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 ANGINA
PECTORIS
BSN (YEAR-2)(SEMESTER-IV)

By Rafay Ahmed
BSN Generic 4th Semester
“ORIGIN OF THE WORD
ANGINA PECTORIS”
THE TERM DERIVES FROM THE LATIN
WORDS ANGERE ("TO STRANGLE")
AND PECTUS ("CHEST"), AND CAN THEREFORE BE
TRANSLATED AS "A STRANGLING FEELING IN THE
CHEST“. THE WORD STRANGLING MEANS TO OBSTRUCT
SERIOUSLY OR FATALLY THE NORMAL BREATHING.
“ DEFINITION ”
1. ANGINA PECTORIS—OR SIMPLY ANGINA—IS CHEST PAIN OR DISCOMFORT THAT KEEPS COMING
BACK.
2. ANGINA PAIN IS OFTEN DESCRIBED AS SQUEEZING, PRESSURE, HEAVINESS, TIGHTNESS OR PAIN IN
THE CHEST. IT MAY FEEL LIKE A HEAVY WEIGHT LYING ON THE CHEST.
3. ANGINA PECTORIS OR ANGINA IS TEMPORARY CHEST PAIN OR DISCOMFORT AS A RESULT OF
DECREASED BLOOD FLOW TO THE HEART MUSCLE.
4. ANGINA IS CHEST PAIN OR DISCOMFORT THAT HAPPENS WHEN YOUR HEART ISN’T RECEIVING
ENOUGH OXYGEN-RICH BLOOD. AS A RESULT, YOUR HEART MAY BEAT FASTER AND HARDER TO
GAIN MORE BLOOD, CAUSING YOU NOTICEABLE PAIN. ANGINA ISN’T A DISEASE. IT’S A SYMPTOM
AND A WARNING SIGN OF HEART DISEASE.
WHAT DOES ANGINA
FEEL LIKE?
• MOST PEOPLE WITH ANGINA DESCRIBE HAVING CHEST PAIN OR PRESSURE.
OR THEY DESCRIBE A SQUEEZING SENSATION OR A TIGHTNESS IN THEIR
CHEST. SOME PEOPLE SAY IT FEELS LIKE INDIGESTION. OTHERS SAY IT’S
HARD TO DESCRIBE ANGINA WITH WORDS.
• THE DISCOMFORT USUALLY BEGINS BEHIND YOUR BREASTBONE.
SOMETIMES, YOU MAY NOT BE ABLE TO LOCATE EXACTLY WHERE THE PAIN
IS COMING FROM.
• PAIN/DISCOMFORT YOU FEEL IN YOUR CHEST MAY SPREAD TO OTHER
PARTS OF YOUR UPPER BODY. THESE INCLUDE YOUR NECK, JAW,
SHOULDERS, ARMS, BACK OR BELLY.
• LACK OF OXYGEN TO YOUR HEART CAN CAUSE OTHER
SYMPTOMS, KNOWN AS “ANGINA EQUIVALENTS.” THESE ARE
SYMPTOMS THAT YOU DON’T FEEL IN YOUR CHEST, INCLUDING:
• FATIGUE.
• NAUSEA OR VOMITING.
• SHORTNESS OF BREATH.
• SWEATING A LOT.
WHAT ARE THE CAUSES
OF ANGINA PECTORIS
• ANGINA IS CAUSED BY REDUCED BLOOD FLOW TO THE HEART MUSCLE. BLOOD
CARRIES OXYGEN, WHICH THE HEART MUSCLE NEEDS TO SURVIVE. WHEN THE
HEART MUSCLE ISN'T GETTING ENOUGH OXYGEN, IT CAUSES A CONDITION CALLED
ISCHEMIA.
• THE MOST COMMON CAUSE OF REDUCED BLOOD FLOW TO THE HEART MUSCLE IS
CORONARY ARTERY DISEASE (CAD). THE HEART (CORONARY) ARTERIES CAN
BECOME NARROWED BY FATTY DEPOSITS CALLED PLAQUES. THIS IS CALLED
ATHEROSCLEROSIS.
• IF PLAQUES IN A BLOOD VESSEL RUPTURE OR A BLOOD CLOT FORMS, IT CAN
QUICKLY BLOCK OR REDUCE FLOW THROUGH A NARROWED ARTERY. THIS CAN
SUDDENLY AND SEVERELY DECREASE BLOOD FLOW TO THE HEART MUSCLE.
