angina /an·gi·na/ (an-ji´nah) (an´jĭ-nah)
Angina pectoris
angina pectoris,
angina [an-ji´nah, an´jĭ-nah]
angina pectoris (an·jīˑ·n
pek·tōrˑ·is),
angina (anjīn
),
Patient discussion about angina pectoris.
1. a. pectoris.
2. spasmodic, choking, or suffocating pain.an´ginal
angina of effort stable a. pectoris; see a. pectoris.
herpes angina , angina herpe´tica herpangina.
intestinal angina cramping abdominal pain shortly after a meal, lasting one to three hours, due to ischemia of the smooth muscle of the bowel.
angina inver´sa Prinzmetal's a.
Ludwig's angina a severe form of cellulitis of the submaxillary space and secondary involvement of the sublingual and submental spaces, usually from infection or a penetrating injury to the floor of the mouth.
angina pec´toris paroxysmal pain in the chest, often radiating to the arms, particularly the left, usually due to interference with the supply of oxygen to the heart muscle, and precipitated by excitement or effort. It is subdivided into stable and unstable a. pectoris based on the predictability of the frequency, duration, and causative factors for attacks.
Plaut's angina necrotizing ulcerative gingivostomatitis.
Prinzmetal's angina a variant of angina pectoris in which the attacks occur during rest, exercise capacity is well preserved, and attacks are associated electrocardiographically with elevation of the ST segment.
pseudomembranous angina necrotizing ulcerative gingivostomatitis.
silent angina an episode of coronary insufficiency in which no pain is experienced.
variant angina pectoris Prinzmetal's a.
angina pec·to·ris (p k t r- s)n. Severe constricting chest pain, often radiating from the precordium to the left shoulder and down the arm, due to insufficient blood supply to the heart that is usually caused by coronary disease. Also called stenocardia. |
Angina pectoris
A feeling of tightness, heaviness, or pain in the chest, caused by a lack of oxygen in the muscular wall of the heart.
angina pectoris,
a paroxysmal thoracic pain caused most often by myocardial anoxia as a result of atherosclerosis or spasm of the coronary arteries. The pain usually radiates along the neck, jaw, and shoulder and down the inner aspect of the left arm. It is frequently accompanied by a feeling of suffocation and impending death. Attacks of angina pectoris are often related to exertion, emotional stress, eating, and exposure to intense cold, but unstable angina can occur in the absence of a stimulus or exertion. The pain may be relieved by rest and vasodilation of the coronary arteries by medication, such as nitroglycerin. Also called cardiac pain.
observations The chief symptom of stable angina is a highly variable, transient, substernal pain that typically starts with physical or emotional exertion and subsides with rest. It may range from a vague ache to an intense crushing sensation. Radiation to the left shoulder, arm, or jaw or to the back is common but does not occur in all cases. Attacks are exacerbated by cold. The most severe class of angina is a constant pain even at rest. Symptom patterns tend to be consistent and stable for a given individual. Any change in symptom patterns, such as an increase in attack frequency or intensity, should be viewed as serious. Such changes are known as unstable angina and are associated with the deterioration of atherosclerotic plaque. The pain in unstable angina is frequently not fully relieved by rest. Unstable angina is often a precursor to myocardial infarction. Tests include a stress test to deliberately induce an angina attack and check for electrocardiographic (ECG) changes. A test dose of nitroglycerin is administered to evaluate the degree of pain relief. Serum lipid and cardiac enzyme levels are evaluated to screen for cardiac risk factors. Nuclear scanning, angiography, and PET may be indicated to check myocardial perfusion and determine the presence of underlying coronary artery disease (CAD).
