This document discusses angina pectoris, also known as angina, which is a temporary chest pain or discomfort due to an imbalance between the heart's oxygen supply and demand. There are three main types of angina: stable angina, which is the most common and occurs during physical exertion; unstable angina, which occurs at rest and is more severe and dangerous; and Prinzmetal's angina, which results from coronary artery spasms, especially during the night. Angina is caused by conditions that reduce blood flow to the heart such as atherosclerosis, high blood pressure, high cholesterol, smoking, and diabetes. Diagnosis involves tests like electrocardiograms, stress tests, and angiography. Treatment

1. ANGINA PECTORIS
BY KAMOLIKA
DOCTOR OF PHARMACY ( 2YR)
TEERTHANKER MAHAVIR UNIVERSITY

2. STRANGLING CHEST
STRANGLING IN THE CHEST
PECTORIS
ANGINA
ANGINA PECTORIS

3. ANGINA PECTORIS
• Angina pectoris is a temporary , substernal chest pain occurring due
to imbalance between myocardial oxygen supply and demand .
or
• A disease market by sudden attack of chest pain or discomfort caused
by deficient oxygenation of heart muscle usually due to impaired
blood flow to the heart .

4. TYPES OF ANGINA
• STABLE ANGINA
• UNSTABLE ANGINA
• PRINZMETAL’S ANGINA

5. STABLE ANGINA /FIXED STENOSIS/ DEMAND ISCHEMIA
Stable angina is the most common.
• Chronic narrowing of coronary arteries due to atherosclerosis
• Tissue become ischemic particularly during times of increaded oxygen
demand
• Physical stress can trigger it
• It usually lasts a few minutes and goes away after rest
• Stable angina is not heart attack , but it suggest that a heart attack is more
likely to happen in future.
• CHARACTERISTICS OF STABLE ANGINA
• Develops during exercise or climb stairs
• Lasts a short time, perhaps five minutes or less
• The severity , duration and type of angina can vary.
• Relieved by rest or medication

7. UNSTABLE ANGINA(THROMBUS)
• Caused by formation and dissolution of a blood clot (thrombus)
within a coronary artery
• It may occur more often and be more severe than stable angina
• This usually occur when person is at resting position
• Sudden pain
• The pain can be strong and long-lasting ,
• Not relieved by nitroglycerin
• Unstable angina is very dangerous and required emergency treatment
• This type of angina is sign that a heart attack may happen soon.

9. PRINZMETAL’S ANGINA ( VARIANT ANGINA)
• Variant angina is rare
• Results from coronary vasospasm ,which temporarily reduced
coronary blood flow
• Emotional stress , dysfunctional coronary vascular endothelium
occurs during night rest.
• A spasm in a coronary artery causes this type of angina
• Narrow artery reduce blood flow to heart , causing chest pain.
• Emotional stress , smoking and use of the illegal drug coccain may
trigger this type of angina
• It is usually happen between midnight and early morning
• Medicine can relive this type of angina

10. CAUSES AND RISK FACTORS
• High blood pressure
• Atherosclerosis
• Blocked artery
• Coronary artery spasm
• Microvascular constriction
• High blood cholesterol or triglyceride
• Excess intake of fat or salt
• Smoking
• Diabetes mellitus
• Obesity
• Metabolic syndrome
• Sedentary life style or overwork
• Older age (men after 45 and women after 55)
• Family history of early heart disease

11. PATHOPHYSIOLOGY :-
VASOSPASM,FIXED STENOSIS, CORONARY THROMBOSIS
INSUFFICIENT CORONARY BLOOD FLOW
DECREADED OXYGEN SUPPLY TO MEET AN INCREASED
MYOCARDIAL CELL FOR OXYGEN
NEED OF OXYGEN EXCEEDS THE SUPPLY
DECREASED OXYGEN SUPPLY /DEMAND RATIO
MYOCAEDIAL HYPOXIA
STIMULATION OF PAIN RECEPTOR WITHIN MYOCARDIUM
ANGINA PECTORIS

12. SIGNS AND SYMPTOMS
• Angina is usually felt in the chest region as;
• Squeezing
• Pressure
• Heaviness
• Tightening
• This pain often spreads to the neck , jaw, arms , shoulders , throat , back , or even the teeth.
• OTHERS SYMPTOMS
• Indigestion
• Heartburn
• Weakness
• Sweating
• Nausea
• Cramping
• Shortness of breath

13. DIAGNOSIS
• ELECTROCARDIOGRAM
• STRESS TEST
• CARDIAC CATHETERIZATION
• CARDIAC MRI
• CORONARY MRI
• CORONARY CT SCAN
• ANGIOGRAPHY
• SERIAL CARDIAC BIOMARKER TEST

14. 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 heat 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

15. TREATMENT
• NITROGLYCERIN
• B –BLOCKER
• CALCIUM CHANNEL BLOCKER
• ANTIPLATELET THERAPY –ASPIRIN , CLOPIDOGRAL
• ANTIANGINAL DRUG THERAPY – GLYCERYL TRINITRATES , ISOSORBIDE
MONONITRATE ,ISOSORBIDE DINITRATE
• POTASSIUM CHANNEL ACTIVATOR – NICORANDIL
• SURGICAL
• CABG- coronary artery bypass grafting
• PCI- percutaneous coronary intervention
• PTCA – percutaneous transmural coronary angioplasty