Angina pectoris: Angina pectoris Prepared By:_ Mrs.Sumathigopinath Lecturer ACN Angina pectoris: Angina pectoris Introduction :- Angina pectoris is chest pain resulting from myocardial ischaemia .(inadequate blood supply to the myocardium ) The term derives from the Latin angina ("infection of the throat") from the Greek ἀγχόνη ankhonē ("strangling"), and the Latin pectus ("chest"), and can therefore be translated as "a strangling feeling in the chest“. Around 2 to 3 percent of people with age between 25 to 64 years old are affected by angina pectoris Definition : Definition Angina pectoris is a clinical syndrome characterized by episodes of pain or pressure in the anterior chest. Chest pain that is typically severe and crushing with a feeling just behind the breastbone (the sternum) of pressure and suffocation, due to an inadequate supply of oxygen to the heart muscle . Causes &risk factors: Causes &risk factors acid reflux ( gastroesophageal reflux disease , GERD), Acute blockage of a coronary artery. Inflammation or infection of the coronary arteries . Injury to one or more coronary arteries . Poor functioning of the tiny blood vessels of the heart ( microvascular angina) Characteristics of Angina Pectoris: Characteristics of Angina Pectoris pain characteristics of angina pectoris : Located retro sternally Feels like pressing Radiates to epigastrium, back (between blade-bones), neck and lower jaw Radiation to the right arm is observed lesser than to the left one. The pain might be originally located in the epigastrium or the arm Continuation…….: Continuation……. Pain usually lasts 3 to 5 minutes in exertion angina. After taking nitroglycerin, the pain disappears. Pain incidents triggered by unstable angina are more severe and prolonged. The beginning of angina pectoris incidents is related not only through exertion, but with arrhythmia paroxisms (arrhythmias) to Continuation…..: Continuation….. The pain is frequently accompanied by dyspnea . Angina pectoris occurs during emotional or physical stress, in the cold temperature, or post- prandial . The pain disappears when the sufferer takes a rest (within few minutes) or after consuming nitroglycerin. Pathophysiology : Pathophysiology . Coronary blood supply slows and become occluded Decrease blood supply to the myocardium Myocardial ischaemia develops Pumping function of the heart is reduced Continuation…….: Continuation……. Reduction in pumping deprives the ischaemic cells in need of oxygen and glucose Cells leave the waste product of lactic acid without oxygen Lactic acid accumulates, pain develops Factors that decrease supply: Factors that decrease supply Coronary vessel disorders Atherosclerosis Arterial spasm Coronary arteritis Circulation disorders Hypotension Aortic stenosis Aortic insufficiency Blood disorders Anaemia Hypoxemia polycythemia Factors that increase demand: Factors that increase demand Increased cardiac output Exercise Emotion Digestion of a large meal Anaemia Increased myocardial need for oxygen Damaged myocardium Myocardial hypertrophy Aortic stenosis Strong emotions Clinical features: Clinical features Characteristics of angina :- Discomfort in the chest,jaw,shoulder,back,or arm. Onset :- Angina can develop quickly or slowly.ask the client when the pain began. Location :- 90% the pain as retrosternal or slightly to the left of the sternum. Radiation :- Pain usuallyradiates to the left shoulder ,upper arm and travel down the inner aspect of the left arm to the elbow,wristand fourth and fifth fingers. Continuation…..: Continuation….. The pain may radiate to right shoulder,neck,jaw,epigastric region. Duration :- Pain lasts less than 5 mins . Attacks precipitated by a heavy meal or extreme anger may lasts for 15-20 mins . Sensation :- Pain as squeezing , burning,pressing , choking,aching,or bursting pressure.pain feellike gas,heartburn,or indigestion. Continuation….: Continuation…. Anginal pain as sharp or knifelike. Severity :- Severe , not able to conclude. Dyspnoea Pallor Sweating Faintness Palpitaions,dizziness . Classification : Classification Stable angina :-is paroxysmal chest pain or discomfort triggered by a predictable degree of exertion or emotion. pain will be stable.eg.nitroglycerin pain will be relieved. Unstable angina :-pain will occur at night. Variant angina :- Occur due to coronary spasm and may be associated with elevation of the ST segment on ECG. Nocturnal angina :-REM during dreaming. Angina decubitus :- Chest pain that occurs when the client reclines and when the client sits or stands up. PowerPoint Presentation: Intractable angina :-chronic incapacitating angina that is unresponsive to intervention. Post infarction angina :- Pain occurs after MI , Diagnostic evaluations: Diagnostic evaluations ECG-ST elevation and depression Chest radiography-treadmill or stationary bicycle. Radioisotope imaging- ischeamia appear as areas of diminished or absent activity. Electron beam computed tomography (EBCT) Coronary angiography- to diagnose the percentage of blockage in coronary arteries. Chest X-ray- cardiomegaly and pleuritis . Management : Management Goals :- Antianginal pharmacologic intervention Education and risk factor modification Interventional cardiology/CABG The American heart association recommends that people with angina control their risk factors. A-for aspirin and antianginal therapy B- betablocker therapy and blood pressure control C- cogarettes and cholesterol D-diet and diabetes E-education and exercise. Medical management: Medical management Goals :- Relieve the acute pain Restore coronary blood flow revent further attack and to reduce the risk of AMI . Relieve the acute pain and restore coronary blood flow:- Opiate analgesics - to relieve pain ,the heat rate often lowers and the need for oxygen by the myocardium also is reduced. Vasodilators -prevent further attacks by widening the diameter of coronary arteries and increasing the supply of oxygen to the myocardium.eg.nitroglycerin sublingually. PowerPoint Presentation: Beta adrenergic blockers- reduce the workload of the heart,decrease myocardial oxygen demand,and may decrease the number of anginal attacks. Calcium channel blockers- used to dilate coronary arteries, increase oxygen supply to the myocardium. Antiplatelet agents -inhibit platelet aggrgationand reduce coagulability,thus prevent clot formation . PowerPoint Presentation: Prevent further attacks:- Education and counselling regarding modification of risk factors to reduce the progression of CHD.