Angina Symptoms, Treatment Nursing NCLEX Review: Stable, Unstable, Variant Angina

hey everyone it's nurse Sarah with register nurse rn.com and in this video I'm going to be talking about angina so let's get started angina is a fancy term for chest pain and this type of chest pain is related to limited blood flow in the heart so we're limiting blood flow to our heart muscles specifically that myocardium and really angina is a warning sign to the patient that something is wrong with the blood supply to the heart and if we don't increase that blood supply to the heart un unfortunately certain sections of the heart will die so let's talk about this blood flow how does your myocardium receive its blood supply well on top of the heart is a network of arteries known as the coronary arteries and the coronary arteries is really where angina is originating from there is something with the coronary artery's ability to deliver blood through itself to that heart muscle so what's really neat is that your coronary arteries actually come from your aorta and remember from anatomy class the aorta came from the heart and it's that huge artery that delivers fresh oxygenated blood from the heart to your body so you have these coronary arteries that just split off from the aorta and then go and Branch itself onto that myocardium onto that heart muscle and they act as a Vine just delivering this fresh oxygenated blood to the heart muscle and the structures within it now there are two main coronary arteries that you want to be familiar with we have the left coronary artery and the right coronary artery and as you can see from their name the left coronary artery is mainly going to feed that left side of the heart and its structures while the right side is mainly going to feed the right side of the heart for example let's take the left coronary artery it comes out of the aorta and branches off onto that left side of the heart then it further branches off into other arteries known as the left anterior descending artery and the left circumflex and then those are going to further Branch off into more arteries but mainly what the left coronary artery does is that it feeds the left atrium so the upper chamber of the heart the left ventricle the bottom chamber of the heart on that left side and then the wall that separates the right ventricle from the left ventricle known as the interventricular septum so if we have a major blockage in a left coronary artery that feeds that left ventricle what's going to happen to that left ventricle well it's going to start to die and remember from anatomy class that our left ventricle is very big and it's responsible for pumping fresh oxygenated blood that just came from the lungs into that aorta which takes it throughout the body so if that part of the heart dies because a coronary artery was blocked we are going to have limited cardiac output from the heart which can lead the person to enter heart failure now with the right coronary artery it's going to come off the aorta and go onto that right side of the heart and it branches off into two main arteries we have the right marginal artery and then we have the right posterior descending artery and these arteries are going to further Branch out and they're mainly going to feed that right side of the heart such as the right atrium the right ventricle some parts of the bottom of the left ventricle and even the electrical structures inner heart like the SA node and the AV node so as you can see with the right coronary artery let's say that we get a blockage in an artery that feeds the SA node and the AV node well for limiting blood supply to these nodes they're not going to work very well so what can happen is the patient can develop dymas therefore as you can see these arteries are extremely important and we need to keep them open so they can deliver blood because if they don't sections of the heart that they feed are going to die so in most patients typically chest pain angina is going to be a symptom that they're going to experience whenever this is going on and this leads us to the three main types of angina stable unstable and variant so first let's take a look at stable angina this is also referred to as exertional angina and to me that's a little bit more of a fitting name because it tells me why this chest pain is occurring in the patient and this type of angina is occurring because there is exertion and we're not only talking about physical exertion but we're talking about emotional exertion as well so whenever a patient is in an exertion type State either physically or emotionally their heart is requiring more oxygen rich blood so that bioc cardium demands more oxygen however in cases of stable angina those arteries cannot keep up with that demand now why can't those arteries keep up with that demand well in most cases of sable angina it's due to a fatty plaque that has grown within that artery so whenever we have a nice little fatty plaque inside that artery not only is it going to narrow the artery and limit the blood flow because that blood flow now has to go around that fatty plaque through throughout rest the artery but it's changed how our artery can work so now with that fatty plaque in there that artery has become stiff it's not as pliable