Essay Sample on Pathophysiology of Angina

Introduction

Angina pectoris, the most stable and common form of myocardial ischemia, and unstable angina are caused by the reduction in blood flow to the heart denying it enough oxygen as a result of blockage of an artery from conditions such as the coronary heart disease. The resulting imbalance between myocardial blood supply and the demand for oxygen can also arise as a result of the atherosclerotic narrowing and impaired epithelial function (Sedding et al., 2018). In a healthy person, blood is delivered to the heart through epicardial vessels, and there is little resistance to blood flow, nonetheless, if there is a restriction to blood flow, autoregulation compensates to an extent. However, when autoregulation fails, the patient experiences angina (chest pain).

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Progression of Angina

According to Wiley, (2018) atherosclerotic plaque destabilization or ulceration at sites of coronary artery narrowing and the significant development of a blood clot influence the progression from stable to unstable angina and even higher risks for developing myocardial infarction. Fissures of atherosclerotic plaque lead to the exposure of collagen and lipids to blood flow initiating clotting (thrombotic platelet aggregation and subsequent coagulation). The platelet release is further supported by the release and accumulation of thromboxane causing dynamic vasoconstriction, worse off, and the thrombosis expands to include white and red blood cells forming a fibrin mesh( Kotapati, Jyotsna, & Lalita, 2017). As a result, there is a higher risk for the development of a fully obstructive coronary thrombosis warranting the progression from unstable angina pectoris to acute myocardial infarction.

Outcome of Angina

Angina, like any other type of disease, is associated with poor quality of life, increased vulnerability to hospitalization, and even death. However, risk factors such as diabetes, hypertension, and increase susceptibility to recurrent angina and CV death. Jon's case is no different from his heath conditions and pasts life choices increases risks to developing adverse outcomes. To start with, his heartbeat is higher than 110 bpm and according to Chenet al., (2018) an elevated heath beat of more than 70bpm is associated with increased CV deaths as the heart rate is an essential determinant of myocardial oxygen consumption. Secondly, as the patient has high levels of cholesterol, he is at high risk of myocardial infarction as a result of high risks of exposure of collagen and lipids to blood flow initiating thrombosis. In response, there is a need for more physical activity and fat lowering therapy which will not only lower cholesterol levels but also reduce blood pressure and subsequent myocardial ischemia.

Admission of Sublingual Glyceryl TrinitrateAdministration

According to Gorath, (2017), Glyceryl Trinitrate has been used for decades as a mild vasodilating agent in ischemic heart diseases and Angina to relief pain. The form of nitrate is administered orally, and unlike other tablets, it is not supposed to be swallowed, instead, upon prescription by a doctor, the patient is required to place the drug under the tongue and allow it to dissolve. However, should the pain fail to subside, the patients need to seeks further medical attention. Also, glyceryl trinitrate is used as a preventive drug in cases where the patient is subjected to predisposing factors for angina attack, such include; low temperatures, emotional stress, and exercises. The dosage differs for pre-emptive and curative interventions in that, one or two 499microgram metered dose is sprayed two or three minutes before inducible angina. On the other hand, on the onset of an attack, it is recommended that the patient receives 400 to 800 microgram (two metered doses) (Dulger, Sik, & Aba, 2018).

Benefits Sublingual Glyceryl Trinitrate is a fast-acting drug that provides temporary relief for chest pain as its induction into the body is through a part of the mouth with an ample supply of blood vessels allowing rapid absorption of the medicine (Huang et al.. 2018). Secondly, the active ingredient glyceryl trinitrate is used as a form of preventive medicine that can be administered before activities that increase the heart rate as the drug works by dilating the veins, therefore, decreasing volume of blood flow to the heart. As a result, there is less resistance making it easier for the heart to pump blood out of the heart without consumption of much energy thus less needs for oxygen.

Risk

Glyceryl Trinitrate induces an analgesic effect on patients which in turn causes headaches. In fact, in a study to establish the impact of intrathecal methylene blues and glyceryl trinitrate administration on orofacial pain in mice, Bohotin et al., (2016) found that, a dose similar to that given to human subjects, GTN led to analgesia 2hours after its administration.

Contraindications

While sublingual Glyceryl Trinitrate, is an effective therapeutic intervention for angina, it has several risks that warrant the withdrawal of its prescription. To begin with, it should not be administered to patients with hypersensitivity to the active substance and in individuals with low blood pressure (severe hypotension characterized by blood pressure that is lower than 90mm Hg) (Little, 2018). Need to do so arises as the vasodilating effect of the drug may further lower the blood pressure to dangerous levels. Moreover, the medication should not be used with phosphodiesterase inhibitors, such as Sildenafil, vardenafil, and tadalafil as they potentiate the hypotensive effect of nitrates (Docherty, Jackson, & Gardner, 2016).

