Acute coronary syndrome refers to a range of conditions caused by reduced blood flow in the coronary arteries including unstable angina and myocardial infarction. Angina pectoris is characterized by chest pain or pressure that is triggered by physical exertion or stress and relieved by rest. Medical management of angina aims to decrease oxygen demand on the heart and increase supply by using nitrates, beta blockers, and calcium channel blockers to dilate arteries and slow the heart rate. Antiplatelet drugs like aspirin are also used to prevent clots from worsening the condition.

1. ACUTE CORONARY
SYNDROME

2. • CORONARY ARTERY DISEASE
Chronic stable Acute coronary syndrome
Angina
Unstable angina STEMI
NSTEMI

4. Normal coronary artery

6. ANGINA PECTORIS
• Angina pectoris is a clinical syndrome
usually characterized by episodes or
paroxysms of pain or pressure in the
anterior chest

7. PRECIPITATING FACTORS OF
ANGINA
• Physical exertion
• Exposure to cold
• Eating a heavy meal
• Stress or any emotion-provoking situation
• Sexual activity

9. Chronic stable angina
• It refers to chest pain that occurs
intermittently over a long period with same
pattern of onset, duration and intensity of
symptoms
• Characteristics of pain become different

10. Unstable angina
• also called preinfarction angina or
crescendo angina
• symptoms occur more frequently and last
longer than stable angina. The threshold
for pain is lower, and pain may
occur at rest.

11. Silent ischemia
• It refers to ischemia that occurs in the
absence of any subjective symptoms
• Patients with diabetes have increase
prevalence of silent ischemia

12. Variant angina/Prinzmetal
angina
• It is a varient often occurs at rest, usually
in response to spasm of a major coronary
artery

13. Assessment and Diagnostic
Findings
• Exercise stress testing
ST segment and T wave changes are
indirect assessment of corornary perfusion
• Cardiac catheterisation
• ECG
• C-reactive protein (CRP)
• Homocysteine

14. Medical Management
• objectives of the medical management of
angina are to decrease the oxygen
demand of the myocardium and to
increase the oxygen supply.
• Thereby preventing MI and death

15. Nitrates
• Short acting
• Long acting
• MOA- dilating peripheral blood vessels
dilating coronary artey and
collaterals

16. • Short acting- nitroglycerin- 5mg
sublingually- 1 tab sublingually,
• Long acting- Isosorbide dinitrate,
Isosorbide mononitrate

17. Beta adrenergic blockers
• It reduce myocardial oxygen consumption
by blocking the beta-adrenergic
sympathetic stimulation to the heart.
• The result is a reduction in heart rate,
slowed conduction of an impulse through
the heart, decreased blood pressure, and
reduced myocardial contractility (force of
contraction)

18. • Propranolol
• Metoprolol
• Atenolol

19. Calcium Channel Blocking
Agents
• MOA- decreases the movement of calcium
into membranes cardiac and arterial
muscle cells
• Eg- Nifidipine, verapamil and diltiazem

20. Antiplatelet and
Anticoagulant Medications
• Aspirin -Aspirin prevents platelet
activation and reduces the incidence of MI
and death in patients with CAD