Myocardial Ischemia: The lack of Oxygen

explanatory Essay
1937 words
1937 words

Angina is chest pain which results from inadequate oxygen flow to the myocardium. If the demand for myocardial oxygen surpasses the ability of the coronary arteries to provide the heart with oxygen, myocardial ischemia happens. Angina is the clinical manifestation of reversible myocardial ischemia caused by either an increased demand for oxygen or a decreased supply of oxygen that can lead to myocardial ischemia (Lewis et al., 2010). Angina is classified as either Chronic Stable Angina (CSA), Unstable Angina (UA) or Prinzmetal's angina. CSA, described as chest pain transpiring periodically over a period of time with an identical pattern of onset, duration, and intensity of symptoms. CSA can further be classified as silent ischemia, nocturnal angina, or angina decubitus (Lewis et al., 2010). Libby et al., refer to Silent ischemia as “ischemia that occurs in the absence of any subjective symptoms” (as cited in Lewis et al., 2010). Nocturnal angina happens at night only; however, not necessarily only when the person is lying down or during sleep. Angina decubitus refers to chest pain that a person experiences solely while lying down. A majority of the time, angina decubitus is relieved by standing or sitting. Prinzmetal's angina frequently occurs at rest, usually as a reaction to spasm of a major coronary artery. UA refers to an acute coronary syndrome (ACS) represented by unpredictable chest pain with occurrences that are new in onset, occur at rest, or have a worsening pattern. Unstable angina is easily provoked with minimal to no exertion, while sleep or rest and its frequency increases. UA represents a medical emergency (Lewis et al., 2010).

Angina is chest pain caused by a lack of oxygen to the myocardial tissues; therefore,...

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...P., Carter, N., Kaasalainen, S., et al. (2010). Utilization of Nurse Practitioners to Increase Patient Access to Primary Healthcare in Canada – Thinking Outside the Box. Nursing Leadership, 23(sp), 239-259. doi:10.12927/cjnl.2010.22281

Heart and Stroke Foundation. (2014). Our Bottom Lines: Social Impacts. Retrieved from

Nurse Practitioners' Association of Ontario. (2011). Nurse Practitioner Led Clinics. Retrieved from

Ontario Medical Association. (2014). Over 900,000 Patients Still Don’t Have a Family Physician: Ontario's Doctors. Retrieved from

World Heart Federation. (2014).What we do. Retrieved from

In this essay, the author

  • Explains that angina is the clinical manifestation of reversible myocardial ischemia caused by either an increased demand for oxygen or a decreased supply of oxygen.
  • Explains that inadequate oxygen to myocardium, denying myocytes of oxygen and glucose required for aerobic metabolism triggering anaerobic metabolism thus lactic acid formation.
  • Explains that anaerobic metabolism begins, and lactic acid accumulates. myocardial nerve fibres transmit a pain message to the cardiac nerves and the upper thoracic posterior nerve roots.
  • Explains that catecholamine is released from the ischemic myocardial cells causing increased stimulation of the sympathetic nervous system. the release results in glycogen, diaphoresis, and vasoconstriction of peripheral blood vessels.
  • Explains that nausea and vomiting can result from reflex stimulation of the vomiting centre by the severe pain.
  • Explains that after a detailed cardiovascular health history and physical assessment, additional information is obtained by numerous diagnostic procedures.
  • Explains the electrocardiogram (ecg) is a noninvasive procedure used to reveal heart conditions by measuring and recording the cardiac electrical activity of from different perspective.
  • Explains that an echocardiogram is an ultrasound of the heart. the transducer records ultrasound waves to generate a picture, record direction and flow of blood, and convert it to audio and graphic data.
  • Explains a procedure where an injection of radioactive dye directly into coronary arteries is used to evaluate the patency and circulation of coronaries.
  • Explains chest radiographs are a picture that shows cardiac contours, heart size and configuration, anatomical changes in the chambers and records any displacement or enlargement of the heart.
  • Explains that the patient will apply techniques to ambulate and complete personal adl care with no chest pain in 3 days.
  • Explains that pharmacists provide cost-effective drug therapy for canadians and ensure safe medication use. physiotherapists are highly skilled and autonomous health care professionals that play a significant role in health promotion.
  • Opines that access to a primary health care provider is essential to effectively managing angina.
  • Describes the nurse practitioner led clinics, an innovation that addresses the lack of access to a primary health care professional.
  • Explains that the canadian heart and stroke foundation and the world heart federation are reliable web-based resources for angina.
  • Explains that the nplc and the emergency department provide comprehensive primary care, health promotion, diagnostic testing, treatment of intermittent and chronic illness, and health assessments to angina patients.
  • Explains that over 900,000 patients still don't have a family physician: ontario's doctors.
  • Explains that angina is caused by insufficient blood flow due to the constriction or narrowing of the coronary arteries by atherosclerosis.
  • Recommends applying supplemental oxygen, increasing oxygenation of myocardial tissues, and administering medication to prompt pain relief.
  • Recommends administering nitrates prior to physical activity and teaching patient self-care techniques to reduce oxygen consumption.
  • Cites dalby, p., dicenso, a. bryant-lukosius, f. harbman, n. carter, s. kaasalainen, et al.
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