ANGINA PECTORIS

Description
1. Angina is chest pain resulting from myocardial ischemia caused by inadequate
myocardial blood and oxygen supply.
2. Angina is caused by an imbalance between oxygen supply and demand.
3. Causes include obstruction of coronary blood flow because of atherosclerosis,
coronary artery spasm, and conditions increasing myocardial oxygen consumption.
4. The goal of treatment is to provide relief of an acute attack, correct the imbalance
between myocardial oxygen supply and demand, and prevent the progression of the
disease ad further attacks to reduce the risk of MI.

Patterns of angina
1. Stable angina
 Stable angina also called exertional angina.
 Stable angina occurs with activities that involve exertion or emotional stress and is
relieved with rest or nitroglycerin.
 Stable angina usually has a stable pattern of onset, duration, severity, and relieving
factors.
2. Unstable angina
 Unstable angina also is called preinfarction angina.
 Unstable angina occurs with an unpredictable degree of exertion or emotion and
increases in occurrence, duration, and severity over time.
 Pain may not be relieved with nitroglycerin.
3. Variant angina
 Variant angina also is called Prinzmetal’s or vasospastic angina.
 Variant angina results from coronary artery spasm.
 Variant angina may occur at rest.
 Attacks may be associated with ST segment elevation noted on the
electrocardiogram.
4. Intractable angina is a chronic, incapacitating angina that is unresponsive to interventions.
5. Preinfarction angina
 Preinfarction angina is associated with acute coronary insufficiency.
 Preinfarction angina lasts longer than 15 minutes.
 Preinfarction angina is a symptom of worsening cardiac ischemia.
6. Postinfarction angina occurs after an MI, when residual ischemia may cause episodes of
angina.
Risk Factors
 Atherosclerosis
 Hypertension
 Diabetes Mellitus
 Thromboangitis Obliterans
 Polycythemia Vera
 Aortic Regurgitation
Assessment
1. Pain

a. Pain can develop slowly or quickly.

b. Pain usually is described as mild or moderate.
c. Substernal, crushing, squeezing, pain may occur.
d. Pain may radiate to the shoulders, arms, jaw, neck, and back.
e. Pain usually lasts less than 5 minutes, however, pain can last up to 15 to 20 minutes.
f. Pain is relieved by nitroglycerin or rest.
2. Dyspnea
3. Pallor
4. Sweating
5. Palpitations and tachycardia
6. Dizziness and faintness
7. Hypertension
8. Digestive disturbances

Difference of the pain of Angina and Myocardial Infarction

  Angina Pectoris Myocardial Infarction

Exertion, especially in
colds; emotional stress;
Predisposing/ Precipitating heavy mealsMay transpire
Factors during rest
Pressing, tight, squeezing, Pressing, tight, squeezing,
viselike heavy occasionally viselike heavy occasionally
Quality burning burning
 Substernal or retrosternal, Substernal or retrosternal,
which may radiate to which may radiate to
shoulder, arms, neck, lower shoulder, arms, neck, lower
jaw, or upper abdomen jaw, or upper abdomen
Region/ Radiation slight to the left side. slight to the left side.
Mild to moderate, rarely to
Severity be described as severe More severe
Pain usually last for 20
minutes or even hours.
Pain usually is 1 to 3 This type of pain is not
minutes up to 10 minutes relieved by rest or
long, or may even last up to Nitroglycerin, but could be
15 to 20 minutes. This pain addressed by Morphine
can be relieved by rest or Sulfate (narcotic
Timing Nitroglycerin (vasodilator) analgesic).
Dyspnea, nausea and Dyspnea, nausea and
vomiting, sweating, and vomiting, sweating, and
Associated Symptoms weakness. weakness.
A temporary myocardial A prolonged myocardial
ischemia which is usually ischemia which leads to an
secondary coronary irreversible myocardial
Pathophysiology atherosclerosis. damage or necrosis.
Source: Balita, C. (2008). Ultimate learning guide to nursing review. Manila, Philippines: Tri-Mega Printing

Diagnostic Evaluation
1. Electrocardiogram: Readings are normal during rest, with ST depression or elevation
and/or T wave inversion during an episode of pain.
2. Stress test: Chest pain or changes in the electrocardiogram or vital signs during
testing may indicate ischemia.
3. Cardiac enzymes and troponins: Findings are normal in angina.
4. Cardiac catheterization: Catheterization provides a definitive diagnosis by providing
information about the patency of the coronary arteries.
Primary Nursing Diagnosis
 Altered tissue perfusion (myocardial) related to narrowing of the coronary artery(ies) and
associated with atherosclerosis, spasm, or thrombosis
Other Diagnoses that may occur in Nursing Care Plans For Angina
 Acute pain
 Risk for decreased cardiac output
 Anxiety
 Deficient knowledge (Learning Need) regarding condition, treatment plan, self-care,
and discharge needs
Medical Management
The goals of medical management are to decrease the oxygen demands of the myocardium
and to increase the oxygen supply through pharmacologic therapy and risk factor control.