or flexible as it used to be because normally whenever you have exertion on your heart your vessels can Vaso dilate or Vaso constrict to accommodate blood flow however when we throw this fatty plaque in there they're more stiff and they can't dilate as needed whenever we have this exertion on the heart so we're limiting the blood flow that we can normally put through there now this fatty plaque that is in this patient's artery is right now considered stable it's not causing any problems it hasn't ruptured causing a clot to form and blocking blood flow but over time chances are this plaque could become unstable and lead to unstable angina which can lead to a mardial infarction so really this may help you think of stable angina as being really that first step that happens early on before a mardial infarction happens now since this type of angina is exertional it comes on whenever the patient has physical or emotional stress on them there's some Hallmark things that you want to remember about this type of angina so to help us sum up all of that information help you remember this stuff for exams remember these big takeaways so we're going to remember the four s's for stable angina first s is see it coming it's predictable for instance they know that if they walk up that flat of stairs or if they start to get stressed emotionally chest pain is going to come on next s is short lived it's going to be 15 minutes or less it's going to stop whenever they rest or they pop in some nitroglycerin and these arteries are stiff they are stenos they are limiting blood flow and that's from this fatty plaque now for a moment let's talk about nitroglycerin because that was one of our FS we know that with stanina Nitro glycerin can relieve it so there's some things you want to educate your patient about plus you want to be familiar with whenever you're working in the hospital so one in the world is nitroglycerin well it is a vasodilator meaning it opens up our vessels which is definitely what we want when we have limited blood flow going to our heart and this medication is part of the nitrate family now how do you give nitroglycerin well you can give it various ways you know you can start a drip of nitroglycerin you can give it under the tongue and so forth so typically whenever a patient is going home on this they're not going to have a drip of course they're going to be taking either some tablets underneath their tongue one tablet with each dose or they're going to be using some type of spray and what this is going to do is that within minutes after administering this it is going to cause that vessel that is stiff and not wanting to cooperate to open up so that blood flow can go through that artery and they're going to get relief with their chest pain now with this you want to make sure you educate the patient about how to take it and when to seek medical attention so typically with nitroglycerin you're going to give one tablet underneath the tongue every 5 minutes as needed for three doses only and during this time the patient needs to be monitoring their chest pain is it being relieved is it going away now if they're in the hospital setting you want to have them on the cardiac monitor you want to be looking at that ECG especially paying attention to that ST segment are we having elevation or depression and those te- waves this could indicate es schea and that our heart muscle is like actively dying in addition you want to make sure you're watching that blood pressure because nitroglycerin definitely decreases the blood pressure and you want to make sure that systolic is staying within range and you don't want to throw more nitroglycerin on now if the chest pain isn't relieved after three doses the patient wants to get immediate medical attention because chances are this has progressed to unstable andana and there's more going on or if you're in a hospital setting you want to call a rapid response now with the chest pain in Sable angina it's going to typically be felt below the sternum and it can radiate to the back up through the arm or the jaw and this really depends on the patient male or female because sometimes females are not going to have the typical chest pain instead they could be extremely fatigued have shortness of breath and not really think that something is going on so you definitely want to educate patients on how to look for this and another big thing is that if your patient is having chest pain with stable angina this chest pain isn't going to gradually increase in intensity like having that Crescendo pattern that occurs in unstable angina now with stable angina there's no damage to the heart just yet but if this plaque does become unstable we will get damage so one way we can look for damage in the heart is looking at troponin levels with staban those troponin typically are going to be negative because remember troponin levels help us detect a protein in the blood that's released by muscle cells whenever they become damaged in addition when you look at the ECG if the patient's resting not exerting themselves it's typically going to look normal however on exertion there can be some ECG changes such as ST depression and those t- waves can be inverted this is telling us we got some esea so a big thing with