Angina pectoris, commonly known as angina, is chest pain due to ischemia (a lack of blood, thus a lack of oxygen supply and waste removal) of the heart muscle, generally due to obstruction or spasm of the coronary arteries (the heart's blood vessels). Coronary artery disease, the main cause of angina, is due to atherosclerosis of the coronary arteries. 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".
There is a weak relationship between severity of pain and degree of oxygen deprivation in the heart muscle (i.e., there can be severe pain with little or no risk of a heart attack, and a heart attack can occur without pain).
Worsening ("crescendo") angina attacks, sudden-onset angina at rest, and angina lasting more than 15 minutes are symptoms of unstable angina (usually grouped with similar conditions as the acute coronary syndrome). As these may herald myocardial infarction (a heart attack), they require urgent medical attention and are generally treated as a presumed heart attack.
Most patients with angina complain of chest discomfort rather than actual pain: the discomfort is usually described as a pressure, heaviness, tightness, squeezing, burning, or choking sensation. Apart from chest discomfort, anginal pains may also be experienced in the epigastrium (upper central abdomen), back, neck area, jaw, or shoulders. This is explained by the concept of referred pain, and is due to the spinal level that receives visceral sensation from the heart simultaneously receiving cutaneous sensation from parts of the skin specified by that spinal nerve's dermatome, without an ability to discriminate the two. Typical locations for referred pain are arms (often inner left arm), shoulders, and neck into the jaw. Angina is typically precipitated by exertion or emotional stress. It is exacerbated by having a full stomach and by cold temperatures. Pain may be accompanied by breathlessness, sweating and nausea in some cases. In this case, the pulse rate and the blood pressure increases. Chest pain lasting only a few seconds is normally not angina (such as Precordial catch syndrome).
Myocardial ischemia comes about when the myocardia (the heart muscles) receive insufficient blood and oxygen to function normally either because of increased oxygen demand by the myocardia or by decreased supply to the myocardia. This inadequate perfusion of blood and the resulting reduced delivery of oxygen and nutrients is directly correlated to blocked or narrowed blood vessels.
Some experience "autonomic symptoms" (related to increased activity of the autonomic nervous system) such as nausea, vomiting and pallor.
Major risk factors for angina include cigarette smoking, diabetes, high cholesterol, high blood pressure, sedentary lifestyle and family history of premature heart disease.
A variant form of angina (Prinzmetal's angina) occurs in patients with normal coronary arteries or insignificant atherosclerosis. It is thought to be caused by spasms of the artery. It occurs more in younger women. (en.wikipedia.org )
4 Nanda Nursing Diagnosis for Angina Pectoris
1. Acute Pain related to myocardial ischemia
Nursing interventions:
- Review the description and the factors that aggravate the pain.
- Observation of vital signs every 5 minutes on each attack of angina pectoris.
- Create a quiet environment, limit the visitor when necessary.
- Put the client on total bedrest during episodes of angina (the first 24-30 hours) with a semi-Fowler position.
- Give soft foods and let the client rest 1 hour after meals.
- Teach distraction and relaxation techniques.
- Medical collaboration in terms of drug delivery.
2. Activity intolerance related to decreased cardiac output.
Nursing interventions:
- Maintain bed rest in a comfortable position.
- Provide adequate rest periods, aids in the fulfillment of self-care activities in accordance with the indication.
- Record the color and quality of the pulse.
- Increase client activity on a regular basis.
- ECG Monitor with frequent, and record ECG if there are complaints of angina pectoris.