Surgical Management
Frequently, therapy includes a combination of medicine and surgery. Surgically, the goals of
management include revascularization of the blood supply to the myocardium.

 Coronary artery bypass surgery or minimally invasive direct coronary artery bypass
(MIDCAB)
 Percutaneous transluminal coronary angioplasty (PTCA) or percutaneous
transluminal myocardial revascularization (PTMR)
 Application of intracoronary stents and atherectomy to enhance blood flow
 Lasers to vaporize plaques
 Percutaneous coronary endarterectomy to extract obstruction.
Pharmacologic Intervention

 Nitrates, the mainstay of therapy (nitroglycerin)

 Beta-adrenergic blockers (metoprolol [Toprol])
 Calcium ion antagonists and calcium-channel blockers (amlodipine [Norvase] and
diltiazem [Cardizem])
 Antiplatelet and anticoagulant medications (aspirin, clopidogrel (Plavix], ticlopidine
[Ticlid], or heparin)
 Oxygen therapy
Nursing Intervention
Immediate management
1. Assess pain.
2. Provide bed rest.
3. Administer oxygen at 3 L/min by nasal cannula as prescribed.
4. Administer nitroglycerin as prescribed to dilate the coronary arteries, reduce the
oxygen requirements of the myocardium and relieve the chest pain.
5. Obtain a 12-Lead electrocardiogram.
6. Provide continuous cardiac monitoring.
Following acute episode:
1. Instruct the client regarding the purpose of diagnostic medical and surgical
procedures and the preprocedure and postprocedure expectations.
2. Assist the client to identify angina precipitating events.
3. Instruct the client to stop activity and rest if chest pain occurs and to take
nitroglycerin as prescribed.
4. Instruct the client to seek medical attention if pain persists.
 5. Instruct the client regarding prescribed medications.
6. Provide diet instructions o the client, stressing that dietary changes are not
temporary and must be maintained or life.
7. Assist the client to identify risk factors that can be modified.
8. Assist the client to set goals that will promote changes in lifestyle to reduce the
impact of risk factors.
9. Assist the client to identify barriers to compliance with therapeutic plan and to
identify methods to overcome barriers.
10. Provide community resources to the client regarding exercise, smoking reduction,
and stress reduction.
Documentation Guidelines
 Description of pain: Onset (sudden, gradual), character (aching, sharp, burning,
pressure), precipitating factors, associated symptoms (anxiety, dyspnea, diaphoresis,
dizziness, nausea, cyanosis, pallor), duration, and alleviating factors of the anginal
episode
 Response to prescribed medications
 Reaction to bedrest or limitation in activity
Discharge and Home Healthcare Guidelines
 PREVENTION. Teach the patient factors that may precipitate anginal episodes and
the appropriate measures to control episodes. Teach the patient the modifiable
cardiovascular risk factors and ways to reduce them. Manage risk factors, including
hypertension, diabetes mellitus, obesity, and hyperlipidemia.
 ACTIVITY. Each person has a different level of activity that will aggravate anginal
symptoms. Most patients with stable angina can avoid symptoms during daily
activities by reducing the speed of any activity.
 MEDICATIONS. Be sure the patient understands all medications, including the dose,
route, action, and adverse effects. If the patient’s physician prescribes sublingual
nitroglycerin (NTG), instruct the patient to lie in semi-Fowler position and take up to
three tablets 5 minutes apart to relieve chest discomfort. Instruct the patient that if
relief is not obtained after ingestion of the three tablets, he or she should seek medical
attention immediately. Remind the patient to check the expiration date on the NTG
tablets and to replace the bottle, once it is opened, every 3 to 5 months.
 COMPLICATIONS. Teach the patient the importance of not denying or ignoring
angina episodes and of reporting them to the healthcare provider immediately.
 

Sources: 
Marilyn Sawyer Sommers, RN, PhD, FAAN , Susan A. Johnson, RN, PhD, Theresa A. Beery, PhD,
RN , DISEASES AND DISORDERS A Nursing Therapeutics Manual, 2007 3rd ed
Handbook for Brunner & Suddarth’s, Textbook of Medical-SurgicalNursing, 11th ed