Angina pectoris, commonly known as angina, is chest pain caused by reduced blood flow to the heart muscle, usually due to coronary artery disease. The main symptoms of angina are chest pain or discomfort that is typically triggered by exertion or stress and relieved by rest. Angina comes in several forms that vary based on triggers and severity. Diagnosis involves medical history, exams, ECGs, stress tests, and sometimes angiography. Treatment focuses on lifestyle changes, medications, and potentially invasive procedures like angioplasty or bypass surgery to improve symptoms and life expectancy.

1.  Jaineel Dharod
Dept. of Pharmacology

2.  Angina pectoris – commonly known as angina – is chest
pain due to ischemia of the heart muscle, generally
due to obstruction or spasm of the coronary arteries.
 The main cause of Angina pectoris is coronary artery
disease, due to atherosclerosis of the arteries
feeding the heart.
 Angina Pectoris is translated as "a strangling feeling
in the chest".

3.  There is a weak relationship between severity of pain and
degree of oxygen deprivation in the heart muscle (i.e.,
there can be severe pain with little or no risk of a
Myocardial infarction (commonly known as a heart attack),
and a heart attack can occur without pain).
 In some cases angina can be extremely serious and has
been known to cause death.
 People that suffer from average to severe cases of angina
have an increased percentage of death before the age of
55, usually around 60%.

10.  Stable/Classical/typical/exertional angina.
 Unstable/Crescendo/Pre-infraction angina.
 Prinzmetal’s or variant angina.
 Decubitus angina.
 Nocturnal angina.

13. [A] Common:
 Physical exertion.
 Cold exposure.
 Heavy meals.
 Intense emotion.
[B] Uncommon:
 Lying flat (decubitus angina)
 Vivid dreams (nocturnal angina).

14.  Age (≥ 55 years for men, ≥ 65 for women)
 Cigarette smoking
 Diabetes mellitus (DM)
 Dyslipidaemia
 Family history of premature cardiovascular disease
 Hypertension (HTN)
 Kidney disease (microalbuminuria or GFR<60 mL/min)
 Obesity (BMI ≥ 30 kg/m2)
 Physical inactivity
 Prolonged psychosocial stress.

15.  Medications
 Vasodilators
 Excessive thyroid replacement
 Vasoconstrictors
 Polycythaemia which thickens the blood causing it to slow its
flow through the heart muscle
 Hypothermia
 Hypovolaemia
 Hypervolemia

16. 1. Site: Retrosternal pain (mainly), left side of chest
(may be).
2. Character: Oppression or tightness in the chest- like
a band round the chest, dull or choking etc.
3. Radiation: left shoulder and ulnar border of left
hand, sometimes to neck, jaw, and back and
occasionally to the epigastric or interscapular region.

17. 4. Duration: Few second too few minutes, usually 2-5 min.
5. Aggravated by: Exercise, emotion, after meal, in the
cold, walking uphill or into a strong wind.
6. Relieved by: Taking rest or GTN ( glyceryl trinitrate)

18. 

19.  Smoking- Nicotine stains.
 Hypertension-High BP, loud.
 Diabetes, myxoedema.
 Hyperlipidaemia-tendon xanthomas, lipids.

20.  Obesity
 Anaemia
 Thyrotoxicosis
 Aortic valve disease

21.  Gallop rhythm (triple beat)
 Cardiomegaly
 Basal crackles
 Elevated blood pressure

22.  Carotid bruits (unusual sounds in neck region)
 Peripheral vascular disease

23. 1. Musculoskeletal pain
2. Pericardial pain
3. Oesophageal pain

24. 

25. 1. Resting ECG: Normal in most patients. May show evidence of previous
MI.
2. ETT (Exercise Tolerance Test): Reversible S-T segment depression
or elevation with or without T inversion.
3. Isotope scanning with Thallium 201, using Gamma camera showing
cold spot.
4. Coronary angiography: Provides detail information about the site,
extent and nature of coronary artery disease.
5. Others:
 X-ray chest: Normal.
 Urine for sugar if Diabetes.
 Serum cholesterol, serum triglyceride & lipoprotein.

26. 

27.  A careful assessment of the like extent and severity
of arterial disease.
 The identification and control of significant risk
factors (e.g. smoking, hypertension, hyperlipidaemia)
 The use of measures to control symptoms.
 The identification of high risk patients & application
of treatment to improve life expectancy.

29. The most widely used invasive options for the treatment of
ischemia heart disease include:
 PCI (Percutaneous coronary intervention) or
 PTCA (Percutaneous transluminal coronary angioplasty)
 CABG (Coronary artery bypass grafting) surgery.

31. 1. Do not smoke (if smoker).
2. Aim at ideal body weight.
3. Take regular exercise (exercise up to but not beyond, the
point of chest pain is beneficial).
4. Avoid sever unaccustomed exertion & vigorous exercise
after a heavy meal or in very cold weather.
5. Take sublingual Nitrate before undertaking exertion that
may induce angina.