Patricia Camille A.

Navarro

The Human
Heart

What is Angina
Pectoris?
Angina pectoris (stable angina) is the
medical term for chest pain or
discomfort that results from reduced
coronary blood flow, causing a
temporary imbalance between
myocardial body supply and demand.
Angina isn't a disease; it is a symptom
of an underlying heart problem.

Factors associated with angina

pectoris

Pathophysiology
Coronary
atherosclerosis

Exposure to
cold
vasoconstrict
ion
elevated
blood
pressure

Physical
exertion
increasing
myocardial
oxygen demand

anemi
a

Legend:
Primary cause
Other factors
associated with AP
Concomitant
factors
S/S

significant
obstruction of a
major coronary
artery
reduced
coronary
blood flow
imbalance
between
myocardial
oxygen supply
and demand

Eating a
heavy
meal
increases the blood
flow to the
mesenteric area for
digestion
hypovole
mia
smoki
ng

Stress or
any
emotionprovoking
situation
release of
catecholamin
es
increases
blood
pressure
and heart
rate
Increase
myocard
ial
workloa
d

anaerobic metabolism
replaces aerobic
metabolism for
nourishment
produces lactic
acid
factor P is
released from
ischemic
myocardial cells
the heart muscle
does not have any
pain fibers pain is felt

wherever
substance P
reacts with a
pain receptor
poorly localized pain and may
radiate to the neck, jaw,
shoulders, and inner aspects of
the upper arms, usually the left

Angina Pectoris

Other symptoms:
Weakness or
numbness in the
arms, wrists, and
hands may
accompany the
pain
Shortness of breath
Pallor
Diaphoresis
Dizziness or lightheadedness
Nausea and

Medical Management: Pharmacologic Therapy

1. Nitroglycerin (glyceryl trinitrate)
Brand names : Deponit, Minitran, Nitro-Bid, Nitrocot,Nitro-Dur, Nitrogard,
Nitroglyn E-R, Nitroject, Nitrol, Nitrolingual, NitroMist, Nitrong SR, Nitro-par,
Nitrostat, Nitro-time, Transderm-Nitro, Tridil
Classification:
Chemical classification: Nitrates
Therapeutic Classification: Antianginal, antihypertensive, vasodilator

Mechanism of Action:
Nitrates cause blood vessels to relax and dilate. This results in a drop in
peripheral resistance and blood pressure and a decrease in venous return
to the heart. These actions will decrease myocardial workload and can
restore the appropriate balance in the supply demand ratio in the heart.

Indications: Treatment of acute angina, prophylaxis of angina, intravenous

treatment of angina unresponsive to beta-blockers or organic nitrates,
perioperative hypertension, and heart failure associated with acute myocardial
infarction; to produce controlled hypotension during surgery.
Contraindications:
Nitrates are contraindicated in the presence of any allergy to nitrates to
prevent hypersensitivity reactions.
These drugs also are contraindicated in the following conditions: severe
anemia because the decrease in cardiac output could be detrimental in a
patient who already has a decreased ability to deliver oxygen because of a low
red blood cell count;
Head trauma or cerebral haemorrhage because the relaxation of cerebral
vessels could cause intracranial bleeding; and
Pregnancy or lactation because of potential adverse effects on the neonate
and ineffective blood flow to the fetus.

Medical Management: Pharmacologic Therapy (Nitroglycerin) c

Medical Management: Pharmacologic Therapy

2. Beta-Adrenergic Blocking Agents
Beta-blockers recommended for use in angina are
metoprolol (Toprol), propranolol (Inderal), and atenolol
(Tenormin)
Mechanism of Action:
Appear to reduce myocardial oxygen consumption by
blocking the beta-adrenergic sympathetic stimulation to the
heart. The result is a reduction in heart rate, slowed
conduction of an impulse through the heart, decreased
blood pressure, and reduced myocardial contractility (force
of contraction) that establishes a more favorable balance
between myocardial oxygen needs (demands) and the
amount of oxygen available (supply). This helps to control
chest pain and delays the onset of ischemia during work or
exercise.

Indication:
They are indicated for the long-term management of angina pectoris
caused by atherosclerosis. These drugs are sometimes used in
combination with nitrates to increase exercise tolerance.
Contraindications:
The beta-blockers are contraindicated in patients with bradycardia,
heart block, and cardiogenic shock because blocking of the
sympathetic response could exacerbate these diseases. They also
are contraindicated with pregnancy and lactation because of the
potential for adverse effects on the fetus or neonate.

Medical Management: Pharmacologic Therapy (Beta-Adrenergic

Medical Management: Pharmacologic Therapy

3. Calcium Channel Blocking Agents
Calcium channel blockers include amlodipine
(Norvasc), diltiazem (Cardizem), nicardipine
(Cardene), nifedipine (Adalat, Procardia), and
verapamil (Calan, Isoptin).

