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Angina

Angina . Angina . Sudden substernal chest pain caused by imbalance btw blood flow and oxygen demands to the myocardium . Normal . Oxygen demands . Oxygen supply . Ischemia . Types of angina . Classic (stable) angina: 90% from the cases Chest occuring upon exertion

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Angina

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  1. Angina

  2. Angina • Sudden substernal chest pain caused by imbalance btw blood flow and oxygen demands to the myocardium

  3. Normal Oxygen demands Oxygen supply Ischemia

  4. Types of angina • Classic (stable) angina: • 90% from the cases • Chest occuring upon exertion • Usually is due to atheromatous lesions • Unstable angina: • Occurs suddenly at rest • 10-20% progress to MI • Prizmetal’s (variant) angina: • Results from coronary vasospasm

  5. Treatment strategy of angina • Increase oxygen supply • Decrease cardiac oxygen demand

  6. Myocardial demands: • Preload • Diastolic filling pressure • Afterload • Peripheral vascular resistance • Heart rate • Wall tension

  7. Nitrates • Nitroglycerin • Isosorbide dinitrate • Isosorbide mononitrate

  8. Nitrates • Nitrates Release Nitric oxide Relaxation of smooth muscle Diminishes preload and afterload Dilation of veins

  9. Nitrates • At higher doses cause dilation of arteriols Decrease in peripheral resistance Decrease in blood pressure

  10. Clinical uses • Releive of acute attack • Sublingual form • Prevention of attack • Oral form or patch form • Cyanide poisoning

  11. Nitrates side effects • Postural hypotension • Reflex tachycardia • Throbbing headache • Flushes • Dizziness • Tolerance

  12. Drug interactions • Nitrates shouldn’t be used in conjunction with drugs used to erectile dysfunction

  13. Calcium channel blockers and beta blockers • Have been discussed in hypertension lecture

  14. Aspirin • Will be discussed later

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