This document provides an overview of angina pectoris (chest pain). It defines angina as a clinical syndrome caused by transient myocardial ischemia due to an imbalance between oxygen supply and demand in the heart. Angina is common in middle-aged and older adults and can be classified as stable, Prinzmetal's variant, or unstable. It is caused by conditions that limit blood supply to the heart like atherosclerosis or coronary artery spasm. Symptoms include chest pain and shortness of breath. Risk factors include physical exertion, smoking, and hypertension. Treatment involves medications to relieve symptoms and improve blood flow as well as procedures like stents or bypass surgery.

1. ANGINA PECTORIS
AKSHAY AGRAWAL

3. 1.Defination
2.Epidemiology
3.Classification
4.Etiology
5.Pathophysiology
6.Clinical Features
7.Risk factors
8.Diagnosis
9.Treatment

4.  Angina is the symptom complex caused
by transient myocardial ischaemia
and is a clinical syndrome rather
than a disease.
Definition

5.  It may occur whenever
there is an imbalance
between myocardial oxygen
supply and demand

6. Epidemiology
 Occurs in both men and women of any age but
commonly middle age and older adults.

7. Classification
1. Stable or typical Angina
2. Prinzmetal’s Variant Angina
3. Unstable Angina
4. Microvascular Angina

8. Etiology
 Atherosclerosis
Coronary artery spasm
Use of cocaine
Blockage of coronary artery by blood clot or compression
Inflammation or infection of coronary artery
Injury to coronary artery
Poor functioning of tiny blood vessels

10. Pathophysiology
Myocardial ischemia results from imbalance between
myocardial energy supply(oxygen and energy substrates
like glucose and free fatty acids)and myocardial oxygen
demand.

11.  Or a fixed reduction in the diameter of the
coronary arteries by at least 70% leads to reduction
in coronary blood flow.
 Inability to increase oxygen extraction or
coronary blood flow, together with elevated
myocardial demand, leads to angina.

12. Clinical Features
Pain - over sternum and spreads
down the left arm
also to backsides , upper abdomen,
neck , jaw or even teeth.
Type –dull ache , heaviness or
a crushing sensation .

13. Breathlessness
Chest Discomfort
Nausea
Fatigue
Dizziness
Profuse sweating
Anxiety

14. Investigations
Resting ECG – Usually normal but during pain there
will be elevation or depression of ST segment with
or withoutT wave inversion.
Exercise ECG - >1mm of flat or down sloping ST
depression .

15. CoronaryAngiogram
BloodTest – Increased cardiac enzymes
likeTroponin

16. Risk Factors
Physical Exertion
Cold exposure
Intense emotions
Heavy meals
Hypertension

17. Diabetes mellitus
Smoking
Left ventricular dysfunction
Obesity
Arterial disease – Peripheral vascular
diseases
Anaemia
Thyrotoxicosis

19. Treatment
A . Medical
Antiplatelet therapy –Aspirin , clopidogrel Reduces risk of MI
Antianginal drug therapy –
Nitrates – glyceryl trinitrates , isosorbide mononitrate
Beta blockers – metaprolol ,atenolol
Calcium channel blockers – nifidipine ,amlodipine
Potassium channel activators – nicorandil

20. B. Surgical
 Percutaneous Coronary Intervention
 CoronaryArtery Bypass Grafting
C. General measures
 Do not smoke
 Reduce overweight
 Regular exercise
 Avoid severe exertion after heavy mealor in very cold
weather

21. Reference
Textbook of Pathology by Harshmohan – sixth
edition 2010
Davidson’s Principles and practice of Medicine
by Brain R Walker
Nicki R . Colledge – 21st edition 2010

22. THANKYOU