The best and updated slide on drug therapy for chronic stable angina

1. Updated drug therapy of chronic
stable angina=Angina of effort
Mohamed Salem
Prof. Internal Medicine
Cairo University
2022

2. Updated drug therapy of chronic
stable angina=Angina of effort
• Diagnosis is mainly clinical
• Resting ECG may be normal
• Needs stress ECG,radionucleotide scan,or CT
coronary angio
• Stable atheroma plaque

3. chronic stable angina
• Recent studies showed
Angioplasty with stent is not
superior to intensive medical
tt.in chronic stable angina only

4. Updated drug therapy of chronic
stable angina=Angina of effort
• The main goals of treatment in angina
pectoris are ;
• 1-relief of symptoms,
• 2-slowing progression of the disease,
• 3-and reduction of future events,

5. Not all drug groups improve mortality
in stable angina
• Some are only symptomatic
• Others are only for vasospasms

6. Group 1 Beta blockers
are not all alike
• B1 adrenergic blockers are the
most preferred for the angina.
Nevibolol, Metoprolol and
Bisoprolol
• Cardioselective

7. Carvedilol
• is a nonselective beta blocker and alpha-1
blocker(dilation of blood vessels)
• used to treat hypertension,congestive
heart failure (CHF), and left
ventricular dysfunction

8. Group 2 Ivabradine-procrolan 5-
7.5mg
treatment of angina for a specific patient population, namely,
1. patients with normal sinus rhythm with a heart rate >60
beats per minute and with a
2. contraindication or an inability to tolerate b-blockers or
failure of BB to reach target HR
3. Agina with low EF HF
Ivabradine works by selectively inhibiting the If pacemaking
current in the sinoatrial node, which lowers the heart rate
without affecting contractility or blood pressure.This, in turn,
increases the diastolic filling time, thereby increasing coronary
perfusion.

9. New
• Ivabradine in combination with beta-blocker
reduces symptoms and improves quality of
life in elderly patients with stable angina
pectoris especially in patients who can not
tolerate high dose of BB:
• Ivadrabine 5mg ½
t.daily+metoprolol 25mg twice daily
starting dose

10. Group 3 Nicorandil-Adancor 10-20mg
Nicorandil is an adenosine triphosphate–sensitive potassium
channel agonist, approved as a second-line agent in combination
with b-blockers or calcium channel blockers for angina
Prevention
Nicorandil is unique in that it causes arterial
vasodilation as its primary mechanism but also
contains a nitrate moiety that induces systemic venous
and coronary vasodilation.
These 2 mechanisms of action allow nicorandil
to reduce preload and afterload as well as
increase coronary blood flow.
No tolerance unlike nitrate

11. Group 4-Calcium Channel Blockers
amlodipine and diltiazem
effective in preventing coronary
vasospasm and are the first-line agent
for Prinzmetal (variant) angina as
monotherapy or in combination with
nitrates
• they do not reduce mortality
• They can also be used as a combination
therapy with b-blockers

12. Management of angina in Diabetic Patients - Is
There a Role for Cardiac Metabolic Agents?
• Group 5-Trimetazidine Vastarel 35mg LA
inhibition of oxidation of free fatty acids in
ischaemic myocytes. Since glucose metabolism
requires less oxygen per mole of adenosine
triphosphate generated it is preferable to fatty
acid oxidation when oxygen availability is limited
in underperfused myocardium.
switch from free fatty acids (FFAs) to
glucose as the metabolic substrate for
energy production exerts favourable effects
on the diabetic heart

13. Rivaroxaban with or without Aspirin in Stable
angina
• Among patients with stable
atherosclerotic vascular disease, those
assigned to rivaroxaban (2.5 mg twice
daily) plus aspirin 81mg daily had better
cardiovascular outcomes events than
those assigned to aspirin alone