Angina Pectoris PDF

These compounds cause a rapid reduction in myocardial oxygen demand followed by rapid relief of symptoms. Role: They are effective in stable and variant angina. Visuals: ischemic heart disease characterized Angina pectoris is a clinical syndrome of: by a sudden and severe pressing substernal pai...

These compounds cause a rapid reduction in myocardial oxygen demand followed by rapid relief of symptoms. Role: They are effective in stable and variant angina. Visuals: ischemic heart disease characterized Angina pectoris is a clinical syndrome of: by a sudden and severe pressing substernal pain Introduction: MOA: 1) Increase blood flow to ischemic tissues Therapy Goal: First, resulting in pooling of blood in the veins. and reduces the work of the heart. Angina pain occurs when the coronary blood flow is insufficient to meet the myocardial requirement Organic nitrates and nitrite: it causes dilation of the large veins, radiating to the left arm. 2) Reduce the O2 demand of the heart ❖ This diminishes preload (venous return to the heart), Effects on cardiovascular system: nitroglycerin dilates the coronary vasculature, Most common Occurs in exertion , emotional stress providing increased blood supply to the heart muscle. Second, Due to coronary artery atherosclerosis ❖ This causes a decrease in myocardial oxygen consumption because of decreased cardiac work. 1. Typical / Stable / Classic / Exertional / Effort angina : The most common adverse effect of nitroglycerin, as well as the other nitrates, is: headache. postural hypotension, High doses of organic nitrates can also cause: facial flushing, Adverse effects: tachycardia. Postural hypotension & Syncope Tachycardia Notes: Other S/E: Drug rash Occurs at rest Facial flushing Headache suppress the activation of the heart and causing a slight decrease in blood pressure. Propranolol and other βblockers: and thereby decrease the myocardial response to stress or exercise ECG changes: β-Adrenergic blockers: Occurs at rest or mild exertion. from broken atherosclerotic plaques Abrupt interruption of propranolol therapy with angina pectoris has been associated with:- due to a sudden increase in sympathetic nervous system tone to the heart. Chest pain at rest due to coronary artery spasm They decrease cardiac output antagonize the actions of catecholamines on the heart Reappearance of angina, acute myocardial infarction, or death 2. Variant / Atypical / Vasospastic / Prinzmetal’s angina : Angina Pectoris The β-adrenergic blocking agents (propranolol, Nadolol, Atenolol, and metoprolol) by blocking β receptors. Due to coronary artery spasm Angina types: It occurs due to presence of labile thrombi originated Adverse effects: 3. Unstable angina : and it may develop to myocardial infarction. Atheroscelerotic plaques The calcium channel blockers inhibit the entrance of calcium into cardiac and smooth muscle cells of the coronary and systemic arterial beds. Platelet aggregation Caused by: Thrombosis ➢ Verapamil mainly affects the myocardium, Coronary artery spasm ➢ Nifedipine exerts a greater effect on smooth muscle in the peripheral vasculature. ❖ Nitrates (Isosorbide dinitrate - Nitroglycerin) ➢ Diltiazem is intermediate in its actions. and thus decreases heart rate and oxygen demand. which cause coronary occlusion, ❖ β-blockers ( Propranolol) Anti-Anginal Drugs: Verapamil slows cardiac conduction directly Three classes of drugs are effective, either alone or in combination, in treating patient’s angina: Diltiazem Verapamil causes greater negative inotropic effects than nifedipine. It also causes constipation. Since digoxin increases calcium levels Nifedipin Calcium channel blockers: Verapamil: ❖ Calcium channel-blockers Verapamil heart contraction Verapamil should be used with caution in digitalized patients, since it increases digoxin levels. Why? And we want to lower them and nitrites (Amyl nitrite) Role: Blood vessels vasodilation Nifedipine is administered orally and has a short half-life (about 4 hours) requiring multiple dosing. caused by spontaneous coronary spasm. The vasodilatation effect of nifedipine is useful in the treatment of variant angina ❖ Flushing ❖ Headache ❖ Hypotension ❖The drug may cause reflex tachycardia Nifedipine: S/E: Drugs: It reduces the heart rate, although to a lesser extent than verapamil, and also decreases blood pressure. and is therefore particularly useful in patients with variant angina Diltiazem: In addition, diltiazem can relieve coronary artery spasm ➢ Nitrate + β-blocker ➢ Calcium channel blocker + nitrate For exertional angina: Combination of drugs in Antianginal Therapy: ➢ Calcium channel blocker + β-blocker + nitrate (in severe resistant cases) ➢ Calcium channel blocker + nitrate For variant angina: Lastly: