Nursing Interventions for Chest Pain Angina

Chest Pain Angina Nursing Diagnosis Care Plan Pathology and NCLEX Review

Angina ( Chest Pain) is a medical condition which involves chest pain due to the decrease in the blood supply to the heart.

It is one of the definitive symptoms of coronary heart disease, and can also be a symptom for other cardiac issues.

Also known as angina pectoris (which means it is located in the chest), angina is a type of pain that can be described as heaviness, tightness, squeezing or pressured, as if something heavy is lying on the chest.

There are three types of angina, which include stable, unstable, variant/ prinzmetal angina, and microvascular angina.

Long-term chest pain may be diagnosed as refractory angina.  

It may be hard to distinguish angina from other types of chest pain such as heartburn due to indigestion. Urgent medical attention is needed for any unexplained or new chest pain.

Signs and Symptoms of Angina Chest Pain

  • Pain in the chest
  • Chest pain may radiate to the neck, shoulders, jaw, back, or arms
  • Shortness of breath
  • Nausea
  • Dizziness
  • Fatigue

Symptoms of angina in women may also include abdominal pain and stabbing pain instead of a pressure feeling on the chest.

Symptoms of angina may also differ depending on the specific type.

Stable Angina – most common form of angina

  • Triggered by exertion, such as climbing the stairs or exercise
  • Last for a short period, usually less than 5 minutes
  • Relieved by rest or by administration of angina medication
  • Usually predictable if the patient has had the same type of chest pain before

Unstable Angina – considered a precursor to myocardial infarction or heart attack

  • Happens even if the patient is at rest
  • Not relieved by angina medication
  • Lasts longer than stable angina, usually 30 minutes or longer
  • Unpredictable / unexpected
  • Different from the usual pattern of chest pain

Prinzmetal or Variant Angina – rare; results from the spasm of coronary arteries due to temporary lack of blood flow

  • Occurs at rest
  • Severe
  • May be alleviated by angina medication

Microvascular angina – common symptom of coronary microvascular disease (MVD), which involves the damage of the tiny branches of a coronary artery.

  • May last from 10 minutes to longer than 30 minutes
  • May occur overnight and associated with sleeping problems

Causes of Angina Chest Pain

Atherosclerosis, or the buildup of cholesterol-containing deposits called plaques in the arterial walls is the common cause of the narrow of the coronary arteries. This results to the reduction of blood flow in the heart, a cardiac condition known as coronary artery disease (CAD).

When there is a decreased blood supply to the cardiac muscle, the heart does not receive enough oxygen. The patient may not have chest pain at rest, but when he/she starts to exert effort such as doing exercise or climbing up the stairs, the demand for oxygenated blood in the heart increases.

Since the blocked coronary arteries cannot supply this additional demand, stable angina happens. Angina can also be referred to as ischemic chest pain because it involves the ischemia of the heart, or lack of oxygenated blood supply.

Unstable angina may result from the sudden blockage (partial or total) of the coronary artery due to the rupture of plaques or formation of blood clot. Usual angina medications do not improve blood flow, thus, the patient needs emergency treatment.

Variant or prinzmetal angina is rare and is particularly caused by the sudden spasm of a narrowed coronary artery. This usually occurs overnight and is mainly triggered by emotional stress, vasoconstrictor drugs, or smoking.

Risk Factors for Angina Chest Pain

There are many risk factors for angina. These include smoking, diabetes or poor diabetic management, high blood pressure, high cholesterol (LDL) levels, old age (Men: 45 years old and above, Women: 55 years old and above), sedentary lifestyle, lack of exercise, stress, obesity, and family history of heart disease.

Complications of Angina

Angina is an important sign of heart attack. Along with chest pain, the patient may experience shortness of breath, radiating pain to the shoulder, arm, jaw, back, and even the teeth.

Abdominal pain may also occur, as well as nausea and vomiting. The patient may feel an impending sense of doom and may also faint.

Diagnostic Tests for Angina

  • Blood tests – Cardiac enzymes such as Troponin T and Troponin I as well as proteins such as creatinine phosphokinase (CPK) and myoglobin may leak into the blood stream when the cardiac blood vessels are damaged.
  • Electrocardiogram
  • Stress test – walking on a treadmill or pedaling a stationary bike while connected to the ECG
  • Echocardiogram – to visualize the heart
  • Nuclear stress test –the injection of a radioactive substance to measure the blood flow to the heart, both when the patient is at rest and when inducing stress through exercise.
  • Chest X-ray – to see if there is any enlargement of the heart
  • Coronary angiography- injection of a dye before taking images
  • Cardiac computerized tomography (CT) scan
  • Cardiac MRI

Treatment for Angina

Medications. The following drugs may be used to treat angina:

  • Nitrates – to relax the blood vessels in order to increase the blood flow to the heart. Nitroglycerin sublingual tablets are the most common form of nitrates used.
  • Anticoagulants such as clopidogrel and ticagrelor – to prevent the formation of blood clot
  • Blood thinning agents such as aspirin – to reduce the ability of the blood to clot, so that the blood flows easier through the narrowed arteries.
  • Statins such as atorvastatin – also called as anti-cholesterol drugs used to reduce the deposits on the arterial walls
  •  Beta blockers – to decrease the cardiac demand for oxygen by means of lowering the heart rate and blood pressure levels
  • Calcium channel blockers – to widen the blood vessels by vasodilation
  • Ranolazine – to treat angina, on its own or in combination with beta blockers, calcium channel blockers, and nitrates

Surgery. Surgical interventions are required if the medical team believes that an urgent, more aggressive treatment for CAD-related angina is needed. These surgeries include:

  • Coronary artery bypass surgery – creation of a graft to reroute the blood flow away from the diseased artery)
  • Angioplasty with stent placement – also known as percutaneous coronary revascularization which involves the insertion of a catheter into the affected artery followed by inflation of balloon and insertion of a stent to keep the blood vessel open.

