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JOSEPHS NYABONDO MEDICAL TRAINING COLLEGE

FACULTY OF NURSING

DEPARTMENT OF MEDICAL SURGICAL NURSING

CARDIOVASCULAR SYSTEM
ANGINA PECTORIS

MR.KIPSANG MARK BScN

 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.

In general, the severity of the symptoms of angina is based on the magnitude of

the precipitating activity and its effect on activities of daily living.
 Factors associated with typical angina pain
• Physical exertion, which can precipitate an attack by increasing myocardial oxygen demand

• Exposure to cold, which can cause 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
 Risk factors to Angina pectoris
Non-modifiable Risk Factors
Age: The risk of developing angina increases with age. Men over 45 and women over 55 are at
higher risk.

Gender: Men are generally at greater risk of coronary artery disease and angina, though the risk
for women increases and may surpass that for men after menopause.

Family History of Heart Disease: Having a family history of heart disease, especially if a parent
or sibling was diagnosed with CAD or had a heart attack at an early age, increases your risk.
Modifiable Risk Factors
Smoking and Tobacco Use: Chemicals in tobacco can damage the coronary arteries, leading to
their narrowing and the development of CAD, which can cause angina.

High Blood Pressure: Over time, high blood pressure can damage arteries by accelerating
hardening of the arteries (atherosclerosis), leading to angina.
High Cholesterol Levels: High levels of bad cholesterol (LDL) and low levels of good
cholesterol (HDL) contribute to the buildup of plaques in the arteries, causing them to narrow
and restrict blood flow.

Diabetes: Diabetes significantly increases the risk of developing cardiovascular diseases

including CAD, mainly due to the associated higher levels of blood sugar, which can damage
the blood vessels.

Obesity: Excess weight typically worsens other risk factors for CAD and angina. Obesity is
also linked to heart disease independently because of the inflammation and other metabolic
issues it causes.

Physical Inactivity: Lack of exercise is associated with many forms of heart disease, including
angina, because it contributes to other risk factors, such as obesity and high blood pressure.
Unhealthy Diet: Diets high in trans fats, saturated fats, sodium, and cholesterol have been
linked to heart disease and related conditions, including angina.
Stress: Chronic stress may damage your artery walls and worsen other risk factors for
coronary artery disease and angina.
 Pathophysiology
Angina is usually caused by atherosclerotic disease.

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 there is an increase in demand, flow through the coronary arteries needs to
be increased.

When there is blockage in a coronary artery, flow cannot be increased, and

ischemia results.
 Types of Angina
Stable angina: predictable and consistent pain that occurs on exertion and is relieved by rest
and/or nitroglycerin.

Unstable angina (also called preinfarction angina or crescendo angina): symptoms increase in
frequency and severity; may not be relieved with rest or nitroglycerin.

Intractable or refractory angina: severe incapacitating chest pain.

Variant angina (also called Prinzmetal’s angina): pain at rest with reversible ST-segment
elevation; thought to be caused by coronary artery vasospasm.

Silent ischemia: objective evidence of ischemia (such as electrocardiographic changes with a

stress test), but patient reports no pain.
 CAUSES
Atherosclerosis: This is the most common cause of angina. Atherosclerosis involves the
buildup of plaques (made of fat, cholesterol, and other substances) in the coronary arteries,
which narrows the arteries and restricts blood flow to the heart muscle.

Coronary artery spasm: This refers to a temporary tightening (spasm) of the muscles within
the walls of the coronary arteries. The spasm decreases or even stops blood flow through the
artery temporarily. It can occur in arteries that are not affected by atherosclerosis and the cause
is often unknown.

Blood clots: Blood clots can suddenly block or reduce blood flow through the coronary artery,
leading to angina or a heart attack. Blood clots can form in arteries already narrowed by
atherosclerosis or on the surface of plaques, leading to sudden angina symptoms.
Anemia: Anemia is a condition where you don't have enough red blood cells to
carry adequate oxygen to your body's tissues, including the heart muscle, causing
increased demand on the heart and potentially leading to angina symptoms.