WHAT ARE THE RISK FACTORS
OF ANGINA PECTORIS
• INCREASING AGE. ANGINA IS MOST COMMON IN ADULTS AGE 60 AND OLDER.
• FAMILY HISTORY OF HEART DISEASE. TELL YOUR HEALTH CARE PROVIDER IF YOUR
MOTHER, FATHER OR ANY SIBLINGS HAVE OR HAD HEART DISEASE OR A HEART ATTACK.
• TOBACCO USE. SMOKING, CHEWING TOBACCO AND LONG-TERM EXPOSURE TO SECOND
HAND SMOKE CAN DAMAGE THE LINING OF THE ARTERIES, ALLOWING DEPOSITS OF
CHOLESTEROL TO COLLECT AND BLOCK BLOOD FLOW.
• DIABETES. DIABETES INCREASES THE RISK OF CORONARY ARTERY DISEASE, WHICH LEADS TO
ANGINA AND HEART ATTACKS BY SPEEDING UP ATHEROSCLEROSIS AND INCREASING
CHOLESTEROL LEVELS.
• HIGH BLOOD PRESSURE. OVER TIME, HIGH BLOOD PRESSURE DAMAGES ARTERIES BY
ACCELERATING HARDENING OF THE ARTERIES.
• HIGH CHOLESTEROL OR TRIGLYCERIDES. TOO MUCH BAD CHOLESTEROL — LOW-DENSITY
LIPOPROTEIN (LDL) — IN THE BLOOD CAN CAUSE ARTERIES TO NARROW. A
HIGH LDL INCREASES THE RISK OF ANGINA AND HEART ATTACKS. A HIGH LEVEL OF
TRIGLYCERIDES IN THE BLOOD ALSO IS UNHEALTHY.
• OTHER HEALTH CONDITIONS. CHRONIC KIDNEY DISEASE, PERIPHERAL ARTERY DISEASE,
METABOLIC SYNDROME OR A HISTORY OF STROKE INCREASES THE RISK OF ANGINA.
• NOT ENOUGH EXERCISE. AN INACTIVE LIFESTYLE CONTRIBUTES TO HIGH CHOLESTEROL,
HIGH BLOOD PRESSURE, TYPE 2 DIABETES AND OBESITY. TALK TO YOUR HEALTH CARE
PROVIDER ABOUT THE TYPE AND AMOUNT OF EXERCISE THAT'S BEST FOR YOU.
• OBESITY. OBESITY IS A RISK FACTOR FOR HEART DISEASE, WHICH CAN CAUSE ANGINA.
BEING OVERWEIGHT MAKES THE HEART WORK HARDER TO SUPPLY BLOOD TO THE BODY.
• EMOTIONAL STRESS. TOO MUCH STRESS AND ANGER CAN RAISE
BLOOD PRESSURE. SURGES OF HORMONES PRODUCED DURING STRESS
CAN NARROW THE ARTERIES AND WORSEN ANGINA.
• MEDICATIONS. DRUGS THAT TIGHTEN BLOOD VESSELS, SUCH AS SOME
MIGRAINE DRUGS, MAY TRIGGER PRINZMETAL'S ANGINA.
• DRUG MISUSE. COCAINE AND OTHER STIMULANTS CAN CAUSE BLOOD
VESSEL SPASMS AND TRIGGER ANGINA.
• COLD TEMPERATURES. EXPOSURE TO COLD TEMPERATURES CAN
TRIGGER PRINZMETAL ANGINA.
“PATHOPHYSIOLOGY OF
ANGINA PECTORIS”
WHAT ARE THE TYPES OF
ANGINA PECTORIS
 STABLE ANGINA
• STABLE ANGINA FOLLOWS A PATTERN THAT HAS BEEN CONSISTENT FOR AT LEAST 2 MONTHS.