this is we want to keep that fatty plaque stable we don't want it to R and there are some things that the patient can do to hopefully help prevent this from happening one thing is following a lowfat low sodium diet we want to decrease further plaques from developing and this plaque from growing even more plus we want to lower sodium levels so we can keep that blood pressure within normal limits and if the patient smokes we want to educate them on the importance of quitting and if they're diabetic to manage their blood glucose cuz smoking and high glucose are very hard on on your vessels it makes them even more stiff which is not what we want whenever we have coronary artery disease going on in addition we want the patient to have their cholesterol lowered so they may be prescribed statins to help achieve that again prevent those fatty plaques from growing or developing new ones and we want to keep that blood pressure lowered and we want to increase blood flow through the heart so there's a combination or various medications that can be used to do this it's based on patients like their kidney function and what's going on with them but some medications that can be used include like beta blockers calcium channel blockers Aces and arbs and I have a whole playlist on how these medications work and what they're used for that you can access up here plus antiplatelet therapy can be used through aspirin now why would we want to do that well if this plaque does rupture one of the first things happens is that platelets start to aggregate there so we can decrease them amount of that we can hopefully decrease um complete blockage from happening in the artery so they may be on aspirin as prevention and depending on the case of this patient what's going on they may or may not be a candidate for a heart cath and what a heart cath is in simple terms is that they go up through an artery they enter into the heart's arteries and they can go and open up that artery to allow blood flow to go through so we just talked about stable and we have in most cases a fatty plaque that is stable but over time this fatty plaque can rupture which leads us into the next type of angana which is known as unstable angina this type of angina is also called pre-infarction angina so this is a type of chest pain that occurs before a big event in the heart known as a mardial infarction therefore this is a very serious type of Vina and if your patient has it they need treatment immediately because we need to investigate what's causing this and get them treatment so we can open up that artery and and they don't progress to a mardial infarction because potentially this is unsurvivable for their muscle cells and for the patient so with this type of angina there is a decrease in oxygen supply to the heart so exertion isn't our problem this type of angina can happen with minimal activity so it can happen at rest now why exactly is it occurring well we've already established that we've had a fatty plaque rupture so whenever a fatty plaque ruptures it sets off a chain of events so we get some platelets going to that side they think they're helping out but instead they're actually making it worse because this little vessel is small and they're going to get there and then we're going to get the formation of a thrombus and thrombus is a fancy word for clot so we're going to get a clot now hanging out in our artery so we went from a fatty plaque to a clot which makes things a lot bigger and this is going to act as a roadblock inside the artery and this is going to partially block blood flow to the muscle and over time this seclusion is going to get worse and as it gets worse the patient is going to enter into the next phase which is my cardial infarction so what are the key things you need to remember about unstable angina that makes it different from stable angina let's remember the four UNS for unstable angina the first un is unexpected chest pain it can happen at any time they cannot see it coming it's not predictable it is unaltered they cannot get relief with rest or nitroglycerin it's un relenting it's going to last more than 15 minutes they're going to have multiple episodes it's going to increase in its intensity over time plus you're going to start seeing shortness of breath cold sweating nausey and vomiting and they can have that Gloom in Doom where they feel like something really bad is about to happen and again these signs and symptoms can vary especially for women where their signs and symptoms aren't as typical and it's potentially going to be unsurvivable for their muscle cells and the patients life if they don't don't get treatment now in regards to troponin levels they typically are negative however if the patient has a high sensitivity troponin done it may be slightly elevated but not too elevated where we're dealing with an MI and the ECG can show some short-lived changes that could reflect ST segment depression or elevation or t-wave inversion but again this is going to be very short-lived on that ECG now this fatty plaque that has ruptured an unstable angina can get worse over time so so this occlusion can get bigger and bigger where we have complete occlusion of that artery so that is where we start getting into nonsi versus stemi territory