interventions The first line of treatment is aggressive modification of risk factors, such as smoking, obesity, physical inactivity, elevated lipid levels, and elevated blood pressure. Drug therapy focuses on the prevention of myocardial insufficiency and pain relief and includes nitrates, beta-blockers, and calcium channel blockers. Prophylactic aspirin and statins are given for individuals with known CAD, and aspirin and heparin are used to treat intracoronary blood clotting in unstable angina and to prevent progression to myocardial infarction. Coronary artery bypass is used for selected individuals with severe angina, localized CAD, no history of MI, and good ventricular function. Percutaneous coronary intervention may be emergently performed to compress plaque, and a stent may placed to keep the coronary artery open. Angioplasty may be used to remove obstructive atherosclerotic lesions. Unstable angina necessitates immediate hospitalization, bed rest, and ECG monitoring for possible MI.
nursing considerations Nursing plays a large role in reducing risk behaviors through smoking-cessation protocols, dietary modification (low-fat, low-sodium diet with complex carbohydrates and fruits), consistent aerobic exercise routines (three to four times weekly for at least 30 minutes), and stress-reduction activities. Patient education is tailored to the individual's symptom set and includes identification of precipitating factors and education to prevent or control those factors. Education about medication effects and side effects is essential. The individual should be able to recognize and report symptoms of unstable angina. Nursing intervention during an acute attack is aimed at maintaining adequate tissue perfusion and relieving pain, including assessment and monitoring of vital signs and ECG patterns, auscultation of heart and lung sounds, administration of oxygen, and prompt administration of nitrates and narcotic analgesics as needed. Rest and cessation of all activity should occur until pain subsides. The nurse should provide comfortable positioning, and supportive calm reassurance to reduce anxiety.
angina [an-ji´nah, an´jĭ-nah]
spasmodic, choking, or suffocative pain; now used almost exclusively to denote angina pectoris. adj., adj an´ginal.
agranulocytic angina agranulocytosis.
crescendo angina old term for unstable angina.
angina cru´ris intermittent claudication.
herpes angina (angina herpe´tica) herpangina.
intestinal angina generalized cramping abdominal pain occurring shortly after a meal and persisting for one to three hours, due to ischemia of the smooth muscle of the bowel.
Ludwig's angina see ludwig's angina.
angina pec´toris acute pain in the chest resulting from myocardial ischemia (decreased blood supply to the heart muscle); the condition has also been called cardiac pain of effort and emotion because the pain is brought on by physical activity or emotional stress that places an added burden on the heart and increases the need for blood being supplied to the myocardium. Some patients can predict the kinds of events that will precipitate an attack while others are unaware of any relationship between onset of an attack and any particular situation in their lives.
Angina pectoris occurs more frequently in men than in women, and in older persons than in younger persons. It is not a disease entity but a symptom of an underlying disease process involving the arteries that supply blood to the heart muscle. About 90 per cent of all cases can be attributed to coronary atherosclerosis. Studies have shown that at least one of the three major coronary arteries usually is stenosed before angina develops. In most cases, all of the major coronary arteries are involved.
Angina pectoris also can result from stenosis of the aorta, pulmonary stenosis and ventricular hypertrophy, or connective tissue disorders such as systemic lupus erythematosus and periarteritis nodosa that affect the smaller coronary arteries.
Angina pectoris occurs more frequently in men than in women, and in older persons than in younger persons. It is not a disease entity but a symptom of an underlying disease process involving the arteries that supply blood to the heart muscle. About 90 per cent of all cases can be attributed to coronary atherosclerosis. Studies have shown that at least one of the three major coronary arteries usually is stenosed before angina develops. In most cases, all of the major coronary arteries are involved.
Angina pectoris also can result from stenosis of the aorta, pulmonary stenosis and ventricular hypertrophy, or connective tissue disorders such as systemic lupus erythematosus and periarteritis nodosa that affect the smaller coronary arteries.
Symptoms. The chief symptom is chest pain, usually unmistakably distinguished by the patient as different from other types of pain such as that caused by indigestion. It is generally described as a feeling of tightness, strangling, heaviness, or suffocation and is usually concentrated on the left side, beginning just under the sternum; it sometimes radiates to the neck, throat, and lower jaw and down the left arm, and occasionally to the stomach, back, or across to the right side of the chest. The pain seldom lasts more than 15 minutes and is usually relieved by rest and relaxation or by administration of nitrates. If it is not relieved in 10 to 15 minutes, the physician should be notified and the patient taken to a cardiac care unit. The decreased blood supply to the heart makes it especially vulnerable to arrhythmias and myocardial infarction, which are the cause of death in about one third of all cases.
