Republic of the Philippines

NUEVA ECIJA UNIVERSITY OF SCIENCE AND

Cabanatuan City, Nueva Ecija, Philippines

COLLEGE OF NURSING

NCM 112: ALTERATION IN OXYGENATION

ANGINA PECTORIS
(PATHOPHYSIOLOGY)

SUBMITTED BY:
ARENAS, JOYCE ANN D.
MANAYAO, SAMUEL S.
BSN III-B

SUBMITTED TO:
DIVINA B. OCAMPO, MAN, RN
ACADEMIC INSTRUCTOR

ANATOMY AND PHYSIOLOGY

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The primary function of human heart is to

pump blood into the arteries that carries
oxygen and nutrients to all the tissues of
the body. The heart is located in the
center of the chest with its apex toward
the left. It is the hardest working muscle
in the body as it beats non-stop.

How does blood flow through the right

and left side of the heart?
The right and left sides of the heart work
together. The pattern described below is repeated over and over (heart rhythm), causing
blood to flow continuously to the heart, lungs, and body to supply oxygen and nutrients to
the body cells and to deliver waste products to organs that remove them from your body.
In general, veins return blood carrying CO2 while arteries usually contain O2 enriched red
blood cells. However, the blood flow through the heart is a little different. For example:

Right side of the heart

Blood enters the heart through two large veins, the inferior and superior vena cava,
emptying oxygen-poor blood from the body into the right atrium of the heart.
As the atrium contracts, blood flows from your right atrium into your right ventricle
through the open tricuspid valve.
When the ventricle is full, the tricuspid valve shuts. This prevents blood from flowing
backward into the atria while the ventricle contracts.
• As the ventricle contracts, blood leaves the heart through the pulmonic valve, into the
pulmonary artery and to the lungs where it is oxygenated. Note that oxygen-poor or CO2
containing blood goes through the pulmonary artery to the lungs where CO2 is exchanged
for O2.
Left side of the heart (operating at the same time as the right side of the heart)
The pulmonary vein empties oxygen-rich blood from the lungs into the left atrium of the
heart.
As the atrium contracts, blood flows from your left atrium into your left ventricle through
the open mitral valve.
When the ventricle is full, the mitral valve shuts. This prevents blood from flowing
backward into the atrium while the ventricle contracts.

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As the ventricle contracts, oxygen-enriched blood leaves the heart through the aortic valve,
into the aorta and to the arteries and eventually into veins to complete the blood
circulation in your body.
How does blood flow through the heart to the lungs?
Once blood travels through the pulmonic valve, it enters your lungs. This is called the
pulmonary circulation.
From your pulmonic valve, blood travels to the pulmonary artery to tiny capillary vessels in
the lungs.
Here, oxygen travels from the tiny air sacs in the lungs, through the walls of the capillaries,
into the blood.
At the same time, carbon dioxide, a waste product of metabolism, passes from the blood
into the air sacs.
Carbon dioxide leaves the body when you exhale.
Once the blood is purified and oxygenated, it travels back to the left atrium through the
pulmonary veins.

ANGINA PECTORIS
Angina is a type of chest pain caused by
reduced blood flow to the heart. Angina
(an-JIE-nuh or AN-juh-nuh) is a symptom
of coronary artery disease.

Angina, also called angina pectoris, is

often described as squeezing, pressure,
heaviness, tightness or pain in your chest.

Symptoms
Angina symptoms include chest pain and discomfort, possibly described as pressure,
squeezing, burning or fullness.

You may also have pain in your arms, neck, jaw, shoulder or back.

Other symptoms that you may have with angina include:

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Dizziness
Fatigue
Nausea
Shortness of breath
Sweating
These symptoms need to be evaluated immediately by a doctor who can determine
whether you have stable angina, or unstable angina, which can be a precursor to a heart
attack.

Stable angina is the most common form of angina. It usually happens when you exert
yourself and goes away with rest. For example, pain that comes on when you're walking
uphill or in the cold weather may be angina.
Causes
Angina is caused by reduced blood flow to your heart muscle. Your blood carries oxygen,
which your heart muscle needs to survive. When your heart muscle isn't getting enough
oxygen, it causes a condition called ischemia.

