Cardiovascular Disorder

“Angina”

Assist prof.dr/ Heba Abu baker

Dr/ Huda Rady Sobh
Faculty of Nursing, Mansoura National University
 Learning objectives
• On completion of this chapter, the students
will be able to:
• Define angina
• Discuss aetiology of angina.
• Describe the symptoms of angina.
• Recognize the diagnostic studies of angina.
• Identify the Medical management of angina
• Discuss the nursing management of angina
Anatomy and physiology
Coronary arteries
 Introduction

• Coronary artery disease, also called ischemic heart

disease. This serious condition develops when
coronary arteries that supply blood and oxygen to
the heart muscle become clogged with fatty
material called plaque or atheroma. plaque builds
up slowly inside the wall of the arteries, causing
them more rigid and narrowed. This process called
atherosclerosis.
• Atherosclerosis is an abnormal accumulation of lipids and
fibrous tissues in the vessel wall.
• The atheromas (plaque) protrude into the lumen of the vessel, narrowing it
and obstructing blood flow.

• The thrombus may obstruct blood flow leading to myocardial infarction or

sudden death.
 Causes of atherosclerosis

• Alteration in the lipid metabolism

• Alteration in the blood coagulation
• Alteration in the biophysical and biochemical
properties of the arterial wall
 Risk factor of coronary artery diseases
Modifiable risk factors: Non modifiable risk factors:

• High cholesterol • Age

• Hypertension • Gender
• Hyper glycaemia (Diabetes mellitus) • Family history
• Obesity
• Sedentary life style (Physical
inactivity)

• smoking
• Stress
 Clinical manifestations of coronary artery

• Cardiac Ischemia
• Cardiac ischemia means reduced blood
flow to the heart. It is usually the result of
the build–up of plaque in the coronary
arteries (coronary artery arthrosclerosis ).
• Cardiac ischemia may lead to angina,
myocardial infarction, or sudden death
according to the degree and duration of
ischemia.
 Angina

Definition

It is a clinical syndrome, characterized

by paroxysms of chest pain(due to
imbalance between o2 supply and
o2 demand to the myocardium , or a
feeling of pressure in the anterior
chest.
 Pathophysiology

Atherosclerotic heart disease lead to ↓

Insufficient coronary blood flow lead to↓

Inadequate oxygen supply of the myocardium lead to↓

Angina
 Precipitating (risk) factors

• Physical exertion

• Eating heavy meals

• Stress

• Cold weather
 Manifestations
Chest pain behind the sternum and it may radiate to the neck, jaw,
shoulders, and inner aspects of the upper extremities.
Duration:
 3-5 minutes→ less than 15 minutes
 Never less than :1 minutes
 The patient often experience a tightness, a choking or strangling
sensation.
 A feeling of weakness or numbness in the arms, wrist be
accompanied by pain.
Differentiate between angina and MI
 Types of angina
• Classic angina: chest pain for short duration
precipitated by exertion and relieved by rest.
• Unstable angina (pre infarction): increasing
frequency, intensity, and duration of
symptoms.
• Nocturnal angina: occurring only at night
• Angina decubitus: precipitated by recumbent
positions and relived by sitting or standing.
 Subjective indicators of angina:

1 - History of one or more of the following risk factors.

 Cigarette smoking.
 Hypertension.
 Hyperlipidemia.
 Family history of coronary artery disease.
 Male gender
 Obesity.
 Diabetes mellitus.
 Lack of regular exercise.

• Chest discomfort which may be described as: heavy pressure, burning

sensation, or squeezing or tightness.
 objective indicators of angina:

 Mental status: fearful but quiet during acute attack.

 Vital signs: normal between anginal episodes,

hypertension and tachycardia during an acute

attack, although hypotension and bradycardia may

occur in some circumstances.

 Heart: Irregular rhythm during an acute attack.

 Diagnosis
• Patient's history
• Clinical manifestations
• ECG
• Echo: may show abnormal motion of the
myocardium .
• Chest X ray
• Coronary angiography ( coronary catheter ) To
detect the site & severity of coronary occlusion
 ECG
A. Resting ECG :
 In between the attacks :
 usually normal.
• During the attack:
 ST segment : depressed. ( more than 1mm )
 T wave : Inverted
B) Exercise ECG : ( in between the attacks only ) is
performed while the patient exercises in a
controlled manner on a treadmill or stationary
bicycle at varied speeds
Stress test is considered +ve when : one or
more of these changes are present :
Symptom : Typical anginal pain during the test.
Sign : Fall in blood pressure (10 mmHg or more)
suggests ischemia
 ECG : Depressed ST segment > 1mm .
Medical treatment of angina:

1. Risk reduction
2. Pharmacological
3. Invasive
 Medical treatment of angina:
1. Risk reduction
• Stop smoking, diet, weight loss, exercise
• Avoid situations that are emotionally
stressful
• Medications to control cholesterol, HTN,
and diabetes
 Pharmacological
• Nitrates :
• Action :Vasodilator → ↓preload (venous return) → ↓myocardial
oxygen demand.
• Coronary dilatation →increase coronary blood flow.
• β blockers :
• Action : Reduce oxygen demand since they reduce heart rate, blood
pressure & contractility
• Calcium channel blockers :
• Action : Reduce oxygen demand
• ↓afterload ( arteriolar dilators ).
• Coronary dilator : increase coronary blood flow
• Aspirin : Action : Antiplatelet → it improves the prognosis
 Invasive
• Percutaneous transluminal angioplasty:
Introduction of balloon or stent to dilate the stenotic
artery( balloon-tipped catheter)
• Carotid artery stent insertion
• Coronary artery bypass grafting (CABG)
(Revascularization):Grafting a piece of saphenous vein or
internal mammary artery between the aorta & the
coronary artery distal to any obstruction
 Nursing management
Nursing assessment; the nurse must observe and ask the

patient

- When attacks tend to occur?