Coronary arteriography and ventriculography are valuable in determining the prognosis for angina pectoris. The mortality rate for patients having a narrowing of all three main coronary arteries is higher than for those who have only one vessel involved. Severity of pain is not a good prognostic indicator; some patients with severe discomfort live for many years, while others with mild symptoms die suddenly. An enlarged heart, a third heart sound, ECG abnormalities at rest, and hypertension are all indicative of a poor prognosis.
Coronary arteriography and ventriculography are valuable in determining the prognosis for angina pectoris. The mortality rate for patients having a narrowing of all three main coronary arteries is higher than for those who have only one vessel involved. Severity of pain is not a good prognostic indicator; some patients with severe discomfort live for many years, while others with mild symptoms die suddenly. An enlarged heart, a third heart sound, ECG abnormalities at rest, and hypertension are all indicative of a poor prognosis.
Treatment and Patient Care. Relief from pain by rest and prevention of attacks by avoiding situations which precipitate them are the first steps in the care of the patient with angina. In most cases patients are eager to learn about the disease process causing the pain and want to know how they can participate in control of their attacks. However, compliance with the prescribed regimen usually requires a change in life style and the breaking of some lifelong habits. The known risk factors for coronary heart disease are explained to the patient, and a regimen designed to avoid further damage to the arteries is prescribed.
Organic nitrates may be administered orally or sublingually for relief from anginal pain. They act by dilating the arteries and may be used to treat acute attacks, for long-term prophylaxis and management, or for prophylaxis in situations likely to provoke an attack. Commonly used nitrates are erythrityl tetranitrate, isosorbide dinitrate, and nitroglycerin.
Beta-adrenergic blocking agents, such as propranolol, are used to treat patients who do not respond to weight control and treatment with vasodilators and whose angina significantly limits their activities. These agents decrease the heart rate, blood pressure, and myocardial oxygen consumption and increase the patient's exercise tolerance.
The calcium channel blocking agents (nifedipine, verapamil, diltiazem, and others) are drugs that are particularly beneficial in relieving pain in patients whose angina is the result of coronary artery spasm or constriction. They act by selectively inhibiting the transport of calcium across the cell membrane of myocardial cells and also by reducing myocardial oxygen utilization. Patients most likely to obtain dramatic relief from drugs of this kind are those who experience chest pain while resting or sleeping, upon exposure to cold, or during emotional stress.
Surgical procedures involving arterial bypass and angioplasty have become fairly common as a form of treatment of certain types of ischemic heart disease and resulting angina pectoris. The surgical procedures attempt to bypass the diseased portion of the coronary artery by suturing a vein graft or the internal mammary artery from the aorta to one or more coronary arteries beyond the area of obstruction. In most instances the graft is obtained from the patient's saphenous vein. Angioplasty reestablishes patency of the vessels; in most cases, it is now accompanied by insertion of a stent to help prevent restenosis.
An attitude of calmness and efficiency is most important when caring for a person suffering from an attack of angina pectoris. The pain produces emotional reactions and the strongest of these is fear. Most of these patients know that their pain is resulting from an insufficient supply of oxygen to the heart and they frequently have a feeling of impending death. It usually helps to raise the patient to a sitting position so that breathing is less difficult. The prompt administration of nitroglycerin or the specific drug ordered by the physician should shorten the attack and relieve pain. Above all, the calm presence of someone who knows how to care for them can do much to reassure patients and help them relax, thus lessening the severity of the attack.
Organic nitrates may be administered orally or sublingually for relief from anginal pain. They act by dilating the arteries and may be used to treat acute attacks, for long-term prophylaxis and management, or for prophylaxis in situations likely to provoke an attack. Commonly used nitrates are erythrityl tetranitrate, isosorbide dinitrate, and nitroglycerin.
