Angina pectoris

Presented by :- V. RAVI KISHORE

Definition :-

It is defined as the chest pain towards left arm shoulder due to less supply of O2 (or) more demand of O2.

Due to imbalance between myocardium oxygen requirement and oxygen supply.

Types of angina pectoris a) Stable angina b) Variant angina c) Unstable angina

Stable angina

Typical, classic,

Common angina Most common

angina Occurs during

emotional stress, heavy exercise,

Esily predictable

Treating more rest,nitroglycern

Also due to atherosclerosis

Variant angina

Prize metal angina

Occurs in rest also

Due to Spasm of coronary artery

Unstble angina

Uncommon or atypicaltype

Occurs in exercise and also during rest

Prolanged angina may lead to

Miocardial infraction Unpredictabl

e

Risk factors :

Age Sex Obesity Smoking Diabetes Hypertension Renal dysfunction

Age :-For men >55 yrs and >65 for women

Classification of ANTI ANGINAL DRUGS The drugs used to treat angina are called Anti

Anginal Drugs

1) NITRATES :- a) Short acting --nitroglycerin (or) --glyceryltri nitrate b) Long acting -- isosorbide mononitrate -- isosorbide dinitrate

2) Ca +2 channel blockers :- --felodipine --nifedipine --amlodipine --diltiazem --verapamil

3) BETA blockers :- --propanolol --esmolol --sotalol --metaprolol --atenolol

4) K+ channel opener :- --nicorandil

5) Vasodilators :- --hydralazine --minoxidil

6) Miscellaneous :- --aspirin --dipyridamole

PATHOPHYSIOLOGY

Myocardial ischemia develops when coronary blood flow becomes inadequate to meet myocardial O2 demand.

This is because myocardial cell switch from aerobic to anaerobic metabolism with a progressive impairment of metabolic , mechanical and electrical functions.

Studies have shown that adenosine may be the main chemical mediator of anginal pain . During ischemia ATP is degraded to adenosine, which after diffusion to the extra cellular space, cause anginal pain .

Goals of treatment :- All the treatment for people with

coronary artery disease have the same goal.

To decrease the elivated symptoms To reduce mortality due to CAD

progression

DRUG THERAPHY :- Currently there are 3 main types of drugs

used a) Nitrates b) Beta blockers c) Ca+2 channel blockers Nitrates and Ca+2 channel blockers may

be added if needed.1) NITRATES:- It improves blood flow by relaxing & dialating veins and arteries.Ex:- Nitroglycerin & Isosorbide mononitrateSIDE EFFECTS :-

Headace, light headedness, flushing, and increase in heart rate

Mechanism of action

BETA BLOCKERS They reduces the heart rate, BP, & force of

contraction and amount of oxygen the heart requires to pump blood.

Ex :- Atenolol, Proponolol, Esmolol,Nadolol

Sides effects :- 1)Cardiac effect :- Worsen heart failure, Bradycardia. 2)Non-cardiac effect :- constriction of airway, circulatory problems , Impotance , Hallucination, Insomnia & Fatigue.

Mechanism of action

Resistance

Ca+2 channel blockers

They dilate arteries & lower blood pressure. Which decreases the force of contractions.

They also dilate veins, reduces the amount

of blood returning to the heart which reduces the work load of the heart.

Ex :- Amlodipine, Nifedipine, Felodipine.

Mechanism of action

Combination therapy Nitarates + beta blockers --- in stable

angina . Ca+2 channel blockers + beta blockers –in

stable angina when the above combination has failed.

Ca+2 channels + nitrates :- in unstable angina.

All 3 together :- when the combination of 2 drugs has filed where

a) Nitrates :- decreased Preload b) Ca+2 channel blockers :- decreased afterload. c) Beta blockers :-decreased heart rate & myocardial contraction.

Other measures in managing CAD

Anticoagulents Ex :- 1) Aspirin :- it help to prevent blood clooting. Keeping the narrowed artaries open and lowering the risk of a heart attack.

Treat high BP.

Thank you