Angina also known as angina pectoris is a medical condition characterized by chest pain usually left sided due to inadequate blood supply (ischemia) to the heart muscles due to obstruction (like presence of blood clot), narrowing or contraction (vasospasm) of the supplying coronary arteries.

1. ANGINA PECTORIS
PRESENTED BY
MR. ABHAY RAJPOOT
M.SC.NURSING FINAL YEAR

2. DEFINITION
A disease marked by brief sudden attacks of chest pain or discomfort
caused by deficient oxygenation of the heart muscles usually due to
impaired blood flow to the heart.

3. INCIDENCE:
An estimated 10 million people in the US suffer from angina.
According to the Framingham Heart Study, an estimated 500,000
new cases of stable angina occur each year.

4. TYPES:
 Stable Angina
 Unstable Angina
 Variant Angina Pectoris
 Nocturnal Angina Pectoris

5. RISK FACTORS:
MODIFIABLE RISK FACTORS:
 Tobacco use
 High blood cholesterol or triglyceride levels
 Lack of exercise
 Obesity
 Stress
NONMODIFIABLE RISK FACTORS:
 Family history of heart disease
 Older age
 Diabetes
 High blood pressure

6. CAUSES
Development of atherosclerosis;
Coronary artery disease is thought to begin with damage or injury to
the inner layer of a coronary artery, sometimes as early as childhood.
The damage may be caused by various factors, including:
 Smoking
 High blood pressure
 High cholesterol
 Diabetes or insulin resistance
 Sedentary lifestyle

7. PATHOPHYSIOLOGY:

8. SYMPTOMS:
CARDIOVASCULAR-
 Angina pectoris- it is sensation of chest pain , pressure or squeezing often due to
insufficient blood flow to the heart muscle as a result of obstruction.
 Ischemia- Ischemia is a restriction in blood supply to tissues, causing a shortage
of oxygen that is needed for cellula.
 Low cardiac output-
 Chest pain –chest pain occurs suddenly , severe immobilizing chest pain that not
relieved by rest , position change and medications.
 Decrease pulse rate.
 BP may be elevated beacuase of sympathetic stimulation or decreased BP because
of decreased contractility, development if cargiogenic shock .
 Myocardial infarction- when the blood flow decreases or stop to apart of the heart
, causing damage to the heart muscle.
 Diaphoresis –excessive sweating
 ECG changes – ST segment and T wave changes, also show tachycardia,
bradcardia, or dysrhythimas.
 Dysarrithmias

9. CONTI…
RESPIRATORY-
 Shortness of breath.
 Pulmonary edema
 Chest heaviness
 Dyspnea- difficulity of brathing
 Fatigue

10. CONTI….
 Genitourinary-Decreased Urinary Output May Indicate Cardiogenic
Shock.
 Gastrointestinal- Nausea And Vomiting
 Skin- Cool, Clammy ,Diaphoretic , And Pale Appearance On Skin

11. DIAGNPOSTIC EVALUATION
 Physical Examination
 History collection
 Stress test

12. Chest X-ray.

13. Electrocardiogram (ECG).

14. Echocardiogram

15. Cardiac catheterization (angiogram).

16. COMPLICATIONS:
 Heart attack
 Heart failure
 Abnormal heart rhythm (arrhythmia)

17. PREVENTION:
 Quitting smoking
 Monitoring and controlling other health conditions, such as high
blood pressure, high cholesterol and diabetes
 Eating a healthy diet and maintaining a healthy weight
 Increasing physical activity. Aim for 150 minutes of moderate
activity each week. Plus, it's recommended that person get 10 minutes
of strength training twice a week and to stretch three times a week for
5 to 10 minutes each time.
 Reducing your stress level
 Limit alcohol consumption to two drinks or fewer a day for men, and
one drink a day or less for women.
 Get an annual flu shot to avoid heart complications from the virus

18. MEDICAL MANAGEMENT:
Various drugs can be used to treat coronary artery disease, including:
 Vasodilators (These drugs acts as blood vessel dilator):
• Nitrates
 Beta-Blockers (Decrease work load in heart):
• Propranolol 20-40 mg
 Calcium channel blocker (They improve coronary blood flow):
• Nifedipine
• Verapamil

19. CONTI….
 Anticoagulant Drugs:
 Heparin
 Opiate Analgesic (For reduce pain)
 Morphine sulphate
 Thrombolytic Drugs:
 Streptokinase,Urokinase

20. ANTIHYPERTENSIVE MEDICINES-
 Methydopa - This medication is used alone or with other medications
to treat high blood pressure (hypertension). Lowering high blood
pressure helps prevent strokes, heart attacks, and kidney problems.
Methyldopa works by relaxing blood vessels so blood can flow more
easily.
 Sodium nitroprusside- It is used for lowering the blood pressure.
 Amlodipine- Amlodipine is used with or without other medications to
treat high blood pressure. Lowering high blood pressure helps prevent
strokes, heart attacks, and kidney problems. Dose-10 mg,20 mg.

21. SURGICAL MANAGEMENT
 Angioplasty and stent placement (percutaneous coronary revascularization):

22. Coronary artery bypass surgery:

23. NURSING MANAGEMENT
 Instruct the client regarding the purpose of diagnostic medical &
surgical procedures and the pre- & post procedure expectations.
 Assist the client to identify risk factors that can be modified, and set
goals that will promote change in lifestyle to reduce the impact of risk
factors.
 Instruct client regarding a low-calorie, low-sodium, low-cholesterol,
low-fat diet with a increase in dietary fiber. Stress that dietary changes
are not temporary and must be maintained for life.
 Provide community resources to client regarding exercise, smoking
cessation and stress reduction.

24. NURSING DIAGNOSIS
 Impaired gas exchange related to decreased blood flow as evidenced by
breathlessness
 Acute pain related to disease condition as evidenced by patient verbalization
 Impaired physical mobility related to weakness as evidenced by patient is
unable to perform daily activity.
 Imbalanced nutrition less than body requirement related to less intake of food
as evidenced by weight loss
 Disturbed sleep pattern related to hospitalization as evidenced by patient
verbalization
 Anxiety related to hospitalization as evidenced by patient asking too many
question.
 Knowledge deficit related to disease process and treatment as evidenced by
patient is having many doubts

25. RESEARCH STUDY
Sleeping less than four hours or more than eight hours a night increases
the risk of dying from some types of coronary heart disease, such as heart
attacks and unstable angina pectoris, according to a study by Norwegian
and Taiwanese researchers.
"This is the single largest study that has looked at how sleep duration
affects the risk of dying from cardiovascular disease. Our results show
that enough, but not too much sleep is important for a healthy lifestyle,"
says first author and postdoctoral fellow Linn Beate Strand at the
Norwegian University of Science and Technology's Department of Public
Health and General Practice.

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india Pvt ltd ;2014.p729-759.
 Chugh N S . text book of medical surgical nursing .volume 1.delhi;avichal
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 https://www.webmd.com/heart-disease/guide/heart-disease-coronary-
artery-disease#1
 http://www.heart.org/en/health-topics/consumer-healthcare/what-is-
cardiovascular-disease/coronary-artery-disease
 https://www.nhlbi.nih.gov/health-topics/coronary-heart-disease
 https://www.nhlbi.nih.gov/health-topics/coronary-heart-disease
 https://my.clevelandclinic.org/health/diseases/16898-coronary-artery-
disease