Chest Pain: Nursing Diagnosis

Nursing Knowledge

Chest Pain: Nursing Diagnosis

Angina pectoris, a condition characterized by acute chest pain or discomfort, plays an important role in the clinical practice of nurses. Understanding the different types and causes of angina pectoris is essential for providing effective care to clients. This quick guide offers insights into the causes, treatment, and symptoms experienced by both men and women, highlighting the importance of recognizing subtle signs in female clients.
Last updated: December 4, 2023

Table of contents

Definition: What is angina pectoris?

Angina pectoris ( “angina”, acute chest pain or discomfort) occurs when the heart doesn’t receive enough blood. 

ICD-10 code for angina pectoris

The ICD-10 code for angina pectoris is I20. 

  • I20.0: Unstable angina
  • I20.1: Angina pectoris with documented spasm
  • I20.8: Other forms of angina pectoris
  • I20.9: Angina pectoris, unspecified

What causes chest pain?

Decreased blood flow leads to decreased oxygen to the myocardium, causing pain. The cause of decreased blood flow varies in each type of angina pectoris. 

Types of angina pectoris and their causes

StableFixed stenosis (demand ischemia)Triggered by exertion, stress, cold exposure, coronary artery disease
Relieved by rest or medication
Predictable and consistent
UnstableThrombus (supply ischemia)May occur at rest or with exertion
Worsens over time
May not be relieved by rest or medication
Lasts longer than 20 minutes, may go away and come back 
Variant PrinzmetalVasospasm (supply ischemia)Occurs most commonly at night, during rest/sleep
Relieved by medication

Angina pectoris symptoms

  • Chest pain
  • Arm pain
  • Dizziness
  • Back. neck, jaw and shoulder pain
  • Cold sweat
  • Shortness of breath
  • Nausea

Angina symptoms in women 

In women, angina symptoms may be more subtle and overlooked, causing a delay in care. In addition to traditional chest pain, women are more likely to experience these symptoms: 

  • Unusual fatigue
  • Discomfort in upper back/shoulder/neck or jaw
  • Abdominal pain and nausea
  • Weakness

What are the ECG changes associated with angina pectoris? 

Understanding ECG changes associated with angina pectoris is essential for nurses to recognize, such as: 

  • Detect heart-related conditions early on
  • Effectively monitor clients to be able to act quickly 
  • Communicate effectively with clients and health care team about significance of ECG changes
  • Assess response to treatment 

Possible ECG changes due to angina pectoris: 

  • ST segment depression (indicating ischemia) 
  • T wave inversion (suggesting ischemia)
  • Pathological Q waves (previous myocardial infarction, associated with coronary heart disease)

Note: EKG may be normal in clients with angina pectoris, especially when currently no symptoms are experienced. 

Nursing diagnoses for chest pain

  • Acute pain: assess pain, administer prescribed pain medication, teach client about importance of rest 
  • Ineffective tissue perfusion: related to compromised coronary blood flow; monitor and provide medications (nitrates or beta blockers may be prescribed)
  • Anxiety or death anxiety: provide reassurance 
  • Activity intolerance: assess, encourage gradual increase in activity, teach energy conservation techniques
  • Knowledge deficit: client education about disease, medications, lifestyle modifications 

Angina pectoris nursing interventions

  • Help client to sit or rest in semi-Fowler’s
  • Provide oxygen (when O₂ SAT < 90% or signs of respiratory distress)
  • Administer medications as ordered
  • Check vitals
  • Assess: location of pain, characteristics, pain scale, health history, onset and duration, contributing factors, relieving factors, other symptoms
  • Prepare for labs, additional testing
  • Provide client education, including how to safely use nitroglycerin for sudden angina pain

Emergency management steps for chest pain

If O2 SAT < 90% or in respiratory distress:

  • M: Morphine
  • O: Oxygen
  • N: Nitrates
  • A: Aspirin

Angina pectoris medications

Clinical tips

  • Short-acting nitrates are used for acute angina attacks. Long-acting nitrates are used to prevent chest pain.
  • Antiplatelet drugs and anticoagulants increase risk for bleeding.
  • β-blockers are not used in variant angina. They can increase risk of coronary artery spasm.

Medications used for treatment of chest pain

  • Nitrates (nitroglycerin, isosorbid mononitrate): vasodilation
  • Calcium channel blockers (verapamil, nifedipine, diltiazem): vasodilation, cardiac depressants
  • Beta blockers (propranolol, metoprolol): cardiac depressants

Bonus download:

Review of medications used for acute and stable angina

Medications for angina pectoris

Review of medications used for acute and stable angina

Types of angina pectoris and their management

TypeGoal of treatmentMedications
StableIncrease cardiac oxygen, decrease cardiac demandNitrates, calcium channel blockers, β-blockers
UnstableMaintain cardiac oxygen, decrease oxygen demand, prevent infarctionNitrates, β-blocker, CE inhibitor or ARB, antiplatelet (ASA), anticoagulant (LMW heparin), possible use of thrombolytics after diagnostics
Variant PrinzmetalIncrease cardiac oxygenNitrates, calcium channel blockers


Chest Pain: Nursing Diagnosis

Free Download

Nursing Cheat Sheet

Review of chest pain types, symptoms and nursing interventions

Master the topic with a unique study combination of a concise summary paired with video lectures. 

User Reviews