Mechanism of Action:
Calcium channel blockers reduce myocardial oxygen
demand and increase myocardial blood and oxygen
supply, lowering blood pressure and reducing
myocardial contractility and heart rate. They are also
potent coronary vasodilators which increases oxygen
supply.

Indication:
Calcium channel blockers are indicated for the treatment of Prinzmetal
angina, chronic angina, effort associated angina, and hypertension. Because
they may actually increase ischaemia and mortality in those with heart
failure, or left ventricular dysfunction, these drugs are not usually prescribed
in the initial treatment of angina.
Contraindication:
Calcium channel blockers are contraindicated in the presence of allergy to
any of these drugs to avoid hypersensitivity reactions and with pregnancy or
lactation because of the potential for adverse effects on the fetus or neonate.

Medical Management: Pharmacologic Therapy (Calcium Channel

Medical Management: Pharmacologic

Therapy
4. 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.
Oxygen inhaled directly increases the amount of oxygen in the
blood

Medical Management: Alternative

Therapy
1. Cardiac Catheterisation
A generic form for a range of procedures such as percutaneous coronary
intervention (PCI), ventriculography, and atherectomy

Percutaneous Coronary Intervention

Medical Management: Alternative

Therapy

2. Coronary Artery Bypass

Nursing Management:
Assessment
What to assess?
patients symptoms and activities especially those
that precede and precipitate attacks of angina
pectoris
risk factors for CAD
patients response to angina
patients and familys understanding of the
diagnosis
adherence to the current treatment plan

ACRONYM

FACTORS ABOUT
PAIN THAT NEED TO
BE ASSESSED

ASSESSMENT QUESTIONS

Position/Location
Provocation

Quality
Quantity

Radiation
Relief

Severity
Symptoms

Timing

Where is the pain? Can you point to it?

What were you doing when the pain began?

How would you describe the pain?

Is it like the pain you had before?
Has the pain been constant?

Can you feel the pain anywhere else?

Did anything make the pain better?

How would you rate the pain on a 010 scale with 0

being no pain and 10 being the most amount of
pain? (or use visual analog scale or adjective rating
scale)
Did you notice any other symptoms with the pain?

How long ago did the pain start?

Nursing Management: Nursing

Dx
Ineffective myocardial tissue perfusion secondary to CAD, as
evidenced by chest pain or equivalent symptoms
Acute pain related to increased cardiac workload/oxygen
consumption
Anxiety related to fear of death
Deficient knowledge about the underlying disease and
methods for avoiding complications
Noncompliance, ineffective management of therapeutic
regimen related to failure to accept necessary lifestyle
changes

Nursing Management: Planning

and Goals
immediate and appropriate treatment when angina
occurs
prevention of angina
reduction of anxiety
awareness of the disease process and
understanding of the prescribed care
adherence to the self-care program
and absence of complications

Nursing Management: Nursing

Interventions
1. Treating Angina
When a patient experiences angina, the nurse should direct the
patient to stop all activities and sit or rest in bed in a semi-Fowler
position
Administer nitroglycerin sublingually and assess patients
response. If the chest pain is unchanged or is lessened but still
present, nitroglycerin administration is repeated up to three
doses.
The nurse administers oxygen therapy if the patients respiratory
rate is increased or the oxygen saturation level is decreased.

Nursing Management: Nursing

Interventions
2. Reducing Anxiety

Provide information about the illness, its treatment, and methods of

preventing its progression

Suggest stress reduction therapy such as music therapy

Address the spiritual needs of the patient and family

3. Preventing Pain

Identify the level of activity that causes the patients pain, and plans the
patients activities accordingly

Nursing Management: Nursing

Interventions
4. Teaching patients self care
The self-care program is prepared in collaboration with the patient and
family or friends. Activities should be planned to minimize the
occurrence of angina episodes.
The patient needs to understand that any pain unrelieved within 15
minutes by the usual methods should be treated at the closest
emergency center or the patient should call 911 for assistance.

Nursing Management:
Evaluation
Expected patient outcomes may include:
1. Reports that pain is relieved promptly
a. Recognizes symptoms
b. Takes immediate action
c. Seeks medical assistance if pain persists or changes in quality

2. Reports decreased anxiety

a. Expresses acceptance of diagnosis
b. Expresses control over choices within medical regimen
c. Does not exhibit signs and symptoms that indicate a high
level of anxiety

Nursing Management:
Evaluation
3. Understands ways to avoid complications and demonstrates
freedom from complications
a. Describes the process of angina
b. Explains reasons for measures to prevent complications
c. Exhibits normal ECG and cardiac enzyme levels
d. Experiences no signs and symptoms of acute MI

4. Adheres to self-care program

a. Takes medications as prescribed
b. Keeps health care appointments
c. Implements plan for reducing risk factors

Potential Complications

Myocardial infarction
Congestive heart failure
Acute pulmonary edema
Cardiogenic shock
Dysrhythmias and cardiac arrest