Understanding Unstable Angina And Its Risk Factors: A Case Study Essay.

Unstable Angina: Symptoms and Manifestations

Angina refers to the pain in the chest because of certain heart conditions. It is of two types: stable and unstable angina (Ohman, 2016).  Unstable angina is defined as severe pain in the chest that arises at rest, during exercise, or under strain. The discomfort becomes more frequent and severe. Unstable angina indicates that obstructions in the arteries that provide oxygenated blood to the heart have approached a severe degree. Unstable angina is a condition that falls under the sub category of the umbrella term acute coronary syndrome (Goyal & Zeltser, 2021). Patients depend on healthcare workers to distinguish acute coronary syndrome from other explanations of chest discomfort; therefore, clinicians must be familiar with the clinical manifestations (Nall, 2018). The clinical manifestations of unstable angina are pain or discomfort that starts from the chest, which can radiate to other organs such as the throat, jaw, left or right arm, back, stomach and shoulders. The other symptoms include nausea, vomiting, shortness of breath, feeling dizzy, and noticeable heartbeats (Santhakumar, 2020). In Jarrah’s case he states that he is having discomfort in his chest if he is moving around. He also reports that the discomfort has radiated to his jaw and he is also feeling nauseous (Referred to case study).  

The risk factors of unstable angina in Jarrah’s case that can lead to the occurrence of angina are Type 2 diabetes, smoking, and hyperlipidaemia (Gonzalez, 2021).  Diabetes mellitus (DM) is a significant predictor of the formation of coronary artery disease (CAD) as well as the result accompanying different presentations of the illness. In fact, rising levels of glucose in the blood, even when they are lower than those associated with diabetes, behave as markers of elevated threat (CDC, 2021).  Diabetes mellitus (DM) is a key determinant of the development of coronary artery disease (CAD) including the complications that precede the illness's many manifestations. In fact, increasing concentrations of sugar in the blood, especially if they are less than those linked with diabetes, act as warning signs (Naito & Miyauchi, 2017). Smoking significantly boosts the probability of blood clots developing inside blood arteries, raising the chance of acute coronary syndrome (ACS), which causes myocardial infarction and unstable angina (Buchanan, et al., 2015).

The creation and breakdown of a clot of blood clot or thrombosis within a coronary artery cause unstable angina. Clots frequently occur as a result of the rupture of plaque in coronary arteries with atherosclerosis (George, 2015).  Atherosclerosis is a condition in which plaques are formed on the inside of arteries. It results in coronary heart disease which is the main cause of unstable angina (Libby, Bornfeldt & Tall, 2016). The formation of plaque is because of the high level of cholesterol in the blood as in the case of Jarrah who has hyperlipidaemia. When there is a formation of a clot, the flow in the coronary artery is diminished, lowering the supply of oxygen. If a clot totally obstructs a coronary artery for an extended amount of time, the myocardium fed by the arterial may get infarcted (acute myocardial infarction) and irreparably destroyed (Bergheanu, Bodde & Jukema, 2017).

Risk Factors for Unstable Angina in the Case Study

The reason for him feeling nauseous can be because of the medicines that he is currently taking such as metformin and Simvastatin. It can be also because of the pain and discomfort in his chest and stress (Khatri, 2020). Jaw discomfort can happen as a result of pain radiating or spreading from the chest to other parts of the body. When pain spreads, it impacts the nerves and extends from the source of the pain to other parts of the body (Sherrell, 2020).

The nurse must assess the pain characteristics, such as whether it is choking, burning, tightness, squeezing, and so on. The location and duration of the pain should also be done as in the case of Jarrah the pain is in the chest and is also radiating to his jaw (Referred to the case study).  He claims that the pain in the chest happens while he is moving around, but that it goes away soon as he sits down (within 5 -10 mins). The characteristics, location, pain score based on the pain scale and duration of pain will help in finding what type of pain it is (Belleza, 2021). The nurse should assess whether the pain that Jarrah is having is acute or chronic. If the pain due to angina is less than 2 months, very intense and frequent, it is generally referred to as unstable angina (Vera, 2022).  The nurse should check the vital signs of Jarrah regularly as any kind of pain or discomfort in the chest activates the sympathetic nervous system (Vera, 2022).  It then increases the blood pressure and heart rate. In Jarrah’s case, BP 150/95 and HR is 98/min (Referred to the case study).

