Angina Pectoris

Patricia Camille A.
Navarro

The Human
Heart

What is Angina
Pectoris?

Angina pectoris (stable angina) is the

medical term for chest pain or
discomfort that results from reduced
coronary blood flow, causing a
temporary imbalance between
myocardial body supply and demand.
Angina isn't a disease; it is a symptom
of an underlying heart problem.

Factors associated with angina

pectoris

Pathophysiology
Exposure to
cold
vasoconstricti
on
elevated
blood
pressure

Physical
exertion
increasing
myocardial oxygen
demand

anemi
a

Coronary
atherosclerosis

Stress or any
emotionprovoking
situation

significant
obstruction of a
major coronary
artery

Eating a
heavy meal

release of
catecholamine
s

increases the blood

flow to the
mesenteric area for
digestion

increases
blood
pressure and
heart rate

reduced
coronary blood
flow
imbalance between
myocardial oxygen
supply and demand

hypovolem
ia
smokin
g

Increase
myocardi
al
workload

anaerobic metabolism
replaces aerobic
metabolism for
nourishment
produces lactic
acid
factor P is
released from
ischemic
myocardial cells
the heart muscle
does not have any
pain fibers

pain is felt
wherever
substance P reacts
with a pain
receptor
poorly localized pain and may
radiate to the neck, jaw, shoulders,
and inner aspects of the upper arms,
usually the left arm

Angina Pectoris

Other symptoms:
Weakness or
numbness in the
arms, wrists, and
hands may
accompany the
pain
Shortness of breath
Pallor
Diaphoresis
Dizziness or lightheadedness
Nausea and

Medical Management: Pharmacologic

1.Therapy
Nitroglycerin (glyceryl trinitrate)
Brand names : Deponit, Minitran, Nitro-Bid, Nitrocot,Nitro-Dur,
Nitrogard, Nitroglyn E-R, Nitroject, Nitrol, Nitrolingual, NitroMist,
Nitrong SR, Nitro-par, Nitrostat, Nitro-time, Transderm-Nitro, Tridil
Classification:
Chemical classification: Nitrates
Therapeutic Classification: Antianginal, antihypertensive, vasodilator

Mechanism of Action:
Nitrates cause blood vessels to relax and dilate. This results in
a drop in peripheral resistance and blood pressure and a decrease in
venous return to the heart. These actions will decrease myocardial
workload and can restore the appropriate balance in the supply
demand ratio in the heart.

Indications: Treatment of acute angina, prophylaxis of angina, intravenous

treatment of angina unresponsive to beta-blockers or organic nitrates,
perioperative hypertension, and heart failure associated with acute
myocardial infarction; to produce controlled hypotension during surgery.
Contraindications:
Nitrates are contraindicated in the presence of any allergy to nitrates to
prevent hypersensitivity reactions.
These drugs also are contraindicated in the following conditions: severe
anemia because the decrease in cardiac output could be detrimental in a
patient who already has a decreased ability to deliver oxygen because of a
low red blood cell count;
Head trauma or cerebral haemorrhage because the relaxation of cerebral
vessels could cause intracranial bleeding; and
Pregnancy or lactation because of potential adverse effects on the neonate
and ineffective blood flow to the fetus.

Medical Management: Pharmacologic Therapy (Nitroglyce

Medical Management: Pharmacologic

Therapy
2. Beta-Adrenergic Blocking Agents
Beta-blockers recommended for use in angina are metoprolol
(Toprol), propranolol (Inderal), and atenolol (Tenormin)
Mechanism of Action:
Appear to reduce myocardial oxygen consumption by blocking
the beta-adrenergic sympathetic stimulation to the heart. The
result is a reduction in heart rate, slowed conduction of an
impulse through the heart, decreased blood pressure, and
reduced myocardial contractility (force of contraction) that
establishes a more favorable balance between myocardial
oxygen needs (demands) and the amount of oxygen available
(supply). This helps to control chest pain and delays the onset
of ischemia during work or exercise.

Indication: They are indicated for the long-term management of

angina pectoris caused by atherosclerosis. These drugs are
sometimes used in combination with nitrates to increase exercise
tolerance.
Contraindications: The beta-blockers are contraindicated in
patients with bradycardia, heart block, and cardiogenic shock
because blocking of the sympathetic response could exacerbate
these diseases. They also are contraindicated with pregnancy and
lactation because of the potential for adverse effects on the fetus
or neonate.

Medical Management: Pharmacologic Therapy (Beta-Adrenergic

Medical Management: Pharmacologic

Therapy 3. Calcium Channel Blocking Agents
Calcium channel blockers include amlodipine
(Norvasc), diltiazem (Cardizem), nicardipine
(Cardene), nifedipine (Adalat, Procardia), and
verapamil (Calan, Isoptin).

Mechanism of Action:
Calcium channel blockers reduce myocardial oxygen
demand and increase myocardial blood and oxygen
supply, lowering blood pressure and reducing
myocardial contractility and heart rate. They are also
potent coronary vasodilators which increases oxygen
supply.

Indication: Calcium channel blockers are indicated for the treatment of

Prinzmetal angina, chronic angina, effort associated angina, and
hypertension. Because they may actually increase ischaemia and mortality in
those with heart failure, or left ventricular dysfunction, these drugs are not
usually prescribed in the initial treatment of angina.
Contraindication: Calcium channel blockers are contraindicated in the
presence of allergy to any of these drugs to avoid hypersensitivity reactions
and with pregnancy or lactation because of the potential for adverse effects
on the fetus or neonate.

Medical Management: Pharmacologic Therapy (Calcium Channel

Medical Management: Pharmacologic

Therapy
4. Oxygen Administration
Oxygen therapy is usually initiated at the onset of chest pain in an
attempt to increase the amount of oxygen delivered to the
myocardium and to decrease pain.

Oxygen inhaled directly increases the amount of oxygen in the

blood

Medical Management: Alternative

Therapy
1.

Cardiac Catheterisation

This is a generic form for a range of procedures such as percutaneous coronary

intervention (PCI), ventriculography, and atherectomy which are performed
under sterile conditions in a fluoroscopy suite to:
Diagnose CAD, heart abnormalities which may be congenital or have
developed overtime
Assess whether it is possible to revascularise the heart by opening up the
blocked artery
Insert a stent
Obtain a biopsy of the heart muscle
Assess the hearts response to drug treatments