Assessment of Angina Pectoris: Case Study, Diagnosis, and Management

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Student Name: AURICA MARIANA LASCU
Student Number: 17087
Module Title: UNDERSTANDING PHYSICAL HEALTH
CONDITION
Module Code: 506
Module Leader: DR. SAMSON OVICHEGAN
Assignment Title: UNDERSTANDING PHYSICAL HEALTH
CONDITION.
Word Count with reference list: 2597
Word Count without reference list:
Submission Date: 20/12/2018
Understanding Physical Health Conditions
Name: Aurica Mariana Lascu
ID NO: 17087
DOB:17/11/1986

TABLE OF CONTENT
INTRODUCTION..............................................................................................................1
MAIN BODY.....................................................................................................................1
Understanding of Angina..............................................................................................1
Main medical intervention used to treat Angina............................................................4
CONCLUSION................................................................................................................. 5
REFERENCES.................................................................................................................9

INTRODUCTION
Understanding physical health condition plays a crucial role in determining wellness
of individuals. World health organisation stated that health comprises of complete
physical, social and mental stability of person (Mygind et al., 2016). The foremost
aspect of managing physical health is exercising regularly which reduces the risk of
chronic diseases like, cancer, cardiovascular and type 2 diabetes. The assessment will
outline case study of an old male patient Fred who is 75 years of age and is recently
diagnosed with Cardio Vascular disease where he experiences regular episodes of
Angina Pectoris.
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Understanding of Angina
Angina is an ischemic chest pain and is major symptom of coronary artery
diseases. The episodes of Angina occur due to reduction in flow of blood to heart
(Mygind et al., 2016). It is a very common chronic illness which occurs due to lack of
physical exercising, unhealthy eating habits and due to unethical practices like smoking,
drinking, etc. The pain is squeezing, heavy, tightening and pressurizing in nature
(Pearson et al., 2013). If diagnosed within time it is a preventable and treatable
condition. The age range among individual suffering or experiencing angina is 9 to 40
years, 40 to 60 years and above 60 years.
Episodes of Angina occur due to lack of blood flow in heart due to which the
person feels pressure on chest which leads to difficulty in breathing (Fiore et al., 2017).
This sort of feeling is present when there is sense of blockage to heart due to improper
flow of blood to the arteries of heart. It is considered as life threatening illness if
symptoms are ignored. It is important for the patients to consult doctor right at the time
of experiencing symptoms or any kind of pressure on chest to avoid the risk to cardiac
arrest.
According to Wright et al (2011), angina is a result of atherosclerosis that is
caused by accumulation of sticky substance known as plaque in the blood vessels over
time. The building of plaque blocks the flow of oxygenated blood into heart which
creates pressure in breathing and circulation of blood contradicting from regular pattern.
The situation cannot be managed with rest and medicine whereas needs proper
diagnosis and clinical treatment. The scholar outlines characteristics of stable angina
that is developing pressure on heart especially at the time of climbing or exercising
(Fiore et al., 2017). Further, the pain in this condition like regular chest pain can be
overlooked as pain due to other cause and the underlying disease may develop to
severe extent. The pain last for few minutes and relieves with help of medication. On
the other hand, unstable characteristics of Angina implies to medical emergency in
which patient experiences acute pain even when resting (Kaski et al., 2015). If the pain
of this sort lasts for long and does not respond to medication and is also present at rest
than it is known as Prinzmetal's angina.
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Bhatia (2010), outlined risk factors of Angina that is use of tobacco as it damages
interior walls of arteries and enhances cholesterol which is the major cause of block or
reduced flow of oxygenated blood in heart. For example, Fred in the case study is
diagnosed with Angina and he is a chain smoker with history of smoking 30 cigarettes
per day. Thus, the researches show that the regular use of tobacco at an advanced age
is major risk factor for cardiovascular disease. Further, diabetes’s is the condition that
leads to reduced production of insulin in human body and thus the blood sugar levels in
human body cannot be regulated. Insulin is a hormone which is secreted from pancreas
and allows body regulate blood glucose level to required levels (Katzung and
Chatterjee., 2012). Diabetes increases the risk of heart disorder because it speeds up
atherosclerosis and escalates cholesterol levels of patients. The study also discussed
that angina is usually misinterpreted as a symptom or condition but it is also associated
as a major risk for cardiovascular disease (Crosta, 2017). Further, high blood pressure
and high blood cholesterol leads to major deposition on arteries which flow blood to
heart. This is the situation when arteries become narrow and this increases the risk of
Angina.
