Overview
This lecture reviews angina, its types, clinical presentation, risk factors, diagnostic approach, and essential nursing care and medication management, focusing on nitroglycerin and aspirin.
Coronary Artery Disease & Ischemia
- Angina is chest pain resulting from coronary artery disease, due to reduced blood flow to the heart.
- Ischemia is insufficient oxygen supply to heart tissue; infarction is severe ischemia with cell death.
- Angina causes transient pain without permanent damage; infarction causes irreversible heart damage.
Types of Angina
- Stable angina: Predictable chest pain with exertion, relieved by rest or nitroglycerin, lasts less than 15 minutes.
- Unstable angina: Can occur at rest, is more severe, not relieved by rest/nitroglycerin, may signal impending heart attack.
- Atypical angina: Especially in women, may present as indigestion, fatigue, jaw/shoulder pain, dizziness.
- Variant (Prinzmetal or vasospastic) angina: Due to coronary artery spasm, can occur at rest, shows transient ST elevation on EKG.
Risk Factors
- Risk factors include atherosclerosis, hyperlipidemia, metabolic syndrome, physical inactivity, obesity, and tobacco use.
Symptoms & Assessment
- Angina typically presents as substernal chest discomfort, possibly radiating to the left arm, induced by exertion or stress.
- Obtain EKG within 10 minutes of chest pain report; look for ST depression or T wave inversion in angina.
- Conduct thorough pain assessment (onset, location, duration, factors that relieve/worsen).
- Assess vital signs, heart rhythm, distal pulses, skin condition, and troponin levels (usually not elevated in angina).
Emergency & Nursing Care
- Assess airway, breathing, circulation, and start EKG monitoring and IV access promptly.
- Administer oxygen to keep saturation >90%, pain relievers, and aspirin unless contraindicated.
- Aspirin (81–324 mg) should be given at chest pain onset and continued daily if prescribed.
- Reassess pain and vitals after each intervention and monitor for deterioration.
- Prevent patient exertion; keep them at rest until chest pain resolves.
Medication Management
- Nitroglycerin: Vasodilator for angina, given sublingually every 5 minutes for up to 3 doses; check BP before each dose.
- Expected side effect: headache; dangerous side effect: hypotension.
- Do not give nitroglycerin with recent use of phosphodiesterase inhibitors (e.g., sildenafil).
- Store nitroglycerin in original, light-protective bottle; replace every 3–5 months.
- Other meds may include transdermal nitro, beta blockers, calcium channel blockers (for vasospastic angina).
Additional Treatments & Tests
- Stress test or pharmacologic stress test may be used if angina is suspected.
- Abnormal stress test may require cardiac catheterization and possible intervention (stent, bypass).
Key Terms & Definitions
- Angina — Chest pain due to myocardial ischemia.
- Ischemia — Inadequate blood supply to an organ, especially the heart.
- Infarction — Tissue death due to prolonged ischemia.
- Stable angina — Predictable chest pain on exertion, relieved by rest.
- Unstable angina — Unpredictable, severe chest pain, not always relieved by rest.
- Variant angina — Chest pain from coronary artery spasm, occurs at rest.
- Nitroglycerin — Vasodilator used to treat angina.
- Aspirin — Antiplatelet drug given for acute chest pain and prevention.
Action Items / Next Steps
- Review hypertension medication section for beta blockers and calcium channel blockers.
- Prepare for NCLEX-style questions on angina types and medication teaching.
- Always educate patients on correct nitroglycerin use and storage.
- Monitor for and report unusual bleeding with antiplatelet therapy.