Angina

Angina
• Sudden substernal chest pain caused by
imbalance btw blood flow and oxygen
demands to the myocardium
 Normal

Oxygen Oxygen
demands supply

Ischemia
 Types of angina
• Classic (stable) angina:
– 90% from the cases
– Chest occuring upon exertion
– Usually is due to atheromatous lesions
• Unstable angina:
– Occurs suddenly at rest
– 10-20% progress to MI
• Prizmetal’s (variant) angina:
– Results from coronary vasospasm
Treatment strategy of angina
1. Increase oxygen supply
2. Decrease cardiac oxygen demand
 Myocardial demands:
1. Preload
– Diastolic filling pressure
2. Afterload
– Peripheral vascular resistance
3. Heart rate
4. Wall tension
 Antianginal
drugs

Nitrates B-blockers CCB Aspirin

 Nitrates
• Nitroglycerin
• Isosorbide dinitrate
• Isosorbide mononitrate
 Nitrates
• Nitrates Release Nitric oxide

Relaxation of smooth muscle

Diminishes preload Dilation of veins

and afterload
 Nitrates
• At higher doses cause dilation of arteriols

Decrease in peripheral resistance

Decrease in blood pressure

 Clinical uses
• Releive of acute attack
– Sublingual form
• Prevention of attack
– Oral form or patch form
• Cyanide poisoning
 Nitrates side effects
1. Postural hypotension
2. Reflex tachycardia
3. Throbbing headache
4. Flushes
5. Dizziness
6. Tolerance
 Drug interactions
• Nitrates shouldn’t be used in conjunction with
drugs used to erectile dysfunction
Calcium channel blockers and beta blockers

• Have been discussed in hypertension lecture

 Aspirin
• Will be discussed later