As Jarrah has presented himself for the dressing of his venous ulcer that is infected. The nurse should assess the size and condition of the wound. Inflammatory response and the reaction of the immune system to localised tissue injuries are manifested by redness, swelling, discomfort, stinging, and itching. Nurses should analyse the characteristics of the ulcer, including its location, size, severity, discharge, colour and odour. These observations will reveal how much the amount of the compromised integrity of the tissues around the wound is. Pale colour of the tissue indicates a lack of oxygenation. An odour might be caused by the development of infection on the spot, or it could be caused by dead tissue. Serous discharge from a wound is a typical element of the inflammatory process and must be distinguished from pus or purulent secretion found in an infection. (Chamanga, 2016).

The nurse should assess and record the respiratory rate every four hours. If the nurse notices any kind of changes in the pattern of the respiratory rate, they should immediately take the required action. They should access the level of ABG. It will help in monitoring the status of proper oxygenation and ventilation. The nurse should observe breathing patterns and breathing sounds.  It might help in diagnosing an underlying disease or condition (Steiner, et al., 2015).

The nurse should monitor the vital signs such as blood pressure and heart rate. The nurse should ask Jarrah about any kind of cardiac symptoms like pain, pressure, palpitations or oedema. The nurse must inspect for the following characteristics in general: whether Jarrah is thin or obese, his degree of attentiveness (anxious, somnolent, lethargic), the colour of his skin, temperature, and oedema. the nurse should examine the mucosal membranes for pallor and the limbs for finger clubbing or cyanosis. Cold, clammy, and pallid skin results from a protective surge in sympathetic nervous system activation, as well as reduced cardiac output and oxygen deficiency. The nurse should take note of any sensations, thrusts, or fine vibrations as well. They should make sure it is the apical impulse and not a muscular contraction or other pulsation. They should examine the frequency and duration of the pulses. Percuss down the anterior axillary line, then towards the sternum all along the fifth intercostal gap, listening for sound alterations. The nurse should also conduct Cardiac auscultation (Fritz & McKenzie, 2015).

Causes and Formation of Unstable Angina

The three relevant diagnostic tests or investigating procedures related to Unstable angina are Electrocardiogram (ECG/EKG), Troponin blood test and Coronary computed tomography angiography. ECG is a tool that records the heart's electrical impulses on graph paper. A computer creates the image using data provided by the electrodes. Sticky patches or electrodes are applied to the chest, as well as the arms and legs on occasion. The electrodes are linked by cables to a computer, that shows the findings of the diagnostic test. An ECG can reveal whether the heart is pumping too quickly, too slowly, or not at all (Mokhtari, et al., 2015).

Troponin tests detect the presence of proteins, troponin T or troponin I in the blood. Whenever the muscle tissue of the heart is injured, such as during myocardial infarction, these proteins are secreted. The greater the damage is done to the heart; the more amount of troponin T and I there will be in the blood (Anthony, 2021).

Coronary computed tomography angiography which is also referred to as coronary CT angiography or CCTA helps in examining the coronary arteries which help in providing blood to the muscles of the heart. This is done using an injection that contains a contrast material that has iodine in it along with the CT scanning. CT scans can be converted to produce three-dimensional (3D) representations that might be examined on a screen, copied on film or by a 3d printing machine, or sent to electronic communication. evaluates if the formation of plaque has constricted the coronary arteries, the blood vessels that supply blood to the heart (De Filippo & Capasso, 2016).

In Jarrah’s case, the Electrocardiogram may exhibit T-waves hyperacute, flattening, inverted, and ST depression. ST elevations indicate STEMI, The acute coronary syndrome can cause a variety of abnormalities in the rhythm of the heart, such as junctional rhythms, sinus tachycardia, ventricular tachycardia, ventricular fibrillation, left bundle branch block, and others. Nevertheless, Jarrah will be in sinus rhythm, particularly as he has unstable angina rather than infarcted tissue (Goyal & Zeltser, 2021).

Jarrah who is suffering from unstable angina will have high levels of cardiac troponin and as a result he might face an unavoidable risk of serious cardiovascular complications (Eggers, Jernberg & Lindahl, 2017).

CCTA will reveal the presence of blockage due to the formation of plaque (Goyal & Zeltser, 2021).

 References

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Bergheanu, S. C., Bodde, M. C., & Jukema, J. W. (2017). Pathophysiology and treatment of atherosclerosis. Netherlands Heart Journal, 25(4), 231-242. https://link.springer.com/article/10.1007/s12471-017-0959-2

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