Angina Pectoris Nursing Care Plan & Management


  1. Angina is chest pain resulting from myocardial ischemia caused by inadequate myocardial blood and oxygen supply.
  2. Angina is caused by an imbalance between oxygen supply and demand.
  3. Causes include obstruction of coronary blood flow because of atherosclerosis, coronary artery spasm, and conditions increasing myocardial oxygen consumption.
  4. The goal of treatment is to provide relief of an acute attack, correct the imbalance between myocardial oxygen supply and demand, and prevent the progression of the disease ad further attacks to reduce the risk of MI.
Patterns of angina

1. Stable angina

  • Stable angina also called exertional angina.
  • Stable angina occurs with activities that involve exertion or emotional stress and is relieved with rest or nitroglycerin.
  • Stable angina usually has a stable pattern of onset, duration, severity, and relieving factors.

2. Unstable angina

  • Unstable angina also is called preinfarction angina.
  • Unstable angina occurs with an unpredictable degree of exertion or emotion and increases in occurrence, duration, and severity over time.
  • Pain may not be relieved with nitroglycerin.

3. Variant angina

  • Variant angina also is called Prinzmetal’s or vasospastic angina.
  • Variant angina results from coronary artery spasm.
  • Variant angina may occur at rest.
  • Attacks may be associated with ST segment elevation noted on the electrocardiogram.

4. Intractable angina is a chronic, incapacitating angina that is unresponsive to interventions.

5. Preinfarction angina

  • Preinfarction angina is associated with acute coronary insufficiency.
  • Preinfarction angina lasts longer than 15 minutes.
  • Preinfarction angina is a symptom of worsening cardiac ischemia.

6. Postinfarction angina occurs after an MI, when residual ischemia may cause episodes of angina.

Risk Factors
  • Atherosclerosis
  • Hypertension
  • Diabetes Mellitus
  • Thromboangitis Obliterans
  • Polycythemia Vera
  • Aortic Regurgitation

1. Pain

  1. Pain can develop slowly or quickly.
  2. Pain usually is described as mild or moderate.
  3. Substernal, crushing, squeezing, pain may occur.
  4. Pain may radiate to the shoulders, arms, jaw, neck, and back.
  5. Pain usually lasts less than 5 minutes, however, pain can last up to 15 to 20 minutes.
  6. Pain is relieved by nitroglycerin or rest.

2. Dyspnea
3. Pallor
4. Sweating
5. Palpitations and tachycardia
6. Dizziness and faintness
7. Hypertension
8. Digestive disturbances

Diagnostic Evaluation
  1. Electrocardiogram: Readings are normal during rest, with ST depression or elevation and/or T wave inversion during an episode of pain.
  2. Stress test: Chest pain or changes in the electrocardiogram or vital signs during testing may indicate ischemia.
  3. Cardiac enzymes and troponins: Findings are normal in angina.
  4. Cardiac catheterization: Catheterization provides a definitive diagnosis by providing information about the patency of the coronary arteries.
Primary Nursing Diagnosis
  • Altered tissue perfusion (myocardial) related to narrowing of the coronary artery(ies) and associated with atherosclerosis, spasm, or thrombosis
Other Diagnoses that may occur in Nursing Care Plans For Angina
  • Acute pain
  • Risk for decreased cardiac output
  • Anxiety
  • Deficient knowledge (Learning Need) regarding condition, treatment plan, self-care, and discharge needs
Medical Management

The goals of medical management are to decrease the oxygen demands of the myocardium and to increase the oxygen supply through pharmacologic therapy and risk factor control.

Surgical Management

Frequently, therapy includes a combination of medicine and surgery. Surgically, the goals of management include revascularization of the blood supply to the myocardium.

  • Coronary artery bypass surgery or minimally invasive direct coronary artery bypass (MIDCAB)
  • Percutaneous transluminal coronary angioplasty (PTCA) or percutaneous transluminal myocardial revascularization (PTMR)
  • Application of intracoronary stents and atherectomy to enhance blood flow
  • Lasers to vaporize plaques
  • Percutaneous coronary endarterectomy to extract obstruction.