Management of patients with refractory angina

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Angina symptoms

Angina symptoms include pain, aching, discomfort in the front of the chest, and tightness. These symptoms are frequently caused by mental distress, physical exercise, after a meal, or chilly weather. Yet, after a ten-minute respite, the symptoms improve. Palpating the damaged area, according to the case study, causes pain. Yet, there is no discomfort when palpating the angina-affected area (McSweeney et al., 2011). As a result, it is prudent to conduct a second diagnosis to determine the problem. It is also usual for the patient to have previously suffered stress. A myocardial infarction could potentially meet the signs and symptoms. However, rest does not improve the pain from myocardial infarction (The Merck Manual 2014). An EKG would come in handy in ensuring we are on the safer side. Hypertension can be signs of developing coronary artery disease (The Merck Manual 2014).


This is the inflammation of the cartilage located at the costosternal joint and affects more females than males. The major symptom of costochondritis is the pain in the front of the chest. Symptoms also include movement pains, deep breathing decreasing with rest and quiet breathing, tenderness on all he sides of sternum and pain which varies in intensity. In addition, there is pain when pressure is exerted on the affected area. In most cases, these symptoms last for a period of one to three weeks (Southern Cross Medical Library 2013). Accordingly, these symptoms reflect the symptoms exhibited by the patint in the case study. Therefore, costochondritis is the viable diagnosis.

Treatment and Management

Costochondritis normally ends without treatment. In the event treatment is necessary, the prime objective is to control pain and reduce inflammation. Drugs including ketoprofen, ibuprofen, naproxen and flurbiprofen, collectively known as non-steroidal anti-inflammatory drugs can be recommended to achieve the goal. It is also recommended in two to three times a day to carry out local heating, biofeedbacking and gentle stretching of the pectoralis muscles in achieving relief (Proulx & Zryd 2009).


It is of importance for the patient to be directed not to repeat the misuse of muscles and also change the unsuitable posture at home or workplace. The patient should also be made aware of the excellence of the prognosis for costochondritis and that is is just a benign condition that will end on is own. Additionally, the patent needs to know and understand the right use and the likely negative impacts of NSAIDS. Most importantly, if the symptoms persists, the patient need to know tht he/she should seek the attention of a physician (Tharpe, Farley & Jordan 2013).


McGillion, M., Arthur, H. M., Cook, A., Carroll, S. L., Victor, J. C., L'Allier, P. L., ... & Cosman, T. (2012). Management of patients with refractory angina: Canadian Cardiovascular Society/Canadian Pain Society joint guidelines. Canadian Journal of Cardiology, 28(2), S20-S41.

McSweeney, J. C., Pettey, C. M., Souder, E., & Rhoads, S. (2011). Disparities in Women’s cardiovascular health. Journal of Obstetric, Gynecologic & Neonatal Nursing, 40(3), 362–371

Proulx, A. M., & Zryd, T. W. (2009). Costochondritis: diagnosis and treatment. American family physician, 80(6), 617-20.

Southern Cross Medical Library(2013). Costochondritis - causes, symptoms, treatment. Retrieved 26 April 2017, from

Tharpe, N. L., Farley, C., & Jordan, R. G. (2013). Clinical practice guidelines for midwifery & Women’s health (4th ed.). Burlington, MA: Jones & Bartlett Publishers

The Merck Manual (2014). Acute Myocardial Infarction (MI) - Cardiovascular Disorders - MSD Manual Professional Edition. MSD Manual Professional Edition. Retrieved 26 April 2017, from

June 12, 2023



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