This document discusses angina pectoris, or chest pain due to insufficient blood flow to the heart. It defines angina and lists its main types. It then covers the epidemiology, etiology, pathophysiology, clinical manifestations, diagnosis, and management of angina. Management involves both non-pharmacological approaches like lifestyle changes as well as pharmacological treatments including nitrates, beta blockers, and calcium channel blockers. Revascularization procedures like percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) may also be used in some cases.

1. Presented by,
Anjali.c
I year M.Pharm,
Department of pharmacy practice,
Grace college of pharmacy

2.  CONTENTS:
1. Definition
2. Types
3. Epidemiology
4. Etiology
5. Etiopathogenesis
6. Pathophysiology
7. Clinical manifestations
8. Diagnosis
9. Management:
 Non-pharmacological
 Pharmacological

3. DEFINITION
 The term angina pectoris is applied to various forms
of transient chest discomfort that are attributable to
insufficient myocardial oxygen.

4. TYPES
 STABLE OR TYPICAL ANGINA
 PRINZMETAL’S VARIANT ANGINA(VASOSPASTIC)
 UNSTABLE OR CRESCENDO ANGINA
 ANGINA DECUBITUS(NOCTURNAL ANGINA)

5. EPIDEMIOLOGY
• Angina due to ischemic heart disease affects
approximately 112 million people (1.6% of the
population)
 slightly more common in men than women (1.7% to
1.5%)
 The prevalence of angina rises with increasing age

6. ETIOLOGICAL FACTORS:
 Major risk factors
 Other medical problems
 medications
 Other cardiac problems

7. ETIOPATHOGENESIS:
 Coronary Atherosclerosis
 Superadded changes in coronary atherosclerosis
 Non-atherosclerotic causes.

8.  PATHOPHYSIOLOGY
Atherosclerosis Arterial spasm Atherosclerosis+Plaque split+Thrombus
gradual sudden not usually reversible
Obstruction sudden reversible occlusion
obstruction
ISCHAEMIA
Hypoxia
Reduced oxygen demand Angina
Thrombolysis Unstable angina

9. CLINICAL MANIFESTATIONS
•Chest pain / chest discomfort

10. • Dyspnea
• Fatigue
• Increased sweating
• Weakness
• pluse rate and the blood pressure increases
• Palpitation

11. DIAGNOSIS:
 EXERCISE TOLERANCE TESTING
 CARDIAC IMAGING
 ECHOCARDIOGRAPHY

12. MANAGEMENT:
1.NON-PHARMACOLOGICAL:
Counselling and education of patients
Life style modification
Smoking cessation
Avoid Alcohol intake
Diet and nutrition
Salt restriction

13.  REVASCULARIZATION-
 PCI:Percutaneous coronary intervention
 PTCA:Percutaneous transmural coronary angioplasty
 CABG:Coronary artery bypass grafting
 PCI versus CABG is the By pass Angioplasty
Revascularization (BARI)

14. PERCUTANEOUS TRANSLUMINAL CORONARYANGIOPLASTY
(PTCA)

15. CORONARY ARTERY
BYPASS GRAFT (CABG)

16. PHARMACOLOGICAL TREATMENT
Anti anginal drugs:
 1)nitrates
 2)Beta blockers
 3)calcium channel blockers
 4)potassium channel opener
 5)others

17. TREATMENT ALGORITHM FOR ANGINA
Stable angina unstable angina
Aspirin ,GTN
spary,Statins
beta blockers
+ or – regular nitrates
Add:CCB,+-
nicorandil
Consider
revascularisation
Pre hospital or on
arrival
GTN ,aspirin
During hospital
admission
Add:clopidogrel,beta
blockers
revascularization
Long term: