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Angina Pectoris

Angina pectoris is a clinical syndrome characterized by episodes of chest pain or pressure caused by insufficient coronary blood flow to meet the increased oxygen demands of the heart during physical exertion or emotional stress. It is usually caused by atherosclerotic disease that significantly obstructs at least one major coronary artery, preventing adequate increase in blood flow to meet heightened oxygen needs. The pain may radiate to the neck, jaw, shoulders or arms and is relieved by rest or nitroglycerin. Unstable angina features attacks that worsen over time and are not relieved by typical means, requiring medical intervention.

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51 views

Angina Pectoris

Angina pectoris is a clinical syndrome characterized by episodes of chest pain or pressure caused by insufficient coronary blood flow to meet the increased oxygen demands of the heart during physical exertion or emotional stress. It is usually caused by atherosclerotic disease that significantly obstructs at least one major coronary artery, preventing adequate increase in blood flow to meet heightened oxygen needs. The pain may radiate to the neck, jaw, shoulders or arms and is relieved by rest or nitroglycerin. Unstable angina features attacks that worsen over time and are not relieved by typical means, requiring medical intervention.

Uploaded by

Vivien Ignacio
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Angina Pectoris

Angina pectoris is a clinical syndrome usually characterized by episodes or paroxysms


of pain or pressure in the anterior chest. The cause is insufficient coronary blood flow,
resulting in a decreased oxygen supply when there is increased myocardial demand for
oxygen in response to physical exertion or emotional stress. In other words, the need
for oxygen exceeds the supply.

Pathophysiology
Angina is usually caused by atherosclerotic disease. Almost invariably, angina is
associated with a significant obstruction of at least one major coronary artery. Normally,
the myocardium extracts a large amount of oxygen from the coronary circulation to meet
its continuous demands. When demand increases, flow through the coronary arteries
needs to be increased. When there is a blockage in a coronary artery, flow cannot be
increased and ischemia results. The types of angina are listed in Chart 27- 2. Several
factors are associated with typical anginal pain:
 Physical exertion, which precipitates an attack by increasing myocardial oxygen
demand
 Exposure to cold, which causes vasoconstriction and elevated blood pressure,
with increased oxygen demand
 Eating a heavy meal, which increases the blood flow to the mesenteric area for
digestion, thereby reducing the blood supply available to the heart muscle; in a
severely compromised heart, shunting of blood for digestion can be sufficient to
induce anginal pain
 Stress or any emotion-provoking situation, causing the release of
catecholamines, which increases blood pressure, heart rate, and myocardial
workload

Clinical Manifestations
Ischemia of the heart muscle may produce pain or other symptoms, varying from
mild indigestion to a choking or heavy sensation in the upper chest. The severity ranges
from discomfort to agonizing pain. The pain may be accompanied by severe
apprehension and a feeling of impending death. It is often felt deep in the chest behind
the sternum (retrosternal area). Typically, the pain or discomfort is poorly localized and
may radiate to the neck, jaw, shoulders, and inner aspects of the upper arms, usually
the left arm. The patient often feels tightness or a heavy choking or strangling sensation
that has a viselike, insistent quality. The patient with diabetes may not have severe pain
with angina because diabetic neuropathy can blunt nociceptor transmission, dulling the
perception of pain (McCance et al., 2014).
A feeling of weakness or numbness in the arms, wrists, and hands, as well as
shortness of breath, pallor, diaphoresis, dizziness or lightheadedness, and nausea and
vomiting, may accompany the pain. An important characteristic of angina is that it
subsides with rest or administering nitroglycerin. In many patients, anginal symptoms
follow a stable, predictable pattern.
Unstable angina is characterized by attacks that increase in frequency and
severity and are not relieved by rest and administering nitroglycerin. Patients with
unstable angina require medical intervention.

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