PowerPoint Presentation

Patricia Camille A. Navarro

The Human HeartWhat is Angina Pectoris?

Angina pectoris (stable angina) is the medical term for chest pain or discomfort that results from reduced coronary blood flow, causing a temporary imbalance between myocardial body supply and demand. Angina isn't a disease; it is a symptom of an underlying heart problem. Factors associated with angina pectoris

PathophysiologyCoronary atherosclerosissignificant obstruction of a major coronary arteryreduced coronary blood flowimbalance between myocardial oxygen supply and demandanemiasmokinghypovolemiaPhysical exertionincreasing myocardial oxygen demandExposure to coldvasoconstrictionelevated blood pressureEating a heavy mealincreases the blood flow to the mesenteric area for digestionStress or any emotion-provoking situationrelease of catecholaminesincreases blood pressure and heart rateIncrease myocardial workloadanaerobic metabolism replaces aerobic metabolism for nourishmentproduces lactic acidAngina Pectorisfactor P is released from ischemic myocardial cellspain is felt wherever substance P reacts with a pain receptorthe heart muscle does not have any pain fiberspoorly localized pain and may radiate to the neck, jaw, shoulders, and inner aspects of the upper arms, usually the left armOther symptoms:Weakness or numbness in the arms, wrists, and hands may accompany the painShortness of breathPallorDiaphoresisDizziness or light-headednessNausea and vomiting

Medical Management: Pharmacologic Therapy1. Nitroglycerin (glyceryl trinitrate)Brand names : Deponit, Minitran, Nitro-Bid, Nitrocot,Nitro-Dur, Nitrogard, Nitroglyn E-R, Nitroject, Nitrol, Nitrolingual, NitroMist, Nitrong SR, Nitro-par, Nitrostat, Nitro-time, Transderm-Nitro, Tridil

Classification: Chemical classification: NitratesTherapeutic Classification: Antianginal, antihypertensive, vasodilator

Mechanism of Action: Nitrates cause blood vessels to relax and dilate. This results in a drop in peripheral resistance and blood pressure and a decrease in venous return to the heart. These actions will decrease myocardial workload and can restore the appropriate balance in the supply demand ratio in the heart.

Indications: Treatment of acute angina, prophylaxis of angina, intravenous treatment of angina unresponsive to beta-blockers or organic nitrates, perioperative hypertension, and heart failure associated with acute myocardial infarction; to produce controlled hypotension during surgery.

Contraindications: Nitrates are contraindicated in the presence of any allergy to nitrates to prevent hypersensitivity reactions. These drugs also are contraindicated in the following conditions: severe anemia because the decrease in cardiac output could be detrimental in a patient who already has a decreased ability to deliver oxygen because of a low red blood cell count; Head trauma or cerebral haemorrhage because the relaxation of cerebral vessels could cause intracranial bleeding; and Pregnancy or lactation because of potential adverse effects on the neonate and ineffective blood flow to the fetus.

Medical Management: Pharmacologic Therapy (Nitroglycerin) contdMedical Management: Pharmacologic Therapy2. Beta-Adrenergic Blocking AgentsBeta-blockers recommended for use in angina are metoprolol (Toprol), propranolol (Inderal), and atenolol (Tenormin)

Mechanism of Action: Appear to reduce myocardial oxygen consumption by blocking the beta-adrenergic sympathetic stimulation to the heart. The result is a reduction in heart rate, slowed conduction of an impulse through the heart, decreased blood pressure, and reduced myocardial contractility (force of contraction) that establishes a more favorable balance between myocardial oxygen needs (demands) and the amount of oxygen available (supply). This helps to control chest pain and delays the onset of ischemia during work or exercise.

Indication: They are indicated for the long-term management of angina pectoris caused by atherosclerosis. These drugs are sometimes used in combination with nitrates to increase exercise tolerance.

Contraindications: The beta-blockers are contraindicated in patients with bradycardia, heart block, and cardiogenic shock because blocking of the sympathetic response could exacerbate these diseases. They also are contraindicated with pregnancy and lactation because of the potential for adverse effects on the fetus or neonate.

Medical Management: Pharmacologic Therapy (Beta-Adrenergic Blocking Agents) contdMedical Management: Pharmacologic Therapy3. Calcium Channel Blocking Agents

Calcium channel blockers include amlodipine (Norvasc), diltiazem (Cardizem), nicardipine (Cardene), nifedipine (Adalat, Procardia), and verapamil (Calan, Isoptin).

Mechanism of Action: Calcium channel blockers reduce myocardial oxygen demand and increase myocardial blood and oxygen supply, lowering blood pressure and reducing myocardial contractility and heart rate. They are also potent coronary vasodilators which increases oxygen supply.

Indication: Calcium channel blockers are indicated for the treatment of Prinzmetal angina, chronic angina, effort associated angina, and hypertension. Because they may actually increase ischaemia and mortality in those with heart failure, or left ventricular dysfunction, these drugs are not usually prescribed in the initial treatment of angina.

Contraindication: Calcium channel blockers are contraindicated in the presence of allergy to any of these drugs to avoid hypersensitivity reactions and with pregnancy or lactation because of the potential for adverse effects on the fetus or neonate.

Medical Management: Pharmacologic Therapy (Calcium Channel Blocking Agents) contdMedical Management: Pharmacologic Therapy4. Oxygen AdministrationOxygen therapy is usually initiated at the onset of chest pain in an attempt to increase the amount of oxygen delivered to the myocardium and to decrease pain.

Oxygen inhaled directly increases the amount of oxygen in the bloodCardiac Catheterisation This is a generic form for a range of procedures such as percutaneous coronary intervention (PCI), ventriculography, and atherectomy which are performed under sterile conditions in a fluoroscopy suite to:Diagnose CAD, heart abnormalities which may be congenital or have developed overtimeAssess whether it is possible to revascularise the heart by opening up the blocked arteryInsert a stentObtain a biopsy of the heart muscleAssess the hearts response to drug treatments

Medical Management: Alternative Therapy