marked

IV Minimal or rest Severe

8/8/2019 Angina Pectoris Demo

http://slidepdf.com/reader/full/angina-pectoris-demo 7/23

FACTORS THAT EVOKE

TYPICAL CHEST PAIN

Physical Exertion

Exposure to cold

Eating a heavy meal

Stress or any emotion-provoking situation

8/8/2019 Angina Pectoris Demo

http://slidepdf.com/reader/full/angina-pectoris-demo 8/23

PATHOPHYSIOLOG Y

CAUSES

INC. M YOCARDIAL

OXYGEN DEMAND

TEMPORARY 

CESSATION

LACTIC ACID 

PRODUCTIONCHEST PAIN

8/8/2019 Angina Pectoris Demo

http://slidepdf.com/reader/full/angina-pectoris-demo 9/23

CLINICAL MANIFESTATIONS

o Chest pain

Retrosternal pain

Compressing, burning, squeezing, crushing heaviness

Radiates to left arm, jaw, neck, and back

5-10 minutes

o Feeling of  indigestion to a choking

o Numbness o Severe apprehension

o Feeling of  impending death

o May accompany diaphoresis, pallor, dizziness or  

lightheadedness, and NV

8/8/2019 Angina Pectoris Demo

http://slidepdf.com/reader/full/angina-pectoris-demo 10/23

CLINICAL MANIFESTATIONS

o Be alert to those patients who are:

Diabetic (Diabetes mellitus Elderly patients

o May be relieved by rest and NTG

8/8/2019 Angina Pectoris Demo

http://slidepdf.com/reader/full/angina-pectoris-demo 11/23

TYPES OF ANGINA

1. STABLE ANGINA

Identifiable cause of  pain (exertion)

Predictable Relieved by rest

2. UNSTABLE

Pain lasts longer  than stable May occur  at rest

8/8/2019 Angina Pectoris Demo

http://slidepdf.com/reader/full/angina-pectoris-demo 12/23

TYPES OF ANGINA

3. VARIANT/PRINZMETAL ANGINA

CAUSE: vasospasm

Pain at rest

4. SILENT ISCHEMIA

No symptoms

Ob jective evidence of  ischemia

8/8/2019 Angina Pectoris Demo

http://slidepdf.com/reader/full/angina-pectoris-demo 13/23

DIAGNOSTICS

11. Clinical manifestations

2. Echocardiogram

3. ECG

4. Stress test

5. Cardiac enzymes

8/8/2019 Angina Pectoris Demo

http://slidepdf.com/reader/full/angina-pectoris-demo 14/23

MEDICAL MANAGEMENT

GOAL:

q the myocardial oxygen demand

o oxygen supply

8/8/2019 Angina Pectoris Demo

http://slidepdf.com/reader/full/angina-pectoris-demo 15/23

PHARMACOLOGICAL

THERAPHY

1. NITROGL YCERIN (Nitrostat, Nitrol, Nitrobid IV)

Mainstay for treating angina pectoris

Dilates veins (higher doses, arteries) ± decreasepreload

Prevent vasospasm and increase perfusion

through the collateral vessels

SL or spray, topical agent, and IV S/E: HPO (and other accompanied signs of it)

8/8/2019 Angina Pectoris Demo

http://slidepdf.com/reader/full/angina-pectoris-demo 16/23

PHARMACOLOGICAL

THERAPHY

2. BETA-ADRENERGIC BLOCKING AGENTS (-olol)

Blocks the beta-adrenergic receptors in the 

heart S /E: HPO, bradycardia, AV block, and heart 

failure

C /I: asthma

Instruct patient not to stop abruptly but decrease gradually

8/8/2019 Angina Pectoris Demo

http://slidepdf.com/reader/full/angina-pectoris-demo 17/23

8/8/2019 Angina Pectoris Demo

http://slidepdf.com/reader/full/angina-pectoris-demo 18/23

PHARMACOLOGICAL

THERAPHY

4. ANTIPLATELET (Aspirin, Clopidogrel)

Prevents platelet activation and reduces the 

incidence of MI Given immediately once angina is diagnosed

If  concurrently under NSAIDs, patient may be 

treated with H2 blockers. 

S /E: Bleeding

8/8/2019 Angina Pectoris Demo

http://slidepdf.com/reader/full/angina-pectoris-demo 19/23

PHARMACOLOGICAL

THERAPHY

5. OXYGEN ADMINISTRATION

Given immediately

O2 saturation and respiratory rate and rhythm

8/8/2019 Angina Pectoris Demo

http://slidepdf.com/reader/full/angina-pectoris-demo 20/23

NURSING MANAGEMENT

1. Assess pain or other signs and symptomsusing the PQRST format.

2. If patient reports pain, instruct patient, place

patient in SEMI-FOWLER¶S POSITION.

3. Measure vital signs.

4. 12-Lead ECG

5. NTG. Assess pain and vital signs.

6. Oxygen administration. 2 L /M.

8/8/2019 Angina Pectoris Demo

http://slidepdf.com/reader/full/angina-pectoris-demo 21/23

NURSING MANAGEMENT

1. Providing information about the illness, itstreatment, and methods of preventing its

progression.

2. Stress reduction (music therapy,

aromatherapy, etc.)

3. Addressing the spiritual needs of the patient

and family

8/8/2019 Angina Pectoris Demo

http://slidepdf.com/reader/full/angina-pectoris-demo 22/23

NURSING MANAGEMENT

1. Identify the level of activity that causes pain.2. Plan the patient¶s activities

3. May alternate patient¶s activities with rest

periods.

4. Balance of activity and rest.

8/8/2019 Angina Pectoris Demo

http://slidepdf.com/reader/full/angina-pectoris-demo 23/23