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Angina. Clinical syndrome characterize by episodes of chest discomfort (pain) or pressureTypically caused by an imbalance in myocardial oxygen supply versus myocardial oxygen demand.>6 million people in US have angina.. Etiology. Typically caused by atherosclerotic heart disease in combination with increased oxygen demand.Unstable angina is also thought to be associated with a temporary blood clot (plaque rupture and bleed) superimposed on atherosclerotic plaque..
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1. Angina Leslie Mickles, RN, MSN, ABD
2. Angina Clinical syndrome characterize by episodes of chest discomfort (pain) or pressure
Typically caused by an imbalance in myocardial oxygen supply versus myocardial oxygen demand.
>6 million people in US have angina.
3. Etiology Typically caused by atherosclerotic heart disease in combination with increased oxygen demand.
Unstable angina is also thought to be associated with a temporary blood clot (plaque rupture and bleed) superimposed on atherosclerotic plaque.
4. Types of Angina Stable
Unstable
Variant (Prinzemetal)
Silent Ischemia
5. Stable angina is the most common type. It occurs when the heart is working harder than usual.
There is a regular pattern to stable angina.
After several episodes, you learn to recognize the pattern and can predict when it will occur.
The pain usually goes away in a few minutes when you rest or take your angina medicine.
Stable angina is not a heart attack but makes it more likely that you will have a heart attack in the future.
6. Also called preinfarction angina or crescendo angina
Unlike stable angina, it does not follow a pattern. It can occur without physical exertion and is not relieved by rest or medicine. Unstable Angina
7. Variant Angina Also called Prinzmetal Angina
Variant angina is rare. It usually occurs at rest. The pain can be severe and usually occurs between midnight and early morning. It is relieved by medication
Thought to be caused by coronary vasospasms
8. Preciptiating Conditions ASHD
Hypertension
Aortic Valve Disease
Anemia
Dysrhythmias
Thyrotoxicosis
Physical Exertion
Heavy Meal
Stress
Coronary Artery Vasospasm
Heart failure
9. Manifestation The pain or discomfort of angina:
Is often described as pressure, squeezing, burning, or tightness in the chest
Usually starts in the chest behind the breastbone
May also occur in the arms, shoulders, neck, jaw, throat, or back
May feel like indigestion.
10. Classifications of Angina
11. Diagnosis Typical Chest Pain History
Risk Factors
Diagnositc Tests
Stress Test positive
Stress Echo
Cardiac Enzymes negative
Cardiac Catheterization with coronary angiography
12. Treatment Support care during acute event
Oxygen
Rest
Nitroglycerin
Morphine sulfate
Arrhythmia monitoring
Monitoring vital signs
Monitoring for complications (e.g. heart failure)
R/O MI
13. Treatment CABG
PTCA (Aggrastat or Reopro) and stent
Angioplasty or athrectomy
Long term medical management
Nitrates
Beta blockers
Calcium Channel blockers
ACE inhibitors or ARBs
Aspirin or other antiplatlet therapy (e.g. plavix, ticlid)
Take nitrate before an event that usually causes chest pain
Meds for hyperlipidemia
Education on dietary and activity changes
14. Vasodilators: Nitrates
15. The Many Faces of Nitro
16. ACE (angiotensin converting enzyme) Inhibitors
17. ARBs (angiotensin II receptor blockers)
18. Calcium Channel Blockers
23. Education of Patient Life style modifications
STOP SMOKING!!!!!!!!
Nitroglycerin use
Recognizing symptoms
If pain persists after 15 minutes or 3 nitro call 911.