This document provides an overview of angina pectoris, including its pathophysiology, types, symptoms, risk factors, and complications. It defines angina as chest pain or discomfort due to reduced blood flow to the heart muscle, usually caused by narrowed or blocked arteries. The document outlines the three main types of angina - stable, unstable, and variant - and describes their distinguishing characteristics. It lists common symptoms of angina and risk factors for developing it. Finally, it summarizes the pathophysiological process leading to angina pain and potential complications like heart attack and stroke if angina is not properly managed.

1. PATHOPHYSIOLOGY OF ANGINA
S K KANTHLAL
DEPT. OF PHARMACOLOGY
AMRITA SCHOOL OF PHARMACY
AIMS KOCHI

2. ANGINA PECTORIS
(NOT A DISEASE IN ITSELF, BUT A SYMPTOM OF HEART DISEASE)

3. What is angina..?
 A sudden attacks of pain, tightness or discomfort in the chest that
occurs when an area of the heart muscle receives less blood oxygen
than usual.
 The pain often also spreads to the shoulders, arms, jaw, neck and
back
 It usually happens when one or more arteries supplying the heart
become hardened and narrowed
 But, it is not a disease. It is a symptom of an underlying heart
problem, usually coronary heart disease (CHD).

4. Prevalence of angina pectoris

5. Pain transmission in angina

6. TYPES
1. Stable angina: Occurs when the heart is working harder than usual
(exercise). Has a regular pattern which can be reversed by rest and
medications. It is chronic and happen over months or even years
2. Unstable angina (crescendo):Can occur when at rest, less common and
more serious. It does not follow a regular pattern. Rest and medication do
not relieve it. A signal a future heart attack within a short time
3. Variant angaina (Prinzmetal's /microvascular): Very rare and can occur at
rest without any underlying coronary artery disease. Abnormal narrowing or
relaxation of the blood vessels, reducing blood flow to the heart produce
pain and relieved by drugs

7. SYMPTOMS
Angina is usually felt in the chest region as:
• squeezing
• pressure
• heaviness
• tightening
• burning or aching across the chest, usually
starting behind the breastbone
• This pain often spreads to the neck, jaw,
arms, shoulders, throat, back, or even the
teeth.
Other symptoms
• indigestion
• heartburn
• weakness
• sweating
• nausea
• cramping
• shortness of breath

8. RISK FACTORS
 Unhealthy cholesterol levels
 High blood pressure
 Smoking
 Diabetes (Type I and II)
 Overweight or obesity
 Metabolic syndrome
 Inactivity
 Unhealthy diet
 Older age (men after 45 and women after 55)
 Family history of early heart disease

9. PATHOPHYSIOLOGY
In adequate blood
supply
Myocardial Ischemia
↓ Oxygen Supply
Aerobic respiration Anaerobic respiration
Accumulation of Lactic
acid
Functional
impairment:
Metabolic
Mechanical
Electrical
↑ Myocardial
contractile strength
Wall thickness
↑ HR
↑ After and preload
↑EDVMyocardial
cell
Oxygen
Demand

10. ANGINAL PAIN
Myocardial Ischemia Lactic acid
accumulation
ATP
Adenosin
e
Arteriolar
dilation Cardiac afferent
nerve
Diffusion
Myocardial nerve fibre
irritation
Stimulati
on
4th thoracic spinal nervesThalamusCerebral cortex
Chemical and mechanical stimulation of sensory afferent nerve endings in the coronary vessels and
myocardium

11. COMPLICATIONS
• Heart Attack
• Most cases of angina are caused by fatty deposits.
• Plague breaks causing a blood then block the supply of oxygen-rich blood to the muscles of the heart,
causing extensive damage to the heart muscles and triggering a heart attack
• Stroke
• The second common complication of angina
• Reduced blood flow to brain
• FAST parameter
• Face – one side dropped face, no smile, drooped eye and mouth
• Arms – arm weakness or numbness
• Speech – slurred or garbled speech
• Time – Should to taken care at the earliest
• Stress, anxiety and depression
• Psychological facts which often felt down, depressed or hopeless
• found little interest or pleasure in doing things

12. THANKYOU