Review of Chronic Stable Angina (Nursing)

00:01 So let's dig deeper into the treatment of the 3 types of chest pain.

00:05 Let's look at chronic stable angina.

00:08 Now, before we go on, on this part of your notes, what I want you to do is to draw what that vessel looks like.

00:14 Is there plaque or not? Is the vessel completely open or not? What does your picture look like? Make sure you include those red cells, and white cells, and your platelets.

00:25 Good. Now let's keep moving.

00:27 Okay. So, look at the vessel on your screen. Is there plaque? Yes. So you'll see that the vessel is a smaller diameter.

00:36 You still have the endothelial cells, the red blood cells, the white cells, the platelets, they're all still there, but definitely, the blood flow has been compromised.

00:45 If I'm just hanging out and chilling, I'm probably getting enough oxygenated blood supply to my heart.

00:50 But if I do something that causes a new demand and exertion on my heart, whether it's emotional excitement, I ate a big, fat meal -- I don't want to mention the name here, but there was an actor in a very famous HBO series about the mafia, that that's all they reported when he passed away is that the big meal that he had before his death.

01:13 But the big meals require a lot from our body to digest them, so it's really an odd thing, but that's something that can cause a higher demand on your body.

01:22 But, you know, if you're going to go out, going out with a lot of carbs sounds good to me.

01:27 What about cold exposure? Oh, that stresses out your body when you're cold, and so that can bring on chronic stable angina or exertional angina.

01:38 And just plain coronary artery disease, right? As it progresses and it gets worse, those are triggers for chronic stable angina.

01:46 Okay, so we've looked at the triggers for chronic stable.

01:49 Now let's look at the treatment goals.

01:51 Well, since its angina, and we want to increase the oxygen supply, so we're going to try and decrease the demand and increase the supply.

02:00 So, definitely, if someone has exertional angina, or chest pain, we want them to rest, okay? So we want to minimize whatever that stressor was, whatever that trigger was, we want to eliminate it or minimize it, and then we want to increase the oxygen supply.

02:18 So, what do we do to treat it with therapeutic agents? We're looking for symptomatic relief, so we're going to try use the organic nitrates.

02:27 We're going to try beta blockers.

02:29 We're going to try calcium channel blockers, and we're going to try ranolazine.

02:32 Now, when I'm actively having chest pain, nitrates are my friend. That's what I'm going to reach for.

02:38 Beta blockers and calcium channel blockers or ranolazine are things that I take on a daily basis to try to minimize the opportunity to have chest pain.

02:48 But nitrates, I can take both on a daily basis, and I'm going to take it when I have chest pain right now.

02:55 Okay, so let's look at non-drug therapy.

02:58 Now, this might not seem exciting to you, but if you can be well-versed and understand these concepts, you can educate your patients and make their lives much better.

03:08 So, it seems like common sense, but you want to explain that to your patients that they need to avoid the factors that can precipitate angina.

03:15 So if you know that you have chronic stable angina, and you haven't been extremely active, going out and shoveling the driveway in the cold -- that's going to be a lot of physical activity -- is not a good idea for a patient with this status.

03:28 Encourage your patients to decrease the risk factors.

03:31 You know the risk factors for coronary artery disease. Now we're talking lifestyle.

03:35 So we'd want them to -- definitely, we'd want them to quit smoking, if they smoke, but at least limit the smoking. You have to work with the patient to come to a common agreement there. You want them to maintain a healthy weight, get adequate physical exercise, eat lots of foods that are fresh, healthy, greens and fiber, and eat a healthier diet.

03:57 Now, if we can't manage this with drugs, then we can consider some procedures or surgeries.

04:03 PCI is an angioplasty or a stent.

04:06 So, go into cath lab, percutaneous coronary intervention.

04:10 Angioplasty is we'll go in -- I'll talk about that a little later, but they'll go in with a balloon and try and open up that blood vessel, and they'll leave a stent behind that will keep that vessel open.

04:20 Or a CABG, as we call it, which is a coronary artery bypass graft.

04:25 So if we can't manage this with medication, look at doing a procedure, a PCI, or surgery, a coronary artery bypass graft.

04:34 So that's an overview of what we do for chronic stable angina.

04:39 Now we talked about 4 different things. We talked about how the triggers, the treatment goals.

04:44 the therapeutic meds we use, and the non-drug therapy.

04:48 Stop, for just a moment, and see if you can recall, what are the medications that we use for chronic stable angina? Okay, I hope you wrote this down in the margin of your notes because the more you can stop, pause, think about something that you're learning, you're really increasing the efficiency of encoding that into your memory, so you'll be able to recall it later.

05:18 I call that studying as you go and that's going to save you time in the long run.