Angina Pectoris

                                 Angina Pectoris

• Angina pectoris occurs when myocardial demands exceeds, myocardial oxygen supply decreased usually caused by obstruction of coronary artery.
• chest pain due to an inadequate supply of oxygen to the heart muscle is characterized by feeling of suffocation.

Etiology :

• atherosclerosis
• prolong narrowing

Risk factor :

• thromboanxietis abliterance (inflammation of small and medium vein and thrombosis of extrimities.
• Polycythemia vera (thickness of blood)
• Polyarthritis nodosa (inflammation of aretery due to infiltraion of eosonophils.)

{Note : Angina can be triggered by exercise ,cold, or anything that incfreases the work load of heart}

Clinical manifestation :

• Pain : -  location: 90% of the clients experience pain slightly left to the sternum 

                        duration : Angina usually last fir 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, emptyness, restlessness.

Pattern of Angina :

1.  Stable Angina :- it is a acute chest pain triggered by exercise or emotion.
2. Unstable Angina :- it is also acute pain but unpredictable degree or cause.
3. Varient Angina:- it is also called as perinzmetals angian and it is for longer                                        duration.
4. Noctural Angina :- it is possibly associated with rapid eye movement during                                       sleeping or dreaming.
5. Angina Decubitis :- it is proximal chest pain that occur when client stand up.
6. Post Infarction Angina :- pain occur after heart attack.

Diagnostic Evaluation :-

• ECG
• Coronary Angiography
• Blood test
• Echo cardio gram
• Electron beam computed domography [EBCD]

Management :-

• the objective of the medical management in angina are to decrease oxygen demand of the myocardial and to increase the oxygen supply.
• medically these objectives are meet through pharmacological therapy and control of risk factor. Medical management focus on these three points :-

1. Relieve the acute pain.
2. Risk of coronary blood flow.
3. Prevent further attack to reduce the risk of myocardial infarction.

      A : Aspirine and anti-anginal 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 straind
• Laser ablation
• CABG (coronary artery bypass grafting)

Nursing management :-

          Diagnosis :

• Acute chest pain related to decrease 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 disease process.
• Anxiety and fear 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.