Nursing Case Study: A Case of Angina Pectoris

RUNNING HEAD: NURSING CASE STUDY 0
NURSING CASE STUDY
A CASE OF ANGINA PECTORIS
[DATE]
HP
[Company address]

Contents
INTRODUCTION.................................................................................................................................2
MAIN BODY........................................................................................................................................2
CONCLUSION.....................................................................................................................................7
REFERENCES......................................................................................................................................8

1.1 PATHOPHYSIOLOGY, PROGNOSIS, ETIOLOGY AND
PREVENTION
Angina pectoris is a manifestation of myocardial ischemia that is caused due to
mismatch between myocardial blood supply and oxygen demand. It is a common
ailment in coronary artery patients with typical symptoms of chest pain. As mentioned
mayocardial ischemia results when coronary blood flow is inadequate to meet the
oxygen demand of the body. This further results in switching of myocardial cells from
aerobic to anerobic metabolism accompanied progressive degeneration of electrical,
chemical and metabolic function. Angina is the most common symptoms seen in case
of myocardial ischemia and caused by chemical and mechanical stimulation of
sensory afferent nerve endings present in myocardium and coronary vessels (Ford,
Corcoran & Berry, 2018). Studies indicate Adenosine might be the major chemical
contributor of angina pain. Study shows during myocardial ischemia, Adenosine Tri-
Phosphate get degraded to adenosine that gets released to extracellular spaces causing
arterial dilation and angina pain. Adenosine led angina mainly occurs by stimulation
of cardiac afferent nerve endings having A1 receptors (Kaski, 2016). The other
etiological factors includes increased extravascular forces such as LV hyperventricular
severity caused due to hypertension, hypertrophic cardiomyopathy, aortic stenosis or
LV increased diastolic pressures. In case of anemia or increased carboxyhemoglobin
concentration thereby reducing the oxygen carrying capacity of the blood. Any
congenital cardiac disease or any major epicardial coronary arteries. The three other
factors includes risk factors, triggering factors and preventive factors (Ben-Shoshan et
al., 2016)

The risk factors for angina pectoris involves the following factors in context of
present case hypercholesterolemia, increased age and gender as males are more prone
to angina. The other factors includes family history (If anybody has history of cardio-
vascular disease), smoking, Diabetes mellitus that can cause vascular damage thus
facilitating plaque development, hypertension persistence can lead to left ventricular
hypertrophy and promotes arterial damage (Iqbal et al., 2016). During the early stage,
chest pain is reported with an increased demand for blood supply. But during later
stages it gets elevated to unstable angina. Unstable angina is characterised by pain in
chest during rest. However, in the present stage definitive diagnosis of myocardial
ischemia is not feasible as ECG or enzymatic pattern, In case the condition is not
treated it can lead to progression of MI and when it is diagnosed, aggressive treatment
is initiated. In order to prevent angina, John has been prescribed preventive
medications that includes metoprolol which is a beta-adrenergic blocking agent that
exert its effect on beta1 adrenoreceptors located on cardiac muscles. This medication is
indicated for hypertension, and angina pectoris and prevention of myocardial
ischemia. The second drug prescribed is aspirin that is anti-platelet factor prescribed
for preventing any forms of myocardial ischemia. The third medication prescribed as a
preventive medication includes pravastatin belonging to statin group of drugs. This
drug helps in lowering of low-density lipoprotein and increase high density lipoprotein
resulting in improvement in hypercholesterolemia. Thus, this medication helps in
reduction of future heart ailments such as artherosclerosis. The fourth preventive
medication prescribed in the present context is glycerine trinitrate as spray indicated
for angina pain that dilates blood vessels and coronary artery in turn reducing stress on
heart. Cefazolin 2 gram TDS IV is a first generation cephalosporin class of antibiotic
prescribed for bacterial infection.