Anginal pain that is prolonged, severe and occurs at the same time each day without precipitating factor is d… - RUHS, Jaipur, PB B.Sc Nursing Entrance-2022

RUHS, Jaipur, PB B.Sc Nursing Entrance-2022

Medical & Surgical Nursing

Easy

Appeared in: RUHS, Jaipur, PB B.Sc Nursing Entrance-2022

Explanation

Variant angina, also called Prinzmetal angina, is caused by coronary artery spasm, not by fixed atherosclerotic blockages.
A hallmark feature is chest pain that occurs at rest and often follows a regular pattern, such as happening at the same time each day or night.
Unlike stable angina, it is not precipitated by physical activity or emotional stress.
The pain is a direct result of transient myocardial ischemia from the vasospasm.

Option A: Stable angina is incorrect because it is characterized by pain that is predictably triggered by physical exertion or emotional stress and is relieved by rest. The question describes pain occurring without a precipitating factor.
Option B: Unstable angina is incorrect because while it can occur at rest and is severe, it does not typically follow a predictable daily time pattern. It represents a sudden worsening of coronary artery disease and is highly unpredictable.
Option D: Non-anginal pain is a general term for chest pain that does not originate from the heart. Given the description of 'anginal pain' in the stem, this option is less specific and likely incorrect. The pattern described fits a specific cardiac pathology.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Classification and characteristics of different types of angina pectoris as background academic context rather than a clinical decision trigger.
Recognizing the pattern of variant angina is crucial because the treatment differs from other types of angina. Calcium channel blockers and nitrates are the mainstay of therapy, while beta-blockers can sometimes worsen the spasms and are generally avoided.
A nurse should educate the patient to keep a diary of their chest pain episodes, noting the time, duration, and any potential triggers (or lack thereof), which can help in diagnosing variant angina.
What if? If the pain was described as a 'heavy weight' on the chest that appears after climbing two flights of stairs and goes away with rest, the most likely diagnosis would be Stable Angina, as it is directly related to exertion.

How to Approach the Question

First, analyze the question stem to identify the key descriptors of the chest pain: 'prolonged', 'severe', 'occurs at the same time each day', and 'without precipitating factor'.
The most unique and telling clue is the cyclical nature of the pain ('same time each day') combined with the absence of a trigger.
Next, evaluate each option against these descriptors.
Recall the definitions: Stable angina is exertional. Unstable angina is unpredictable and worsening. Variant angina is due to vasospasm and often occurs at rest in a cyclical pattern.
Match the clinical picture from the stem to the definition that fits best. The description perfectly aligns with the classic presentation of Variant (Prinzmetal's) angina.

Concept Tested & Keywords

Concept Tested: Classification and characteristics of different types of angina pectoris.
Stem keywords: anginal pain, prolonged, severe, same time each day, without precipitating factor
Lead-in keywords: described as
Clinical cues: The cyclical nature of the pain ('same time each day') is a classic indicator for a specific type of angina.

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E6 Pathology- ROBBINS & COTRAN PATHOLOGIC BASIS OF DISEASE 10TH Ed p. 546-548

E6 Pharmacology Nursing Lilley 11e Part 2 p. 54-56