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
Coronary
atherosclerosis

Exposure to
cold
vasoconstrict
ion
elevated
blood
pressure

Stress or
any
emotionprovoking
situation

Physical
exertion
increasing
myocardial
oxygen demand

anemi
a

significant
obstruction of a
major coronary
artery
reduced
coronary
blood flow
imbalance
between
myocardial
oxygen supply
and demand

Eating a
heavy
meal
increases the blood
flow to the
mesenteric area for
digestion
hypovole
mia
smoki
ng

release of
catecholamin
es
increases
blood
pressure
and heart
rate
Increase
myocard
ial
workloa
d

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

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

Therapy
1. 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 (Nitroglycerin) c

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