Angina Pectoris

• Angina Pectoris

  The most common cause of angina pectoris is atherosclerosis.
• Angina Pectoris

  The most characteristic manifestation of angina pectoris is chest pain.
• Angina Pectoris

  The main pathophysiology of angina pectoris is decreased myocardial oxygenation.
• Angina Pectoris

  Pathophysiology:

  Atherosclerosis - decreased myocardial oxygenation - increased lactic acid production - nerve irritation - chest pain
• The chest pain in angina pectoris has the following characteristics:

  "SAVERS"

  • Substernal
  • Anterior chest
  • Vague, it radiates
  • Exertion-related
  • Relieved by rest and Nitroglycerine
  • Short duration; less than 30 minutes
• The 4 E's are common triggers for angina pectoris:

  • Exertion
  • Emotions
  • Eating a heavy meal
  • Exposure to cold
• The mainstay medication for angina pectoris is Nitroglycerine, a coronary vasodilator. Its expected therapeutic effect is relief of chest pain.
• Angina Pectoris: Pharma

  Betablockers - to decrease heart rate, BP, myocardial contractility.
• Angina Pectoris: Pharma

  CCB - to reduce coronary spasm.
• Angina Pectoris: Pharma

  Antiplatelet - to prevent thromboembolism.
• Angina Pectoris: Pharma

  Anticoagulant - To prevent growth of existing blood clots and to prevent formation of new blood clots.
• Patient Teachings in Nitroglycerine Therapy

  • Advise the patient to: Practice gradual change of position (orthostatic hypotension)
  • Maximum of three doses at 5 minute interval.
  • Potency = burning or stinging sensation under the tongue.
  • Storage = dark or amber - colored, air tight container.
  • Change stock of nitroglycerine tablets every three months.
  • Nitroglycerine patch is removed during the night to prevent tolerance from the medication.
  • Common side effect = headache.
  • Expected therapeutic effect = relief of chest pain.
• Nursing Interventions in Beta - adrenergic Blockers Therapy

  • Assess pulse rate before administration of the drug. Beta-blockers may cause bradycardia.
  • Administer with food to prevent GI upset.
  • Propranolol (Inderal) is contraindicated in asthma and DM.
  • Propranolol causes bronchoconstriction and hypoglycemia.
  • Antidote: glucagon.
• Nursing Interventions in Calcium - channel Blockers Therapy

  • Administer 1 hour before or 2 hours after meals for adequate absorption
  • Antidote: glucagon.
• Nursing Interventions in Platelet Aggregation Inhibitors Therapy

  • Assess for signs and symptoms of bleeding.
  • Do not give ASA with Coumadin to prevent risk of bleeding.
  • ASA should be given with food to prevent Gl ulceration.
  • ASA toxicity is manifested by tinnitus.
  • ASA is not to be given to a client with asthma. It causes bronchoconstriction.
• Nursing Interventions in Anticoagulant Therapy

  • Assess for signs and symptoms of bleeding.
  • The antidote for Heparin is Protamine sulfate.
  • The antidote for Coumadin is Vitamin K.
  • If heparin is administered subcutaneously, do not aspirate, do not massage site of injection. This is to prevent hematoma formation.
• Nursing Interventions in Anticoagulant Therapy

  • Monitor PTT or APTT for Heparin therapy. Therapeutic effect: normal value of PTT or APTT x 2 to 2.5.
  • Monitor PT or INR for Coumadin therapy. Therapeutic effect: INR 2 to 3; or normal value of PT x 1.5 to 2.
• Nursing Interventions in Anticoagulant Therapy

  If the physician plans to shift Heparin to Coumadin, give Heparin and Coumadin at the same time, then give 3 more doses of Heparin as prescribed. The onset of action of Coumadin is within 48 hours, and the duration of action of Heparin subcutaneous is 8-12 hours; Heparin IV is 2to 6 hours. Therefore, effect of Heparin had elapsed before the onset of action of Coumadin.
• Nursing Interventions in Anticoagulant Therapy 


  Given IV or SQ: Heparin
• Nursing Interventions in Anticoagulant Therapy 


  Given PO: Coumadin
• Treatments for Angina Pectoris:

  PTCA

  • It involves insertion of a balloon-tipped catheter to compress and scrape off atheromatous plaque from the blocked coronary artery. It is indicated in one-vessel occlusion.
• Treatments for Angina Pectoris:

  CABG

  • It involves use of a graft (usually saphenous vein) to divert blood flow frim the area of blockage. This is to improve blood flow in the affected area and prevent myocardial infarction.
• Treatments for Angina Pectoris:

  Endarterectomy

  • It is surgical resection of atheromatous plaque from the affected coronary artery.
• Treatments for Angina Pectoris

  PTCA - Percutaneous Transluminal Coronary Angioplasty

  CABG - Coronary Artery Bypass Graft