12. Stable Angina
Fixed atheromatous stenosis of one or
more coronry arteries
Typical anginal pain
◦ Retrosternal, tightness or discomfort
◦ Radiating to left(± right) shoulder/arm/
neck/jaw
◦ Brief duration, lasting <10-15 min
◦ Associated with diaphoresis, nausea, anxiety
◦ Worse on exertion
◦ Relieved by rest and nitrates
13. Positive Levine sign-When pt is asked to localize the pain, he/ she typically places a
hand over the sternum, sometimes with a clenched fist, to indicate a squeezing,
central, substernal discomfort
14. Canadian Cardiovascular Society classification
system
Class Definition
CCS
1
Angina with strenuous activity
CCS
2
Angina with moderate activity (walking
greater than two blocks)
CCS
3
Angina with mild activity (walking less
than two blocks)
CCS
4
Angina with any activity or at rest
16. Variant Angina (Prinzmetal Angina)
A spasm in coronary artery
◦ Exposure to cold
◦ Emotional stress
◦ Medicines that tighten or narrow blood vessels
◦ Smoking
◦ Cocaine use
Occurs at rest
Not related to exertion
Small elevations of cardiac enzymes may
occur
Beta blockers contraindicated
CCB / nitrate/ other vasodilators are useful
17. Syndrome X
Coronary microvascular disease that affects the
heart’s smallest coronary arteries.
Typical symptoms of angina but normal
angiogram
May show definite signs of ischemia with
exercise testing
18. Nocturnal Angina
Angina during sleep (REM)
Decubitus Angina
Anginal pain in supine (recumbent) position
23. Coronary arteriography
◦ Gold standard
◦ Quantify the presence and severity of
atherosclerotic lesions
◦ Assess the non-atherosclerotic causes of
ischemia(eg.-coronary anomaly, aortic
dissection, radiation vasculopathy)
25. Goals of treatment
◦ To prevent MI
◦ To reduce cardiac death
◦ To reduce symptoms
Treatment modalities
◦ Medical therapy
◦ Coronary Revasularization
◦ Lifestyle modifications
◦
26. Improve myocardial oxygen supply
Reduce MVO2(myocardial volume
oxygen consumption)= SBP*HR
Control exacerbating factors
Limit the development of further
atherosclerotic disease
27. Medical therapy
Agents action
Aspirin
clopidogrel
Prevent Pletlets aggregation
and Reduce thrombus
formation
Nitrate Arteriovenous dilation
ACEIs
Beta blockers Reduce MVO2
Ranolazine Noval anti anginal agent
HMG CoA reductase
inhibitors (Statins)
Limit atherosclerotic burden
and reduce cardiac
outcomes
28. Coronary revascularization
Primary coronary intervention (PCI)
Coronary Artery Bypass Graft (CABG)
Indications
◦ Angina refractory to medical therapy
◦ Angina with reduced LV function
◦ Severe activity limiting Angina (CCS class III-IV)
◦ Angina in the presence of LMCA(left main CA) or
severe TVD
30. Unstable Angina
Dynamic obstruction d/t plaque rupture
or erosions with superimposed
thrombosis
more severe and lasts longer than SA,
may be as long as 30 minutes
Not relieved by rest or nitrate
10-20% risk of progression to acute MI
31. Have a
Good life
With low cardiac risk factors And
Lots of Good days with
lots of exercise capacity
Editor's Notes
O2 supply is given by coronary vessels
Demand develops according to the work load