Angina Pectoris “Chest pain” or angina pectoris is a symptom of ischemic heart disease caused by an imbalance between oxygen requirement of the heart and oxygen supply. • Peculiarities of coronary circulation Functional end arteries Maximum oxygen extraction
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Angina Pectoris “Chest pain” or angina pectoris is a symptom of ischemic heart disease caused by an imbalance between oxygen requirement of the heart and.
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Angina Pectoris
“Chest pain” or angina pectoris is a symptom of ischemic heart disease caused by an imbalance between oxygen requirement of the heart and oxygen supply.
• Peculiarities of coronary circulation Functional end arteries Maximum oxygen extraction
Blood flow mainly during diastole
Angina Pectoriso Exertional angina (Stable or effort, or classic):
oMyocardial oxygen demand increase triggered by physical activity, pain persists few minutes and subsides with rest (~ 90% of angina cases).
o Vasospastic angina (or Prinzmetal, or variant):oConsequence of an abrupt reduction in blood flow due to
a vasospasm and characterized by pain at rest.o Unstable (or “crescendo angina”, acute coronary
insufficiency, preinfarction angina or intermediate syndrome): oAngina symptoms are more frequent, longer lasting,
often occurs at rest and not relieved by nitroglycerine.
– these patients are at a high risk for developing an MI or non-STEMI• Anticoagulants (heparin or LMWH)• Nitroglycerin (sublingually or by buccal spray; i.v. if pain persists; topical or
oral for maintenance)• Beta-blocker (reduce heart rate to 50-60 beats/min; caution in patients with
evidence of heart failure)• Statin or other lipid-lowering agent if applicable (prophylactic therapy)
Summary of Antianginal Drugs
Drug class Antianginal actions
Nitrates and nitrites
- Decrease in cardiac O2 demand by reducing preload- Increase in cardiac O2 delivery by relieving coronary spasm.
Ca++channel blocking
drugs
- Decrease in cardiac O2 demand by: a) reducing afterload b) reducing cardiac contractility and rate- Increase in cardiac O2 delivery by relieving coronary spasm.
β-blocking drugs
- Decrease in cardiac O2 demand by reducing cardiac contractility and rate