Angina

Angina Pathophysiology

• Myocardial Oxygen demand> myocardial oxygen supply

Coronary artery narrowing → decreased blood flow → decreased O2 to myocardium → ischemia → chest pain

Chronic Angina

• same pattern, onset, duration

• pain 5-15 min

• chest pain controlled with rest; trigger is exercise

Chronic Stable Angina Symptoms

• pressure/ache, squeeze, heavy, choking, or suffocating sensation

• indigestion/burning sensation

• radiation to neck jaw or arms

• diabetics may not feel pain to neuropathy

Angina Pain scale

P=precipitating factors/position

Q= Quality/Quantity

R= Radiation/Relieving factors

S= Severity/Symptoms

T= Timing

Chronic Stable Angina Laboratory

• Troponin

  • <0.1

  • drawn every 6 hrs every 3x

• CK-MB

  • cardiac enzyme

  • released with myocardial tissue injury

• Myoglobin

  • protein

  • myocardial injury

Chronic Stable Angina Dx studies

• ECG

• Chest x-ray

• Stress Test

• Pharmacological nuclear imaging: stress test for those who can’t walk - blood flow/perfusion

Chronic Stable Angina tx/interventions

1. semi-fowlers

2. oxygen

3. nitrate

4. auscultate heart/lungs

Medications for Chronic Stable Angina

Same as CAD

1. Nitroglycerine

2. Ace inhibitors

3. Antiplatelets

4. beta-blockers

5. calcium channel blockers

Complication os Stable Angina

Stable Angina → Unstable Angina → NSTEMI → STEMI

Unstable Angina Symptoms

• new onset

• occurring at rest w/o relief

• worsen pattern

• unpredictable

• symptoms can be vague like fatigue

Priority Nursing Intervention for ANGINA

1. stop the activity to decrease workload

2. Position the pt in Semi-Fowlers position

3. Assess: vs, pain, heart/lung signs

4. ECG obtains

5. Oxygen

6. Nitrate

7. Monitor