DEFINITION

Angina or chest pain is the clinical

manifestation of reversible myocardial
Ischemia
Causes of Angina
 Non cardiac conditions like anemia,
hypoxemia, anxiety, pneumonia,
asthma, physical exertion, COPD and
low blood volume
 Cardiac conditions like coronary artery
spasm, coronary artery thrombosis,
dysrrhythmias, heart failure and valve
disorders, aortic stenosis,
cardiomyopathy, tachycardia
Types of Angina
 Chronic stable Angina: It refers to chest pain that occurs
intermittently over a long period with the same pattern of
onset, duration and intensity of symptoms.

 Silent Ischemia: It refers to the ischemia that occurs in the

absence of any subjective symptoms.

 Nocturnal Angina or Angina decubitus: It occurs only at

night but not necessarily when the person is in the
recumbent position or during sleep.

 Prinzmetal’s Angina or Variant Angina: It occurs at rest

usually in response to spasm of a major coronary artery.
PATHOPHYSIOLOGY
Coronary atherosclerosis

Attraction of platelets to the arterial wall

Thrombus adhere to the wall of the artery

Occlusions of the coronary arteries

Lack of blood flow to myocardium

Anaerobic metabolism

Accumulation of lactic acid to the muscles

Angina pectoris
Assessment of Angina
P- precipitating events i.e. what events or
activities precipitated the pain
Q- quality of pain i.e. how is the pain felt
whether dull, aching, squeezing, tight or
pressure type
R- Radiation of Pain i.e. to all what areas pain
is radiating
S- severity of pain i.e. on a scale of 0-10 rate
the pain
T- timing of pain i.e. when the pain begins
and the duration and frequency of pain
DIAGNOSTIC EVAUATION
 History and physical examination
 ECG
 Chest X-ray
 Exercise stress test (HOTLLER test )
 Echocardiogram
 Nuclear imaging tests
 CT scan
 Positron emission tomography
 Coronary angiography
 Laboratory test- CK-MB, CBC, Lipid profile, C-
reactive protein, myoglobin.
management
 Admn morphine sulfate to reduce pain.
 Drug therapy Anti platelet therapy (Aspirin)
 Admn Inj.Nitroglycerine
 β- Adrenergic blockers (Metoprolol, Inderol)
 Calcium channel blockers (Amlong,
Nimodip)
 ACE inhibitors (captopril, ramipril) to
reduce after load
 Fibronolytic agents (Streptokinase,
Heparin)
 Percutaneous coronary intervention
SURGICAL MANAGEMENT
 Coronary artery bypass graft
surgery(CABG)
 Minimally invasive direct coronary
artery bypass
 OFF- PUMP CORONARY ARTERY
BYPASS
 Transmyocardial Laser
Revascularization(TMR)