Angina Pectoris

Chest pain that is transitory and paroxysmal is referred to as angina pectoris. Myocardial ischemia, which results in inadequate blood flow to the heart muscle, causes the chest pain..

Risk factors of Angina Pectoris

Angina is brought on by CAD, atherosclerosis, hypertension, diabetes, thromboangiitis obliterans, severe anemia, aortic insufficiency, exertion, emotion, and exposure to cold.

Pathophysiology

Myocardial ischemia can result from:

• An acute blockage of the heart's arteries brought on by stenosis, spasm, or an embolus that reduces blood flow to the heart.
• Vessel resistance in the blood
• educed blood's ability to carry oxygen.
• Decrease supply:
  • A coronary artery disorder that reduces blood flow and supply
  • Vascular spasm and atherosclerosis raise flow resistance.
  • circulatory system dysfunction
  • Hypotension (drug use, blood loss, and spinal anesthesia) reduces the heart's ability to receive blood
  • Filling pressure of the coronary arteries in the presence of aortic stenosis or insufficiency
• Increased demand:
  • Exercise, emotion, eating a large meal, anemia, and hyperthyroidism all increase cardiac output.
  • Increased need for oxygen in the myocardium, such as in cases of hypertension, myocardial hypertrophy, thyrotoxicosis, intense emotion, or strenuous activity
• Reduced oxygen-carrying capacity of the blood for example anemia:

                             Atherosclerotic changes in coronary artery

                                                               ↓

                                             Obstruction of coronary artery

                                                              ↓

                                      Decrease in blood flow to the heart

                                                              ↓

                         Decrease in oxygen supply Ischemia of the tissues`

                                                              ↓

                                              Chest pain (angina)

Classifications

• Stable angina: Additionally known as exertional angina. It is brought on by physical exertion or emotional stress and is alleviated by rest or nitroglycerin.
• Unstable angina: Additionally known as preinfarctional angina. It happens with an unpredictably high level of effort or emotion and gets worse over time, becoming more frequent and lasting longer. Nitroglycerine might not be able to ease pain.
• Variant angina: Also known as vasospastic angina or Prinzmetal's angina. It can happen while you're at rest and is caused by coronary artery spasm. ST segment elevation seen on the ECG may be connected to the attacks.
• Intractable angina: A persistent, incapacitating angina that does not respond to treatment

Signs and Symptoms

Angina typically results in substernal chest pain that feels like pressure, crushing, tightness, or squeezing; it may radiate to the arms, neck, jaw, or back and is relieved by rest. Additional clinical signs include:

• Tachycardia and palpitations
• Hypertension.
• Dyspnea.
• Diaphoresis.
• Pallor.
• Fainting and dizziness

Diagnosis

• History of chest pain.
• Cardiac catheterization or angiography.
• ECG and ambulatory ECG, TMT.
• Cardiac enzymes, TC, DC.
• Chest X-ray.

Management

The goals of angina management Relieving an acute attack (2) Preventing more attacks to lower the risk of MI The goal of treatment is to reduce the myocardium's oxygen demand, increase oxygen supply, and relieve symptoms.

• Pharmacological management:
  • Vasodilators, such as Nitroglycerines, GTN, nitri mononitrate, and isordil can be administered orally, intravenously, topically, or sublingually to lower myocardial oxygen demand and cardiac stress.
  • By preventing platelet aggregation, antiplatelet medications like aspirin and clopidogrel reduce the formation of thrombus.
  • Beta-blocking medications, such as metoprolol, atenolol, and propranolol, lower myocardial oxygen consumption by lowering heart rates and myocardial contractility and afterload.
  • Smooth muscle relaxation, peripheral vasodilation, and afterload are caused by calcium channel blockers such amlodipine, verapamil, and diltiazem.
  • Ischemia inhibitors
  • Inhibitors of the angiotensin-converting enzyme (ACE) aid in blood vessel relaxation.
• Dietary management:
  • Diet with low L cholesterol and saturated fat. Increase your consumption of fresh produce and whole grains.
• Surgery: Patients with left main artery stenosis greater than 50%, 2- or 3-vessel disease dysfunction (ejection fraction, 45%), poor prognostic signs during noninvasive studies, or severe symptoms despite receiving the maximum amount of medical treatment may be candidates for revascularization therapy.
  • Angioplasty by the percutaneous transluminal route, either with or without coronary stenting.
  • Bypassing the coronary arteries (CABG)

Nursing Management

Assess the patient's state of awareness, pain, vital signs, dysrhythmias, cardiac output, anxiety, dyspnea, pallor, and diaphoresis. Learn about the location, radiation, frequency, aggravating and mitigating factors throughout the pain assessment process. The acronym "PQRST" can be used to quantify pain.

• Place the patient in a semi-high Fowler's posture and give them bed rest.
• As directed, administer 02 at 3L/min with a nasal cannula.
• As directed, give nitroglycerin or narcotic analgesics for quick pain relief.
• Obtain a 12-lead ECG and continually monitor the ECG
• Offer emotional assistance
• Tell the patient to call the doctor if they experience pain that doesn't go away with rest or medication.
• Provide teaching:
  • Purposes of diagnostic procedure, management, assessment of pain
  • Proper use of nitrates
  • Nitroglycerine sublingual
• Allow the tablet to dissolve:
  • To prevent dizziness, unwind for 15 minutes after taking the medication.
  • If one tablet does not provide relief, take additional tablets at 5-minute intervals, but do not take more than three tablets in a 15-minute period.
• A frequent adverse effect is a brief headache.
• Prevent exposure to air, light, and heat by keeping the bottle tightly closed.
• Make sure tablets are always accessible.
• Verify the medicine's shelf life and expiration date.
• Nitroglycerine ointment: rotate sites to prevent inflammation and remove previously applied ointment. Avoid rubbing or massaging as these activities increase absorption and impede the drug's sustained action.
• Ways to minimize precipitating events:
  • By using relaxation techniques, reduce tension and anxiety.
  • Avoid using tobacco, becoming too hot, or going too cold.
  • Eat little and often.
• Increase your activity and exercise gradually. can exercise on a regular basis while maintaining rest times.
• Diet: low in saturated fat and cholesterol
• Keep your ideal weight.

Evaluation

• The patient is still pain-free.
• The patient is still trouble-free.
• The patient doesn't display any symptoms of a high level of anxiety.