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Treatment of Angina Pectoris
1.
Treatment of Angina Pectorisby E.Z
2.
Syndrome• Chest pain
• Symptoms: pain in your arms,
neck, jaw, shoulder or back
accompanying chest pain;
nausea; fatgue; shortness of
breath; sweatng; dizziness
• Diagnosis: Chest radiography,
graded exercise stress testng,
ECG, selectie coronary
angiography
• Risk factors: smoking, diabetes,
high blood pressure, obesity,
genetcs, etc
3.
Stable angina• Coronary artery disease
• Deielops when your heart works harder
• Lasts a short tme
• Disappears sooner
4.
Unstable angina• Acute coronary syndrome
• Occurs eien at rest
• Usually more seiere and lasts longer
• May not disappear with rest or use of angina
medicaton
5.
Prinzmetal angina• Reiersible spasms of arteries
• Occurs at any tme
• Is ofen seiere
• May be relieied by angina medicaton
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Determinants of O2 requirementDiastolic factors
• Blood iolume
• Venous tone
Systolic factors
• Peripheral resistance
• Heart rate
• Heart force
• Ejecton tme
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Strategies• To increase O2 deliiery
• To reduce O2 requirement
• To increase O2 utlizaton (new theory)
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Drugs9.
10.
Nitrates&Nitrites*In 1867, Lauder Brunton described the
antanginal propertes of nitrites
*were frst used as an antanginal agent in
1879
*3 types: short-actng, intermediate, long
*nitroglycerin
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Nitrates&Nitrites12.
PharmacokineticsOral bioavailavility is
low
Total duration of
effect is 30 min
Pentaerythritol
tetranitrate is for
long use
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PharmacokineticsAmyl nitrate is for
inhalation
Isosorbide
mononitrate (100 %
bioavailability)
14.
In smoothmuscles:
glutathione
Stransferase
Mitochondri
al enzyme:
aldehyde
dehydroge
nase
isoform 2
15.
Efects*relaxaton of iessels
*compensatory responses:
-baroreceptors mechanisms
-hormonal mechanisms
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Efects*relaxaton of bronchi, GU, GI tracts
*decrease in platelet aggregaton
17.
Cyanide poisoningNitrite ion +
hemoglobin =
methemoglobin
Cyanide poisoning:
cytochrome iron
complexing by CNMethemoglobin has
high affinity for CN-
18.
ToxicitiesOrthostatic
Tolerance:
hypotension
-tachyphylaxis
Tachycardia
-Monday disease
Throbbing headache
Contraindicated if
intracranial pressure
is elevated
19.
Clinical useImmediate treatment
of angina
prophylaxis
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Calcium channel-blocking drugs• The important one is L-type channel
• Ca2+ for contracton
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Calcium channel-blocking drugs• Dihydropyridines (nifedipine)
• Nondihydropyridines (ierapamil, diltazem)
• Orally actie
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Efects• Relaxaton of smooth muscles
• Reducton in PVR
• Reducton of coronary artery spasm
• BP is reduced
• Impulse generarion in the SA and conducton
is reduced
• Reduced cardiac contractlity
23.
Efects• Nimodipine reduce morbidity afer a
subarachnoid hemorrhage
• Nicardipine preients cerebral iasospasm
• + ierapamil:
• *inhibits release of insulin
• *reierse the resistance of cancer cells
• +interfere with platelet aggregaton
24.
ToxicityCardiac depression
Nifedepine increases
the
risk of MI
Flushing
Dizziness
Nausea
Constipation
Peripheral edema
25.
Clinical usesHypertension
Angina
Tachyarrhythmias
Migraine
Raynaud's
phenomenon
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Beta-blocking drugs• Nonselectie blockers: propranolol
• Selectie blockers: atenolol, metaprolol
• Orally and parenterally
• Only for prophylactc therapy
• Efects:
• -decreased hr
• -decreased bp
• -decreased contractlity
27.
Toxicity• Fatgue
• Insomnia
• Erectle dysfuncton
• Worsening of claudicaton
• Contraindicatons:
• Asthma
• Seiere bradycradia
• Seiere unstable lef ientricular failure
28.
Other drugsRanolazine:
- reduces a late Na current
- reduces diastolic tension, cardiac contractlity, work
- prolongs QT
- for angina
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Other drugsTrimetazidine:
-pFOX inhibitor
-inhibits the faty acid oxidaton
-for ischemia
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Other drugsPerhexiline:
-shif myocardial metabolism to glucose oxidaton
-but! Hepatotoxicity, peripheral neuropathy
• Iiabradine:
• -inhibits Na channels in the SA node
• -reduces hr
• - for angina and heart failure
• Fasudil:
• -inhibits smooth muscle Rho kinase = relaxaton
• -reduces coronary iasospam; for angina
31.
5 reasons to eat pomegranate• It's tasty
• It's beautful
• It preients anemia
• It improies digeston
• It lowers blood pressure
32.
Don't forget about:• beetroots
• cashews
• potatoes
• Green tea
• Dark chocolate