INTRODUCTION:-

Name of students: -Prajapati Nidhi

Name of evaluator: -

Subject: - Medical-Surgical Nursing

Topic: - Angina Pectoris

Date: - 17/08/20

Time: - 10 AM

Duration: - 30 Minute

Types of teaching: - Lecture-cum Discussion

A.V. Aids: - Black-board

GENERAL OBJECTIVE:
At the completion of the lecture, the students will accumulate knowledge about the
Angina Pectoris.

SPECIFIC OBJECTIVE:
After the completion of lecture, students will be able to:

➢ Define the Angina Pectoris.

➢ List out the types of the angina pectoris.
➢ Discuss the etiology and risk factors of Angina Pectoris.
➢ Illustrate the pathophysiology of Angina Pectoris.
➢ Describe the diagnostic evaluation of Angina Pectoris.
➢ Explain the clinical manifestation of angina pectoris.
➢ Elaborate medical management of Angina Pectoris.
➢ Discuss the surgical management of Angina Pectoris.
➢ explain the nursing management of the Angina Pectoris.

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1 min INTRODUCTION:

Angina pectoris also called as ischemic chest pain. It is caused

reduced by blood flow to the heart. Angina is a symptom of coronary
artery disease. Its occurs when the heart muscle does not get as much
blood as it needs. This usually happens because one or more of the
heart arteries is narrowed or blocked, also called ischemia.

1 min Define the DEFINITION: Lecture cum Black board What is the
angina discussion angina pectoris?
pectoris. It means, “strangling in the chest”. It is a disease marked by
brief sudden attacks of chest pain or discomfort caused by deficient
oxygenation of heart muscle usually due to impaired blood flow to
the heart. Angina is symptoms of condition called myocardial
ischemia.

4 min List out the TYPES: Lecture cum Black board Which are the
types of angina discussion types of angina
pectoris. There are mainly five types of the angina pectoris. pectoris?
1. Stable angina
2. Unstable angina
3. Variant angina
4. Micro vascular angina
5. Silent angina

1) Stable angina:

- Stable angina caused by chronic narrowing of coronary arteries

due to arthrosclerosis causes stable angina.
- When coronary artery is narrowed, myocardial tissue perfused
by the arteries will not receive adequte blood flow.
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- Ischemia occurs when the oxygen demand increase, so this is
referred to as “demand ischemia”.
- Symptoms usually last less than 5 minute.
- They are usually relieved by rest or nitrate, such as nitro-
glycerine under the tongue.

2) Unstable angina:

- Unstable angina is caused by dissolution of a blood clot

(thrombosis) within coronary arteries.
- When the clot forms, coronary flow is reduced, leading to
reduction in the oxygen supply.
- Symptoms usually pains are more frequent, more severe, last
longer more than 20 minute, occurs at rest.
- They are no relived by NTG under the tongue.

3) Variant angina:-

- Variant angina result from coronary vasospasm, which reduced

coronary blood flow and decreasing oxygen supply.
- Variant angina usually occurs during periods of rest, usually at
night.

4) Micro-vascular angina:-

- Micro vascular angina symptoms of coronary micro-vascular

disease.
- Coronary micro vascular disease is heart disease that affects the
heart smallest coronary arteries.
- Reduced blood flow in the small coronary arteries may cause
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micro vascular angina.
- Plaque in the arteries, artery spasms, or damaged or artery wall
can reduced blood flow through the small coronary arteries.
- It is harder to recognize and diagnosis but prognosis is excellent.

5) Silent angina:

- The absence of chest pain with evidence of an imbalance

between myocardial oxygen supply and ischemia as determine
by ECG, exercise stress test and Holter ECG monitoring.

3 min Discuss the RISK FACTORS: Lecture cum Black board Which are the
risk factor and discussion risk factors
causes of Modified risk factors: including in the
angina - Tobacco use angina pectoris?
pectoris. - Increase use of cholesterol
- Increase exercise
- Obesity
- Stress
- Smoking
- Diabetes malitus
- Increase intake of fat or salt
- Eating heavy meals

Non-modified risk factors:

- Family history
- Older age
- Increase blood pressure
- Diabetes mallitus
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CAUSES:-

• Development of arthrosclerosis
• Smoking
• Increase blood pressure
• Increase cholesterol
• Sedentary lifestyle
• Exposure of cold and wind
• Fatigue
• Overwork
• Kidney disease
• Thyroid disease
• Other disease:
- Blocked artery
- Aortic valve disease
- Hypertrophic cardiomyopathy
- Micro vascular constriction
- Coronary artery spasm
- Pulmonary hypertension
Lecture cum Black board What is the
2 min Illustrate the PATHO-PHYSIOLOGY: discussion patho-
pathophysiolog physiology of
y of angina Coronary blood flow decrease caused by angina pectoris?
pectoris. • Vasospasm
• Arteriosclerosis
• thrombosis

due to any etiological factors

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Increase oxygen demand in body

