Your SlideShare is downloading. ×
  • Like


Flash Player 9 (or above) is needed to view presentations.
We have detected that you do not have it on your computer. To install it, go here.


Now you can save presentations on your phone or tablet

Available for both IPhone and Android

Text the download link to your phone

Standard text messaging rates apply


  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
  • ^^
    Are you sure you want to
    Your message goes here
No Downloads


Total Views
On SlideShare
From Embeds
Number of Embeds



Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

    No notes for slide


  • 1.
  • 2. Angina Pectoris
    • - is recurring acute chest pain or discomfort resulting from decreased blood supply to the heart muscle(myocardial ischemia). Angina occurs when the heart’s need for oxygen increases beyond the level of oxygen available from the blood nourishing the heart. Angina is a common symptom for coronary heart disease (CHD). The symptoms of angina include mild or severe pain, pressure, or discomfort in the chest, the pain is generally described as a feeling of a squeezing, strangling, heaviness, or suffocation sensation in the chest.
  • 3. 3 Types of Angina
    • Stable
    • Unstable
    • Variant
  • 4. 3 Types of Angina
    • Stable
      • Effort-induced pain from physical activity or emotional stress
      • Relieved by rest
      • Predictable and reproducible
    • Unstable
    • Variant
  • 5. 3 Types of Angina
    • Stable
    • Unstable
      • Pain occurs with increasing frequency
      • Diminishes patient’s ability to work
      • Has decreasing response to therapy
      • May signal an oncoming MI
    • Variant
  • 6. 3 Types of Angina
    • Stable
    • Unstable
    • Variant
      • Pain due to coronary artery spasm
      • Pain may occur at certain times of the day, but is not stress induced
  • 7.
    • Prinzmetal's Angina
    • - Prinzmetal’s or variant angina is caused by a vasospasm, a spasm that narrows the coronary artery and lessens the blood flow to the heart.
    • - Prinzmetal's Angina usually occurs in arteries already narrowed by atherolsclerosis, in fact most people with it have severe coronary atherosclerosis in at least one major vessel. stable and unstable angina, Prinzmetal's Angina usually occurs when  a person is at rest or sleep and not after physical exertion or emotional stress.
  • 8.
    • Microvascular Angina  Microvascular angina, or Syndrome X, occurs when the patient experiences chest pain but has no apparent coronary artery blockage. This condition results from poor functioning of the tiny blood vessels that nourish the heart, arms and legs. Microvascular angina can occur during exercise or at rest. Reduced vasodilator capacity of the coronary microvessels is thought to be a cause of angina during exercise, but the mechanism of angina at rest is not known. 
  • 9. Symptoms of Angina
    • Severe chest discomfort (heaviness, pressure, tightness, choking, squeezing)
    • Sweating
    • Dizziness
    • Dyspnea
  • 10. Risk Factors for Angina
    • Advanced age
    • Coronary artery disease
    • Hypertension
    • Increased serum glucose levels (diabetes)
    • Increased serum lipoprotein levels
    • Obesity
    • Smoking
    • Type A personality
  • 11. Initiating Factors of an Attack
    • Cold weather
    • Emotions
    • Heavy meals
    • Hypoglycemia
    • Pain
    • Smoking
  • 12. Discussion
    • Explain why some of these factors may initiate an angina attack: cold weather, emotions, heavy meals, hypoglycemia, pain, smoking.
  • 13. Discussion
    • Explain why some of these factors may initiate an angina attack.
    • Answer: cold weather – tension in the muscles, possible decrease in blood flow….
  • 14. Nitrates
    • Most commonly used drugs for angina
    • Relax vascular smooth muscle and cause vasodilation
    • Helps with pulmonary edema in CHF
  • 15. Agents for Angina Nitrates
    • isosorbide dinitrate (Dilatrate-SR, Isordil)
    • isosorbide mononitrate (Imdur, Ismo)
    • nitroglycerin (Minitran, Nitrolingual, Nitrostat)
    Drug List
  • 16. nitroglycerin (Minitran, Nitrolingual, Nitrostat)
    • Drug of choice for acute attacks
      • Spray and tablets taken sublingually
    • May also be used as a prophylaxis
    • If using a patch, it should not remain on the skin for a full 24 hours, there needs to be free time
  • 17. nitroglycerin’s Side Effects
    • Severe headache
    • Orthostatic hypotension
    • Flushing
  • 18. nitroglycerin Dispensing Issues
    • Tablets must be dispensed in the original amber glass bottle
    • Medication should be refilled every 3 months and discard any remaining drug
  • 19. Calcium Channel Blockers
    • Relaxes vascular smooth muscle
    • Some of these drugs should be taken with food and caffeine should be limited
    • Constipation is most common side effect
  • 20. Agents for Angina Calcium Channel Blockers
    • amlodipine (Norvasc)
    • bepridil (Vascor)
    • diltiazem (Cardizem, Dilacor XR)
    • felodipine (Plendil)
    • isradipine (DynaCirc)
    Drug List
  • 21. Agents for Angina Calcium Channel Blockers
    • nicardipine (Cardene)
    • nifedipine (Procardia)
    • nisoldipine (Sular)
    • verapamil (Calan, Covera HS, Isoptin, Verelan)
    • Beta Blockers – Table 12.5
    Drug List
  • 22. verapamil (Covera HS)
    • Timed-release product designed for bedtime dose
    • Drug is pumped out of 2 holes in the tablet
    • Patients may see a ghost tablet in the stool
  • 23. Beta Blockers and Angina
    • Effective in slowing the heart rate, decreasing myocardial contractility, and lowering blood pressure
  • 24.
    • Thank You for Listening!