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Angina pectoris


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Angina pectoris

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  2. 2. 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. 3 3 Types of Angina  Stable  Unstable  Variant
  4. 4. 4 3 Types of Angina  Stable Effort-induced pain from physical activity or emotional stress Relieved by rest Predictable and reproducible  Unstable  Variant
  5. 5. 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. 6. 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. 7. 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. 8. 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. 9. 9 Symptoms of Angina  Severe chest discomfort (heaviness, pressure, tightness, choking, squeezing)  Sweating  Dizziness  Dyspnea
  10. 10. 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. 11. 11 Initiating Factors of an Attack  Cold weather  Emotions  Heavy meals  Hypoglycemia  Pain  Smoking
  12. 12. 12 Discussion Explain why some of these factors may initiate an angina attack: cold weather, emotions, heavy meals, hypoglycemia, pain, smoking.
  13. 13. 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. 14. 14 Nitrates  Most commonly used drugs for angina  Relax vascular smooth muscle and cause vasodilation  Helps with pulmonary edema in CHF
  15. 15. 15 Agents for Angina Nitrates  isosorbide dinitrate (Dilatrate-SR, Isordil)  isosorbide mononitrate (Imdur, Ismo)  nitroglycerin (Minitran, Nitrolingual, Nitrostat) Drug List
  16. 16. 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. 17. 17 nitroglycerin’s Side Effects  Severe headache  Orthostatic hypotension  Flushing
  18. 18. 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 Warning!
  19. 19. 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. 20. 20 Agents for Angina Calcium Channel Blockers  amlodipine (Norvasc)  bepridil (Vascor)  diltiazem (Cardizem, Dilacor XR)  felodipine (Plendil)  isradipine (DynaCirc) Drug List
  21. 21. 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. 22. 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. 23. 23 Beta Blockers and Angina  Effective in slowing the heart rate, decreasing myocardial contractility, and lowering blood pressure
  24. 24. 24 Thank You for Listening!