Increase heart workload

Heart need more blood supply

Coronary artery dilated and supply more blood to heart

Due to any factor blood supply defected

Heart need more blood demand

Increase oxygen level

Ischemia

Angina pectoris
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3 min Explain the SIGN AND SYMPTOMS: Lecture cum Black board What is the sign
sign and discussion and symptoms
symptoms of • Cardiovascular: of the angina
angina - Chest pain: as a squeezing pressure, heaviness, tightness, pectoris?
pectoris. burning or aching across the chest, usually starting behind
breastbone. Pain often spread to the neck, jaw, arms,
shoulder, throat, back or even teeth.
- Decrease cardiac output
- Decreased pulse rate
- Elevated BP
- Myocardial infraction
- Excessive sweating
- Tachycardia
- Heartburn
- dysarrthmias
• Respiratory:
- Shortness of breath
- Pulmonary edema
- Chest heaviness
- Breathing difficulties
- fatigue
• Genitourinary:
- Decrease urine output
• Gastrointestinal:
- Nausea and vomiting
• Skin:
- Cool and clammy skin
- Diaphoretic
- Pale skin
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4 min Describe the DIGNOSTIC EVALUATION: Lecture cum Black board What is the
diagnostic discussion diagnostic
evaluation of • History collection: evaluation of
angina - Symptoms of pain angina pectoris?
pectoris. - Previous illness
- Family health history
- Particularly heart disease
• Physical examination:
- Level of chest pain
- Check vital sign
- Check symptoms
• Echocardiogram:
- Evaluate ventricular function
- It’s used when ECG is non-diagnostic
• Holter monitoring:
- Evaluate chest pain with exercise testing.
- Check the symptoms of irregular heartbeat, arrhythmias.
• PET scanning (positron emission tomography)
- It is functional imaging technique uses radioactive substance
known as radiotracer to visualize and measure changes in
metabolic process and in other physiological activities
including blood flow.
• Angiography:
- Shown any obstruction, ischemia, blood clot, plaque,
embolism, vasospasm in coronary arteries
• ECG:
- ST segment elevation
- T wave inversion
- Appearance of wide deep Q waves
• Chest X-ray:
- Show cardiomegaly
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4 min Elaborate the MEDICAL MANAGEMENT: Lecture cum Black board Which are the
medical discussion medicine
management PHARMACOLOGICAL MANAGEMENT: included in the
of angina angina pectoris?
pectoris. • Oxygen therapy: it is usually initiated at the onset of chest pain.
Increase amount of oxygen delivered to the myocardium to
decrease pain.

• Vasodilator: a vasodilator agent nitrates such as nitro-glycerine

reduce myocardial oxygen consumption, which decrease
ischemia and relieve pain. It helps to increase coronary blood
flow by preventing vasospasm.

• Beta-blockers: such as propranolol and atenolol reduce

myocardial oxygen consumption, decrease ischemia and relieve
pain.

• Calcium channel blocker: nifedipine, amlodipine that dilate the

smooth muscle wall of the coronary arterioles and reduce
systematic arterial pressure.

• Antiplatelet medication: aspirin, heparin to prevent platelet

aggregation which impedes blood flow.

• Analgesic: morphine sulphate is reduce the pain of chest.

NONPHARMACOLOGICAL MANAGEMENT:

• Bed rest
• Emotional rest
• Monitor for chest discomfort
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• Cardiac monitor
• Cardiac enzyme test
• ECG monitoring
• Lifestyle modification
• Control risk factor
4 min Discuss the SURGICAL MANAGEMENT: Lecture cum Black board Which are the
surgical discussion surgical
management 1. Coronary artery bypass surgery: intervention of
of angina - It is surgical procedure in which one or more blocked angina pectoris?
pectoris. coronary arteries are bypassed by a blood vessel graft to
restore normal blood flow to the heart.
- Graft usually come from patients own arteries and veins
located in the chest (thoracic), leg (saphenous) or arm (radial).
- The graft goes around the blocked artery to create new
pathways for oxygen-rich blood to flow to the heart.
2. Percutaneous transluminal coronary angioplasty:
- It is procedure to open up blocked coronary arteries, allowing
blood to circulate unobstructed to heart muscle.
- A tiny balloon is attached to end of catheter. When the
catheter reaches the blockage, the balloon is inflated, the
plaque is flattened against the arterial lining, and the coronary
artery is effectively widened.
3. Coronary stent:
- It is artificial support device placed in the coronary artery to
keep the vessel open after treatment for coronary artery
disease.
- A small, expandable metal sheath is slipped over the catheter
and placed at the site where the artery has just been widened,
to prevent it narrowing again.
- The stent is inserted into the artery with balloon tip catheter.
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- When stent is correctly position in the coronary artery, the
balloon is inflated, expending the stent against the walls of
the coronary artery.
- The balloon is deflated and removed, leaving the stent
permanently in place to hold the coronary artery open.
4. Atherectomy:
- It is a procedure during which a small cutting device or high-
speed drill on the tip of catheter is used to shave away plaque
that builds up within the wall of coronary arteries.
- It is similar to PTCA.
5. Transmyocardial laser revascularization:
- TMLR involves the use of laser to create tiny channel in the
lower left chamber of the heart, which may increase the blood
flow within the heart.
- A special carbon dioxide laser is used to create small channel
in the heart muscle, improving blood flow in the heart.
- A procedure performed through a small left chest incision or
through a midline incision.

