Angina Pectoris Factors: Physical exertion- increase myocardial oxygen demand.

and. Exposure to cold- vasoconstriction and elevated blood pressure which increase oxygen demand. Eating heavy meal- increase the blood flow to the mesenteric area for digestion, thereby reducing the blood supply available to the heart muscle. Stress or any emotion- provoking situation causes release of catecholamines, which increases blood pressure, heart rate, and myocardial workload. A clinical syndrome usually characterized by episodes or paroxysms of pain or pressure in the anterior chest. Caused by insufficient coronary blood flow resulting in decrease oxygen supply when there is increase myocardial demand for oxygen in response to physical exertion or emotional stress. The need for oxygen exceeds the supply. It is not a disease but a symptom itself.

Risk Factors: Hypertension Smoking Male gender Inactive (sedentary lifestyle) Family history of coronary disease Aging Regular use of stimulants -nicotine -cocaine -caffeine -diet pills -decongestants

Manifestations: Pain or other symptoms varying in severity from mild indigestion to a choking or heavy sensation in the upper chest that ranges from discomfort to agonizing pain accompanied by severe apprehension and a feeling of impending death. Pain felt in the chest behind the sternum (retrosternal area) Poorly localized and may radiate to neck , jaw,shoulders and inner aspects of the upper arms usually at the left Tightness or a heavy or strangling sensation Weakness or numbness in the arms, wrists and hands

Shortness of breathing Pallor Diaphoresis Dizziness Lightheadedness Nausea and vomiting may accompanied with pain

Diagnostic test Patient history related to the clinicl manifestation of ischemia Twelvw leads ECG Chest x-ray-fluid buikd up in the lungs that can rule out other causes of pain. Medications 1. Nitroglycerin-vaso active agent that reduces myocardial oxygen consumption which decreases ischemia and relieves pain. It primary dilates veins and with higher doses dilates the arteries. 2. Beta-adrenergic blocking agents- (metropolol and atenolol) Reduces myocardial oxygen consumption, decreases heart rate, slowed conduction of impulses decreases blood pressure and balances oxygen supply and oxygen demands. 3. Calcium channel blocking agents- ( amlodipine) o It decreases sino atrial node automacity and atrioventricular node o Conduction. o Slows the heart rate and decrease in the strength of myocardial o Contraction. o Decrease coronary artery perfusion and dilate the smooth muscles o wall. 4. Anti platelet-prevents platelet aggregation and subsequent thrombosis. -Aspirin, clopidogrel, Heparin 5. Oxygen administration - initiated on the onset of pain. 6. Angioplasty- uses if angina does not get better with medications.