In accordance with this, it can be stated that high level of triglycerides which is
blood fat is also undesirable and risky concern for Coronary artery disease, like in case
of Fred who has healthy appetite and generally consumes fried food which owns greater
risk of high blood cholesterol that narrows and block the flow of blood in vessel. Apart
from this, old age, lack of exercise, stress, obesity is another potential risk factor to
Angina (Schmidt et al., 2014).
As per Fukumoto et al (2016), Angina is a clinical syndrome which leads to
discomfort in chest, jaw, neck, arm, etc. that determines the radiation of pain to different
parts of body linked to myocardial ischemia. Based on this study, it is determined that
majority of cases of Angina are recognised with chest pain. The management of angina
includes treatment and interventions to promote healthy lifestyle changes, stop
smoking, alcohol and lifestyle modifications with inclusion of physical activity in routine.
The treatment of disorder depends on its criticality like some cases needs coronary
angioplasty if the blockage is severe and life threatening (Mygind et al., 2016). While, it
is important for the patients to have proper workout routine like healthy eating and living
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habits. For example, in case of Fred the risk factor of Angina can be controlled by
modifying his dietary routine and enabling intervention for his tobacco consumptions.
Use of appropriate medication is also advised to treat and control Angina which
included nitrates which is considered as fast and long acting treatment for Coronary
artery disease (Fiore et al., 2017). Thus, it can be outlined that, it is important for the
patient diagnosed with Coronary artery diseases to maintain normal blood pressure by
changing lifestyle where it is necessary for the person to quit smoking, lose body fat,
modify diet and minor physical exercising included in the routine.
However, basic investigation for person experiencing system of Angina are
resting electrocardiogram where Pathological Q waves specify myocardial infarction.
Chest X ray which helps in determining increase or decrease in cardiothoracic ratio that
determines the pulmonary venous congestion (Katzung and Chatterjee., 2012). Blood
test to detect hypothyroidism with the help of health professionals can determine
impaired glucose tolerance to determine diagnostic possibilities towards coronary artery
disease (Heart conditions – angina, 2018). In addition, there is exercise test, radio
isotope myocardial perfusion scanning, coronary calcification score, stress
echocardiography to diagnose actual reason of chest pain and blockage and narrowing
of blood vessels that flow oxygenated blood to heart.
Apparently, as per Park et al (2017), Angina is serious concern for which early
diagnosis is a factor which helps in managing risk of cardiac arrest. Diagnosis of Angina
is done in two ways that is exercise stress test and Cardiac Catheterisation. In exercise
stress test heart of patient is monitored with the help of device that is electrocardiogram
(ECG) at the time when the individual is working out like a walk on a treadmill or ride on
stationery bicycle. This test is ceased when coronary artery diseases is triggered
(Katzung and Chatterjee., 2012). Other test is Cardiac Catheterisation in which catheter
is threaded into coronary arteries via blood vessels in groin. Further, in this process
radioactive dye is injected into coronary artery. The dye outlines artery in X rays to
appreciate the blockage of the vessels. The study also discussed about treatment for
Angina for which appropriate medication, healthy life style and surgery are considered
an essential element. The patient suffering from Angina is prescribed regular aspirin
which helps in eliminating blood clots and enables smooth flow of oxygenated blood in
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heart (Angina, 2018). Further, nitrates are given to ease the pain. It is given in many
forms like sublingual tablet which is prescribed to keep under the tongue and gets
dissolve on its own or an aerosol pump spray. This is generally prescribed in case
patient feels headache, flushing and unsteadiness.
Short-term /Long-term plans for Fred:
Short -Term: self-management and carer support; quit smoking; restriction of alcohol;
take his medication. appropriate amounts and types of physical activity; behaviour
modification (Katzung and Chatterjee., 2012).
Long -Term: dietary changes; walking included in his routine; take regularly tablets;
maintenance of weight during future years; behaviour therapy.