4 min Explain the NURSING MANAGEMNT: Lecture cum Black board What is the
nursing discussion nursing
management 1) Acute pain related to decreased myocardial blood flow as management of
of angina manifested by chest pain, diaphoresis. angina pectoris?
pectoris. - Assess patient description of chest pain including onset,
location, radiation, duration.
- Obtain 12 lead ECG during pain.
- Provide semi-fowler position to patient for comfort.
- Administer oxygen therapy as prescribed 3-4 liters/min.
- Assess and record vital signs frequently.
- Vital sign about provide information about heart rate and
respiratory rate.
- Administer nitroglycerin, morphine as ordered.
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2) Ineffective tissue perfusion related to reduced coronary blood
flow as evidence by hypotension.
- Initially and every hours assess, document and report to
physician.
- Check skin temperature and peripheral pulses frequently.
- Ensure physical rest for patient by keeping the patient on bed
or chair rest.
- Administer oxygen therapy as prescribed in enriched supply
of circulating oxygen.
3) Decreased cardiac output related to decreased cardiac
contractility as evidence by alteration in heart rhythm.
- Assess heart rate, heart round, blood pressure and respiration
and lung fields every 2-4 hours.
- Monitor ECG patterns for cardiac dysarrthmias and
administer anti-dysrhthamic drugs.
- Employ hemodynamic monitoring.
- Monitor urine output hourly, may indicate a decreased in
cardiac output.
- Administer intravenous fluids as ordered.
- Administer medication and evaluate patient’s response.
4) Anxiety related to situational crises, threat to self-concept as
evidence by expressed concern regarding changes in life events.
- Assess the patient for signs of anxiety such as restlessness.
- Allow the patient to express fear and anxiety by facilitating
communication and by answering questions.
- Provide psychological and emotional support to patient and
family.
- Encourage them to talk about their concern.
- Instruct patient in relaxation and diversion techniques and
guided imagery to relieve tension and anxiety.
- Administer antianxiety agents such as diazepam.
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CONCLUSION:

Angina pectoris is the strangling is the chest; this is sudden brief

episode of chest pain caused by the reduced the blood flow and
increased the oxygen demand. Mainly cause by the thrombosis,
vasospasm, and arthrosclerosis. For the management provide the
symptomatic treatment is given especially vasospasm, calcium
channel blocker, beta-blocker, antiplatlet, analgesic. In addition, if
there are fail than the surgical intervention is needed.

SUMMARY:

Today we discussed about definition, etiology, risk factor and causes,

patho-physiology, clinical manifestation, diagnostic evaluation,
medical management, surgical management and nursing management
of the angina pectoris.

BIBLOGRAPHY:

1) Bennette and plum, “TEXTBOOK OF MEDITION”; 10th

edition-1996; W.B. Saunders company, New York; 1996,
P.P:5544-5548
2) Black J.M, “MEDICAL SURGICAL NURSING”; 5th
edition-1999; W.B. Saunders company, Philadelphia, P.P:
4786-4789.
3) Brunners & Suddarth’s, “TEXTBOOK OF MEDICAL-
SURGICAL NURSING”; 10th edition-2004; Elsevier
Publishers, New Delhi, India, P.P: 1568-1589.
4) Ross & Willson, “ANATOMY AND PHYSIOLOGY IN
HEALTH ILLNESS”; 10th edition-2009; Elsevier
Publication, New Delhi, P.P: 457-460.
 NAME: Mrs. Nidhi Prajapati
DATE: 17/08/2021
SUBJECT: Medical-Surgical Nursing
TOPIC: Lesson plan on
(ANGINA PECTORIS)