THAT MEANS THE FOLLOWING FACTORS HAVE NOT CHANGED:
• HOW LONG YOUR ANGINA EVENTS LAST
• HOW OFTEN YOUR ANGINA EVENTS OCCUR
• HOW WELL THE ANGINA RESPONDS TO REST OR MEDICINES
• THE CAUSES OR TRIGGERS OF YOUR ANGINA
• IF YOU HAVE STABLE ANGINA, YOU CAN LEARN ITS PATTERN AND PREDICT WHEN AN EVENT WILL
OCCUR, SUCH AS DURING PHYSICAL EXERTION OR MENTAL STRESS. THE PAIN USUALLY GOES
AWAY A FEW MINUTES AFTER YOU REST OR TAKE YOUR ANGINA MEDICINE. IF THE CONDITION
CAUSING YOUR ANGINA GETS WORSE, STABLE ANGINA CAN BECOME UNSTABLE ANGINA.
 UNSTABLE ANGINA
• UNSTABLE ANGINA DOES NOT FOLLOW A PATTERN. IT MAY BE NEW
OR OCCUR MORE OFTEN AND BE MORE SEVERE THAN STABLE
ANGINA. UNSTABLE ANGINA CAN ALSO OCCUR WITH OR WITHOUT
PHYSICAL EXERTION. REST OR MEDICINE MAY NOT RELIEVE THE PAIN.
• UNSTABLE ANGINA IS A MEDICAL EMERGENCY, SINCE IT CAN
PROGRESS TO A HEART ATTACK. MEDICAL ATTENTION MAY BE
NEEDED RIGHT AWAY TO RESTORE BLOOD FLOW TO THE HEART
MUSCLE.
 MICROVASCULAR ANGINA
• MICROVASCULAR ANGINA IS A SIGN OF CORONARY HEART
DISEASE AFFECTING THE TINY ARTERIES OF THE HEART.
MICROVASCULAR ANGINA EVENTS CAN BE STABLE OR
UNSTABLE. THEY CAN BE MORE PAINFUL AND LAST LONGER
THAN OTHER TYPES OF ANGINA, AND SYMPTOMS CAN
OCCUR DURING EXERCISE OR AT REST. MEDICINE MAY NOT
RELIEVE SYMPTOMS OF THIS TYPE OF ANGINA.
 VARIANT ANGINA
• VARIANT ANGINA, ALSO KNOWN AS PRINZMETAL’S ANGINA, IS
RARE. IT OCCURS WHEN A SPASM — A SUDDEN TIGHTENING OF THE
MUSCLES WITHIN THE ARTERIES OF YOUR HEART — CAUSES THE
ANGINA RATHER THAN A BLOCKAGE. THIS TYPE OF ANGINA USUALLY
OCCURS WHILE YOU ARE AT REST, AND THE PAIN CAN BE SEVERE.
IT USUALLY HAPPENS BETWEEN MIDNIGHT AND EARLY MORNING
AND IN A PATTERN. MEDICINE CAN EASE SYMPTOMS OF VARIANT
ANGINA.
“ MYOCARDIAL
INFARCTION ”
PRESENTED BY: RAFAY AHMED
BSN (YEAR-2)(SEMESTER-IV)
ROOT WORDS
1. THE TERM MYOCARDIAL IS ALSO BROKEN DOWN INTO
ITS PREFIX AND SUFFIX TO UNDERSTAND ITS MEANING.
THE PREFIX MYO- MEANS MUSCLE AND THE
SUFFIX -CARDIAL MEANS PERTAINING TO THE
HEART. THUS, THE WORD MYOCARDIAL'S MEANING IS
THAT IT IS AN ADJECTIVE THAT MEANS "RELEVANT TO
OR PERTAINING TO THE MUSCLE OF THE HEART.“
2. THE WORD "INFARCTION" COMES FROM THE LATIN
"INFARCIRE" MEANING "TO PLUG UP OR
CRAM." IT REFERS TO THE CLOGGING OF THE ARTERY.
DEFINITION
1. MYOCARDIAL INFARCTION (MI), COLLOQUIALLY KNOWN AS "HEART
ATTACK," IS CAUSED BY DECREASED OR COMPLETE CESSATION OF
BLOOD FLOW TO A PORTION OF THE MYOCARDIUM.
2. A HEART ATTACK (MEDICALLY KNOWN AS A MYOCARDIAL INFARCTION) IS
A DEADLY MEDICAL EMERGENCY WHERE YOUR HEART MUSCLE BEGINS
TO DIE BECAUSE IT ISN’T GETTING ENOUGH BLOOD FLOW.
