Medical management for the pt with angina pectoris

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					     Angina Pectoris

Prepared by :
                Ansam Sharef
                Ahmad Aswad




                               1
 Angina Pectoris

Definition :
 Angina pectoris is a clinical syndrome
 usually characterized by episodes of pain
 or pressure in the anterior chest . The
 cause is usually insufficient coronary
 blood flow which results in a decreased
 oxygen supply to meet an increased
 myocardial demand for oxygen in
 response to physical exertion or
 emotional stress.
                                       2
Pathophysiology

Myocardial ischemia can result from:

•   A reduction of coronary blood flow
    caused by fixed &\or dynamic
    epicardial artery stenosis.

•   Abnormal constriction or deficient
    relaxation of coronary artery.

•   Reduce O2-carrying capacity of the
    blood .
                                         3
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Factors are associated
with typical angina
pain

1. Physical exertion (increase
   myocardial o2 demand).
2. Exposure to cold ( cause elevation
   of BP increase oxygen demand )
3. Eating heavy meals
4. Stress or any emotion-provoking
   situation
                                        5
Type of angina

1. Stable angina: predictable &
   consistent pain that occurs on
   exertion and relieved by rest.

2. Unstable angina or preinfarction or
   cresendo angina: symptoms occur
   more frequently and longer than
   stable angina.

3. Intractable or refractory angina:
   sever incapacitating chest pain.
                                         6
 Type of angina


4. Variant angina or prinzmetals angina :
   pain at rest with reversable ST-
   segment elevation, caused by coronary
   artery vasospasm.

5. Silent ischemia: objective evidence of
   ischemia (as ECG changes with a test),
   but pt report no symptom.
                                      7
Risk Factors for
atherosclerosis

1. Family history of premature
     coronary artery disease.
2.   DM, systemic HTN.
3.   Cigarette smoking.
4.   Hypercholesterolemia.
5.   Others as obesity, increase
     levels of lipoprotein,fibrinogen,
     s.triglycerides.
                                     8
Clinical manifestations

1. May produce pain vary in severity
   from feeling of indigestion to
   chocking in retrosternal area ,
   radiate to neck , jaw shoulders ,
   inner aspects of upper arms

2. Feeling of weakness or numbness
   in the arms , wrists and the hands

3.   Shortness of breath
                                        9
Clinical manifestations

4. Pallor, Diaphoresis

5. Dizziness or
   lightheadedness

6. Nausea and vomiting



                          10
Diagnostic findings

  Often made by evaluating the
  clinical manifestations of ischemia
  and the pts history

1. 12-Lead ECG and blood laboratory
   values help in making diagnosis

2. C-reactive protein ( CRP) is a
   marker for inflammation of vascular
   endothelium which caused by CAD
                                      11
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Diagnostic findings

3. An elevated blood level of
   homocysteine ,an amino acid
   proposed as an
   independent risk factor for
   cardiovascular disease , but no
   studies supported the relationship
   between elevation of
   homocysteine and atherosclarosis


                                    13
Medical management for
the pt with angina pectoris




                         14
• The objective is to decrease
  oxygen demand of myocardium
  and to increase oxygen supply

• 1.Nitroglycerin : administered to
  reduce myocardial oxygen
  consumption

                                  15
2.Beta-adrenergic blocking agents :
  ( propranolol ,metoprolol , atenolol)
  appear to reduce myocardial oxygen
  consumption, result in a reduction in
  heart rate, decreased BP , and
  reduced myocardial contractility .




                                      16
3-Calcium channel blocking
  agents : some decrease
  sinoatrial node automaticity and
  node conduction ,resulting in
  slower heart rate



                                 17
4- Antiplatelet and
anticoagulent
medications


  Aspirin: prevents platelet
  activation and reduces the
  incidence of MI and death with
  CAD

  Heparin : prevents the
  formation of new blood clots
                                 18
•   Oxygen administration :
    usually initiated at the onset of
    chest pain to increase the amount
    of oxygen delivered to the
    myocardium and to decrease the
    pain.


                                        19
Prevention

Self care action plan changing habits.

 Stop smoking
 Increase level of exercise
 Cut down on fatty foods
 Eat more oats, which decrease
  cholesterol
                                     20
 Lose wt if u DR. thinks you are
  overweight.

 Make sure your BP is not high by
  regular check

 Consider another method of
  contraceptive if you take pill

                                     21
Nsg process for pt with
Angina pectoris

 Assessment

The nurse gather information about
the pts symptoms and activities .
The nurse may ask about the period
that angina last , and if any
medication relieve the angina.


                                     22
Diagnosis


1. Ineffective myocardial tissue
   perfusion secondary to CAD as
   evidence by chest pain or equivalent
   symptoms

2. Anxiety related to fear of death

                                      23
Diagnosis


3. Noncompliance , ineffective
   management of therapeutic
   regimen related to failure to
   accept necessary lifestyle changes




                                    24
Planning and goals



 The major goal include
 immediate treatment when
 angina occur , preventing of
 angina , reduction of anxiety
 and absence of complications



                                 25
NSG interventions


1. Treating angina : when pt
   experiences angina the nurse should
   direct pt to stop activities and sit or
   rest in bed in semi-fowler position

2. Reducing anxiety : The nurse should
   explore and implicate that the
   diagnosis has for the pt providing
   information about the illness ,
   treatment and methods of preventing
   its progression                    26
3. Preventing pain : when the pt has
   pain with minimal activity , the
   nurse alternates the pts activities
   with rest periods




                                         27
Evaluation


expected pts outcomes may include


1. Reports that pain is relieved
   promptly

2. Reports decreased anxiety


                                    28
3. Understands ways to avoid
   complications and demonstrates
   freedom from complications

4. Adheres to self-care program



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