Angina pectoris is chest pain due to an imbalance between the heart's oxygen demand and supply. There are three types: stable angina occurs during exercise and is relieved by rest; variant angina occurs at rest due to coronary artery spasm; unstable angina is unpredictable and may lead to heart attack. Risk factors include age, sex, smoking, diabetes, and hypertension. Treatment includes nitrates, beta blockers, and calcium channel blockers to reduce symptoms and mortality from coronary artery disease progression.

1. Angina pectoris
Presented by :-
V. RAVI KISHORE

2. Definition :-
It is defined as the chest pain towards left arm
shoulder due to less supply of O2 (or) more demand
of O2.
 Due to imbalance between myocardium oxygen
requirement and oxygen supply.
 Types of angina pectoris
a) Stable angina
b) Variant angina
c) Unstable angina

3. Stable angina
 Typical, classic,
Common angina
 Most common
angina
 Occurs during
emotional stress,
heavy exercise,
 Esily predictable
 Treating more
rest,nitroglycern
 Also due to
atherosclerosis
Variant angina
 Prize metal
angina
 Occurs in rest
also
 Due to Spasm of
coronary artery
Unstble angina
 Uncommon or
atypicaltype
 Occurs in
exercise and
also during rest
 Prolanged
angina may
lead to
Miocardial
infraction
 Unpredictable

4. Risk factors :
 Age
 Sex
 Obesity
 Smoking
 Diabetes
 Hypertension
 Renal dysfunction
Age :-
For men >55 yrs and >65 for women

5. Classification of ANTI ANGINAL DRUGS
 The drugs used to treat angina are called Anti
Anginal Drugs
1) NITRATES :-
a) Short acting
--nitroglycerin (or)
--glyceryltri nitrate
b) Long acting
-- isosorbide mononitrate
-- isosorbide dinitrate

6. 2) Ca +2 channel blockers :-
--felodipine
--nifedipine
--amlodipine
--diltiazem
--verapamil
3) BETA blockers :-
--propanolol
--esmolol
--sotalol
--metaprolol
--atenolol

7. 4) K+ channel opener :-
--nicorandil
5) Vasodilators :-
--hydralazine
--minoxidil
6) Miscellaneous :-
--aspirin
--dipyridamole

8. PATHOPHYSIOLOGY
 Myocardial ischemia develops when coronary blood
flow becomes inadequate to meet myocardial O2
demand.
 This is because myocardial cell switch from aerobic to
anaerobic metabolism with a progressive impairment of
metabolic , mechanical and electrical functions.
 Studies have shown that adenosine may be the main
chemical mediator of anginal pain . During ischemia
ATP is degraded to adenosine, which after diffusion to
the extra cellular space, cause anginal pain .

9. Goals of treatment :-
 All the treatment for people with coronary
artery disease have the same goal.
 To decrease the elivated symptoms
 To reduce mortality due to CAD progression

10. DRUG THERAPHY :-
 Currently there are 3 main types of drugs used
a) Nitrates
b) Beta blockers
c) Ca+2 channel blockers
 Nitrates and Ca+2 channel blockers may be
added if needed.
1) NITRATES:- It improves blood flow by relaxing
& dialating veins and arteries.
Ex:- Nitroglycerin & Isosorbide mononitrate
SIDE EFFECTS :-
 Headace, light headedness, flushing, and increase in
heart rate

11. Mechanism of action

12. BETA BLOCKERS
 They reduces the heart rate, BP, & force of
contraction and amount of oxygen the heart
requires to pump blood.
Ex :- Atenolol, Proponolol, Esmolol,Nadolol
Sides effects :-
1)Cardiac effect :- Worsen heart failure,
Bradycardia.
2)Non-cardiac effect :- constriction of airway,
circulatory problems , Impotance , Hallucination,
Insomnia & Fatigue.

13. Mechanism of action
Resistance

14. Ca+2 channel blockers
 They dilate arteries & lower blood pressure.
Which decreases the force of contractions.
 They also dilate veins, reduces the amount of
blood returning to the heart which reduces the
work load of the heart.
Ex :- Amlodipine, Nifedipine, Felodipine.

15. Mechanism of action

16. Combination therapy
 Nitarates + beta blockers --- in stable angina .
 Ca+2 channel blockers + beta blockers –in
stable angina when the above combination has
failed.
 Ca+2 channels + nitrates :- in unstable angina.
 All 3 together :- when the combination of 2 drugs
has filed where
a) Nitrates :- decreased Preload
b) Ca+2 channel blockers :- decreased
afterload.
c) Beta blockers :-decreased heart rate &
myocardial contraction.

17. Other measures in managing CAD
 Anticoagulents
Ex :- 1) Aspirin :- it help to prevent blood clooting.
Keeping the narrowed artaries open and lowering
the risk of a heart attack.
 Treat high BP.