and these are both types of heart attacks however they differ in terms of severity and location of the blockage within that coronary artery so first let's talk about non- stemi this stands for non ST segment elevation mardial infarction and with this type of Mi we have partial blockage of a coronary artery so whenever you look at the ECG one of the defining things is that you're not going to see ST segment elevation hence this is why it's called non ST segment elevation so you're not going to have that but on the ECG you could see ST depression or inverted t- waves telling us we have definitely some esea to that heart muscle troponin can be elevated as well so whenever this happens some treatments that could be used are starting them on a nitroglycerin drip this will help increase blood flow to the heart because it causes Vaso dilation which is what we majorly need in a condition like this in addition the patient can be started on a Hein drip which is going to prevent further development of thrombus hence clots and the patient can be started on antiplatelet therapy through clo pigil which the brand name is Plavix and this will help decrease platelet aggregation and prevent those platelets from sticking together so much much now depending on the patient's condition and if signs and symptoms have stabilized a heart calf can be performed which will help assess the coronary arteries see where the blockage is how bad is the blockage and then treatment options can be discussed the next is a semi which stands for ST segment elevation mardial infarction and this is the worst of them all so non stemi is very very serious but a stemi is extremely serious the patient needs to be reused to to their heart muscle immediately so with this we have a complete blockage of a coronary artery so that heart muscle not getting peruse and it is going to die and it's going to be irreversible so whenever you look at the ECG you're going to see ST segment elevation as you can see in this example here whenever you see this this is a very bad sign get your patient help immediately because it's telling us a huge area of this heart is not receiving blood flow whenever you look at the patient's stonin levels they are going to be elevated telling us that some muscle cells have died and that is not a good thing so to help with this what we can do is we can get them to the cath lab immediately they can hopefully go in there if the patient's a candidate put in a stent open up blood flow to the heart and reperfuse that muscle or if it's a really bad severe case they can go and get open heart surgery and then lastly we have variant angina and this is also referred to as Prince metal angina so this type of angina is not very common compared to the other two we just went over and it's a type of chest pain that occurs because the patient is having a vasospasm on a main coronary artery so to help you remember that cause remember we have variant angina variant is VA and then we have a vasospasm VA first two letters so that is what is causing it so to help you visualize it look at those arteries that set on the heart and imagine one of those main arteries all of a sudden just spasming opening closing really fast and clamping down on itself that is going to limit the amount of blood flow that can get to that specific structure it feeds therefore that patient is going to have some intense chest pain so patients typically report that this happens whenever they're resting and it tends to happen at night or in the morning so with this if a patient let's say has a cardiac monitor that they're wearing like a halter monitor over time A lot of times they go to the cardiologist they order them to wear this and they want to monitor that heart rhythm while they are having these type of attacks so if we could see that during one of these attacks they may have some ST segment elevation indicating yeah our heart muscle is not being profused but it's going to be very shortlived it's not going to last for a very long time so who is most at risk for having variant angina well patients who are ingesting medications or drugs that have a Vaso constriction effect on the heart such as cocaine marijuana they smoke smoke or they use high amounts of alcohol in addition patients who have certain vascular disorders such as Ray nose phenomenon and whenever a patient has this how they can treat it is that they can use nitroglycerin that will help relax that vessel and prevent it from spasming and to prevent further attacks they can take calcium channel blockers okay so that wraps up this review on anjana and don't forget to access the free quiz that will test you on the material we just covered

Channel: RegisteredNurseRN

Views: 78,034

Keywords: angina, chest pain, angina symptoms, angina treatment, angina nclex, cardiac nclex review, angina pronounciation, angina nursing, angina vs myocardial infarction, myocardial infarction, angina causes, angina pathophysiology, angina pain, nurse sarah, cardiac review, next generation nclex, nclex review, nclex rn, nursing school, nursing lecture, stemi, nstemi, variant angina, stable angina, unstable angina, preinfarction angina, exertional angina, angina types

Id: mZ6kwCQZUIk

Length: 20min 30sec (1230 seconds)

Published: Mon Dec 11 2023