Nursing Assessments

One of physical assessment that should be done to Jon is holistic evaluation which collects detailed subjective and objective data (Kar, 2016). It helps nurses to analyze the patient's mind, body and some spiritual essentials, besides; holistic assessment tends to evaluate the patient's health history to determine the potential risks that could make Jon's situation worse. By doing so, it would help the nurse to come up with strategic mitigation measures that would help relieve Jon's chest pains. Nevertheless, during emergency cases, holistic assessment usually is delayed so that the rhythm of the heart, illnesses and other crucial signs of the patient (Cox & Blackwood, 2019).

The other type of evaluation that should be carried out by the nurse is the cardiovascular assessment. It helps nurses to identify the causes of the problems of the chest, and this may include, the use of tobacco, high blood cholesterol, diabetes and other factors that may cause cardiovascular diseases. It is through the cardiovascular assessment that would guide the nurses into a valid physical exam of the patient. In every health institution, it is mandatory for every patient with suspected underlying cardiovascular illness to go through a cardiovascular assessment. It has been found out by the Centres for Disease Control that eighty-nine percent of patients with chest pains have are more likely to be exposed by one of the cardiovascular illness (Richards et al.,. 2018)

Functional Assessment is also vital to determine the physical activity of patients. The evaluation tends to identify the best position to sit or the appropriate physical activities to do that would ensure the Patients do not feel the Angina pains. For Jon's situation, the functional assessment would help nurses to find out whether he can walk comfortably if the Cellulitis in his lower leg is treated and what physical activity he should engage himself in to avoid the angina pains from coming back. Functional assessment should be done frequently to patients especially to the older adults who experience angina pains and Cellulitis (Camici, d'Amati, G., & Rimoldi, 2015).

Nursing Interventions

Mild forms of physical exercises are essential for well being as getting tired after working out releases endorphins which are feel-good hormones that also ease the tension that even the shortest physical sessions result in a reduction in depressive symptom among patients with chronic chest pains. The exercise entails a variety of body poses, different breathing techniques, and meditation, the therapy reduces stress levels, improves concentration, harnesses body energy, and, helps those recovering from cancer to restore motion. Moreover, as Yoga effectively stimulates muscles, increases the flow of blood oxygen concentration, enhances lymphatic functions it enhances self-purification mechanisms and in the process can reduce the strain of the victims' heart (Chhajer, Singh, Kumari, & Lohmor, 2018).

Being sick can often be depressing, and in this case, by providing a conducive environment for meditation, it becomes easy for the patient to relax relieving him of the pain he is suffering. The unconscious self is responsible for depression and its sustenance especially when a patient engages in repetition compulsion. According to Freudian psychoanalysis theories, such a patient is unaware that he or she keeps on forgetting a traumatic event thus the patient keeps re-enacting the event or subjecting themselves to predisposing situations (Butler, 2015). Nonetheless, through meditation, a form of alternative therapy an individual focuses the mind to a particular event or thought to allow resulting in mental and cognitive clarity (Mate, G. & Levine, 2015). Moreover, meditation prevents unwanted thoughts through ceasure and unlocks the unconscious part of the brain. As a result, the approach is effective in relieving pain that is in turn caused by stress especially if it is being propagated by repetition compulsion.

Talk therapy can also be used as a non-pharmacological form of treatment as it results in cognitive clarity and this can help ease pain and lower the heart rate (Ali & Patel, 2018). The use of non-meditative forms of therapy dates back to Sigmund Freud, an Austrian neurologist who made significant contributions to psychotherapy through talk therapy. From a psychoanalytic perspective, depression arises when the conscious and unconscious parts of the mind can come into conflict with one another as the id reigns over the other parts of the brain, and an individual begins to experience periods of extreme happiness and sadness, a distinct quality of depressive moods characterized by a sense of despair, agitation and aggression, and psychomotor incongruence. Depressive symptoms arise as a result of suppressing thoughts; failing to make the unconscious conscious. Nonetheless, in such a scenario, talk therapy comes in hand in releasing pent-up emotions.

Abnormal Finding in the EGC

Perturbations in ventricular repolarization are evident as the ECG indicates a considerable distance between the QRS complex and the end of the T wave. As a result, it is highly likely that there is arrhythmia in the patient as the ventricular repolarisation causes ventricular diastole; nonetheless, as the interval is large, it is a cause of alarm. According to Haissaguerre et al., (2018), QRS wave indicates ventricular depolarization, which is followed by contraction and an increase in pressure in the ventricles (ventricular systole), however, in this case, ventricular diastole is impaired, and the doctor should be informed immediately. The irregular beat of the heart is an indicator of likely premature ventricular contractions and the poor circulation of blood. PVCs are a leading cause of myocardial infarction which when left unattended to is a sign of impending death. There is also need to inform the doctor because, during ventricular repolarization, contraction of the atria forces blood through the tricuspid and mitral valves into the ventricles which in turn contract to pump blood out of the heart to other body parts. Blood flowing from the left ventric...