3. MYOCARDIAL INFARCTION (MI) REFERS TO TISSUE DEATH (INFARCTION)
OF THE HEART MUSCLE (MYOCARDIUM) CAUSED BY ISCHAEMIA, THE
LACK OF OXYGEN DELIVERY TO MYOCARDIAL TISSUE.
4. A HEART ATTACK (MYOCARDIAL INFARCTION) HAPPENS WHEN ONE OR
MORE AREAS OF THE HEART MUSCLE DON'T GET ENOUGH OXYGEN. THIS
HAPPENS WHEN BLOOD FLOW TO THE HEART MUSCLE IS BLOCKED.
5. MYOCARDIAL INFARCTION (MI) (IE, HEART ATTACK) IS THE IRREVERSIBLE
NECROSIS OF HEART MUSCLE SECONDARY TO PROLONGED ISCHEMIA.
CAUSES OF MYOCARDIAL
INFARCTION
• THE VAST MAJORITY OF HEART ATTACKS OCCUR BECAUSE OF A
BLOCKAGE IN ONE OF THE BLOOD VESSELS THAT SUPPLIES YOUR HEART.
THIS MOST OFTEN HAPPENS BECAUSE OF PLAQUE, A STICKY SUBSTANCE
THAT CAN BUILD UP ON THE INSIDES OF YOUR ARTERIES (SIMILAR TO
HOW POURING GREASE DOWN YOUR KITCHEN SINK CAN CLOG YOUR
HOME PLUMBING). THAT BUILD UP IS CALLED ATHEROSCLEROSIS.
• SOMETIMES, PLAQUE DEPOSITS INSIDE THE CORONARY (HEART)
ARTERIES CAN BREAK OPEN OR RUPTURE, AND A BLOOD CLOT CAN GET
STUCK WHERE THE RUPTURE HAPPENED. IF THE CLOT BLOCKS THE
ARTERY, THIS CAN DEPRIVE THE HEART MUSCLE OF BLOOD AND CAUSE A
HEART ATTACK.
• HEART ATTACKS ARE POSSIBLE WITHOUT A BLOCKAGE, BUT THIS IS RARE
AND ONLY ACCOUNTS FOR ABOUT 5% OF ALL HEART ATTACKS. THIS KIND
• CORONARY ARTERY SPASM: A CORONARY ARTERY SPASM IS A QUICK
TIGHTENING OF THE BLOOD VESSELS THAT DELIVER BLOOD TO YOUR HEART
MUSCLE.
• RARE MEDICAL CONDITIONS: AN EXAMPLE OF THIS WOULD BE ANY DISEASE
THAT CAUSES UNUSUAL NARROWING OF BLOOD VESSELS.
• TRAUMA: THIS INCLUDES TEARS OR RUPTURES IN THE CORONARY ARTERIES.
• OBSTRUCTION THAT CAME FROM SOMEWHERE ELSE IN YOUR BODY: A
BLOOD CLOT OR AIR BUBBLE (EMBOLISM) THAT GETS TRAPPED IN A CORONARY
ARTERY.
• EATING DISORDERS: OVER TIME, THESE CAN DAMAGE YOUR HEART AND
ULTIMATELY RESULT IN A HEART ATTACK.
• BROKEN HEART SYNDROME:
• BROKEN HEART SYNDROME (STRESS CARDIOMYOPATHY OR TAKOTSUBO
CARDIOMYOPATHY) IS A REAL CONDITION. ALTHOUGH ITS SYMPTOMS MIMIC A
• ANOMALOUS CORONARY ARTERIES : (A
CONGENITAL HEART DEFECT YOU’RE BORN WITH
WHERE THE CORONARY ARTERIES ARE IN
DIFFERENT POSITIONS THAN NORMAL IN YOUR
BODY. COMPRESSION OF THESE CAUSES A HEART
ATTACK)
 RISK FACTORS FOR
MYOCARDIAL INFARCTION
• AGE. MEN AGE 45 AND OLDER AND WOMEN AGE 55 AND OLDER ARE MORE LIKELY TO
HAVE A HEART ATTACK THAN ARE YOUNGER MEN AND WOMEN.
• TOBACCO USE. THIS INCLUDES SMOKING AND LONG-TERM EXPOSURE TO
SECONDHAND SMOKE. IF YOU SMOKE, QUIT.
