causes types and treatment

1. STARTING WITH THE NAME OF
ALLAH THE MOST
BENEFICIENT AND THE MOST
MERCIFUL

2. Mahum almas tariq
roll no. 39
topic: angina
presented to:
Dr. tamseela mumtaz

3. ANGINA
Chest pain

4. Contents:
definition
symptoms
classification
causes
pathophysiology
diagnosis
treatment
drug therapy
prevention

5. Angina is described
as squeezing,
pressure, heaviness,
tightness or pain in
the chest.

6. ►Angina is a clinical syndrome of IHD resulting from
transient myocardial ischemia.
►It is characterized by paroxysmal pain in the
substernal and precordial region of the chest which is
aggravated by an increase in the demand of the heart
and relieved by a decrease in the work of the heart.
►Often the pain radiates to the left arm, neck, jaw or
the right arm.
►It was more common in men during the past 5th
decade of life.

7. Angina

8. Symptoms:
.Chest pain
.Pain in arms, neck, back and
shoulders
.Nausea
.Fatigue
.Shortness of breath
.Sweating
.Dizziness

9. Chest discomfort rather than actual pain.
The discomfort is usually described as a
---pressure
---heaviness
---tightness
---squeezing
---burning
---choking sensation

10. .Apart from chest discomfort, anginal pains
may also be experienced in the
epigastrium, back, neck area, jaw or
shoulders.
.It is exacerbated by having a full stomach
and by cold temperatures.
.Pain may be accompanied by
breathlessness, sweating and nausea in
some cases.

11. Types of angina:
Stable angina
Unstable angina
Intractable angina
Prinzmetal (Variant) angina
Microvascular angina

13. Stable angina
►Stable angina is the most common type of
angina.
►It occurs when the heart is working harder than
usual.
►Stable angina has a regular pattern.
►The pain usually goes away a few minutes after
you take rest or take your angina medicine.
►Stable angina is not a heart attack but it
suggests that a heart attack is more likely to
happen in the future.

14. Unstable angina
►Unstable angina does not follow a pattern.
►It may occur more often and be more severe than
stable angina.
►It may also occur with or without any physical
exertion, and rest or medicine may not relieve the
pain.
►It is very dangerous and requires emergency
treatment.
►This type of angina is a sign that a heart attack
may happen very soon.

15. INTRACTABLE ANGINA
►Intractable or refractory angina is defined by the
presence of severe angina with objective evidence of
ischemia as demonstrated by exercise treadmill
testing, stress imaging study or coronary
psychological study and failure to relieve symptoms
with conventional medical therapy and even with
revascularization techniques.
►Refractory angina is a chronic and incapacitating
condition and often responds poorly to treatments.

16. Variant angina
►Variant angina is very rare.
►A spasm in the coronary artery causes this type
of angina.
►Variant angina usually occurs when you are at
rest and the pain can be severe.
►It usually happens between midnight and early
morning.
►Medicine can relieve this type of angina.

17. 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 the 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 micro
vessels is thought to be a cause of angina during
exercise but mechanism of angina at rest is not known.

20. Other medical problems:
hyperthyroidism
hypoxemia
profound anemia
uncontrolled hypertension
other cardiac problems
tachyarrhythmia
Brady arrhythmia
valvular heart disease
hypertrophic cardiomyopathy

21. Pathophysiology
►angina results when there is an imbalance
between the heart’s oxygen supply and demand.
►This imbalance can result from an increase in
demand without a proportional increase in supply.
►However, the pathophysiology of angina in
female varies significantly as compared to males.
►Non-obstructive coronary disease is more
common in females.

23. RISK FACTORS
►Advanced age
►coronary artery disease
►hypertension
►increased serum glucose levels
►increased serum lipoprotein levels
►obesity
►smoking

24. Initiating factors for angina
cold weather
emotions
heavy meals
hypoglycemia
pain
smoking

25. Diagnosis:
ECG
Stress test
Echocardiogram
Nuclear stress test
Chest X-ray
Blood test
Coronary angiography
CT scan
Cardiac MRI

28. MANAGEMENT
risk factors pharmacological surgery
modifications management

29. Risk factors modifications
►Limit alcohol.
►Regular exercise.
►no high saturated fat or high cholesterol
foods.
►optimal weight.
►maintain normal blood lipid levels.
►no tobacco.
►maintain blood pressure within normal range
►maintain blood glucose.

30. Pharmacological management
●beta blockers
●calcium channel blockers
●nitrates
●anti-platelets
●other agents

31. most common drugs used in
treating angina
vasodilators cardiac depressants
nitrates calcium blockers beta-blockers

32. Classification of anti-anginal agents
1- Nitrates:
. Short-acting: (10 minutes)
glyceryl trinitrate(GTN and nitroglycerine)-EMERGENCY.
.Long-acting: (1 hour)
Isosorbide dinitrate, Isosorbide mononitrate, erythrityl tetranitrate,
pentaerythritol tetranitrate.
2- Calcium channel blockers:
a) phenylalkylamine: verapamil
b) benzothiazepin: diltiazem
c) dihydropyridines: nifedipine, felodipine, nitrendipine, and nimodipine.
3- Beta—adrenergic blockers:
Propranolol, metoprolol, atenolol and others.
4- Potassium Channel openers:
nicorandil
5- Others:
dipyridamole, trimetazidine, ranolazine and oxyphedrine.

33. Organic nitrates
●Organic nitrates are pro drugs and they
release nitric oxide.
●Nitrates are mainly vasodilators and also
cause arterial dilation and as a result reduce
both pre load and after load.
●These compounds cause a rapid reduction in
myocardial oxygen demand, followed by rapid
relief of symptoms.

34. administered nitrates
increased nitrates in the blood
increased formation of nitric oxide
increased cGMP formation
increased dephosphorylation of myosin
vascular smooth muscle relaxation
vasodilation

35. ANGIOPLASTY
angioplasty is a medical technology used to
unblock blood vessels, most commonly the
coronary artery.
Angioplasty is a minimally invasive procedure
that involves the use of inserting a small wire
with a balloon at the end into the blocked blood
vessel. The inflation of the balloon opens up
the blockages.

36. Prevention:
Quit smoking
Monitoring health conditions
Eating healthy diet
Limit alcohol consumption

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