Critically analyse via research as to what kind of care will be essential for Elderly people
like Fred:
The amount of calories Fred eat, and drink has a direct impact on his weight.
Some drinkers can permanently become alcohol dependent, which defines as
characterised by craving, tolerance, and continued drinking in spite of harmful
consequences (Tarkin and Kaski., 2013).
If these risk factors in elderly patients specially cannot be controlled over time can lead
to major health issues.
Lifestyles and health-related factors are critical components of the risks including
diabetes, hypertension, obesity, depression, physical inactivity, smoking, for Fred
(Henderson and O'flynn., 2012).
Medical Intervention – NICE Guidelines:
Treatment can help stop angina attacks and reduce the risk of further problems like
cardiac arrest. To reduce the risks for Fred the care plan should include: a balanced diet
for Fred; cut down on alcohol, quit smoking and lose weight (Henderson and O'flynn, N.,
2012).
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Consultation with the GP and GP will recommend the treatments that can help, such as
medicines or talking therapy. Also, it is useful in this case to enrol the patient in a
support group such as the British Heart Foundation {BHF}.
Main medical intervention used to treat Angina
Medical intervention is crucial part of Angina as it is serious coronary Artery disorder
which needs to be diagnosed at an early stage for better an effective treatment. There is
various medical intervention which helps in managing safety from blockage and
narrowing of blood vessels and are prescribed to patients suffering from coronary artery
disease like, Angina (Fiore, 2017).
Aspirin is an acetylsalicylic acid; it is suggested to patient suffering from Angina like
Fred in case study because it helps in reducing blood clots which makes smooth flow of
oxygenated blood into heart. It promotes easier blood flow through narrow blood
vessels by thinning down the consistency of blood (Tarkin and Kaski., 2013).
Nitrates is a polyatomic ion and is given to patient suffering from Angina because it
increases flow of blood an oxygen in heart and helps in improving functioning of heart
(Kaski et al., 2015). It promotes health and normal life to patient diagnosed with
Coronary artery disease. It is a form of medicine which is recommended to keep
underneath the tongue to get absorbed quickly and act rapidly.
Beta blockers are another pharmacological intervention which blocks the effect of
adrenaline on heart. It is used for treating Angina because it slows down heart rate at
time of stress and physical exercising (Pearson et al., 2013). It is effective intervention
because it reduces force of heart muscle contraction. On the other hand, there are Stets
for coronary artery disease as it avoids acute, unstable coronary events by maintenance
of the “vulnerable plaque”.
Further, the major surgical intervention for Angina are two types of surgery one is
Coronary Angioplasty in which thin tube I threaded into coronary blood arteries via
blood vessel in a wrist or groin. It is like the procedure of cardiac catheterisation which
is done to diagnose the narrowing and blockage of blood vessels (Heart conditions –
angina, 2018.). However, in Coronary Angioplasty small balloon attached to the end of
tube is inflated that helps in widening of blocked portion of artery and increase flow of
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oxygenated blood in affected part of heart muscle (Mahoney et al., 2012). The tubular
grids that are stent which is inserted to open and hold the affected part of blood vessel
is also widely used intervention. Thus, the balloon is inflated and removed from body.
On the other hand, there is bypass surgery in which blockage of artery is
bypassed with the segment of vein which is taken from leg or artery is taken from inside
the chest or from forearm. In this the oxygenated blood flow is directed in new artery in
to a blocked or narrowed artery.
Nevertheless, it can be outlined that long-term self-care management of Angina
comprise, healthy eating, physically active, smoke free life, control over high blood
pressure and high blood cholesterol. In addition, it is important for the service user to
have controlled and adequate body weight. In accordance with study it is determined
that Fred and Mary need focus on self-care management of Angina in order to avoid its
long-term effect for which it is essential for the couple to make serious modification in
diet like eliminate consumption of fried food. Further tobacco cessation for Fred is
mandatory to reduce the risk for advancement of cardiovascular disease (Tarkin and
Kaski., 2013).