• HIGH BLOOD PRESSURE. OVER TIME, HIGH BLOOD PRESSURE CAN DAMAGE
ARTERIES THAT LEAD TO THE HEART. HIGH BLOOD PRESSURE THAT OCCURS WITH
OTHER CONDITIONS, SUCH AS OBESITY, HIGH CHOLESTEROL OR DIABETES,
INCREASES THE RISK EVEN MORE.
• HIGH CHOLESTEROL OR TRIGLYCERIDES. A HIGH LEVEL OF LOW-DENSITY
LIPOPROTEIN (LDL) CHOLESTEROL (THE "BAD" CHOLESTEROL) IS MOST LIKELY TO
NARROW ARTERIES. A HIGH LEVEL OF CERTAIN BLOOD FATS CALLED TRIGLYCERIDES
ALSO INCREASES HEART ATTACK RISK. YOUR HEART ATTACK RISK MAY DROP IF LEVELS
OF HIGH-DENSITY LIPOPROTEIN (HDL) CHOLESTEROL — THE "GOOD" CHOLESTEROL —
ARE IN THE STANDARD RANGE.
• OBESITY. OBESITY IS LINKED WITH HIGH BLOOD PRESSURE, DIABETES, HIGH LEVELS
OF TRIGLYCERIDES AND BAD CHOLESTEROL, AND LOW LEVELS OF GOOD
• DIABETES. BLOOD SUGAR RISES WHEN THE BODY DOESN'T MAKE A HORMONE
CALLED INSULIN OR CAN'T USE IT CORRECTLY. HIGH BLOOD SUGAR INCREASES THE
RISK OF A HEART ATTACK.
• METABOLIC SYNDROME. THIS IS A COMBINATION OF AT LEAST THREE OF THE
FOLLOWING THINGS: ENLARGED WAIST (CENTRAL OBESITY), HIGH BLOOD PRESSURE,
LOW GOOD CHOLESTEROL, HIGH TRIGLYCERIDES AND HIGH BLOOD SUGAR. HAVING
METABOLIC SYNDROME MAKES YOU TWICE AS LIKELY TO DEVELOP HEART DISEASE
THAN IF YOU DON'T HAVE IT.
• FAMILY HISTORY OF HEART ATTACKS. IF A BROTHER, SISTER, PARENT OR
GRANDPARENT HAD AN EARLY HEART ATTACK (BY AGE 55 FOR MALES AND BY AGE 65
FOR FEMALES), YOU MIGHT BE AT INCREASED RISK.
• NOT ENOUGH EXERCISE. A LACK OF PHYSICAL ACTIVITY (SEDENTARY LIFESTYLE) IS
LINKED TO A HIGHER RISK OF HEART ATTACKS. REGULAR EXERCISE IMPROVES HEART
HEALTH.
• UNHEALTHY DIET. A DIET HIGH IN SUGARS, ANIMAL FATS, PROCESSED FOODS,
TRANS FATS AND SALT INCREASES THE RISK OF HEART ATTACKS. EAT PLENTY OF
• STRESS. EMOTIONAL STRESS, SUCH AS EXTREME ANGER, MAY
INCREASE THE RISK OF A HEART ATTACK.
• ILLEGAL DRUG USE. COCAINE AND AMPHETAMINES ARE
STIMULANTS. THEY CAN TRIGGER A CORONARY ARTERY SPASM
THAT CAN CAUSE A HEART ATTACK.
• A HISTORY OF PREECLAMPSIA. THIS CONDITION CAUSES HIGH
BLOOD PRESSURE DURING PREGNANCY. IT INCREASES THE
LIFETIME RISK OF HEART DISEASE.
• AN AUTOIMMUNE CONDITION. HAVING A CONDITION SUCH AS
RHEUMATOID ARTHRITIS OR LUPUS CAN INCREASE THE RISK OF A
HEART ATTACK.
TYPES OF MYOCARDIAL
INFARCTION
• UNSTABLE ANGINA:
• ALSO CALLED ACUTE CORONARY INSUFFICIENCY, UNSTABLE ANGINA CAUSES PLATELET
CLOTS IN THE ARTERIES DUE TO PLAQUE BUILDUP. A KEY CHARACTERISTIC OF
UNSTABLE ANGINA IS THAT CHEST PAIN AND OTHER SYMPTOMS TEND TO DEVELOP AND
WORSEN DURING PERIODS OF REST. IF LEFT UNTREATED, IT MAY LEAD TO A HEART
ATTACK.
