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Angina Managment

The document discusses different types of angina, their causes, risk factors, and treatments. It describes three main types of angina - classical, unstable, and variant - and their characteristic symptoms. It outlines risk factors for coronary artery disease and lists four main types of drugs used to treat angina by reducing oxygen demand or increasing supply: nitrates, beta-blockers, calcium channel blockers, and sodium channel blockers. It provides details on the mechanisms and effects of these drug classes as well as guidelines for nitrate tolerance.

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53 views27 pages

Angina Managment

The document discusses different types of angina, their causes, risk factors, and treatments. It describes three main types of angina - classical, unstable, and variant - and their characteristic symptoms. It outlines risk factors for coronary artery disease and lists four main types of drugs used to treat angina by reducing oxygen demand or increasing supply: nitrates, beta-blockers, calcium channel blockers, and sodium channel blockers. It provides details on the mechanisms and effects of these drug classes as well as guidelines for nitrate tolerance.

Uploaded by

AliImadAlKhasaki
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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Dr Khulood Alsaraf

It is a clinical manifestation that result from coronary atherosclerotic disease.

Anginal pain is described as:


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

Types of Angina
1- Classical (stable)
occur with stress or exertion

2-Unstable (preinfarction, crescendo)


arteries.

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

3-Variant (prinzmetal, vasospastic)

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

occur during rest

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

Acute anginal attack (secondary angina)

Variant (primary angina)

Result of vasospasm of large epicardial coronary vessels or one of their major branches. Result from a combination of coronary vasoconstriction, platelets aggregation, plaque rupture, & an increase myocardial oxygen demand.

Crescendo or unstable angina

Risk factors

1-Hypertension

2-Cigarette smoking

3-obesity

4-Physical inactivity

5-Heavy meal

6-Emotions 7-Cold Weather

8-Diabetes mellitus

9-Hperlipidemia

Types of Antianginal Drugs


These drugs relieve attacks of acute myocardial oxygen supply or by decreasing myocardial oxygen demand or both. 4 groups are effective in reducing the frequency, severity, or both of angina:

1-Nitrates 2- Beta-blockers 3-Ca-channel blockers 4- Sodium-channel blocker

Nitrates

Organic nitrates: used in A.P therapy from more than 140y Also used in CHF & acute MI therapy .

Nitrates are: Nitroglycerin (protoytpe) Isosorbide mononitrate Isosorbide dinitrate Pentaerythritol tetranitrate.
They differ in their volatility NG: liquid having a high vapor pressure ISMN, ISDN, & PET are solid at room temp. All organic nitrates are very lipid soluble.

Effect of Nitrates :
On Stable Angina :
1Venodilatation Preload Arteriolar dilatation Afterload

Myocardial Oxygen demand

2- Redistribution of coronary flow towards subendocardium 3- Dilatation of coronary collateral vessels.

-Sublingual or buccal NG is used either to terminate an acute attack of angina or for short-term prevention of angina. -Orally administered Nitrate esters, NG ointment, & transdermal NG -prophylactic therapy of A.P

Clinical uses

Effect of Nitrates

Effect of Nitrates

Repeated and frequent exposure to organic nitrates is accompanied by the development of tissue tolerance to the drugs vasodilating effects. To avoid tolerance: 1-Employ smallest effective dose
2-A daily nitrate-free period these period is typically (6-8hr) & usually at night because there is decreased demand on the heart at that time

Tolerance

Adverse effects
-Vascular headache -Postural hypotension -Reflex tachycardia -Facial flushing

Atenolol, Propranolol, Metoprolol, & Sotalol

Blockers

Effect of -BK

Calcium Channels Blockers


Amlodipine, Diltiazem, Felodipine & Verapamil

Effect of Ca+2-Ch-BK
Ca antagonists

Sodium Channel Blocker


Inhibit the late phase of sodium current thus improving the oxygen supply and demand equation. Indicate for treatment of chronic angina. May be used alone or in combination with other traditional therapies. It is not be used for acute attack of angina.

Ranolazine

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