ANGINA

PECTORIS
Marcos , Jose R.N
 Description/
Definition
 Chest pain caused by myocardial ischemia(cell
hypoxia)

 Deprivation of oxygen leads to anaerobic metabolism

of the heart producing lactic Acid, which causes chest
pain and other related clinical problems

 A disease marked by brief paroxysmal attacks of

chest pain precipitated by deficient oxygenation of
the heart muscles
Anatomy and
Physiology
 Layers of the heart
 Endocardium- innermost layer consist of thin
endothelial tissue lining the inner chambers and
heart valves.
 Myocardium- middle layer consist of striated
muscle fiber ; actual muscle of the heart.
 Epicardium
 Visceral epicardium- covers the outer surface of the
heart; it adheres to the heart.
 Parietal epicardium- encapsulates the visceral
epicardium.
 Chambers of the heart
 Atria- upper collecting chambers

a.Right atrium- receives deoxygenated blood

b.Left atrium- receives oxygenated blood

 Ventricles- lower pumping chambers

a.Right ventricle- pumps blood into the lungs

b.Left ventricle- heart’s largest, most muscular chamber
that pumps blood into the systemic circulation.
 Functions of the
cardiovascular system
 Electrophysiologic properties
a. Excitability- ability of the cardiac muscle cells to
depolarize in response to stimulus through the NA- K
pump and calcium ions.
b. Automacity/ rhythmicity- initiate an impulse
c. Contractility- the contraction per second
d. Refractoriness- inability to respond to a new stimulus
while still in a state of depolarization from an earlier
stimulus
e. Conductivity- ability to propagate electrical impulses
through the conduction system
 Cardiac cycle: one cardiac cycle = one complete heart
beat
 Predisposing
Factors:
 Sex – male
 Black raise
 Hyperlipidemia
 Smoking
 Hypertension
 Diabetes mellitus
 Sedentary lifestyle
 Stress
 Precipitating
Factors:
 Eating
 Emotion
 Effort
 Extreme temperature
 Elimination
 Factors that Factors that
decrease increase
supply: demand:
 Coronary vessel  Increase cardiac output
disorders  Increase myocardial
 Circulating disorders need for oxygen
 Blood disorders
 Signs and
Symptoms
 An uncomfortable pressure, fullness, squeezing, or pain in
the center of the chest

 It may also feel like tightness, burning, or a heavy weight.

 The pain may spread to the shoulders, neck, or arms.

 It may be located in the upper abdomen, back, or jaw.

 The pain may be of any intensity from mild to severe.

Other symptoms may occur
with an angina attack:
 Shortness of breath
 Lightheadedness
 Fainting
 Anxiety or nervousness
 Sweating or cold, sweaty skin
 Nausea
 Rapid or irregular heart beat
 Pallor (pale skin)
 Feeling of impending doom
 Priority 1: Acute Pain R/T
decrease myocardial blood
flow
Assessment Nursing Planning Intervention Rationale Evaluation
Diagnosis

Objective: Pain R/T After the Instructed client to notify

• Pain and decreased cardiac output
•
The goal
nurse immediately when may stimulate the sympathetic
>Facial Grimace decrease shift, the chest pain occurs. nervous system to release
was met,
>Guarding pain myocardial patient excessive amounts of after the
>Clinched fist blood flow will Norepinephrine ,w/c increases shift the
>irritable report a platelet aggregation patient
Assessed and document
•
>diaphoresis decrease client response of Provides information about disease
•
verbalized
>Narrowed in pain medication progression . decrease
Focus as in pain with
>Disturbed evidence
•Identified precipitating Helps differentiate this chest pain,
•
a pain
event frequency, duration, and aids in evaluating possible
Sleep by a pain intensity, and location of progression to unstable angina scale of
>pain scale of scale of pain 1/10
7/10 1/10 •Decrease cardiac output stimulates
Observed for associated
• sympathetic/para sympathetic
symptoms of dyspnea, nervous system, causing a variety
nausea/vomiting, of vague sensations
dizziness, palpitations,
dsire to micturate •Reduces myocardial oxygen
demand to minimize risk of tissue
•Placed client at complete injury
rest during angina
episodes Facilitates gas exchange to
•

decrease hypoxia
Elevated head of bed , if
•

client is short of breath Blood pressure may initially rise

•

because of sympathetic stimulation

Monitored vital signs
•

every 5 min. during initial

angina attack Mental/ emotional stress increases
•

myocardial workload
•Maintained quiet,
comfortable environment, Decreases myocardial workload
•

restrict visitors as associated with workload of

necessary digestion, reducing risk of angina
attack
Provided light meals.
•

Have client rest for 1 hr Increases oxygen available for

•
Priority 2: Risk for Decrease
Cardiac Output R/T altered
heart rate/rhythm
Assessment Nursing Planning Intervention Rationale Evaluation
Diagnosis

