Anginal pain vs. sternotomy pain

Daytonite, BSN, RN · Dec 10, 2008

How would you recognize the difference? ie, specifically regarding a post-op CABG.

By assessing the pain. Angina has a sudden onset, will be sharp and may radiate to the shoulder arm or jaw; postop surgical pain occurs gradually and does not become sharp until the effects of pain medication wear off and more analgesic is needed nor does it necessarily radiate.

http://www.fpnotebook.com/CV/Sx/ChstPn.htm

Jedi of Zen · Dec 10, 2008

By assessing the pain. Angina has a sudden onset, will be sharp and may radiate to the shoulder arm or jaw; postop surgical pain occurs gradually and does not become sharp until the effects of pain medication wear off and more analgesic is needed nor does it necessarily radiate.
http://www.fpnotebook.com/CV/Sx/ChstPn.htm

You mean more analgesia is needed for sternotomy pain?

jmgrn65, RN · Dec 10, 2008

yea, also Cabg patients shouldn't be having angina their problem has been fixed.

Jedi of Zen · Dec 10, 2008

yea, also Cabg patients shouldn't be having angina their problem has been fixed.

That makes sense to me.

In my textbook it stresses the need to watch for anginal pain anyway, because if present it could indicate graft failure.

And, I actually just found more material in my book that seems to clarify the difference a little better for me. Thanks for the response.

Daytonite, BSN, RN · Dec 10, 2008

you mean more analgesia is needed for sternotomy pain?

i mean that from the time the patient comes out of the or he will be given analgesia. they are not going to let him suffer. he will be medicated and kept comfortable. these days pca (patient controlled analgesia) is often used where the patient has a continuous feed of an opiate and can also give themselves an extra boost by pressing a button. their surgical pain is due to the doctors cutting on them and tinkering about inside. trauma, inflammatory response (4 cardinal signs of inflammation are redness, heat, swelling and pain - because it is occurring inside the body you can't see the swelling that is pushing on the pain receptors sending signals to the brain screaming, "i hurt!") and all that is why they are in pain.

angina is due to ischemia. the pathophysiology is that a section of the heart muscle isn't getting its supply of oxygen, usually because of atherosclerosis of the arteries. activity often brings it on because of the increased demand for oxygen. when the heart muscle hurts it says it by bizarre means: radiation of the pain to odd areas. it shouldn't happen after a cabg because those nasty clogged up arteries have just been bypassed so new pathways for the blood flow have been created.

http://www.merck.com/mmpe/sec07/ch073/ch073b.html - angina pectoris