Understanding Angina: Causes, Pathophysiology, and Diagnosis

Nursing
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Introduction
People suffeing from heart conditions often experience sudden changes in signs and symptoms.
Close monitory is therefore needed as a slight change can signify onset of serious complications.
Question 1
An electrocardiogram is able to show electrical activity of the heart at rest. It can also show any
signs of the arterial blockage, cardiac enlargement due to hypertension, detect heart disease and
heart attack occurrence (Hassan 2015). Since Betsy has a history of coronary heart disease and
coronary artery bypass graft, it is important to perform an ECG whenever the patient feels any
discomfort. In addition, there is some silent sign of heart attack including; chest discomfort,
nausea, indigestion, dizziness, sweating arm pain and others. Performing an ECG to Betsy is
therefore important in case the symptoms she is feeling are silent signs of a heart attack.
Question 2
Causes
According to Puelacher et al (2018), angina is a type of chest pain that is caused due to reduced
blood flow to the heart muscles. The main cause of angina is coronary heart disease which
causes narrowing of coronary artery reducing blood flow to the heart muscles. Other
precipitating factors are exposure to cold, some medicine, alcohol, stress, and cocaine use.
Patophysiology
The most common type of angina is angina pectoris which occurs when oxygen supply to the
muscles is lower than the demand. Oxygen is usually delivered to the heart by arteries and
arterioles which include the pericardial and myocardial arteries. They end up supplying various
muscles of the heart as they branch into a number of capillaries. Normally, there is very minimal
resistance in these vessels and therefore blood supply is to the maximum. However, in diseases
such as coronary heart disease, there is narrowing of arteries due to deposition of atherosclerotic
plaques which subsequently increase blood pressure resulting in decreased blood supply to the
muscles. When this occurs, the body can compensate through autoregulation to some extend.
This is achieved through dilation of myocardial vessels when the body detects decreased oxygen

supply. This leads to a sudden increase in the flow of blood to the muscles and therefore eases
the pain due to ischemia. The main mediators in this process are adenosine which is a potent
vasodilator and nucleotides such as nitric oxide.
The endothelial layer also plays an important role when intact (Goto 2018). It usually promotes
vasodilation and prevents sclerotic plaque and thrombus formation. It also synthesizes tissue
plasminogen activator and nitric oxide. When the layer is destroyed or damaged either
mechanically or by chemical assault, then there is a reduced synthesis of nitric oxide and other
vasodilators. Damage can also be as a result of ischemia which further worsens the disease. The
prognosis of angina is largely dependent on the number of vessels and extends of vessels
obstruction. When a lower number of obstructions such as one or two vessels obstruction, then
the level of survival is promising about 80% survival rate. However, if the obstruction of vessels
is about 80% and above, then the chances of survival are very low. This is because there is an
increased risk of vasospasm and thrombosis which can cause a heart attack. Prognosis is also
dependent on the type of angina the patient is suffering from.
Types of angina stable, unstable, STEMI and non-STEMI
There are different types of angina. One of them is stable angina which is more common. The
attacks are triggered by for example stress or alcohol use and exercise but the pain stops when
the person rests. Another type is unstable angina which is more serious than stable angina.
Attacks are more unpredictable and the pain can persist even when the person is at rest. STEMI
(ST-elevation myocardial infarction) and nonSTEMI (non-ST- elevation myocardial infarction)
are types of acute coronary syndrome (Iqbal et al 2018). STEMI occurs when there is a sudden
complete blockage of the coronary artery and there resulting in a sudden heart attack due to
sudden oxygen deprivation to the heart muscles. In non-STEMI, coronary artery blockage is
gradual but the artery is severely narrowed but not blocked. This results in very minimal blood
supply to the muscles. The acute coronary syndrome can be aggravated by certain factors such as
aging, obesity, high blood pressure, diabetes, cigarette smoking and lack of physical exercise.
Betsy has a history of hypertension and also diabetes mellitus which are the main risk factors of
acute coronary syndrome.
Question 3