ANGINA PECTORIS

Pathophysiology

Angina pectoris is a chest pain caused by reduced/decreased blood flow to the heart muscle.

The pain is usually described as a squeezing or pressure sensation and is often worse with
physical exertion, emotional stress, or exposure to cold temperatures

It occurs when the heart muscle does not receive enough oxygen and nutrients to meet its
demands.

The most common cause of angina pectoris is atherosclerosis, a condition in which fatty
deposits build up in the walls of the arteries. These deposits narrow the arteries, reducing the
amount of blood and oxygen that can reach the heart. The reduced blood flow causes the
heart to become oxygen deprived and the muscle cells to become inflamed. This leads to the
release of inflammatory chemicals, such as histamines, prostaglandins, and leukotrienes.
These chemicals cause the arteries to constrict further, reducing the flow of blood even more.
This also causes the heart to work harder, leading to an increased heart rate, elevated blood
pressure, and chest pain. The chest pain is often described as squeezing or pressure and
typically radiates to the neck, arms, or jaw. It is usually worse with physical exertion, emotional
stress, or exposure to cold temperatures. Other symptoms of angina pectoris can include
shortness of breath, dizziness, nausea, and fatigue.

TREATMENT

Treatment for angina pectoris focuses on improving the flow of blood to the heart. This can
include lifestyle changes such as quitting smoking, eating a healthier diet, and getting more
exercise.

Medications such as beta-blockers and calcium channel blockers can also be prescribed to
reduce stress on the heart.

Ivn some cases, angioplasty or bypass surgery may be recommended.

Treatment focuses on improving blood flow to the heart and may include lifestyle changes,
medications, angioplasty, or bypass surgery.

TYPES

There are three types of angina pectoris:

stable angina,

unstable angina, and

variant angina (also known as Prinzmetal's angina). { S.U.V}

 1.Stable angina is also called exertional angina . Its the most common type and occurs when
the heart is stressed, such as during physical activity. The pain usually goes away with rest or
nitroglycerin.

2. Unstable angina, its also known as pre-infaction , it occurs when the heart is not under
stress, but the pain is still present. This type of angina is more serious and can be a sign of an
impending heart attack. The pain may not be relief by Nitroglycerin.

3.Variant angina/ intractable Angina usually occurs at rest and is caused by spasms of the
coronary arteries. This type of angina can be triggered by cold weather, stress, caffeine, or
tobacco use. Its a chronic type that is unresponsive to intervention.

CLINICAL MANIFESTATION OF ANGINA PECTORIS

The primary symptom of angina pectoris is chest pain. The pain is typically described as a
squeezing or pressure sensation in the middle of the chest or in the arms, shoulders, neck, jaw,
or back.

It may be worse with physical activity, emotional stress, or exposure to cold temperatures.

Other symptoms can include shortness of breath, dizziness, nausea, fatigue,pallor,

palpitation,weakness and fatigue. etc.

DIAGNOSTIC EVALUATION OF ANGINA PECTORIS

The diagnosis of angina pectoris is usually made based on the patient’s medical history and
physical examination. Other tests, such as an electrocardiogram (ECG), echocardiogram,
cardiac stress test, and cardiac catheterization, may be used to confirm the diagnosis and
identify any underlying causes.

An ECG is used to measure the electrical activity of the heart and can detect ischemia
(reduced blood flow to the heart) and arrhythmias (abnormal heart rhythms).

An echocardiogram is an ultrasound of the heart that can detect changes in the heart’s size,
shape, and function.

A cardiac stress test is used to measure the heart’s response to physical exercise.

A cardiac catheterization is a procedure in which a thin tube is inserted into an artery and
threaded to the heart to measure the pressure and oxygen levels in the heart.

NURSING CARE AND MANAGEMENT

The primary goal of nursing care for patients with angina pectoris is to reduce symptoms and
prevent further complications. Nurses can help by educating patients about their condition,
encouraging lifestyle changes, and providing support. Nurses should also help patients
understand their medications, monitor their response to treatment, and recognize signs of
worsening or new symptoms. They should also assess the patient’s risk factors for heart
disease and provide education and support on how to reduce those risks. Finally, nurses
should provide emotional support to help the patient cope with the stress and anxiety of living
with angina pectoris.

NURSING DIAGNOSIS

1. Activity Intolerance related to decreased cardiac output

2. Anxiety related to fear of death or cardiac event

3. Risk for Decreased Cardiac Tissue Perfusion related to inadequate coronary blood flow

4. Risk for Injury related to chest pain

5. Impaired Physical Mobility related to chest pain

6. Acute Pain related to chest pain

7. Ineffective Health Maintenance related to lack of knowledge of lifestyle modifications

8. Ineffective Coping related to inability to cope with the condition

9. Imbalanced Nutrition: Less Than Body Requirements related to anorexia.

MYOCARDIAL INFACTION

Myocardial infarction (MI), also known as a heart attack, is a serious medical condition
caused by the blockage of blood flow to the heart, leading to damage of the heart muscle.

The blockage is usually caused by a buildup of fat, cholesterol, and other substances that
form a plaque in the coronary arteries, the arteries that supply blood to the heart .

The area affected are divided into three zone.

{1}Zone of necrosis {2}injury and{3} ischamia respectively ,Necrosis is the death to the muscle
and its irreversible while at the injury stage , coupled with the last zone of ischeamia area is
reversible while When the plaque breaks down, a blood clot forms and blocks the artery,
preventing oxygen-rich blood from reaching the heart. This can cause the heart muscle to
become damaged or even die.

The most common symptom of an MI is chest pain, usually described as a sudden, crushing
sensation in the chest. Other symptoms can include shortness of breath, nausea, vomiting,
sweating, and dizziness. If you think you may be having a heart attack, it is important to get
medical help right away.

Treatment for an MI usually includes medications to dissolve the blood clot and restore blood
flow to the heart, as well as lifestyle changes to reduce the risk of future heart attacks. These
may include quitting smoking, exercising regularly, eating a healthy diet, and managing stress.

CAUSES .
high blood pressure, diabetes, obesity, smoking, high cholesterol, Embolism, anaemia ,
hypoxia, Artherosclerosis ,sedentary lifestyle.etc.