Angina Managment

7/30/2019 Angina Managment

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Dr Khulood Alsaraf


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It is a clinical manifestation thatresult from coronary atherosclerotic

disease.


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Anginal pain is described as:

-tightness-sudden-sever-pressing substernal pain-radiating down the left arm-referred pain felt in the neck & leftarm.-last for a few min.


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1- Classical (stable) occur with stress or exertion

2-Unstable (preinfarction, crescendo)

occur frequently over the course of a day with progressive severityThese 2 types caused by narrowing or partial occlusion of coronary

arteries.

3-Variant (prinzmetal, vasospastic) occur during rest

& caused by or due to vessels spasm (vasospasm).

Types of Angina


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Acuteanginalattack (secondary angina)

An imbalance between myocardial oxygensupply & demand.as a result of sever coronary artery atherosclerosis

Variant (primary angina)

Result of vasospasm of large epicardial coronaryvessels or one of their major branches.

Crescendo or unstable anginaResult from a combination of coronary

vasoconstriction, platelets aggregation, plaquerupture, & an increase myocardial oxygen demand.


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2-Cigarette

smoking

3-obesity

4-Physical

inactivity

5-Heavy meal 6-Emotions 7-Cold Weather

Risk factors

1-Hypertension

8-Diabetes mellitus 9-Hperlipidemia


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Types of Antianginal DrugsThese drugs relieve attacks of acute myocardial oxygen supplyor by decreasing myocardial oxygen demand or both.4 groups are effective in reducing the frequency, severity, orboth of angina:

1-Nitrates2- Beta-blockers3-Ca-channel blockers4- Sodium-channel blocker


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NitratesOrganic nitrates: used in A.P therapy from more than 140yAlso used in CHF & acute MI therapy .

Nitrates are:Nitroglycerin (protoytpe)Isosorbide mononitrateIsosorbide dinitrate

Pentaerythritol tetranitrate.

They differ in their volatilityNG: liquid having a high vapor pressure

ISMN, ISDN, & PET are solid at room temp.All organic nitrates are very lipid soluble.


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Effect of Nitrates :

On Stable Angina :

VenodilatationArteriolar

dilatation

Preload Afterload

Myocardial Oxygendemand

2- Redistribution of coronary flow towards subendocardium3- Dilatation of coronary collateral vessels.

1-


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Clinical uses-Sublingual or buccal NG is used eitherto terminate an acute attack of angina

or for short-term prevention of angina.

-Orally administered Nitrate esters, NGointment, & transdermal NG

-prophylactic therapy of A.P


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Effect of Nitrates


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Effect of Nitrates


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ToleranceRepeated and frequent exposure toorganic nitrates is accompaniedby the development of tissue toleranceto the drugs vasodilating effects.To avoid tolerance:1-Employ smallest effective dose

2-A daily nitrate-free periodthese period is typically (6-8hr) & usually at night

because there is decreased demand onthe heart at that time


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Adverse effects

-Vascular headache-Postural hypotension-Reflex tachycardia

-Facial flushing


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Effect of-BK


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Calcium Channels Blockers

Amlodipine, Diltiazem, Felodipine & Verapamil


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Ca antagonists

Effect of Ca+2-Ch-BK


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Sodium

Channel BlockerRanolazineInhibit the late phase of sodium current thusimproving the oxygen supply and demand equation.Indicate for treatment of chronic angina.May be used alone or in combination with othertraditional therapies.It is not be used for acute attack of angina.


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Documents

Angina Managment