- How the patient describe the pain?

- Is the onset of the pain gradual or sudden?

- How long does it lasts?

- Is the discomfort accompanied with others symptoms/

- Full history taken and physical examination

 Nursing diagnosis

Nursing diagnosis; It may be include

 Chest pain related to myocardial ischemia
 Anxiety related to fear of death
 Health maintenance altered related to lack of
knowledge about nature of the disease, how to
deal with it, and ways to avoid complications
 Nursing intervention

1. Prevention and controlling of chest pain

2. Reduction of anxiety

3. Health teaching to the patient in relation to

nature of the disease, life style changes needed

to cope with the disease, and ways to avoid

complications.
 Health education
• Diet
 Eat a well-balanced diet with an appropriate caloric intake.

 If obese, participate in a supervised weight-reduction

program.

 Avoid activity immediately after meals.

 Restrict intake of caffeine because it can increase heart rate.

 Maintain a diet low in fat.

 Eat small frequent diet

 Health education

• Smoking

 Participate in a smoking cessation

program. Smoking can increase heart rate,
blood pressure, and blood carbon monoxide
levels.
 Avoid smoke-filled environments.
 Health education

• Cold Weather

 Avoid exposure to cold and windy

weather. Exercise indoors when necessary.
 When outdoors, dress in warm clothing,
and cover mouth and nose with a scarf.
 Use a moderate pace of walking in cold weather.
 Health education
Medications
 Carry sublingual nitroglycerin at all times.
 Keep the pills in a dark-colored glass bottle to protect
them from sunlight.
 Do not place cotton in the bottle because the cotton will
absorb the active ingredients of the medication.
 Takes nitroglycerin prophylactically to avoid pain
 If pain occurs, place tablet under the tongue, stop
activity, and wait for medication to dissolve.
 Health education
 Doesn't swallow saliva until the tablet has
dissolved
 Take another tablet in 3 to 5 minutes if pain is
not resolved. If pain continues, seek immediate
care.
 Be aware of side effects of nitroglycerin,
including, headache, flushing, and dizziness.
 Health education
• Activity and Exercise
 Participate in a daily program of exercise that does
not precipitate pain.
 Avoid activities that require heavy effort
 Uses moderation in all activities of life
 Refrains from engaging in physical exercise for 2
hours after meals
 Alternates activities with periods of rest
 Avoid walking against the wind
 QUIZ
1.What is the primary cause of coronary
artery disease?
o A) Viral infection
o B) Hypertension
o C) Valve disease
o D) Atherosclerosis
 QUIZ
2. Which of the following is a modifiable risk
factor for CAD?
o A) Physical inactivity
o B) Family history
o C) Age
o D) Gender
 QUIZ
3.Which type of angina occurs only at night?
o A) Classic angina
o B) Unstable angina
o C) Nocturnal angina
o D) Angina decubitus
 QUIZ
4. What medication is commonly used to
relieve angina pain?
o A) Corticosteroid
o B) H2 Receptor -blockers
o C) Steroid
o D) Nitroglycerin
 QUIZ
5. Which symptom is typically associated with
angina?
o A) Nausea
o B) Severe headache
o C) Chest pain or pressure
o D) Dizziness
 QUIZ
6. Which of the following is NOT a common
precipitating factor for angina?
o A) Physical exertion
o B) Heavy meals
o C) Exposure to cold
o D) Hydration
 QUIZ
7. What is the primary goal of pharmacological
treatment for angina?
o A) Increase heart rate
o B) Decrease blood pressure
o C) Relieve chest pain and improve blood flow
o D) Increase cholesterol levels
 QUIZ
8. Which type of angina is characterized by
increasing frequency and severity?
o A) Stable angina
o B) Unstable angina
o C) Nocturnal angina
o D) Angina decubitus
 QUIZ
9. The pain from angina typically radiates to
which areas?
o A) Lower abdomen
o B) Legs
o C) Neck, jaw, shoulders, and arms
o D) Back only
 QUIZ
10. What is the role of aspirin in the management of
CAD?
 A) To lower blood pressure
 B) To increase heart rate
 C) To relieve chest pain
 D) To prevent blood clot formation
 QUIZ
11. Which of the following is a non-invasive method to
assess the severity of coronary artery disease?
 A) Coronary angiography
 B) Echocardiogram
 C) Heart catheterization
• D) Coronary artery bypass grafting (CABG)
 QUIZ
12. In what type of bottle should nitroglycerin pills
be kept?
• A) Plastic bottle
• B) Clear glass bottle
• C) Dark-colored glass bottle
• D) Transparent container