Angina pectoris: A case study

Running header: ANGINA PECTORIS 1
Angina pectoris
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1.1 Describe the pathophysiology (cause, progression and outcome) of Angina. Include in
your answer the risk factors for Angina and treatment options for Angina. Demonstrate
links to Jon’s case (what has been commenced for Jon in terms of preventive
pharmacology and what preventive strategies would be appropriate in his case?). (400
words)
Pathophysiology
a. Cause
Angina is a condition characterized by series of pain in the anterior chest wall that can last for
1-15 minutes caused by a decreased blood flow to the heart muscles. A fatty substance known as
plaque accumulates and narrows the coronary arteries preventing movement of the blood to the
heart muscles (Ambrose, Winters, & Stern, 2014).. The decreased blood flow leads to a
decreased oxygen supply/demand ratio in response to emotional stress or exercise resulting to
ischemia (Fuster, Cannol, & Danielson, 2013).
b. Progression
Angina may progress to become unstable angina if not treated (Alison, Russell, & Rackley,
2012). At this stage the chest pain begins to occur at rest. If left untreated the cells are deprived
oxygen leading to ischemia, cellular damage occurs, and over time the lack of oxygen in muscle
tissue leads to the death of cells. This condition is called myocardial infarction (White & Chew,
2012).

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c. Outcome
i. Increasing episodes of chest pain
ii. Sweating
iii. Fainting
iv. Nausea and vomiting
v. Shortness of breath
vi. Prolonged pain in the lower abdomen
d. Risk factors
i. Tobacco use- long term use of tobacco may damage the interior walls of the
arteries causing accumulation of cholesterol (Daly & Graham, 2013).
ii. Diabetes- diabetes accelerates atherosclerosis and elevates cholesterol levels
which may lead to angina and heart attacks (Yasue & Kugiyama, 2014).
iii. High blood pressure- high blood pressure damages the arteries and hardens
the arteries which leads to accumulation of cholesterol (Yasue & Kugiyama,
2014).
iv. Family history of heart disease- if one of the family member has a history of
coronary artery disease, there is high chances of the siblings developing
angina (Yasue & Kugiyama, 2014).
e. Treatment
i. Beta blockers and calcium channel blockers which decreases the heart rate
and reduces the blood pressure (Zhuo & Hengxi, 2012).
ii. Nitrates example nitroglycerine which open the coronary arteries improving
supply of blood to the heart (Nissen, Nicholas, & Sipahi, 2012).

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iii. Antiplatelet medication example clopidogrel which prevent blood clots from
forming or blocking the coronary arteries (Barnet & Burril, 2013).
Preventive pharmacology
Jon’s prescribed medication include, cefazolin 2g administered intravenously for the
treatment of cellulitis, metoprolol, glyceryl trinitrate, pravastatin, and lastly aspirin.
Preventive strategies
Eating lots of fruits, vegetables and low-fat sources protein example fish, quit smoking,
exercise regularly, maintain a healthy weight, don’t drink a lot of alcohol, take steps to manage
stress and lastly get the appropriate amount of exercise.
1.2 Discuss three types of physical assessment that would be appropriate for Jon’s
complaint (excluding vital signs) you would initiate for Jon and provide a description of
each of these in the context of Jon’s complaint with the rationale as to why these would
be your priority. (400 words)
a) Thorax and lungs assessment
Assessment
 Assess the history of tobacco use,
including the kind of tobacco used,
amount in pack and duration
 Stand behind the client to check
thorax for shape, slope of ribs,
deformities, position of the spine,
retraction of intercostal space during
Rationale
 Smoking can lead to heart diseases,
lung cancer and chronic lung
disease
 Allows for identification of any
conditions that may impair chest
expansion and cause respiratory