Angina Pectoris
Angina Pectoris
Angina Pectoris
Dr Sidra Tanwir
DEFINITION
A type of chest pain caused by reduced blood flow to
the heart.
Angina pectoris is a clinical syndrome of IHD
resulting from transient myocardial ischemia.
It is characterized by paroxysmal pain in the
substernal or precordial region of the chest which is
aggravated by an increase in the demand of the heart
and relieved by a decrease in the work of the heart.
Often, the pain radiates to the left arm, neck, jaw or
right arm.
It is more common in men past 5th decade of life.
CLASSIFICATION
Stable angina
Smoking
Diabetes
Dyslipidemia
Obesity
Hypertension
Stress
Kidney Diseases
Inactivity
CAUSES
Other Medical Problems
Hyperthyroidism
Hypoxemia
Profound anemia
Uncontrolled hypertension
CAUSES
Other Cardiac Problems
Tachyarrhythmia
Bradyarrhythmia
Valvular heart disease
Hypertrophic cardiomyopathy
PATHOPHYSIOLOGY
Angina results when there is an imbalance between
the heart's oxygen demand and supply.
This imbalance can result from an increase in demand
(e.g., during exercise) without a proportional increase
in supply (e.g., due to obstruction or atherosclerosis of
the coronary arteries).
However, the pathophysiology of angina in females
varies significantly as compared to males Non-
obstructive coronary disease is more common in
females
DIAGNOSIS
Acute Chest Pain
ECG
ST↑ No ST↑
Troponins
Troponins (+ 4 hrs)
Cardiac
Vasodilato
Depressan
rs
ts
Peripheral pooling
↓PVR
of blood
↓Venous return to
↓Afterload
the heart
↓Cardiac work
↓Oxygen requirement of
myocardium
Relief of Pain
Classification of Anti-anginal Agents
The most common adverse effect of nitroglycerin, as
well as of the other nitrates, is headache.
High doses of organic nitrates can also cause postural
hypotension, facial flushing, and tachycardia.
Sildenafil potentiates the action of the nitrates.
Over doses may cause methaemoglobinaemia.
Classification of Anti-anginal Agents
Calcium channel blockers:
Nifedipine
This drug has minimal effect on cardiac conduction or
heart rate.
Nifedipine is administered orally, usually as extended-
release tablets.
It undergoes hepatic metabolism to products that are
eliminated in both urine and the feces.
Classification of Anti-anginal Agents
• ↓ Heart rate
• ↓ Force of
• Propranolol
Β1 myocardial
Beta • Metoprolol
• receptors contraction
blockers Atenolol • ↓↓ Cardiac work
• of heart
Timolol • ↓ Myocardial oxygen
consumption
Classification of Anti-anginal Agents
They are, however, contraindicated in patients with
asthma, diabetes, severe bradycardia, peripheral
vascular disease, or chronic obstructive pulmonary
disease
Adverse effects:
Bradycardia
Heart block
Bronchospasm
Hypoglycaemia
Classification of Anti-anginal Agents
Combination therapy
KEY
Calcium Channel
Commonly used
Blockers
Less effective
drugs drugs