The most common cause of reduced blood flow to your heart muscle is coronary artery
disease (CAD). Your heart (coronary) arteries can become narrowed by fatty deposits
called plaques. This is called atherosclerosis.

During times of low oxygen demand — when you're resting, for example — your heart
muscle may still be able to function on the reduced amount of blood flow without
triggering angina symptoms. But when you increase the demand for oxygen, such as when
you exercise, angina can result.

There are three types of angina:

Stable angina is the most common type. It happens when the heart is working harder than
usual. Stable angina has a regular pattern. Rest and medicines usually help.
Stable angina. Stable angina is usually triggered by physical activity. When you climb stairs,
exercise or walk, your heart demands more blood, but narrowed arteries slow down blood
flow. Besides physical activity, other factors such as emotional stress, cold temperatures,
heavy meals and smoking also can narrow arteries and trigger angina.

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Unstable angina is the most dangerous. It does not follow a pattern and can happen without
physical exertion. It does not go away with rest or medicine. It is a sign that you could have
a heart attack soon.
Unstable angina. If fatty deposits (plaques) in a blood vessel rupture or a blood clot forms,
it can quickly block or reduce flow through a narrowed artery. This can suddenly and
severely decrease blood flow to your heart muscle. Unstable angina can also be caused by
blood clots that block or partially block your heart's blood vessels.
Unstable angina worsens and isn't relieved by rest or your usual medications. If the blood
flow doesn't improve, your heart is starved of oxygen and a heart attack occurs. Unstable
angina is dangerous and requires emergency treatment.
Variant angina is rare. It happens when you are resting. Medicines can help.
Prinzmetal's angina. This type of angina is caused by a sudden spasm in a coronary artery,
which temporarily narrows the artery. This narrowing reduces blood flow to your heart,
causing severe chest pain. Prinzmetal's angina most often occurs at rest, typically
overnight. Attacks tend to occur in clusters. Emotional stress, smoking, medications that
tighten blood vessels (such as some migraine drugs) and use of the illegal drug cocaine may
trigger Prinzmetal's angina.

Risk factors
The following risk factors increase your risk of coronary artery disease and angina:

Tobacco use. Chewing tobacco, smoking and long-term exposure to secondhand smoke
damage the interior walls of arteries — including arteries to your heart — allowing
deposits of cholesterol to collect and block blood flow.
Diabetes. Diabetes increases the risk of coronary artery disease, which leads to angina and
heart attacks by speeding up atherosclerosis and increasing your cholesterol levels.
High blood pressure. Over time, high blood pressure damages arteries by accelerating
hardening of the arteries.
High blood cholesterol or triglyceride levels. Cholesterol is a major part of the deposits that
can narrow arteries throughout your body, including those that supply your heart. A high
level of low-density lipoprotein (LDL) cholesterol, also known as "bad" cholesterol,
increases your risk of angina and heart attacks. A high level of triglycerides, a type of blood
fat related to your diet, also is unhealthy.
Family history of heart disease. If a family member has coronary artery disease or has had a
heart attack, you're at a greater risk of developing angina.
Older age. Men older than 45 and women older than 55 have a greater risk than do younger
adults.

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Lack of exercise. An inactive lifestyle contributes to high cholesterol, high blood pressure,
type 2 diabetes and obesity. However, it is important to talk with your doctor before
starting an exercise program.
Obesity. Obesity is linked with high blood cholesterol levels, high blood pressure and
diabetes, all which increase your risk of angina and heart disease. If you're overweight,
your heart has to work harder to supply blood to the body.
Stress. Stress can increase your risk of angina and heart attacks. Too much stress, as well as
anger, also can raise your blood pressure. Surges of hormones produced during stress can
narrow your arteries and worsen angina.

Diagnosis
To diagnose angina, your doctor will start by doing a physical exam and asking about your
symptoms. You'll also be asked about any risk factors, including whether you have a family
history of heart disease.

