ANGINA PECTORIS

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CORONARY ARTERY
DISEASE / ISCHEMIC
HEART DISEASE

Jyothi lekshmi s
INTRODUCTION

Ischemic heart disease (IHD), is a disease

characterized by ischemia (reduced blood
supply) to the heart muscle, usually due to
coronary artery disease (atherosclerosis of
the coronary arteries).
 Coronary artery disease (CAD) is the most
common form of heart disease.

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 Coronary artery disease (CAD) (or
atherosclerotic heart disease or
atherosclerosis) is the end result of the
accumulation of atheromatous plaques
within the walls of the coronary arteries
that supply the myocardium (the muscle of
the heart) with oxygen and nutrients.
 Coronary artery disease is a narrowing of the
small blood vessels that supply blood and
oxygen to the heart.

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Angina Pectoris
 It is recurring acute chest pain or discomfort
resulting from decreased blood supply to the
heart muscle(myocardial ischemia).
 Angina occurs when the heart’s need for
oxygen increases beyond the level of oxygen
available from the blood nourishing the heart.
Angina is a common symptom for coronary
heart disease (CHD).
 The symptoms of angina include mild or severe
pain, pressure, or discomfort in the chest, the
pain is generally described as a feeling of a
squeezing, strangling, heaviness, or suffocation
sensation in the chest.
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 Angina is the symptom complex caused

by transient myocardial ischaemia and is a clinical

syndrome rather than a disease.

 Definition
Angina pectoris is a primary
symptom of myocardial ischemia,
which is the severe chest pain that
occurs when coronary blood flow is
inadequate to supply the oxygen
required by the heart.
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INCIDENCE
Occurs in both men and women of
any age but commonly middle age
and older adults.
ETIOLOGY  Stress or any
 Atherosclerotic emotion-provoking
disease situation
 Obstruction of a  Sedentary lifestyle
major coronary  Diabetes
artery.  High cholesterol
 Physical exertion  High blood
 Exposure to cold pressure
 Eating a heavy  Smoking
meal

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 Diabetes mellitus  Atherosclerosis
 Smoking  Coronary artery spasm
 Left ventricular
 Use of cocaine
dysfunction
 Obesity  Blockage of coronary
 Arterial disease – artery by blood clot or
compression
Peripheral vascular
diseases  Inflammation or
 Anaemia infection of coronary
 Thyrotoxicosis artery
 Poor functioning of  Injury to coronary
tiny blood vessels artery
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Physical Exertion

Cold exposure

Intense emotions

Heavy meals

Hypertension
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CHARACTERISTICS OF ANGINA
1.Onset:- It can develop quickly or slowly.
2.Location:- Retrosternal or to the left of
sternum.
3.Radiation: Radiates to left shoulder and
upper arm then travels to inner aspect of left
arm to the elbow, wrist, fourth and fifth
fingers. Also, to right shoulders, neck, jaw,
or epigastric region .

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4.Duration: Less than 5 minutes.⚫
5.Sensation: As squeezing, burning,
pressing, choking, aching, or bursting
pressure. It feels like gas, heart burn or
indigestion.
6.Severity: Mild or moderate in severity
7. Associated characteristics: Dyspnea,
pallor, sweating. faintness, palpitation,
dizziness and digestive disturbance.
8. Relieving/aggravating factors:
Aggravated by continued activity and
relieved by nitroglycerin and rest.
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 Is caused by narrowed arteries due to
atherosclerosis
 Occurs when the heart works harder
 Episodes of pain tend to be alike
 Usually lasts a short time
 Is Effort-induced pain from physical
activity or emotional stress
 Relieved by rest
 Predictable and reproducible relieved by
a rest or angina medicine
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 PATTERNS OF ANGINA:-
1.Stable angina:- Predictable and consistent
pain that occurs on exertion and is relieved
by rest.
2.Unstable angina:- (pre infarction angina):
Symptoms occur when the patient is at rest;
symptoms occur more frequently and last
longer. Threshold for pain is lower as well.
3.Variant angina (Prinzmetal's angina):-
Chest discomfort of longer duration while
the client is at rest happens in the early
hours of the day. Results from coronary
artery spasm with elevation of ST segment in
ECG
4.Intractable or refractory angina:-
Severe incapacitating chest pain.
6.Silent ischemia:- Objective evidence of
angina but patient reports no
symptoms.
7. Post infarction angina:- It occurs
after MI, when residual ischemia may
cause episodes of angina.
8.Angina decubitus: -Angina
decubitus is a variant of angina
pectoris that occurs at night while
the patient is recumbent.  27
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Typical Symptom
 Heavy strangling or pressure-like pain

