Angina: Pathophysiology, Treatment, and Nursing Interventions

This document provides an in-depth understanding of angina, including its pathophysiology, treatment options, and nursing interventions. It discusses the risk factors associated with angina and emphasizes the importance of lifestyle changes. The document also explores the role of sublingual glyceryl trinitrate and ECG in diagnosing and managing angina. It provides insights into nursing assessments and interventions for angina patients.

Running Head: ANGINA 0
Case Study
Essay

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1.1 Pathophysiology of angina
Angina is chest discomfort or pain caused by reduced blood flow to the heart muscle,
usually associated with coronary heart disease. Treatment primarily involves symptom relief
through rest and use of angina medications, as well as lifestyle changes to improve overall
heart health. It can be caused by underlying coronary artery disorder. When the cholesterol
aggregates are there on the walls of the artery and result in plaques form, ultimately it results
in contraction of the artery (Kones, 2010). The progressive frequency or the prolongation of
angina episodes, reduces exercise thresholds, a requirement for augmented nitro-glycerine
dosing, and lengthier recovery period all the symptoms for the physician to diagnose further.
Uncontrolled angina may results in severe chest pain, squeezing, nausea, sweating, dizziness,
shortness for breathing, and anxiety. In more severe cases it can also lead to death (Norton,
Georgiopoulou, Kalogeropoulos, & Butler, 2011). Risk factors associated with angina include
unhealthy cholesterol levels, tobacco smoking, high blood pressure, diabetes, being
overweight, sedentary lifestyle, being over 45 years old, lack of physical activity, stress and
anxiety, sleep deprivation, and family history (Kones, 2010).
Treatment
In mild cases, lifestyles changes can be helpful to control angina. Some of the lifestyle
changes are; stop smoking, losing weight, healthy diet, exercise, avoiding stress events and
limiting the alcohol consumptions (Samim, Nugent, Mehta, Shufelt, & Merz, 2010).
The physician may prescribe medicines that control the progression of these health
conditions. Medicines like nitrates, aspirin, clot-preventing drugs like clopidogrel, beta
blockers, statins, calcium channel blockers, blood pressure lowering medications, and
ranolazine can be used in issues associated with angina (Tarkin, & Kaski, 2013).

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Lifestyle changes and medicine are often applied to address stable angina. If both the
above treatment does not work, in case, the medical processes like stenting, angiography, and
coronary artery bypass operation can be used to deal with angina issues (The, 2015). Jon has
been prescribed with metoprolol, pravastatin, aspirin, and glyceryl trinitrate spray. He is also
provided with cefazolin 2g TDS IV for cellulitis issues.
Some of the preventive strategies can be implemented in the case of Jon are quitting
smoking, treating the known issues like hypertension, hypercholesterolemia and cellulitis,
avoiding the known triggers of angina such as overeating, regular exercise, maintain a
favourable or healthy weight, managing blood sugar level and learning about how to manage
the mental stress that may leads to angina disorder. As mentioned in the case study Jon has
been facing a lot of additional health issues, therefore his regular vital assessment should be
done.
1.2 Nursing assessment
The patient has been complaining about the severe pain issues, he is experiencing
after the taking shower. The viral sign of Jon’s indicated that his body temperature is normal,
and irregular pulse of 110 bpm, the pressure was 110/90, respiration rate reported 24 and
oxygen saturation rate was 93 Per cent at room environment. His temperature was 37.9
degree Celsius. The chest pain during the treatment period of angina might make nurses
nervous as it can enhance chances of cardiac arrest and other cardiovascular issues. But it is
also possible that the pain occurs due to indigestion, any innocuous issues, or muscle strain.
First assessment
First of all the nurse should asses the position of the pain and try to find out the
answer of some queries like where is the pain, can patient point it, what cause the pain more

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worse, what can be done, and is pain reduces or increases with repositioning (Zetta, Smith,
Jones, Allcoat& Sullivan, 2011). Sometime the positioning might cause chest pain it may be
indicated that the pain is associated with the musculoskeletal, pericarditis I in which the pain
is reduced by taking rest by setting and leaning forward), or pleuritic (Rodrigues, Moraes,
Sauer, Kalil, & de Souza, 2011). As Jon discussed that the pain occurs after taking shower,
therefore it might be possible that he is facing the problems due to changed position.
Second assessment
The severity of the pain should also be assessed by using the pain assessment rating
scale. Accompanying the symptoms of angina might also include vomiting and nausea. The
diseased person may also face dizziness, hypotension and also reduced heart rate and feeling
scared. If the pain is recognized to be very severe, the patient should be referred to the
emergency department as it might be possible that he will be experience cardiac attack
(Nezamzadeh, Khademolhosseini, Mokhtari Nori, & Ebadi, 2012). Mr Jon is an old male, so
it is possible that severe pain might be life threatening for him.
Third assessment
The time of pain should also be examined by assessing how long the pain remains and
is the pain is intermittent, means is the pain starts and stops at regular intervals or it
continues. This because the angina attacks typically occur for 2 to 5 minutes and sometimes
occurs for up to thirty minutes (Oriolo, & Albarran, 2010).
1.3 Nursing intervention
First intervention
Chest pain is the major symptom in angina and it might be low or extreme. The severe
might also be associated with the occurrence of cardiovascular diseases. First of all the