There are several tests your doctor may order to help confirm whether you have angina:

Electrocardiogram (ECG or EKG). Each beat of your heart is triggered by an electrical

impulse generated from special cells in your heart. An electrocardiogram records these
electrical signals as they travel through your heart. Your doctor can look for patterns
among these heartbeats to see if the blood flow through your heart has been slowed or
interrupted or if you're having a heart attack.
Stress test. Sometimes angina is easier to diagnose when your heart is working harder.
During a stress test, you exercise by walking on a treadmill or pedaling a stationary bicycle.
Your blood pressure and ECG readings are monitored as you exercise. Other tests also may
be done at the same time as a stress test. If you're unable to exercise, you may be given
drugs that cause your heart to work harder to simulate exercising followed by an imaging
test.
Echocardiogram. An echocardiogram uses sound waves to produce images of the heart.
Your doctor can use these images to identify angina-related problems, including heart
muscle damage due to poor blood flow. An echocardiogram can be given during a stress
test, and this can show if there are areas of your heart that are not getting enough blood.
Nuclear stress test. A nuclear stress test helps measure blood flow to your heart muscle at
rest and during stress. It is similar to a routine stress test, but during a nuclear stress test, a
radioactive substance is injected into your bloodstream.

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This substance mixes with your blood and travels to your heart. A special scanner — which
detects the radioactive material in your heart — shows how the substance moves with the
blood in your heart muscle. Poor blood flow to any part of your heart can be seen on the
images because not as much of the radioactive substance is getting there.

Chest X-ray. This test takes images of your heart and lungs. This is to look for other
conditions that might explain your symptoms and to see if you have an enlarged heart.
Blood tests. Certain heart enzymes slowly leak out into your blood if your heart has been
damaged by a heart attack. Samples of your blood can be tested for the presence of these
enzymes.
Coronary angiography. Coronary angiography uses X-ray imaging to examine the inside of
your heart's blood vessels. It's part of a general group of procedures known as cardiac
catheterization.

During coronary angiography, a type of dye that's visible by X-ray machine is injected into
the blood vessels of your heart. The X-ray machine rapidly takes a series of images
(angiograms), offering a detailed look at the inside of your blood vessels.

Cardiac computerized tomography (CT) scan. In a cardiac CT scan, you lie on a table inside
a doughnut-shaped machine. An X-ray tube inside the machine rotates around your body
and collects images of your heart and chest, which can show if any of your heart's arteries
are narrowed or if your heart is enlarged.
Cardiac MRI. In a cardiac MRI, you lie on a table inside a long, tubelike machine that
produces detailed images of your heart's structure and its blood vessels.

Treatment
There are many options for angina treatment, including lifestyle changes, medications,
angioplasty and stenting, or coronary bypass surgery. The goals of treatment are to reduce
the frequency and severity of your symptoms and to lower your risk of a heart attack and
death.

However, if you have unstable angina or angina pain that's different from what you usually
have, such as occurring when you're at rest, you need immediate treatment in a hospital.

Medications

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If lifestyle changes alone don't help your angina, you may need to take medications. These
may include:

Nitrates. Nitrates are often used to treat angina. Nitrates relax and widen your blood
vessels, allowing more blood to flow to your heart muscle. You might take a nitrate when
you have angina-related chest discomfort, before doing something that normally triggers
angina (such as physical exertion) or on a long-term preventive basis. The most common
form of nitrate used to treat angina is nitroglycerin tablets, which you put under your
tongue.
Aspirin. Aspirin reduces the ability of your blood to clot, making it easier for blood to flow
through narrowed heart arteries. Preventing blood clots can also reduce your risk of a
heart attack. But don't start taking a daily aspirin without talking to your doctor first.
Clot-preventing drugs. Certain medications such as clopidogrel (Plavix), prasugrel (Effient)
and ticagrelor (Brilinta) can help prevent blood clots from forming by making your blood
platelets less likely to stick together. One of these medications may be recommended if you
can't take aspirin.
Beta blockers. Beta blockers work by blocking the effects of the hormone epinephrine, also
known as adrenaline. As a result, the heart beats more slowly and with less force, thereby
reducing blood pressure. Beta blockers also help blood vessels relax and open up to
improve blood flow, thus reducing or preventing angina.
Statins. Statins are drugs used to lower blood cholesterol. They work by blocking a
substance your body needs to make cholesterol. They may also help your body reabsorb
cholesterol that has accumulated in plaques in your artery walls, helping prevent further
blockage in your blood vessels. Statins also have many other beneficial effects on your
heart arteries.
Calcium channel blockers. Calcium channel blockers, also called calcium antagonists, relax
and widen blood vessels by affecting the muscle cells in the arterial walls. This increases
blood flow in your heart, reducing or preventing angina.
Blood pressure-lowering medications. If you have high blood pressure, diabetes, signs of
heart failure or chronic kidney disease, your doctor will likely prescribe a medication to
lower your blood pressure. There are two main classes of drugs to treat blood pressure:
angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers
(ARBs).
Ranolazine (Ranexa). Ranexa can be used alone or with other angina medications, such as
calcium channel blockers, beta blockers or nitroglycerin.
Medical procedures and surgery
Lifestyle changes and medications are frequently used to treat stable angina. But medical
procedures such as angioplasty, stenting and coronary artery bypass surgery may also be
used to treat angina.

