ANGINA PECTORIS IN ENGLISH

                                                 

                                  ANGINA  PECTORIS  IN ENGLISH

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ANGINA PECTORIS-

Ø  Angina pectoris is defined as a clinical syndrome caused by ischemia or reduced oxygen supply to the heart muscles. It is usually associated with increased activity while oxygen supply is compromised to cardiac muscles.

CAUSATIVE  FACTORS-

Ø  The main causative factor of angina pectoris is coronary artery atherosclerosis. angina is associated with obstruction of at least one major coronary artery. Obstructed coronary artery can not provide sufficient blood to myocardium during increased need hich leads to angina pectoris

CLASSIFICATION OF  ANGINA-

            Angina pectoris is classified into 5 types-

            01.  Stable angina:  Stable angina is predictable and patient has consistent pain that occurs on exertion and is relieved by rest and/or nitroglycerin

            02.  Unstable angina: Unstable angina is also known as pre-infarction angina. In this type of angina  symptoms increase in frequency and severity and may not be relieved with rest or nitroglycerin

            03.  Refractory angina:   In this type of angina there is severe incapacitating chest pain. It is also known as intractable angina.

            04. Variant angina: In this type of angina patient feels pain at rest and there is  reversible ST-segment elevation in ECG. It is also known as Prinzmetal’s angina.

            05.  Silent angina:   In this type of angina patient patient reports no pain (only detected during stress test ECG)

CLINICAL  MANIFESTATIONS-

Ø  Angina Pectoris may produce chest pain.

Ø   Mild indigestion.

Ø   Respiratory distress.

Ø   Heavy sensation in the upper chest.

Ø   Severe apprehension and.

Ø   Feeling of impending death.

Ø  The angina pain is typical and often felt deep in the chest behind the sternum  and may radiate to the neck, jaw, shoulders, and inner aspects of the upper arms. The patient often feels tightness or a heavy choking or strangling sensation.

Ø  diaphoresis, dizziness or lightheadedness, and nausea and vomiting may accompany the angina pain.

DIAGNOSTIC INVESTIGATIONS-

Ø  History and Physical examination. (presence of clinical manifestations of angina pectoris)

Ø  ECG.

Ø  Treadmill ECG( stress test).

Ø  CRP.

Ø  Eco-cardiography.

Ø  Angiography.

TREATMENT-

Ø  The main objectives of the medical management of angina are to decrease the oxygen demand of the myocardium and to increase the oxygen supply.

Ø  Nitroglycerin is administered to reduce myocardial oxygen consumption, which decreases ischemia and relieves pain. Sublingual nitroglycerin is generally placed under the tongue or in the cheek (buccal pouch).

Ø  Beta-blockers such as metoprolol and atenolol help in reducing myocardial oxygen consumption by blocking beta-adrenergic sympathetic stimulation to the heart.

Ø  Calcium channel blockers increase myocardial oxygen supply by dilating the smooth muscle wall of the coronary arterioles. The calcium channel blockers most commonly used for angina are amlodipine and diltiazem

Ø  Blood thinners such as aspirin and clopidogrel may be prescribed to prevent clot formation and to reduce risk for MI.

Ø  Oxygen therapy is usually initiated at the onset of chest pain. Oxygen inhalation help to increase the amount of oxygen delivered to the myocardium and to decrease pain

NURSING MANAGEMENT-

Ø  Proper assessment is done by health history and physical examination and nursing care plan is prepared.

Ø  The nurse should also assess the risk factors of CAD, during assessment process.

Ø  When a patient experiences angina, the patient is directed to stop all activities and sit or rest in bed in a semi-Fowler’s position to reduce the oxygen requirements of the ischemic myocardium.

Ø  The nurse then continues to assess the patient, measuring vital signs and observing for signs of respiratory distress.

Ø  The nurse assesses the patient’s progress and response to treatment, and provides physical and emotional support.

Ø  Nitroglycerin is administered sublingually, as prescribed and the patient’s response is assessed and recorded.

Ø  Nitroglycerine may be repeated three times if pain persists. Each time blood pressure, heart rate, and the ECG should be monitored                (if facilities are available)

Ø  The nurse administers oxygen therapy as prescribed and if the patient’s respiratory rate is increased or if the oxygen saturation level is decreased.

Ø  Patients with angina often fear loss of their roles within society and the family. They may also fear that the pain may lead to an MI or death. The nurse provide psychological support the patient by providing proper information.

Ø  Nurse alternates the patient’s activities with rest periods to prevent angina pain. Balancing activity and rest is an important aspect of the educational plan for the patient and family

Ø  The prescribed Medications are provided on time to prevent pain. During medication administration the client should be explained about drug compliance.

Ø  During discharge planning the Nurse provides health education regarding home care, adherence to drug schedule, diet management and to come for follow up as needed.