Angina is a type of chest pain caused by reduced blood flow to the heart. It is usually due to obstruction or spasm of the coronary arteries from atherosclerosis. There are three main types of angina: stable angina occurs with activity and is relieved by rest; unstable angina occurs at rest or with less activity and lasts longer; variant angina occurs at rest due to coronary artery spasm and responds to nitroglycerin. Treatment involves lifestyle changes and medications like beta blockers, calcium channel blockers, nitrates, and ranolazine to reduce symptoms and risk of heart attack.

1. ANGINA
It’s is a type of chest pain causes by reduced blood flow to the heart”
Angina is a symptom of coronary a called angina pectoris is often describe as
• Squeezing
• Pressure
• Heaviness
• Tightness or pain in your chest
Causes:
Angina is Usually due to
• The obstruction or spasm of the coronary arteries
• anemia
• Abnormal heart rhythm
• Heart failure

2. • The Major mechanism of the coronary artery obstruction is
“Atherosclerosis” as part of CDA
ANGINA : a strangling feeling in the chest
Classification of angina pectoris
• STABLE ANGINA
• UNSTABLE
• VARIANT ANGINA
1. STABLE ANGINA :also called as effort angina related to the myocardial
ischemia
Typical PPT: chest discomfort , associate with some activity for example
• Running
• Walking
• Exercise
Minimum or no symptoms at rest or after administration of sublingual nitroglycerin

3. 2- UNSTABLE ANGINA
• It’s a type of acute Coronary syndrome ‘ is defined as angina pectoris
It has one of three features
1. It occurs at rest , usually lasting >10 minutes
2. It is severe and of new onset
3. It occurs with crescendo Pattern ( more severe probngel ,then before)
3-PRINZMTAL VARIANT ANGINA
Occurs at rest due to coronary artery spasm
Respond promptly to nitroglycerin

4. RISK FACTORS
• HTN ,diabetes, smoking, obesity,anemia ,arterial disease,
hyperlipidemia and thyrotoxicosis
INVESTIGATION
• ECG :
Usually normal during rest but during pain elevation of ST segment
with or without T- wave inversion
• Blood test:
increase cardiac Enzyme like ‘Troponins’

5. Treatment and strategies
Four type of drug , used above or combination
• Beta blockers
• Ca++ channel blocker
• Organic nitrates
• Sodium channel blocking drug (Ranolazine)

6. stable ischemic heart disease
angina symptoms present
sublingual nitroglycerine for immediate relief
BETA-BLOCKERS
add (if inadequate relief after titration)
Ca++ channel blocker OR long acting nitrate
(inadequate relief)
RANOLAZINE

7. 1. BETA BLOCKERS:
• Decrease oxygen demand for the myocardium by inhibiting B1
receptor.
• Decrease heart rate
• Decrease contractility
• Decrease cardiac output
• Decrease BP

8. • Beta-blockers reduces both frequency and severity of disease
angina.
• Metoprolol , atenolol , nebivolol
• 2-3 weeks dose values should be gradually taper off.

9. 2. CALCIUM CHANNEL BLOCKERS:
• Calcium is essential for muscular contraction.
• Increase Ca++ influx in ischemia
• Calcium channel blockers protect the tissue by inhibiting the
entrance of Ca++ into cardiac
• All Ca++ blockers are arteriolar vasodilator.
• Reduces myocardial oxygen consumption
• Example: diltiazem , verapamil , amlodipine , nifedipine

10. 3. ORGANIC NITRATES:
• These compounds cause a reduction in myocardial oxygen demand followed
by relief of symptoms.
• They are effective in stable, unstable, and variant angina.
M.O.A: organic nitrates relax vascular smooth muscles
Administered nitrates increase nitrites increase nitric oxide
increase cGMP increase dephosphorylation vascular
smooth muscles relaxation

11. Sublingual nitroglycerine:
• Available in tablet or spray formula.
• Drug of choice for prompt relief of an angina attack.
• All patients should have nitroglycerine on hand to treat acute angina attacks.
• It is commonly administered via sublingual because first pass metabolism
occurs in liver, or transdermal route
isosorbide mononitrate
isosorbide dinitrate
SIDE EFFECTS:
• Headache
• High doses can cause hypotension, tachycardia.

12. 4. SODIUM CHANNEL BLOCKER:
• EXAMPLE: ranolazine
• It has anti angina and anti arrhythmic properties.
• It is most often used by patients who have failed to response
often antianginals metabolized in liver.
• SIDE EFFECTS:
QT prolongation