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Angioplasty and stenting. During an angioplasty — also called a percutaneous coronary

intervention (PCI) — a tiny balloon is inserted into your narrowed artery. The balloon is
inflated to widen the artery, and then a small wire mesh coil (stent) is usually inserted to
keep the artery open.

This procedure improves blood flow in your heart, reducing or eliminating angina.
Angioplasty and stenting is a good treatment option if you have unstable angina or if
lifestyle changes and medications don't effectively treat your chronic, stable angina.

Coronary artery bypass surgery. During coronary artery bypass surgery, a vein or artery
from somewhere else in your body is used to bypass a blocked or narrowed heart artery.
Bypass surgery increases blood flow to your heart and reduces or eliminates angina. It's a
treatment option for both unstable angina as well as stable angina that has not responded
to other treatments.
External counterpulsation (ECP). With ECP, blood pressure-type cuffs are placed around
the calves, thighs and pelvis to increase blood flow to the heart. ECP requires multiple
treatment sessions. The American College of Cardiology, American Heart Association and
other heart organizations say ECP may help reduce symptoms in people with refractory
angina.

Lifestyle and home remedies

Because heart disease is often the cause of angina, you can reduce or prevent angina by
working on reducing your heart disease risk factors. Making lifestyle changes is the most
important step you can take.

If you smoke, stop smoking. Avoid exposure to secondhand smoke.

If you're overweight, talk to your doctor about weight-loss options.
Eat a healthy diet with limited amounts of saturated fat, lots of whole grains, and many
fruits and vegetables.
Talk to your doctor about starting a safe exercise plan.
Because angina is often brought on by exertion, it's helpful to pace yourself and take rest
breaks.
Treat diseases or conditions that can increase your risk of angina, such as diabetes, high
blood pressure and high blood cholesterol.
Avoid large meals that make you feel overly full.

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Avoiding stress is easier said than done, but try to find ways to relax. Talk with your doctor
about stress-reduction techniques.
Limit alcohol consumption to two drinks or fewer a day for men, and one drink a day or
less for women.

Pathophysiology of Angina Pectoris

MODIFIABLE FACTORS NON-MODIFIABLE FACTORS

 Tobacco use  Family history of heart

 High blood cholesterol or disease
triglyceride levels.  Diabetes
 High blood pressure
 Lack of exercise.
 Older age
 Obesity
 Stress

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Due to atherosclerotic disease

Increased oxygen demand in the body

Increased heart workload

The heart needs more blood supply

Then coronary artery dilates and supply more blood

to the heart

But due to any factors, blood supply defected

Decreases oxygen level in the heart and

develop condition of ischemia

Starts angina (pain) in pectoris

(chest muscles)

References:
https://www.medicinenet.com/heart_how_the_heart_works/article.htm
https://www.acls.net/anatomy-of-the-human-heart.htm

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https://www.mayoclinic.org/diseases-conditions/angina/symptoms-causes/syc-
20369373
https://medlineplus.gov/angina.html
https://www.mayoclinic.org/diseases-conditions/angina/diagnosis-treatment/drc-
20369378

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