Sunday, December 11, 2005

angina, angina pectoris


angina pectoris (angina) - Common in people over the age of 60 years, angina pectoris occurs when myocardial oxygen demand exceeds myocardial oxygen supply. Although it is usually caused by ATHEROSCLEROSIS of the coronary vessels, the incidence of angina pectoris is high in people with hypertension, DIABETES MELLITUS, THROMBOANGIITIS OBLITERANS, POLYCYTHEMIA VERA, PERIARTERITIS NODOSA, and AORTIC REGURGITATION.
Classically, angina is characterized by recurrent deep chest pain, often radiating down the inner aspect of the left arm. The angina is frequently precipitated by exertion, anger, emotional stress, cold, or eating.
The main symptom of angina is chest pain in the sternal area, but dyspnea, pallor, sweating, and faintness can also occur. The pain is described as a burning pressure, much like indigestion-a squeezing, a choking feeling in the upper chest or throat or a tightening in the chest that may radiate to the shoulder, left arm, jaw, neck, or teeth. The duration of the pain is usually less than five minutes. Frequently, rest and sometimes belching alone will alleviate the pain.
Medical therapy is aimed at reducing myocardial oxygen demand. The precipitating factors that bring on the angina-such as hypertension, obesity, and smoking should be identified and avoided if possible. Frequently, an exercise program is prescribed. The purpose in the exercise program is to reduce the rise in blood pressure and pulse rate upon exertion. The result is a decrease in myocardial oxygen demand and an increase in the amount of exercise an individual can do without experiencing angina.
When people who have angina pectoris must be exposed to the cold they should dress warmly and avoid heavy exertion. It is unwise, for instance, to sleep in a cold bedroom or to walk against a cold wind. The person with angina may be advised to eat small meals rather than large ones to reduce cardiac output. Excessive emotional strain may cause vasoconstriction by releasing epinephrine into the circulation. People with angina need to accept situations as they find them and avoid emotional outbursts and stress whenever possible. As optimistic outlook helps to relieve the work of the heart and therefore reduces angina.
Treatment for angina is primarily with the use of nitroglycerin. This may be used when the pain starts by placing a tablet under the tongue. If the pain is not relieved within 15 minutes (one tablet taken every five minutes) a physician should be contacted. Nitrol ointment or Nitro patch (long-acting forms of nitrates) is being used more commonly to diminish attacks and increase exercise capacity. Nitroglycerin loses its potency after six months so individuals should be instructed to keep this medication in a dark brown bottle and to check the expiration date regularly. If the nitroglycerin is fresh it should cause a burning sensation on the tongue, flushing, and sometimes a headache. These side effects diminish as the individual develops a tolerance to the drug. The person should also be cautioned not to stand or sit up abruptly after taking nitroglycerin because it decreases the systolic blood pressure and may cause dizziness or faintness. Nitroglycerin therapy is successful in the great majority of angina cases. However, when medical therapy does not control the angina, artery expansion or coronary bypass surgery may be considered.
Frequent evaluations of angina should be obtained, since the chest discomfort is similar to that of a heart attack, hernia, gall bladder disease, and esophagitis and can cause these diseases to go unnoticed.
It is important not to ignore angina. Angina pain is a warning that the myocardium is not receiving enough blood and something needs to be done. With use of medication, resting, or altering daily habits, most people continue to live active, productive lives despite attacks of angina pectoris.

Phipps, W. J., et al. Medical Surgical Nursing. St. Louis: C. V. Mosby Co., 1983.
Scherer, J. C. Introductory Medical-Surgical Nursing. Philadelphia: J. B. Lippincott Co., 1982.


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