ANGINA PECTORIS

DEFINITION:-
It is Chest pain due to ischemia of heart muscles generally due to obstruction or spasm in Coronary Artery.

TYPES:-

  1. Stable: Increases Oxygen demand

  2. Unstable: During rest chest pain

  3. Variant: Similar to classical Angina

  4. Nocturnal: At night associated with rapid eye movement during dreaming.

  5. Decubitis: When patient raised up after lying

  6. Post infraction: After myocardial infraction.

CAUSES:-

There are two main causes for this:
  1. Decrease blood supply in heart
    • Coronary artery disease
    • Circulatory disorders, e.g., Aortic valve stenosis
    • Aortic aneurysm (distension of coronary artery lumen)
    • Blood disorders, e.g., Severe anaemia
    • Hypoxia (Decrease oxygen level in cell/tissue).

  2. Increase blood demand in heart
    • Excessive exercise
    • Excessive emotional level
    • Excessive food intake.

    Others
    • Hypertension
    • Some other heart diseases.

PATHOPHYSIOLOGY:-

    Due to any cause
    ↓
    Increase oxygen demand in body
    ↓
    Increase heart workload
    ↓
    Heart needs more blood supply
    ↓
    Then coronary artery dilate and supply more blood to heart
    ↓
    But due to any factors, blood supply defected
    ↓
    Heart needs more blood demands
    ↓
    Decreases oxygen level in heart and develop condition of ischemia
    ↓
    Starts angina (pain) in pectoris (chest muscles)

SIGNS AND SYMPTOMS:-

  • Chest Pain
  • Pallor and cold skin
  • Tachycardia
  • Dyspnea
  • Palpitation (rapid and irregular heart rate)
  • Increases and decreases blood pressure
  • Motionless.

SPECIAL CHARACTERSTICS OF CHEST PAIN:-

  • Location: To left of sternum
  • Severity: Mild to moderate
  • Onset: May quick or slow
  • Radiation: Generally in neck, left shoulder and upper left arm and downward 4th and 5th fingers.
  • Sensation: Burning, bursting, Sensation, patient have gas problem and indigestion.
  • Duration: Less than 5 minutes.

DIAGNOSTIC EVALUATION:-

  • Chest Pain
  • By ECG (ST elevation)
  • Nitroglycerin test (patient feel relief after taking nitroglycerine)
  • Coronary Angiography (it shows CAD)
  • Cardiac catheterization (it shows blockage site of coronary artery).

COMPLICATIONS:-

  • MI
  • Heart Failure

MEDICAL MANAGEMENT:-

  1. Vasodilator:
    They increase blood flow in myocardium (muscles in heart) without affected oxygen requirement and B.P. change.
    Example: Nitrates.


  2. Beta-Blocker:
    Decreases work load in heart by vasodilation action.
    Example:
    • Propranolol- 20-40 mg
    • Atenolol- 20-50 mg.


  3. Calcium channel blockers:
    They improve coronary blood flow.
    Example:
    • Verapamil
    • Nifedipine.


  4. Opiates analgesics:
    They reduce pain.
    Example:
    • Morphine sulphates.


  5. Antiplatelate drugs:
    Blood thinner.
    Example:
    • Aspirin-75-150mg.

SURGICAL MANAGEMENT:-

  • PTCA (Percutaneous transluminal coronary angioplasty)
  • Coronary arteriactomy.
  • Insertion of coronary shunt.
  • CABG (Coronary artery bypass grafting).

DIETARY MANAGEMENT:-

  • We should advice to patient for low fat and low cholesterol diet. They increases extra pressure on heart.
  • Advice to take light and fibers diet.
  • Avoid caffeine intake.
  • Advice to take low sodium diet.
  • Avoid alcohol and smoking.

HEALTH EDUCATION:-

  • Avoid smoking, alcohol, sexual activity.
  • Avoid excessive exercise.
  • Avoid intake of heavy meals.
  • Avoid undue excitement.
  • Avoid sudden exposure of cold weather.

NURSING MANAGEMENT:-

Assessment:

  • Take history of Anginal Pain.
  • Take medical history of patient.
  • Assess anxiety level of patient.
  • Assess knowledge level about family.
  • Assess drugs effects.

NURSING DIAGNOSIS

  • Pain related to myocardial ischemia.
  • Altered cardiac output related to reduced preload and after load.
  • Anxiety related to disease.
  • knowledge deficit related to disease.

Comments

Post a Comment

Popular posts from this blog

PNEUMONIA

Image
PNEUMONIA DEFINITION: - It is an inflammation of lung parenchyma which is associated with marked increase interstitial and alveolar fluid. CAUSES/AETIOLOGY:- Bacterial infection: Gram +ve: Strep. Pneumonia Strep. aurious. Gram -ve: H. influenza Pseudomonas Anaerobic bacteria Viral infection: Influenza virus Para influenza virus Adenovirus Fungus infection: Candidiasis Histoplasmosis Mycoplasma and protozoa in AIDS. CLASSIFICATION:- Community Acquired Pneumonia It occurs in normal healthy persons Bacterial infection Viral infection Hospital Acquired Pneumonia It occurs either when immunity is week or in lung disorders or anatomical abnormal lungs. TYPES:- Segmental Pneumonia:  Only in one small segmental lobes of lung. Bilateral Pneumonia:  Both side segmental lobes of lungs are affected. Lobar Pneumonia:  Complete lobe affected. Broncho Pneumonia:  Patchy like formation in the lungs. RISK FACTORS:- Air pollution/Aspiration Bed rest/prolonged immobility Ch...
Read more

COPD

Image
DEFINITION:-  COPD is the progressive and partially reversible disease of the airway  Comprises primarily of two related disease- chronic bronchitis and Emphysema  Chronic obstruction of the flow of air through the airway and out of the lungs permanent and progressive obstruction over time. Chronic bronchitis is defined clinically as a daily cough with production of sputum at least 3 month per year for 2 or more consecutive year.  It involves inflammation and swelling of the lining of the air way that leads to narrowing and obstruction of the air way.  The inflammation also stimulate production of mucus which can cause further obstruction of the airway.  EMPHYSEMA  It is permanent enlargement of the alveoli due to destruction of the wall between alveoli which leads to reduce the elasticity of the lungs over all.  Loss of elasticity leads to collapse of the bronchioles, obstructing air flow out of the alveoli. Air become trapped to the alveoli and reduce the ab...
Read more

OSTEOMYELITIS

Image
OSTEOMYELITIS DEFINITION:- It is an inflammation of bone due to infection, it may affect any bone. CAUSES:- Bacterial infection: - Staphylococcus Aureus - Streptococcus Viral infection Fungal infection PATHOPHYSIOLOGY:- Due to infection in medullary part of bone ↓ Infection spreads to periosteum ↓ Oedema or abscess formation ↓ Narcotic bone (sequestra) ↓ Peritonsillar abscess (Pus formation) SIGNS AND SYMPTOMS:- Fever Inability in weight bearing Signs of sepsis Erythema Chills Nausea Malaise Restlessness Spontaneous fracture. Night sweats Swelling, tenderness, and warmth at infection site.DIAGNOSTIC FINDING:- DIAGNOSTIC FINDING:- C.B.C - WBC es - ESR es X-ray C.T. scan/MRI Radionuclide bone scan COMPLICATIONS:- Non-healing wound Sepsis Immobility Amputation. MEDICAL MANAGEMENT:- Antibiotics, - Penicillin - Tetracycline - Cephalosporin, e.g., cefalexin Analgesics and antipyretics as prescribed Application of plaster cast and traction FNAC (Fine needle aspiration cytology) fo...
Read more