Complete details regarding angina pectoris. Causes of Angina Pectoris. Symptoms of Angina Pectoris and recovery from it

1. ANGINA PECTORIS
PRESENTED BY
BATCH C1 (199-220)

2. Angina Pectoris
■ A sudden characteristics Cushing, strangling, squeezing, burning,
chocking or pressure like sensation due to cardiac ischemia.
Sites
Typical location substernally radiating to:
■ Neck
■ Shoulders
■ Arms
■ Neck
■ Jaws

3. Types
1. Atherosclerosis Angina:
■ Classic or angina of effort..
■ Atherosclerotic plaques occlude coronary arteries..
■ Cardiac workload increase..
■ Obstruction to flow.
■ Decrease O2 delivery..
■ Accumulation of lactic acid ..
■ Ischemia, myocardial pain.
■ 90% of angina cases.
■ Relieved by rest, within 15 min of period.

4. 2. Vasospastic angina:
■ Reversible spasm of coronary arteries usually at the site of
atherosclerotic plaque.
■ Spasm can occur even during sleep.
■ It can lead to unstable angina.
■ 10% of angina cases.

5. 3. Unstable Angina
■ Increased frequency and severity of attack resulting from condensation
of atherosclerotic plaque..
■ Platelet aggregation at that site and vasospasm which leads to MI

6. Causes of Angina Pectoris
Major Risk Factors:
■ Females less than or equals 45 years, Males less than or equals 35 years.
■ Smoking
■ Dyslipidemia
■ Family history of CVS diseases
■ HIN
■ Kidney disease
■ Obesity
■ Physical inactivity
■ Prolonged psychosocial stress

7. Other conditions:
■ Provoking angina medications
■ Vasodilation
■ Vasoconstriction
■ Excessive thyroid replacement
■ Polycythemia
■ Hypovolemia
■ Hypothermia
■ Anemia
■ Hypothyroidism
■ Hypoxemia

8. Symptoms
■ It can be painful or there is only chest discomfort and radiating pain in sites discussed
before..
Associated symptoms:
■ Breathlessness
■ Sweating
■ Nausea
■ Vomiting,
■ Pallor
■ Vitals : increased bp , increased pulse rate

9. Pathophysiology
■ Imbalance between heart and oxygen’s demand & supply.
■ The imbalance usually occurs during strenuous work like exercise.
Diagnosis
 It is suspected when patient comes with the complaints of heavy chest
discomfort retrosternal on left sided radiates to left arm, neck, jaw or back.
 Associated with exertion or emotional stress and relieved in within several
minutes by taking rest.
 It is precipitated by cold weather or meal.
 Pain is not relieved by antacid and simple analgesics however relieved by
glyceryl trinitrate.

10. ■ St segment may be depressed or elevated, constant monitoring of Bp and pulse is also
done.
■ Thallium scintigram is done in patients of asthma or arthritis, in others, treadmill teats
are done.
■ Coronary angiogram for identifying the nature of lesion.
Aggravator factors
■ Stress
■ Strenuous work (exercise)
Relieving factors
■ Medication
■ Rest

11. Drugs used in Angina Pectoris
Vasodilators Cardiac Depressants Other Drugs
Calcium Blockers
(veraparnil)
Nitrates
Beta Blockers
(Propranolol)
Metabolism
Modifiers, Rate
Inhibitors
Short
Duration(sub
lingual
nitroglycerin
)
Intermediate
(oral
nitroglycerin)
Long Duration
(transdermal
nitroglycerin)

12. Drugs Used In Angina Pectoris1. Vasodilators
2. Nitrates:
■ Short actins (within minutes) Sublingual
■ Intermediate (within 4-6 hours) Oral
■ Long actins (8-10 hours)Transdermal
Mode of Action
Increases CGMP, Relaxation of SM muscles
PK
Short actins, rapid onset (limit) duration is up to
Intermediate actins, slow onset , duration up to 2-4 hours
Long actins, slow onset , duration up to 8-10 hours
Ultra short actins, onset seconds, duration 1-5 minutes
S/E
Tachycardia orthostatic hypotension due to headache
Example
Nitroglycerin, Amyl nitrate

13. Calcium channel blockers
Mode Of Action
■ Block calcium channel in SM muscles & heart, depress I.C calcium (intracellular
calcium)
PK
■ Oral parenteral and slow release for arteries available.
S/E
■ Constipation
■ Pretibial edema
■ Flushins, dizziness
■ Increased dose results in cardiac depression and hypotension
Example
Verapamil, Nifedipine.

14. Beta Blockers
Mode Of Action
■ Block sympathetic effect on heart & blood pressure, reduce renin release.
PK
■ Oral parenteral
S/E
■ Bradycardia
■ AV blockage
■ Heart failure, Fatigue
■ Sleep problems
■ Sexual dysfunction
Example
Propranolol, atenolol, metoprolol etc..

15. Na- channel blockers(ranolazine)
Mode Of Action
■ Blocks late sodium channel in myocardium, reduces cardiac rate.
PK
■ Oral given duration 10-12 hours.
S/E
■ QT Prolongation on ECG
■ InhibitCYP 3A & 2D6
Example
Verapamil, Nifedipine.

16. Ivabradine
Mode Of Action
■ Block pacemaker sodium Current ion, SA node reduces heart rate.
PK
■ Given Oral twice a day.
 NOT KNOWN SIDE EFFECTS!

17. Treatment Strategy
1. Decreased Oxygen demand (vasodilators)
2. Decreased cardiac work loads (Beta blocks, Calcium blocks)
Balloon Angioplasty
■ Balloon inserted at the end of catheter inflated to widen arterial lumen.
Stents
■ Stents also used to mountain arterial widening. coronary bypass
Coronary bypass
■ Exercise
■ Healthy life plan
■ Diet