Master of Science in Nursing (MSN) Student Scholarship

Date Written

Summer 2015

Document Type


Course Number

NURS 5330

Course Name

Advanced Pathophysiology

Professor’s Name

John D. Chovan, James R. Cacchillo


Coronary Heart Disease, Treatment, Patient Outcomes

Subject Categories

Cardiovascular Diseases | Medical Pathology | Medicine and Health Sciences | Nursing


According to the literature, coronary heart disease (CHD) is responsible for 370,000 deaths annually in the United States (Centers for Disease Control and Prevention [CDC], 2015). A symptom commonly associated with CHD is angina (US Department of Health & Human Services, National Institute of Health, National Heart, Lung, and Blood Institute [NIH], 2011). An estimated 300,000 to 900,000 patients in the United States have refractory angina pectoris (RAP), with nearly 100,00 new cases diagnosed yearly (Manchanda, Aggarwal, Aggarwal, & Soran, 2011). Kones describes refractory angina as continued angina class III/IV, in the nonsurgical candidate, with objective evidence of ischemia despite optimum medical treatment (Kones, R., 2010). Many medications are available for the treatment of angina. Beta blockers, calcium channel blockers, and angiotensin-converting enzyme inhibitors are often useful in the reduction of angina pain. Angioplasty and life changes such as smoking cessation, weight loss, and stress reduction are additional treatment options for the patient suffering from chronic angina (Mayo Clinic, 2015). Despite endless treatment options, chronic angina continues to pose significant challenges to both patient and medical professional. The patient diagnosed with chronic angina frequently suffers from anxiety, fear, pain, and decreased quality of life. According to the literature, a continual challenge of modern cardiovascular medicine is to discover new, effective treatments for patients with refractory angina pectoris, a clinical condition characterized by severe angina despite optimal medical therapy (Gennari, Gambini, Bassetti, Capogrossi, & Pompilio, 2014). Enhanced external counterpulsation (EECP) is approved for the management of refractory angina. EECP has proven beneficial in the decrease of anginal symptoms, decreased nitroglycerin use, and improvement of exercise tolerance (Sharma, Ramsey, & Tak, 2013). A 62 year old



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