CONCLUSION
The assessment summarized about Coronary artery diseases that is Angina where
the blood vessel that are responsible for flowing oxygenated blood to heart starts getting
blocked or narrow because of unhealthy living habits such as excessive use of
Tobacco, eating fatty and oily food, inability of body to produce insulin, etc. The study
outlined the case of 75 years old man presently diagnosed with Angina. The is based on
review articles which helps in developing critical understanding over Angina and its
main medial intervention. Thus, it can be concluded that it is important for the person
suffering from Angina to regular take prescribed medicine and follow healthy life style.
The NHS is currently the biggest challenge in its existence. Most areas of services
are running perfectly in the present. We are already seeing sings of the strain in areas
such as hospital care, A& E and GP service reaching this crisis point. Health promotion
and awareness is considered for better and healthy life.
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REFERENCES
Books and Journals
Angina. 2018. [Online]. Available through:
<https://www.bhf.org.uk/informationsupport/conditions/angina>.
Angina. 2018. [Online]. Available through: <https://www.mayoclinic.org/diseases-
conditions/angina/symptoms-causes/syc-20369373>.
Bhatia, S.K., 2010. Coronary Artery Disease. In Biomaterials for Clinical Applications
(pp. 23-49). Springer, New York, NY.
Crosta, P., 2017. Everything you need to know about angina. [Online]. Available through:
< https://www.medicalnewstoday.com/articles/8886.php>.
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Fiore, D., 2017. Cardiac Stenting No Better Than Aggressive Medical Management for
Stable Angina and Single Vessel Disease. Internal Medicine Alert. 39(24).
Fukumoto, et.al., 2016. Extracorporeal cardiac shock wave therapy ameliorates
myocardial ischemia in patients with severe coronary artery disease. Coronary
artery disease, 17(1), pp.63-70.
Heart conditions – angina. 2018. [Online]. Available through:
<https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/heart-
conditions-angina>.
Henderson, R.A. and O'flynn, N., 2012. Management of stable angina: summary of
NICE guidance. Heart, 98(6), pp.500-507.
Kaski, et.al., 2015. Cardiac syndrome X: clinical characteristics and left ventricular
function: long-term follow-up study. Journal of the American College of
Cardiology. 25(4). pp.807-814.
Katzung, B.G. and Chatterjee, K., 2012. Vasodilators and the treatment of angina
pectoris. Basic and clinical pharmacology, 11, pp.191-316.
Mahoney et.al., 2012. Cost and cost-effectiveness of an early invasive vs conservative
strategy for the treatment of unstable angina and non–ST-segment elevation
myocardial infarction. Jama. 288(15). pp.1851-1858.
Mygind, N.D., Michelsen, M.M., Pena, A., Frestad, D., Dose, N., Aziz, A., Faber, R.,
Høst, N., Gustafsson, I., Hansen, P.R. and Hansen, H.S., 2016. Coronary
microvascular function and cardiovascular risk factors in women with angina
pectoris and no obstructive coronary artery disease: the iPOWER study. Journal
of the American Heart Association, 5(3), p.e003064.
Online
Park, et.al., 2017. Body mass index, carotid plaque, and clinical outcomes in patients
with coronary artery disease. Coronary artery disease. 28(4). pp.278-286.
Pearson, et.al., 2013. Markers of inflammation and cardiovascular disease: application
to clinical and public health practice: a statement for healthcare professionals from
the Centers for Disease Control and Prevention and the American Heart
Association. Circulation. 107(3). pp.499-511.
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Schmidt, M., Bøtker, H.E., Pedersen, L. and Sørensen, H.T., 2014. Young adulthood
obesity and risk of acute coronary syndromes, stable angina pectoris, and
congestive heart failure: a 36-year cohort study. Annals of epidemiology, 24(5),
pp.356-361.
Tarkin, J.M. and Kaski, J.C., 2013. Pharmacological treatment of chronic stable angina
pectoris. Clinical medicine, 13(1), pp.63-70.
Wright, et.al., 2011. 2011 ACCF/AHA focused update of the guidelines for the
management of patients with unstable angina/non–ST-elevation myocardial
infarction (updating the 2007 guideline): a report of the American College of
Cardiology Foundation/American Heart Association Task Force on Practice
Guidelines developed in collaboration with the American College of Emergency
Physicians, Society for Cardiovascular Angiography and Interventions, and
Society of Thoracic Surgeons. Journal of the American College of Cardiology.
57(19). pp.1920-1959.
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