Vincent angina

Patient care

Medical intervention for abdominal angina can include supportive care including anticoagulant therapy. Surgical intervention includes angioplasty, partial colectomy, (removing the ischemic section of the bowel and reconnecting the remaining ends). It may be necessary to create a colostomy or ileostomy and to correct blockages in the mesenteric arteries. The patient must be monitored for signs and symptoms of peritonitis and/or sepsis. As the patient recovers, patient education focuses on prevention of further episodes, recognition of signs and symptoms including cramping abdominal pain after eating, blood in the stool, red or black stools, diarrhea and/or constipation. It also includes instructions and support for living with permanent or temporary colostomy or ileostomy.

Symptoms

Patients typically describe a pain or pressure located behind the sternum and having a tight, burning, squeezing, or binding sensation that may radiate into the neck, jaw, shoulders, or arms and be associated with difficulty in breathing, nausea, vomiting, sweating, anxiety, or fear. The pain is not usually described as sharp or stabbing and is usually not aggravated by deep breathing, coughing, swallowing, or twisting or turning the muscles of the trunk, shoulders, or arms. Women, diabetics, and the elderly may present with atypical symptoms, such as shortness of breath without pain.

Treatment

In health care settings, oxygen, nitroglycerin, and aspirin are provided, and the patient is placed at rest. Morphine sulfate is given for pain that does not resolve after about 15 min of treatment with that regimen. Beta-blocking drugs (such as propranolol or metoprolol) are used to slow the heart rate and decrease blood pressure. They are the mainstay for chronic treatment of coronary insufficiency and are indispensable for treating unstable angina or acute myocardial infarction. At home, patients should rest and use short-acting nitroglycerin. Patients with chronic or recurring angina pectoris may get symptomatic relief from long-acting nitrates or calcium channel blockers. Patients with refractory angina may be treated with combinations of all of these drugs in addition to ranolazine, a sodium channel blocker.

Patient care

The pattern of pain, including OPQRST (onset, provocation, quality, region, radiation, referral, severity, and time), is monitored and documented. Cardiopulmonary status is evaluated for evidence of tachypnea, dyspnea, diaphoresis, pulmonary crackles, bradycardia or tachycardia, altered pulse strength, the appearance of a third or fourth heart sound or mid- to late-systolic murmurs over the apex on auscultation, pallor, hypotension or hypertension, gastrointestinal distress, or nausea and vomiting. The 12-lead electrocardiogram is monitored for ST-segment elevation or depression, T-wave inversion, and cardiac arrhythmias. A health care provider should remain with the patient and provide emotional support throughout the episode. Desired treatment results include reducing myocardial oxygen demand and increasing myocardial oxygen supply. The patient is taught the use of the prescribed form of nitroglycerin for anginal attacks and the importance of seeking medical attention if prescribed dosing does not provide relief. Based on his needs, the patient should be encouraged and assisted to stop smoking, maintain ideal body weight, lower cholesterol by eating a low-fat diet, keep blood glucose under control (if the patient is diabetic), limit salt intake, and exercise (walking, gardening, or swimming regularly for 45 min to an hour every day). The patient is also taught about prescribed beta-adrenergic or calcium channel blockers and any other needed interventions should they become necessary.

Four major forms of angina are identified: 1. stable: predictable frequency and duration of pain that is relieved by nitrates and rest; 2. unstable: pain that is more easily induced and increases in frequency and duration; 3. variant: pain that occurs from unpredictable coronary artery spasm; and 4. microvascular: impairment of vasodilator reserve that causes angina-like chest pain even though the patient’s coronary arteries are normal. Severe and prolonged anginal pain is suggestive of a myocardial infarction.