Myocardial Infarction & Peripheral Vascular Diseases Q 49

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A client with angina complains that the angina pain is prolonged and severe and occurs at the same time each day, most often in the morning, On further assessment a nurse notes that the pain occurs in the absence of precipitating factors. This type of anginal pain is best described as:

  

     A. Stable angina

     B. Unstable angina

     C. Variant angina

     D. Nonanginal pain

    

    

Correct Answer: C. Variant angina

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Variant angina, or Prinzmetal’s angina, is prolonged and severe and occurs at the same time each day, most often in the morning. Patients with vasospastic angina present with a chronic pattern of episodes of chest pain at rest that last 5 to 15 minutes, from midnight to early morning. Typically, the chest pain is not triggered by exertion or alleviated with rest as is typical angina. Pain decreases with the use of short-acting nitrates. Often, the patient is younger with few or no classical cardiovascular risk factors.

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Option A: Stable angina is induced by exercise and is relieved by rest or nitroglycerin tablets. Stable angina is characterized by chest discomfort or anginal equivalent that is provoked with exertion and alleviated at rest or with nitroglycerin. This is often one of the first manifestations or warning signs of underlying coronary disease. As previously mentioned, typical angina usually presents as chest discomfort or anginal equivalent that is provoked with exertion and alleviated at rest or with nitroglycerin.

Option B: Unstable angina occurs at lower and lower levels of activity and rest, is less predictable and is often a precursor of myocardial infarction. Patients will often present with chest pain, shortness of breath. The chest pain will often be described as pressure-like, although it is not necessarily limited to this description. Nitroglycerin and aspirin administration may also improve the pain. One distinguishing factor of unstable angina is that the pain may not completely resolve with these reported relieving factors.

Option D: It is important to distinguish between cardiac and non-cardiac chest discomfort. Discussing the details of the patient’s symptoms will further guide this differentiation. Relevant details include the quality, location, influencing factors, timing, and duration of the pain.

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