Angina Pectoris

Episodes, paroxysmal (sudden attack) of pain

or pressure in the anterior chest.
Angina isnt a disease; its a symptom of
underlying cause of heart problem

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.yocardial cells become ischemic 1ithin
23 seconds of coronary artery occlusion

pumping action of the heart

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/lood supply (glucose and oxygen)
AP production
anaerobic metabolism
production of lactic acid

(hest pain


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/lood supply (glucose and oxygen)
AP production
anaerobic metabolism
production of lactic acid

(hest pain


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Stable

Unstable/pre infarction/crescendo/ intermittent

coronary syndrome

Intractable

Variant/prinzmetal

Silent

Postinfarction

Nocturnal angina

Angina decubitus

Microvascular

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Exertion, Exposure to cold, Eating, Emotion

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(hest pain, mild indigestion, -"/

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-iaphoresis, pallor, nausea and 5omitting

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(7reacti5e Protein

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/lood test, chest x7ray, stress testing

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E(', (oronary Angiography, (omputed

omography Angiography

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"8 demand of the myocardium; "8

supply

Nitroglycerin*short term and long term

reduction of myocardial oxygen
consumption through selecti5e 5asodilation

$&, 5olatile and inacti5ated 1ith heat, moist air, light, dark glass
bottle, chane in 9 months, best taken before de5elops angina, 9 $& c
: minute inter5al, sitdo1n to a5oid syncope and hypotension

$ide effects* flushing, headache, hypotension, ta5hycardia

.E-%(A& .A,A'E.E,
/eta adrenergic
reduce myocardial o8 consumption by beta
symphathetic stimulation to the heart

$ide effects* hypotension, bradycardia,

acute heart failure

(ontraindicated*
asthma;bronchoconstriction
diabetic; hypoglycemia

/eta blockers

Assess for pulse rate 1ithhold if brady

Admin c food; gastrointestinal upset

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!eart rate and myocardial contraction

(ommonly used* Amlodipine, -iltia=em

;treat and pre5ent 5asospasm

Assess heart rate and /P

.onitor hepatic and renal function

Admin 2 hour or before 8 hours after meal, 4ood delays

absorption and decrease plasma le5els of drugs.

Antidote* 'lucagon

Platelet Aggregation %nhibitor

Aspirin7pre5ent
platelet aggregation
and reduces the
incidence of .% and
death in patients
1ith (A-

"bser5e A$A
toxicity (ringing of
ears)

Assess for bleeding

A5oid straining of stool* pre5ent

'% bleeding

A$A c food* pre5ent '% upset

Platelet Aggregation %nhibitor

(lopidogrel7 gi5en
addition in aspirin in
patient 1ith high
risk of .%,acts to
different path1ays
to block platelet
acti5ation

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!eparin* pre5ents
the formation of
ne1 blood clots

Amount 1ill be
depending on AP

!eparin therapy* 8
to 8.:

Assess for bleeding

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aspirate, do not
massage

.onitor P and
P
Antidote*
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(oumadin

Assess signs of
bleeding

Antidote* 0itamin <

herapeutic P*
2.:x 8

.inimi=e green
leafy 5egetable

-o not gi5e A$A

and coumadin
together

"ther .eds

'lycoprotein %%b?%%%A
7pre5ent platelet
aggregation by
blocking 'P %%/?%%%A
receptors on the
platelets

"8 therapy
7initiated onset of
chest pain in an
attempt to o8
deli5ered in
myocardium and
decrease pain

$urgical %nter5entions

Percutaneous
ransluminal
(oronary
Angioplasty
7mechanical dilation of
coronary 5essel 1all
by compressing
atherosclerotic pla@ue

$urgical %nter5entions

%ntra5ascular
$tenting
7prosthetic
intra5ascular cylindric
stents maintain good
luminal geometry after
ballon deflation and
1ithdra1al

$urgical %nter5entions

&aser herapy
laser light produces
necrosis and
hemostasis,
coagulation and
e5aporation of
tissue

$urgical %nter5entions

(oronary Artery
bypass 'raft
7.yocardial
re5asculari=ation

7saphenous 5ein
and internal
mamary artery

,ursing %nter5entions

$it and rest, semi7fo1lers positionA

"8 therapy

+educing anxiety

&o1 salt and lo1 fat diet

$pecial considerations

Elderly

-iabetic

1oman

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A7aspirin, anticoagulant, o8 therapy

,7nitroglycerin

'7gi5e pt. -iet and 1eight management

%7increase kno1ledge of pt.

,7normali=e /P

A7a5oid cigarettes and control -.

&7lifestyle changes