Coronary microvascular disease: This is a condition affecting the heart’s tiny

arteries and can lead to angina. It's more common in women and not always
associated with traditional coronary artery disease.
 CLINICAL MANIFESTATION
Chest Pain or Discomfort: The hallmark symptom of angina is chest pain or
discomfort, often described as pressure, heaviness, tightness, squeezing, or
aching in the center or left side of the chest. This sensation can mimic
indigestion or heartburn.

Radiation of Pain: The pain or discomfort may radiate to the arms (often the left
arm), back, neck, jaw, or stomach area.

Shortness of Breath: Individuals may experience difficulty breathing or shortness

of breath, either as a standalone symptom or accompanying the chest pain.

Nausea: Some people with angina may feel nauseated or experience a sense of
indigestion.
Fatigue: A feeling of overwhelming tiredness or weakness, especially with
physical activity, can occur with angina.

Dizziness: Patients may report feeling lightheaded or dizzy, particularly if the

angina is associated with a significant reduction in blood flow to the heart.

Sweating: Unexpected sweating without physical exertion can accompany an

angina episode.

Anxiety: A feeling of doom or anxiety, especially if the chest discomfort is

unfamiliar, may occur during an angina attack.
 MEDICAL MANAGEMENT
Nitrates (e.g., nitroglycerin): Help to relax and widen blood vessels, allowing more blood to
flow to the heart muscle.

Beta-blockers (e.g., metoprolol, atenolol): Reduce heart rate and the workload on the heart.

Calcium channel blockers (e.g., amlodipine, diltiazem): Relax and widen arteries, increasing
blood flow to the heart muscle and reducing blood pressure.

Antiplatelet agents (e.g., aspirin, clopidogrel): Help prevent blood clots, reducing the risk of
heart attack.

Statins: Lower cholesterol levels, helping to prevent plaque buildup in the arteries.

ACE inhibitors or ARBs: Used in patients with certain conditions like diabetes or heart failure
Oxygen Administration Oxygen therapy is usually initiated at the onset of chest
pain in an attempt to increase the amount of oxygen delivered to the
myocardium and to decrease pain.
 NURSING MANAGEMENT

1. Pain Management
Administer Prescribed Medications: Nitroglycerin is commonly used to relieve
angina pain. Ensure timely administration and monitor its effectiveness.
Position for Comfort: Help the patient find a comfortable position, usually sitting
upright, to ease the chest pain.

2. Monitoring and Observation

Vital Signs: Monitor blood pressure, heart rate, and oxygen saturation regularly
to detect any changes indicating worsening of the condition or side effects of
medication.
ECG Monitoring: Continuous or periodic ECG monitoring might be required for
patients with unstable angina to detect changes in the heart’s electrical activity.
3. Lifestyle Modification and Education

Dietary Changes: Educate about heart-healthy diets, emphasizing low

cholesterol, low sodium, and rich in fruits, vegetables, and whole grains.

Exercise: Discuss the importance of regular, moderate exercise, tailored to the

individual's capacity and condition, to improve heart health.

Smoking Cessation and Limiting Alcohol: Advise on quitting smoking and

limiting alcohol consumption, as both can exacerbate heart conditions.

Stress Management: Provide guidance on techniques to reduce stress, such as

relaxation techniques, meditation, or counseling.
4. Medication Education
Educate the patient and family about the importance of adherence to prescribed medications
(e.g., antiplatelet, beta-blockers, statins) to manage angina and prevent heart attacks.
Explain how and when to use short-acting nitrates for angina attacks.

5. Follow-Up and Referral

Regular Monitoring: Emphasize the importance of regular follow-up visits with the healthcare
provider to monitor heart health and adjust treatments as necessary.

Rehabilitation: Refer to cardiac rehabilitation programs for structured exercise and education
designed to improve health and recovery.

6. Emergency Plan
Teach the patient and family to recognize the signs of a heart attack and the difference
between angina pain and heart attack symptoms. Ensure they know when to call emergency
services.
 ASSIGMENTS
1. Priority care plan for a patient with angina pectoris.
2. Complications of angina pectoris.
3. Discuss surgical management of angina pectoris
a. Coronary artery bypass
b. Intracoronary stents
c. Atherectomy
d. percutaneous transluminal coronary angioplasty [PTCA]