External counterpulsation (ECP) – the use of multiple blood pressure-like cuffs on the pelvis, thighs, and calves to improve the blood flow to the cardiac muscle.

Lifestyle changes.

  • Smoking is one of the biggest risk factors of angina and CAD. The nicotine in cigarettes facilitates the constriction of blood vessels, which then increases the cardiac workload. This eventually damages the lining of the coronary arteries, as well as other blood vessels.
  • Having a low cholesterol, low sugar diet to control cholesterol and blood glucose levels. Foods rich in omega-3 fatty acids such as fish, soybeans, and flaxseeds are recommended.
  • Taking prescribed blood pressure medications helps control hypertension.
  • Increasing physical activity by doing at least 150 minutes of moderate aerobic exercises will help promote an active lifestyle
  • Learning stress management techniques is helpful in lowering the risk for angina and CAD.
  • Some alternative medicine may help, including fish oil, flaxseed oil, canola oil, and soybean oil.

Nursing Care Plans for Angina

  1. Decreased cardiac output related to the disease process of coronary artery disease (CAD) as evidenced by angina, patient’s verbalization of heavy and tight chest pain, sweating, nausea, and heart rate of 150 bpm and blood pressureof 85/50

Desired outcome: The patient will be able to maintain adequate cardiac output.

InterventionsRationale
Assess the patient’s vital signs and characteristics of heart beat at least every 4 hours. Assess heart sounds via auscultation. Observe for signs of decreasing peripheral tissue perfusion such as slow capillary refill, facial pallor, cyanosis, and cool, clammy skin.To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment. The presence of signs of decreasing peripheral tissue perfusion indicates deterioration of the patient’s status which require immediate referral to the physician.
Administer prescribed medications for coronary artery disease and angina.  Nitrates – to relax the blood vessels in order to increase the blood flow to the heart. Anticoagulants such as clopidogrel and ticagrelor – to prevent the formation of blood clot Blood thinning agents such as aspirin – to reduce the ability of the blood to clot Statins such as atorvastatin – also called as anti-cholesterol drugs used to reduce the deposits on the arterial walls Beta blockers – to decrease the cardiac demand for oxygen by means of lowering the heart rate and blood pressure levelsCalcium channel blockers – to widen the blood vessels by vasodilationRanolazine – to treat angina
Administer supplemental oxygen, as prescribed. Discontinue if SpO2 level is above the target range, or as ordered by the physician.To increase the oxygen level and achieve an SpO2 value of at least 94%.
Educate patient on stress management, deep breathing exercises, and relaxation techniques.Stress causes a persistent increase in cortisol levels, which has been linked to people with cardiac issues. Chronic stress may also cause an increase in adrenaline levels, which tend to increase the heart rate, respiratory rate, and blood sugar levels. Reducing stress is also an important aspect of dealing with fatigue.
Angina Nursing Care Plan
  • Nursing Diagnosis: Acute Pain related to decreased myocardial blood flow as evidenced by  pain score of 10 out of 10, verbalization of pressure-like/ squeezing chest pain (angina), guarding sign on the chest, blood pressure level of 180/90, respiratory rate of 29 cpm, and restlessness

Desired Outcome: The patient will demonstrate relief of pain as evidenced by a pain score of 0 out of 10, stable vital signs, and absence of restlessness.

InterventionsRationale
Administer prescribed medications that alleviate the symptoms of angina.Aspirin may be given to reduce the ability of the blood to clot, so that the blood flows easier through the narrowed arteries. Nitrates may be given to relax the blood vessels. Other medications that help treat angina include anti-cholesterol drugs (e.g. statins), beta blockers, calcium channel blockers, and Ranolazine.
Assess the patient’s vital signs and characteristics of pain at least 30 minutes after administration of medication.  To monitor effectiveness of medical treatment for the relief of angina. The time of monitoring of vital signs may depend on the peak time of the drug administered.  
Elevate the head of the bed if the patient is short of breath. Administer supplemental oxygen, as prescribed. Discontinue if SpO2 level is above the target range, or as ordered by the physician.To increase the oxygen level and achieve an SpO2 value of at least 94%.
Place the patient in complete bed rest during angina attacks. Educate patient on stress management, deep breathing exercises, and relaxation techniques.Stress causes a persistent increase in cortisol levels, which has been linked to people with cardiac issues. The effects of stress are likely to increase myocardial workload.
Chest and Angina Nursing Care Plan

Other nursing diagnoses:

  • Activity Intolerance
  • Deficient Knowledge
  • Anxiety
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