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patient should be asked to lay down in forwarding leaning positions comfortably. Angina
pain does not last for long and it is reduced with time (Veeram, Reddy, Harinder, Singh, &
Reddy, 2010). It is generally triggered by the exertion, it commonly subsides within a few
time as the patient rest. If the pain resists for more than two minutes It can leads to heart
attack, in this case, the nurses should call for emergency services and report to the physician
for further recommendations. The chest muscles should relax and hot baths might also be
helpful by adding 2 cups of the Epsom.
Second intervention
Patient education is another approach that can be used as the nursing intervention for
the pain associated with angina. After the immediate nursing physical assistance, the nurse
should instruct Mr Jon to report the pain instantly. They should maintain a quiet environment,
calm practices, and comforts measures. This will ultimately reduce the external inducements,
which might increase the anxiety and the cardiac strain, and also limits the coping capabilities
and adjustment to the present situation (Brown, Clark, Dalal, Welch, & Taylor, 2011). The
nurse should also educate the patient to perform relaxations techniques such as deep and
relaxed breathing, interruption behaviours, imaginations, guided imagery. This will help Mr
Jon to distract himself from the severe pain. As the patient might feel stressed and anxiety
these distraction activities might reduce the occurrence of heart-related issues. This may also
be helpful in reducing the perception and reaction to the pain. Provide the patient with a sense
of control on the conditions, and enhance the positive or favourable attitude (Tobin, 2010).
Third intervention
After providing the emergency interventions some of the exercises can be applied in
the daily life of Mr Jon. Yoga might be a beneficial activity in reducing the pain associated
with angina. Chest pain or chest tightness sometimes happens because of the gastrointestinal

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issues, in which yoga might be a gold standard approach as it helps in decreasing the chest
tightness through opening the, stretching and expanding the chest. It addresses problems like
poor gestures, a strain of muscles unfavorable positions. Yoga improves the range of motion
and helps in stretching the pectoral muscles and enhances the patient’s flexibility which
ultimately eradicates the chest pain (Cramer, Lauche, Haller, Dobos, & Michalsen, 2015).
The excess blanked has been taken off, and skin condition has been checked. He is
also provided with the face washer, and administered with intravenous ABX and gave nurses
initiated 1g Paracetamol orally.
1.4 Sublingual Glyceryl Trinitrate
At the initial indication of chest pain, the patient should sit down and place a single
tablet below the tongue or between the cheek and gum letting it liquefy. The medicine is
generally absorbed instantly through the coating of the mouth. The patient should not chew
or engulf the pill and should not eat, drink or smoke while the medicine is in the mouth. The
effects of this drug commonly start appearing in one to three minutes. If after five minutes the
patient does not feel the relief of pain, another tablet should be administered (Oliver, Kerr, &
Webb, 2009).
GTN works in two different ways; it extends the blood vessels in the body by causing
them to broaden and this decrease the pressure on the heart, allowing it to pump the blood
easily around the body, which ultimately increases the blood flow to the heart muscle. These
effects of GTN also fulfill the oxygen requirements of the heart (Fan, Mitchell, & Cooke,
2009).
Side effects associated with sublingual Glyceryl Trinitrate include trouble in
breathing, headaches, change in heart rate, seizers, extreme sweating, blurred vision, pale and

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clammy skin, dizziness and fainting, nausea and vomiting, and flushing (Fan, Mitchell, &
Cooke, 2009).
The contradiction of this particular drug includes hypersensitivity to the active
constituent, to other nitro complexes, Patients treating with phosphodiesterase type five
inhibitors such as sildenafil, vardenafil, and tadalafil. Angina occurs due to the hypertrophic
obtrusive cardiomyopathy as it might overstress outflow hindrance, the individual with
possible enhanced intracranial stress such as cerebral hemorrhage or head trauma, marked
anemia, closed angle glaucoma (Lamey, & Lewis, 2013).
Sublingual Glyceryl Trinitrate is the effective drug that can provide relief in angina
instantly, therefore patients should be asked to keep this medicine with them all the time. The
pain associated with the angina is not reduced even after taking sublingual Glyceryl
Trinitrate; they should call for the ambulance immediately. A patient needs to keep the tablets
beneath the tongue and should not engulf it instantly (Fan, Mitchell, & Cooke, 2009).
1.5 ECG
This particular test notes the electrical indications of the heart and diagnoses any
abnormality of the heart like arrhythmias or display ischemia. The ECG results are mostly

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normal between the attacks, throughout the attack, there might be a transient (Cademartiri, et
al., 2009). The ECG interpretations of Mr Jon indicate that the new horizontal or the
descending ST depression is equal to or higher than 0.05 mV and the T inversion is higher or
more than 0.1 mV in in the two different contiguous leads with the pro-eminent R wave or
the R/S ratio is less than one. The ST section and the initial half of the T-wave are principally
regular. At its highest the T-wave creates a sharp >90° turn, and its fatal portion is negative.
ECG (monitor strip, lead II): existence of a big ST segment raise with a positive T wave.
ECG tracing in the one lead exposed a great elevation of ST segment. Evocative of acute
myocardial infarction is detected in the ECG findings. The interpretations should be recorded
in the patient’s record sheet and the unstable and abnormality of QRS complex and other
waves must be reported to the physician. While recording the interpretations the help of ECG
technician should be taken. The discussion should be done between the nurses and other the
health care team assigned to Mr Jon and treatment should be fowled accordingly.

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