Etiology | Risk factor | Clinical Manifestation | Pattern of Angina | Diagnostic Evaluation | Management | Nursing management |
Angina Pectoris – Chest Pain – Risk factor, Clinical Manifestation
Introduction:-
- Angina pectoris occurs when myocardial demands exceed, myocardial oxygen supply decreased usually caused by obstruction of the coronary artery.
- chest pain due to an inadequate supply of oxygen to the heart muscle is characterized by a feeling of suffocation.
Etiology of Angina Pectoris:-
- atherosclerosis
- prolong narrowing
The Risk factor of Angina Pectoris:-
- Thromboangiitis obliterans (inflammation of a small and medium vein and thrombosis of extremities.
- Polycythemia Vera (thickness of blood)
- Polyarteritis nodosa (inflammation of artery due to infiltration of eosinophils.)
{Note: Angina can be triggered by exercise, cold, or anything that increases the workload of heart}
Clinical manifestation of Angina Pectoris:-
- Pain:- location: 90% of the clients experience pain slightly left to the sternum.
duration:- Angina usually lasts for 10 min. however, attacks precipitate by emotional disturbance last for 15-20 min.
Severity: the pain is described as mild or moderate or often called as Discomfort.
- Dyspnea, weakness, light headache, nausea, vomiting, emptiness, restlessness.
The pattern of Angina Pectoris:-
- Stable Angina:-It is an acute chest pain triggered by exercise or emotion.
- Unstable Angina:- It is also acute pain but unpredictable degree or cause.
- Variant Angina:- It is also called Prinzmetal’s angina and it is for a longer duration.
- Nocturnal angina:- It is possibly associated with rapid eye movement during sleeping or dreaming.
- Angina Decubitus:– It is proximal chest pain that occurs when the client stands up.
- Post-Infarction Angina:-pain occurs after a heart attack.
Diagnostic Evaluation of Angina Pectoris:-
- ECG
- Coronary Angiography
- Blood test
- Echocardiogram
- Electron beam computed domography [EBCD]
Management of Angina Pectoris:-
- The objective of the medical management in angina is to decrease the oxygen demand of the myocardial and to increase the oxygen supply.
- Medically these objectives are met through pharmacological therapy and control of risk factors. Medical management focus on these three points:-
- Relieve acute pain.
- Risk of coronary blood flow.
- Prevent further attack to reduce the risk of myocardial infarction.
A: Aspirin and antianginal therapy
B: beta-blocker and blood pressure control
C: cigarette smoking and cholesterol control
D: Dietary modification
E: Education and exercise.
- Restore blood supply
- PTCA
- Intracoronary strain
- Laser ablation
- CABG (coronary artery bypass grafting)
Nursing management of Angina Pectoris:-
Nursing Diagnosis:-
- Acute chest pain related to decreasing blood supply to the heart resulting from coronary artery obstruction,
- Ineffective tissue perfusion related to decreased cardiac output as evidence by cyanosis, decrease arterial oxygen, and dyspnea.
- Risk of heart failure related to the disease process.
- Anxiety and fear are related to hospital admission, fear of death, fear of treatment procedure, and disease process.
- Risk of impaired skin integrity related to bed rest, edema, and decrease tissue perfusion.