Objective: Risk for After the 1.Maintained bed rest •Decreases oxygen Goal was
>edema decrease shift, the in position of comfort consumption/ demand, met,
>weight gain cardiac patient during acute episodes reducing myocardial The patient
>dysnea output will workload and risk of had actively
>Clammy skin related to Participa 2.Auscultated breath decompensation participated
sounds and heart
>decreased altered heart te in in activites
sounds . S3, S4, or crackles can
•
peripheral rate/rhythm activities that help
occur with cardiac
pulses that 3.Provided adequate decompensation. reduce the
>tachycardia reduce rest periods . workload of
the •Conserve energy, reduces the heart
workloa 4.Assess for signs cardiac workload
d of the and symptoms of
heart. Heart failure •Disease may compromise
cardiac function to point of
5.Evaluated mental decompensation
status, noting
development of •Reduced perfusion of the
confusion, brain can produce observable
disorientation changes in sensorium

6.Noted skin color •Peripheral circulation is

and presence of reduced when cardiac output
pulses falls, giving a skin pale or
gray color and diminishing
7.Administered the strength of peripheral
supplemental oxygen pulses
as needed
•Increase oxygen available
8.Monitored pulse for myocardial uptake to
oxymetry/ ABG as improve contractility, reduce
indicated ischemia, and reduce lactic
 Priority 3: Anxiety R/T
Change in Health Status
Assessment Nursing Planning Intervention Rationale Evaluation
Diagnosis

Objective: Anxiety R/T After the •Explained purpose of Reduces anxiety

• Goal was
>poor eye Change in shift the test and procedures attributable to fear of met, the
contact Health patient unknown diagnosis and patient
>restless Status will prognosis. identified
>irritable identify healthy
Encouraged
• •Verbalization of concerns
>difficulty healthy ways to
expression of feelings reduces tension, verifies
concentratin ways to and fears deal with
level of coping, and
g deal with facilitates dealing with and
>increased and feelings. expressed
tension express anxiety.
anxiety. Encouraged family
• •Reassures client that the
and friends to treat role in the family and
client as before business has not been
altered.
•Tell client the medical •Encourages client to test
regimen has been symptom control, to
designed to reduced increase confidence in
attacks and increase medical program, and
cardiac stability. integrate abilities into
perceptions of self
•Administered •May be desired to help
sedatives, client relax until physically
tranquilizers, as able to re-establish
indicated adequate coping
strategies.
 Discharged
Planning
 Medication:

- Continue medications as per advised by the medical doctor.

- Common medications for the treatment of Angina Pectoris to
decrease the workload of
the heart and increase myocardial perfusion:
a. Nitrates (NTG SL, PO, Spray, Patch and IV)
b. Beta Blockers (atenolol, metoprolol)
c. Calcium Channel Blocker (verapamil HCL)
 Discharged
Planning
 Exercise:

-Increase walking time by 5min/week until

walking 20-30min 3-4 times a week

-ankle flexion and extension exercises.

 Discharged
Planning
 Treatment:

-Surgical interventions are used to increase coronary

perfusion and myocardial oxygen supply such as:

a. PTCA- Percutaneous Transluminar Coronary

Angioplasty. – The insertion of a
balloon tip catheter

b. CABG- Coronary Artery Bypass Grafting.-

rerouting of coronary artery
 Discharged
Planning
 Health teaching:

-teach the patient to do the following after discharged:

- do not lift, push or pull anything greater than 10pounds for 4-6 weeks

- Return to work as prescribed the medical doctor

- resume sexual activity when physical exercises is tolerated well (ex: able to
climb 2 flights of stairs comfortably.)

- bring medications everyday everywhere.

- Avoid strenuous activities

 Discharged
Planning
 Out-patient:

- Regular follow-up check-up

- Update administration of medication that are prescribe
by the physician

 Diet

-Avoid processed food & Low salt, Low Fat and high in
fiber foods.