Angina may feel like pressure or squeezing in your chest. The pain also can occur in your shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion. Angina is chest pain or discomfort that occurs if an area of your heart muscle doesn't get enough oxygen rich blood.

1. Prepared by:
Ms. Shivanee Vyas
Assistant Professor
Angina Pectoris
and
Myocardial infarction

3. Angina is chest pain or discomfort that occurs if an area of your heart muscle doesn't
get enough oxygen rich blood.
ANGINA PECTORIS
• Angina may feel like pressure or squeezing in your
chest. The pain also can occur in your shoulders, arms,
neck, jaw, or back. Angina pain may even feel like
indigestion.
• Angina isn't a disease; it's a symptom of an underlying
heart problem. Angina usually is a symptom of
coronary heart disease (CHD) is the most common
type of heart disease in adults.
• It occurs if a waxy substance called plaque builds up
on the inner walls of your coronary arteries. These
arteries carry oxygen-rich blood to your heart.

4. TYPES OF ANGINA PECTORIS
1. Stable Angina- Stable angina is the most common type of angina. It occurs when the heart is
working harder than usual. The pain usually goes away a few minutes after you rest or take your
angina medicine. Stable angina isn't a heart attack, but it suggests that a heart attack is more
likely to happen in the future.
2. Unstable Angina- It may occur more often and be more severe than stable angina. Unstable
angina also can occur with or without physical exertion, and rest or medicine may not relieve the
pain. Unstable angina is very dangerous and requires emergency treatment. This type of angina is
a sign that a heart attack may happen soon.
3. Variant (Prinzmetal's) Angina- Variant angina is rare. A spasm in a coronary artery causes this
type of angina. Variant angina usually occurs while you're at rest, and the pain can be severe. It
usually happens between midnight and early morning. Medicine can relieve this type of angina.

5. Causes of
ANGINA PECTORIS

6. The following risk factors increase your risk of coronary artery disease and angina
1. Tobacco use- Chewing tobacco, smoking and long-term exposure to second-hand smoke
damage the interior walls of arteries including arteries to your heart, allowing deposits of
cholesterol to collect and block blood flow.
2. Diabetes- Diabetes is the inability of your body to produce enough or respond to insulin properly.
Insulin, a hormone secreted by your pancreas, allows your body to use glucose, which is a form
of sugar from foods. Diabetes increases the risk of coronary artery disease, which leads to angina
and heart attacks by speeding up atherosclerosis and increasing your cholesterol levels.
3. High blood pressure- Blood pressure is determined by the amount of blood your heart pumps
and the amount of resistance to blood flow in your arteries. Over time, high blood pressure
damages arteries by accelerating hardening of the arteries.
4. Personal or family history of heart disease- If you have coronary artery disease or if you've
had a heart attack, you're at a greater risk of developing angina.
5. Older age- Men older than 45 and women older than 55 have a greater risk than do younger
adults.

7. 6. Lack of exercise- An inactive lifestyle contributes to high cholesterol, high blood pressure, type
2 diabetes and obesity. However, it is important to talk with your doctor before starting an
exercise program.
7. Obesity- Obesity raises the risk of angina and heart disease because it's associated with high
blood cholesterol levels, high blood pressure and diabetes. Also, your heart has to work harder
to supply blood to the excess tissue.

8. ETILOGY & PATHOPHYSIOLOGY
Decreased
coronary
blood flow
Angina
(Chest
Pain)
Increased
oxygen
consumption
Increased
Heart rate
Contractility
Vasospasm

9. ● Angina symptoms include chest pain and discomfort, possibly described as
pressure, squeezing, burning or fullness.
● Also have pain in arms, neck, jaw, shoulder or back.
● Other symptoms that may have with angina include:
○ Dizziness
○ Fatigue
○ Nausea
○ Shortness of breath
○ Sweating
SIGN AND SYMPTOMS

10. MEDICATION

11. If lifestyle changes alone don't help your angina, you may need to take medications.
1. Nitrates- Nitrates relax and widen blood vessels, allowing more blood to flow to heart muscles.
The most common form of nitrate used to treat angina is with nitro-glycerine tablets put under your
tongue.
2. Aspirin- Aspirin reduces the ability of your blood to clot, making it easier for blood to flow through
narrowed heart arteries. Preventing blood clots can also reduce your risk of a heart attack. But
don't start taking daily aspirin without talking to your doctor first.
3. Clot-preventing drugs- Certain medications such as clopidogrel, prasugrel, and ticagrelor can
help prevent blood clots from forming by making your blood platelets less likely to stick together.
4. Statins- Statins are drugs used to lower blood cholesterol. They work by blocking a substance
body needs to make cholesterol. They may also help the body to reabsorb cholesterol that has
accumulated in plaques in your artery walls, helping prevent further blockage in your blood
vessels.
5. Calcium channel blockers- Calcium channel blockers, also called calcium antagonists, relax and
widen blood vessels by affecting the muscle cells in the arterial walls. This increases blood flow in
your heart, reducing or preventing angina.

12. MYOCARDIAL INFRACTION
“Myocardial infarction (MI) refers to tissue
death (infarction) of the heart muscle
(myocardium). It is a type of acute coronary
syndrome, which describes a sudden or
short-term change in symptoms related to
blood flow to the heart”
OR
“Myocardial infarction (MI) is the irreversible death
(necrosis) of heart muscle secondary to prolonged lack
of oxygen supply (ischemia)”.

13. • This is usually the result of a
blockage in one or more of
the coronary arteries. A
blockage can develop due to
a buildup of plaque, a
substance mostly made of
fat, cholesterol, and cellular
waste products.

14. ETIOPATHOGENESIS
1. Rupture of an atherosclerotic plaque on an artery that supplies the heart muscle.
Plaques can become unstable and burst, which can lead to a blood clot that blocks
the artery. This can happen in just a few minutes. When an artery gets blocked, the
tissue that is being supplied by that artery can die.
2. A myocardial infarction can develop from a heart due to less blood supply and
elevated oxygen needs, in cases such as exercise, emotions, fever, a rapid heart
rate, hyperthyroidism, too few red blood cells, or low blood pressure.
3. Diminished coronary blood flows e.g. in coronary artery disease, shock.

15. Sign and symptoms of MI

16. TREATMENT
 Non-Pharmacological Treatment
These include:
1. Schedule a checkup: Find a primary care provider and see them at least once a year for a
checkup or wellness visit.
2. Quit tobacco products: This includes smokeless tobacco and all vaping products.
3. Exercise regularly: Aim for 20 to 30 minutes of moderately intense physical activity a week.
4. Eat a healthy diet: A plant-based diet approach is an excellent alternative.
5. Maintain a healthy weight: Your primary care provider can advise you on a healthy goal weight.
6. Manage your existing health conditions: This includes high cholesterol levels, high blood
pressure, and diabetes.
7. Reduce your stress: Consider techniques such as yoga, deep breathing, and meditation.
 Pharmacological Treatment
1. A number of different medications can also be used to treat a heart attack:
• Blood thinners, such as aspirin, are often used to break up blood clots and improve blood flow
through narrowed arteries.
• Thrombolytics are often used to dissolve clots.
• Antiplatelet drugs can be used to prevent new clots from forming and existing clots from growing.
2. Pain relievers: may be used to reduce any type of discomfort.

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