Angina Pectoris

Question 1

Types of angina pectoris

Answer 1

Classic angina (stable) - exertional angina

Unstable angina (crescendo or pre-infarction)

Variant angina (prinzmetals’s or vasospastic)

Question 2

Classic angina (stable) - exertional angina

Answer 2

Associated with coronary arteriosclerosis

Precipitated by cold, exertion, or stress

Pain: 15 mins and disappears with rest and nitrates

Question 3

Unstable angina (crescendo or pre-infarction)

Answer 3

Progressive angina

Attack occurs during rest with less relief from nitrate

Question 4

Variant angina (prinzmetals’s or vasospastic)

Answer 4

Pain due to spasms of the coronary arteries

Occur in the presence of coronary stenosis

Occurs at rest

Regular patterns: occurring at night

Dysrhythmias accompany the attack:
(ST segment elevation)

Question 5

Four E’s that cause angina pectoris

Answer 5

Exercise

Eating

Emotional stress

Exposure to cold

Question 6

Nitrates
What body does to it
What it does
What it treats

Answer 6

Converted to nitric oxide in body

Cause peripheral vasodilation by relaxing smooth muscle

Treats:
Angina pectoris
Peripheral vascular disease

Question 7

Angina pectoris nitrates

Med name
Use
SE

Answer 7

Nitroglycerin

Can be used for prophylactically or acutely

SE: HA, dizziness, hypotension(don’t let them get up)

Question 8

Nitrate routes

Answer 8

SL:
Tablet or spray q5” x 3 then seek medical help

Transdermal patch for long term use:
Rotate sites, nitrate free period q8-12 hours
High risk for rebound vasoconstriction without rotation

Question 9

Angina pectoris nitrates

Use caution with what type of pts

Answer 9

Head injury( may have swelling)

Conjunctive use with B blockers (⬇️HR and ⬆️contratility)

Renal impairment

Question 10

Angina pectoris nitrates

Patient teaching

Answer 10

Take with first sign of chest pain
(take 3 with episodes then call 911)

Avoid erectile dysfunction meds

Orthostatic hypotension may occue

Question 11

Angina pectoris

Other med tx :
O2
Ca channel blockers
Morphine sulfate
Aspirin or anti-platelet meds

Answer 11

Supplemental o2
(⬆️hgb saturation and oxygenation of myocardial tissue)

Calcium channel blockers
(Coronary artery blood vessel dilation)

Morphine sulfate
(Dilates coronary artery and control pain)

Aspirin or antiplatelet meds
(Plavix, ReoPro, integrilin or Aggrastat)
⬇️or stop the potential for platelet aggregation

Question 12

MONA

Answer 12

Morphine

Oxygen

Nitrates

Aspirin