ANGINA PECTORIS -episodic chest pain due to insufficient oxygen supply by the blood to the heart muscle (mild

ischemia) -secondary to significant coronary atherosclerosis or coronary spasm . -relieved by rest and nitroglycerin Precipitating Factors 1. 2. 3. 4. 5. Exercise Extreme of temperature Emotions Excessive eating Exertion

Types of angina A. Stable predictable and consistent pain that occurs on exertion and is relieved by bed rest B. Unstable angina chest pain occurs more frequently and lasts longer than stable, but ECG or cardiac biomarkers shows no evidence of acute MI Pain may occur at rest C. Intractable or refractory angina severe incapacitating chest pain D. Variant due to coronary vasospasm E. Silent angina evidence of ischemia on ECG but no symptoms Clinical Manifestation 1. 2. 3. 4. 5. 6. 7. Chest Pain radiates toward the neck, jaw, shoulder and left upper arm. Feeling of indigestion Choking sensation Heavy sensation of the chest Apprehension/Feeling of impending death Feeling of weakness or numbness in the arms, wrists and hands Shortness of breath

Diagnostic Tests 12 lead ECG Stress test Cardiac catheterization 2 D echocardiography

Medical management Pharmacologic therapy

I. II. III. IV.

Nitroglycerin (nitrates) Mainstay for treatment of angina pectoris Dilates the vein and arteries, increase coronary blood flow, increase perfusion Routes : Sublingual, spray, topical and IV SE : hypotension CI : SBP <90mmHg Beta-Adrenergic blocking agents Propanolol, atenolol, metoprolol Block the beta adrenergic sympathemic stimulation to the heart SE : hypotension, bradycardia,, decrease libido, heart failure Calcium Channel blockers Decreases heart rate by decreasing SA node automaticity and AV node conduction Ex. Amlodopine, verapilim, dilataizam SE : hypotension, bradycardia, constipation, gastric distress Anti platelet/Anti coagulant

-Prevent platelet aggregation which may impede bood flow - A. aspirin prevents platelet activation -B. Clopidogrel SE: N\V Decrease neutrophil count -C. Heparin prevent the formation of new blood clots -D. GP Iib/IIIa agents (ABCIXIMAB) -for patients with unstable angina -prevent platelets aggregation -E. Oxygen -F. Alternative IV infusion of herbal medicine Nursing Diagnosis 1. Ineffective myocardial tissue perfusion 2. Anxiety related to fear of death 3. Alteration in comfort

Potential Complication 1. 2. 3. 4. 5. 6. 7. 8. Acute pulmonary edema CHF Cardiogenic shock Dysrhythmia Myocardial Infarction Myocardial rapture Pericardial effusion Cardiac tamonade

Nursing Intevention 1. 2. 3. 4. 5. 6. A patient in chest pain Instruct patient to stop all activities. To sit and rest in bed Position : semi fowlers Monitor vital signs Get a 12 lead ECG Give sublingual NTG Give O2 at 2 LPM even if not in respiratory distress