[Adults] Angina

 앤지나.

Chest pain in response to myocardial ischemia or vasospasm

 

Chronic Stable Angina

1. Occurs due to a fixed partial obstruction

-symptoms result when myocardial oxygen demand exceeds supply

-Also called exertional angina

-occurs with exertion, stress, or emotional upset

-Chest pain, nausea, and dyspnea

-Relieved with rest or nitroglycerin

-usually has a stable pattern of onset, duration, severity and relieving factors.

-Duration <5 minutes

 

Nursing interventions

-Treat as outpatient since stable

-Goal: decrease oxygen demand and/or increase oxygen supply

-Preventative: beta blockers, calcium channel blocks, long-acting nitrates.

-Acute pain: short-acting nitroglycerin

-Treat underlying atherosclerosis:

antiplatelet agents(아스피린, 클로피도그렐), statin therapy.

Nitroglycerin
rapidly dilates coronary arteries and blood vessels throughout the body to relieve angina by reducing preload, cardiac workload, and myocardial oxygen demand.

Doses of subligual nitroglycerin are taken 5 minutes apart.
NTG may be taken prophylactically before events known to cause angina (eg. stressful situations, strenuous physical activity)
Headache and dizziness are expected side effects of NTG due to the sudden reduction in blood pressure. A tingling sensation under the tongue may also occur when taking the sublingual form.
The client should sit or lie down when taking NTG to prevent falls that can result from dizziness or orthostatic hypotension. 
If pain is unrelieved after the first dose, the client should call emergency medical services (EMS) and take up to 2 additional doses. Life-saving interventions like coronary stents should not be delayed by waiting until a third dose is taken to call EMS.
Do NOT "I will call emergency medical services if my symptoms persist after taking 3 doses of nitroglycerin"

Unstable Angina

-Ruture of unstable plaque in coronary artery

:also called preinfarction angina

:Occurs with an unpredictable degree of exertion or emotion

:increases in occurrence, duration and severity over time

:Can occur at rest or with minimal exertion

:Pain may not be relieved with nitroglycerin

:Last > 10min

 

Nursing interventions

-Position client upright and provide supplemental oxygen

-Assess vital signs, heart / lung sounds

-Obtain 12-lead ECG

-Obtain cardiac biomarkers.

-Pain relief: nitroglycerin and IV opioid analgesic

-Coronary angiography if evidence of myocardial tissue damage

 

Variant/Vasospastic (Prinzmetal) Angina

-Coronary vasospasm

:Often occurs at rest or during sleep

:Truggered by smoking

:May or may not be related to blockage of coronary arteries

:ECG still shows ST elevation, similar to MI.

:Resolves within a few minutes

 

Nursing interventions

-Preventative

:Treated with long-acting nitrates or calcium channel blockers 

-Acute spasm pain 

:Sublingual nitroglycerin or light exercise.