ANGINA PECTORIS

A MEDICAL OVERVIEW

ANGINA PECTORIS
A major clinical manifestation of myocardial
ischemia usually characterized by episodes of
pain or pressure in the anterior chest
Oftentimes a Precursor to Myocardial
Infarction

Normal Cardiac Anatomy and

Physiology

RISK FACTORS
MODIFIABLE:
Atherosclerosis
Obesity
Diabetes
Hypertension
Sedentary Lifestyle
Metabolic Syndrome
Unopposed estrogen
taking

NON-MODIFIABLE:
Age (Post Menopausal
Women)
Race
Gender
Familial Tendency

TYPES
1.
2.
3.
4.
*

Stable Angina
Unstable Angina
Prinzmetal | Atypical | Variant
Angina Decubitus
Syndrome X

PATHOPHYSIOLOGY
Risk Factors

Narrowed arterial coronary

lumen
Exertion, Physical Activities

Increased myocardial workload

Increased myocardial oxygen demand
Narrowed coronary arteries
unable to meet Myocardial demand
Anginal Pain, S/S

Myocardial Ischemia

SIGNS AND SYMPTOMS

CHEST PAIN
L- Retrosternal area
Q- Heavy Sensation, Feeling of impending
death, squeezing, burning, choking sensation
R- Epigastrum, Back, Neck, Jaw, Shoulders,
Inner aspects of the upper arm (usually left
arm)
S- Severe (rated 7-10) in pain rating scale
T- Maybe precipitated or unprecipitated

Palpitations
Pallor
Diaphoresis
Nausea and Vomiting
(+) Levines Sign
S3 and S4 heart sounds
Dizziness / Lightheadedness
Shortness of Breath

DIAGNOSTIC FINDINGS
Blood tests
Reveal: LDL, Triglyceride, VeryLDL,
Erythrocyte Sedimentation rate, C-Reactive
protein ; HDL
Electrocardiography (ECG) (Usually a 12-lead
ECG is used)
Stable and Unstable- ST Depression
Prinzmetal- ST Elevation
Stress Test with ECG
Echocardiography

Normal ECG Tracing

Stress Test

Echocardiography

Coronary Angiography (Gold Standard)

Definition
A Procedure performed to detect obstruction
in the coronary arteries of the heart. During
the procedure a catheter is inserted into an
artery into the arm or groin (subclavian /
femoral) and then threaded carefully into the
heart The blood vessels of the heart are then
studied by injection of contrast media through
the catheter. A rapid succession of X-rays
(fluoroscopy) is taken to view blood flow.

Nursing Considerations
Assess patient allergy to iodine (seafood)
Assess blood test results for possible surgical
complications: hgb, aPTT, BUN, creatinine,
plt, electrolyte levels
During Procedure: Continuous BP and ECG
monitoring, ensure IV line patency, Prepare
resuscitation equipment incase any
complication may occur
Outpatient basis: 2-6 hours bed rest before
ambulation
After: Monitor for bleeding on catheter
insertion site

Pharmacological Treatment

ANTIPLATELET
Aspirin (ASA)
bleeding precautions, blood coagulation tests,
dont use in patients with severe anemia,
caution in pt with gout
Clopidogrel (Plavix) for patients with
contraindications to aspirin

BETA-BLOCKERS
Metoprolol, Atenolol, Propanolol
-Compete with endogenous catecholamines
for beta-adrenergic receptors
-Contraindicated in CHF, Asthma, cardiogenic
shock, AV conduction abnormalities

CALCIUM CHANNEL BLOCKERS

Smooth muscle relaxation-peripheral arterial
vasodilation
Amlodipine(Norvasc), Diltiazem, Verapamil,
-May increase LFT, use with caution in
hepatic and renal patients, A/E include
constipation (valsalva maneuver)

Short-Acting Nitroglycerin
Immediate relief of exertional or rest angina
Nitroglycerin (Nitrostat, Nitro-bid, Nitrol)
- Metered dose sprays and patches are used
for prophylaxis
Caution patients on vasodilating effects
(headache), C/I in severe anemia, ischemia
may worsen upon withdrawal

Long Acting Nitroglycerin

Causes venous and arterial dilatation

Ideal for prinzmetal angina
Isosorbide (Isordil, ISMO)
For patients with poor prognosis

ACE Inhibitors
Inhibits conversion of angiotensin I to
angiotensin II thereby breaking RAAS chain
resulting to vasodilation and reduced fluid
retention (lowered aldosterone secretion)
Ramipril (Altace)

Anti-ischemic Agents
Ranolazine (Ranexa)
-prolongs QT interval (Torsades de Pointes),
inhibits fatty acid oxidation
-indicated for Chronic Angina unresponsivce
to other anti-anginal agents
-does not reduce blood pressure or heart rate

SURGICAL TREATMENTS

Percutaneous Transluminal Coronary

Angioplasty (PTCA)

Nursing Considerations:
Assess blood test results for possible surgical
complications: hgb, aPTT, BUN, creatinine,
plt, electrolyte levels
During Procedure: Continuous BP and ECG
monitoring, ensure IV line patency, Prepare
resuscitation equipment incase any
complication may occur
After: Monitor for bleeding on catheter
insertion site
Place 10lbs Sandbag on catheter insertion
site (Femoral Artery) for max of 6 hours after
surgery

Diet and Lifestyle Modifications

Specifics
Reduce fat, sodium and cholesterol in the diet
Avoid stimulating agents such as those that
contain caffaine (coffee, chocolate)
Quit/ STOP smoking
Reduce Stress
Exercise
Treatment of Underlying Disease (DM, HTN,
Obesity)

Thank You!!!