Beta-adrenergic blocking agents, such as propranolol, are used to treat patients who do not respond to weight control and treatment with vasodilators and whose angina significantly limits their activities. These agents decrease the heart rate, blood pressure, and myocardial oxygen consumption and increase the patient's exercise tolerance.
The calcium channel blocking agents (nifedipine, verapamil, diltiazem, and others) are drugs that are particularly beneficial in relieving pain in patients whose angina is the result of coronary artery spasm or constriction. They act by selectively inhibiting the transport of calcium across the cell membrane of myocardial cells and also by reducing myocardial oxygen utilization. Patients most likely to obtain dramatic relief from drugs of this kind are those who experience chest pain while resting or sleeping, upon exposure to cold, or during emotional stress.
Surgical procedures involving arterial bypass and angioplasty have become fairly common as a form of treatment of certain types of ischemic heart disease and resulting angina pectoris. The surgical procedures attempt to bypass the diseased portion of the coronary artery by suturing a vein graft or the internal mammary artery from the aorta to one or more coronary arteries beyond the area of obstruction. In most instances the graft is obtained from the patient's saphenous vein. Angioplasty reestablishes patency of the vessels; in most cases, it is now accompanied by insertion of a stent to help prevent restenosis.
An attitude of calmness and efficiency is most important when caring for a person suffering from an attack of angina pectoris. The pain produces emotional reactions and the strongest of these is fear. Most of these patients know that their pain is resulting from an insufficient supply of oxygen to the heart and they frequently have a feeling of impending death. It usually helps to raise the patient to a sitting position so that breathing is less difficult. The prompt administration of nitroglycerin or the specific drug ordered by the physician should shorten the attack and relieve pain. Above all, the calm presence of someone who knows how to care for them can do much to reassure patients and help them relax, thus lessening the severity of the attack.
Plaut's angina necrotizing ulcerative gingivostomatitis.
preinfarction angina angina that lasts longer than 15 minutes; it is a symptom of worsening cardiac ischemia.
Prinzmetal's angina a variant of angina pectoris in which the attacks occur during rest, exercise capacity is well preserved, and attacks are associated electrocardiographically with elevation of the ST segment. It is cyclic in nature and is believed to be caused by coronary artery spasm.
pseudomembranous angina necrotizing ulcerative gingivostomatitis.
stable angina chest pain of cardiac origin that has not changed in character, frequency, intensity, or duration for 60 days.
unstable angina chest pain of cardiac origin that is variable, usually increasing in frequency and intensity and with irregular timing.
variant angina Prinzmetal's angina.
Vincent's angina see vincent's angina.
angina pectoris (an·jīˑ·n
pek·tōrˑ·is),n chest pain, often caused by myocardial anoxia and arterial constriction.
angina (anjīn
),n a spasmodic, choking pain. The term is sometimes applied to the disease producing the pain (e.g., Ludwig's angina).
angina, agranulocytic
n See agranulocytosis.
angina, Ludwig's,
n.pr a cellulitis involving the submandibular space and characterized clinically by a firm swelling of the floor of the oral cavity, with elevation of the tongue.
)
Ludwig's angina.
angina, monocytic,
n a “sore throat” associated with infectious mononucleosis.
angina pectoris,
n a symptom of cardiovascular diseases; characterized by a severe, viselike pain behind the sternum that sometimes radiates to the arms, neck, or mandible. It also includes a sense of constriction or pressure of the chest. Angina pectoris is caused by exertion or excitement and is relieved by rest.
angina, Vincent's,
n an older term for involvement of the pharynx by the spread of necrotizing ulceromembranous gingivitis. See also gingivitis, necrotizing ulcerative.
Patient discussion about angina pectoris.
Q. I still have chest pain after 5 angioplasties/stents. Does anybody else still have that much angina?
A. my uncle had the same problem. went through several catheterization at several different cardiologist (some are well known), but couldn't get this annoying pain off his chest. the weird part was that it didn't even reacted to effort. but eventually (i don't remember the stent amount) one of the cardiologist solved the problem. so don't give up and continue searching the cause!
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