Angina Pectoris

Chest pain upon the consultation of a patient in the emergency room can mean a lot of findings. It can either be a cardiac or gastrointestinal origin. However, if the patient has a chest pain caused by a temporary ischemia of the heart muscle, then it is angina pectoris.

Angina in Latin means spasmodic, choking or cramp like pain located in the chest area. It may mean that the heart experienced a certain artery blockage temporarily inhibiting the normal flow of the heart. A patient may further describe it as a pain that radiates to the left shoulder and arm.

Causative Factors:

1. Atherosclerosis – fatty plaque deposits in the intima of the artery.
2. Arteriosclerosis – calcium deposits in the media of the artery causing hardening of the artery.

Precipitating Factors:

1. Strenuous exercise
2. Effort upon exertion can also demand an increase in the demand of blood, the arteries cannot temporarily meet those demand.
3. Strong emotions from sudden news or external factors that affect the patient can stimulate the sympathetic nervous system leading to increased demand of blood supply to the heart.
4. Ingestion of large amount of food can also increase the demand of blood supply in the gastrointestinal tract thereby leaving the arteries to pass more blood.
5. Cold weather can also make people feel angina pectoris. The surrounding temperature can affect the person.

Categories of Angina

1. De novo angina – a chest pain that lasts for at least days to one month only.
2. Stable Angina – this lasts between a month and more
3. Worsening or Unstable Angina – A sudden pain that increases in frequency as well as in duration

Diagnosis and Management

Physical Findings:

1. Unstable Angina (Preinfarction Stage)
• Chest pain when at rest. There is still pain felt even when at rest since the increase demand for oxygen supply of the heart is inhibited by a previous block on the arteries.
• Duration may last more than 10 minutes
• The pain cannot be relieved by pain or nitroglycerine
• May have Myocardial Infarction like symptoms
2. Stable Angina
• Chest pain as felt after a physical exertion or due to emotional stress
• Rest as well as intake of nitroglycerine can also relieve the symptoms thereafter

Treatment

For Acute Attacks

1. Refrain from doing strenuous activities
2. Try to be in the most comfortable position as much as possible
3. Comply with the medications prescribed such as nitroglycerine

For Prevention of Attacks

1. Regulate your emotions as well as manage anxiety in a healthy manner
2. Control the weight gain by eating the right kind of food
3. Have a schedule for regular exercise
4. Take short periods in between activities to recover
5. Comply with medications as well as cardiac follow up especially when there are known illness related to the cardiovascular system.

Byron Webb Romero, RN, MSN

Finished BSN at Lyceum of the Philippines University, and Master of Science in Nursing Major in Adult Health Nursing at the University of the East Ramon Magsaysay Memorial Medical Center. Currently working at Manila Doctors College of Nursing as a Team Leader for Level I and II, Lecturer for Professional Nursing Subjects, and also a Clinical Instructor.

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