• STEMI:
• ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION (STEMI) IS A TYPE OF HEART ATTACK
THAT INVOLVES THE BLOCKAGE OF ONE OR MORE ARTERIES IN YOUR HEART. IT MAY
CAUSE SERIOUS INJURY TO THE HEART MUSCLE, INCLUDING LOSS OF TISSUES AND
CELLS.
• NSTEMI:
• NON-ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION (NSTEMI) IS THE SECOND TYPE
OF HEART ATTACK ASSOCIATED WITH ACS. WHILE STILL A SERIOUS EVENT, NSTEMI
USUALLY INVOLVES PARTIAL OR NEAR-COMPLETE ARTERY BLOCKAGE.
• ALSO, COMPARED WITH UNSTABLE ANGINA AND STEMI, NSTEMI HAS A LOWER
• THE THREE TYPES OF HEART ATTACKS ARE:
1. ST SEGMENT ELEVATION MYOCARDIAL INFARCTION (STEMI)
2. NON-ST SEGMENT ELEVATION MYOCARDIAL INFARCTION
(NSTEMI)
3. CORONARY SPASM, OR UNSTABLE ANGINA
• “ST SEGMENT” REFERS TO THE PATTERN THAT APPEARS ON AN
ELECTROCARDIOGRAM, WHICH IS A DISPLAY OF YOUR
HEARTBEAT. ONLY A STEMI WILL SHOW ELEVATED SEGMENTS.
BOTH STEMI AND NSTEMI HEART ATTACKS CAN CAUSE ENOUGH
DAMAGE TO BE CONSIDERED MAJOR HEART ATTACKS.
SIGN AND SYMPTOMS OF
MYOCARDIAL INFARCTION
• SYMPTOMS OF A HEART ATTACK VARY. SOME PEOPLE HAVE MILD SYMPTOMS. OTHERS HAVE SEVERE SYMPTOMS.
SOME PEOPLE HAVE NO SYMPTOMS.
• COMMON HEART ATTACK SYMPTOMS INCLUDE:
• CHEST PAIN THAT MAY FEEL LIKE PRESSURE, TIGHTNESS, PAIN, SQUEEZING OR ACHING
• PAIN OR DISCOMFORT THAT SPREADS TO THE SHOULDER, ARM, BACK, NECK, JAW, TEETH OR SOMETIMES THE
UPPER BELLY
• COLD SWEAT
• FATIGUE
• HEARTBURN OR INDIGESTION
• LIGHTHEADEDNESS OR SUDDEN DIZZINESS
• NAUSEA
• SHORTNESS OF BREATH
• WOMEN MAY HAVE ATYPICAL SYMPTOMS SUCH AS BRIEF OR SHARP PAIN FELT IN THE NECK, ARM OR BACK.
SOMETIMES, THE FIRST SYMPTOM SIGN OF A HEART ATTACK IS SUDDEN CARDIAC ARREST.
• SOME HEART ATTACKS STRIKE SUDDENLY. BUT MANY PEOPLE HAVE WARNING SIGNS AND SYMPTOMS HOURS,
DAYS OR WEEKS IN ADVANCE. CHEST PAIN OR PRESSURE (ANGINA) THAT KEEPS HAPPENING AND DOESN'T GO
AWAY WITH REST MAY BE AN EARLY WARNING SIGN. ANGINA IS CAUSED BY A TEMPORARY DECREASE IN BLOOD
 PATHOPHYSIOLOGY OF
MYOCARDIAL INFARCTION
References:
• Carol, Porth M. (2000). Pathophysiology concept
of altered health states (new ed). Philadelphia: J.
B. Lippincott
• Sue, Huether E. (2000). Understanding
pathophysiology New York: Mosby.
• Tortora, G. J., & Anagnostakos, N. P. (2000).
Principles of anatomy and physiology New
York:Harper & Row.
• Wilson, Sylvia A. Price & Lorraine M. (1997).
Clinical concepts of disease processes (5th ed).
Mosby.