 Sometimes may feel like indigestion,

 Located in substernal area or

praecordium
 Radiating to the left shoulder, left arm,

jaw , neck,
Epigastrium or back.
PAIN:-
 over sternum and
spreads down the left
arm also to backsides
upper abdomen,
neck , jaw or even
teeth.
Type –dull ache ,
heaviness or a
crushing sensation .
 Pain and discomfort  Shortness of breath
 Heavy sensation in the  Pallor
upper chest  Diaphoresis
 A feeling of weakness  Dizziness or
or numbness in the lightheadedness
arms, wrists, and  Nausea and vomiting
hands  Anxiety

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 ECG:- Suggests transient ischemic attacks with ST
segment elevation or depression and coronary
artery involvement.
 Exercise ECG: During a stress test, client
exercises on a treadmill or stationary bicycle until
reaching 85% of maximal heart rate.
 Radioisotope imaging: Regions of poor perfusion
or ischemia appears as areas of diminished or
absent activity(cold spots).
 Coronary angiography: About patency of
coronary arteries and visualization of artery for
any blockages.
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 Management
Mainly focus on two goals:
1. Relief of acute attack.

2. 2. Prevention of further attacks to reduce

MI.

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 SURGICAL MANAGEMENT

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1.Atherectomy is a procedure used to open up
narrowed coronary arteries to increase blood
flow. It might be done, if an artery has hard
plaque with a lot of calcium.Atherectomy may
make it easier for doctor to place a stent in the
artery.
2.Transmyocardial Laser Revascularization:-
Transmyocardial laser revascularization is a new
procedure used to treat inoperable heart
disease in patient with persistent angina, i.e.
not relieved by any other method.
2. It is performed through a small incision in the
left side of the chest. Frequently, it is
performed along with coronary bypass surgery,
occasionally alone.
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NURSING MANAGEMENT
1.Instruct the client regarding the purpose of
diagnostic medical & surgical procedures and
the pre- & post procedure expectations
2.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.
3.Provide community resources to client
regarding exercise, smoking cessation and
stress reduction.
4.Instruct client regarding a low-calorie, low-
sodium, low-cholesterol, low-fat diet with a
increase in dietary fiber.
5.Relieve/control pain 4
•Prevent/minimize development of myocardial
complications
•Provide information about disease
process/prognosis and treatment.
•Support patient in initiating necessary
lifestyle/behavioral changes.
•Encourage to stop all activities and sit or rest in
bed in a semi-fowler’s position
•Measuring Vital Signs
•Observe for signs of respiratory distress
•Administer Nitroglycerin as prescribed
•Administer Oxygen therapy if the patient’s
respiratory rate is increased or oxygen saturation
is decreased

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Nursing Management
1. Provide bed rest or semi fowler's position.
2. Monitor vital signs.
3. Obtain an ECG.
4. Administer nitroglycerine sublingually.
5. Administered O2 therapy, if O2 saturation level
decreases at the rate of 2 litres per minute by nasal
cannula.
6. Reduce the anxiety level of the patient.
Restore Cardiac Output
1. Frequent readings of blood pressure, heart rate and
CVP arterial pressure.
2. Urinary output is also measured. As decrease urinary
output, indicates decrease in cardiac output..
3. Mucous membrane, lips, ear lobes are observe for signs
of cyanosis.
4. 4. If cardiac output decreases skin becomes cool, moist
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1. Ineffective myocardial tissue perfusion
secondary to CAD, as evidenced by chest pain
or equivalent symptoms
2.  Impaired gas exchange related to decreased
blood flow as evidenced by breathlessness
3.  Impaired physical mobility related to weakness
as evidenced by patient is unable to perform
daily activity. 
4.  Imbalanced nutrition less than body
requirement related to less intake of food as
evidenced by weight loss 
5. Deficient knowledge about the underlying
disease and methods for avoiding complications
6. Noncompliance, ineffective management of
therapeutic regimen related to failure to accept
necessary lifestyle changes 4
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Thank You !

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