Treatment of Angina Pectoris

1.

Treatment of Angina Pectoris
by 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

6.

Determinants of O2 requirement
Diastolic factors
• Blood iolume
• Venous tone
Systolic factors
• Peripheral resistance
• Heart rate
• Heart force
• Ejecton tme

7.

Strategies
• To increase O2 deliiery
• To reduce O2 requirement
• To increase O2 utlizaton (new theory)

8.

Drugs

9.

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

11.

Nitrates&Nitrites

12.

Pharmacokinetics
Oral bioavailavility is
low
Total duration of
effect is 30 min
Pentaerythritol
tetranitrate is for
long use

13.

Pharmacokinetics
Amyl nitrate is for
inhalation
Isosorbide
mononitrate (100 %
bioavailability)

14.

In smooth
muscles:
glutathione
Stransferase
Mitochondri
al enzyme:
aldehyde
dehydroge
nase
isoform 2

15.

Efects
*relaxaton of iessels
*compensatory responses:
-baroreceptors mechanisms
-hormonal mechanisms

16.

Efects
*relaxaton of bronchi, GU, GI tracts
*decrease in platelet aggregaton

17.

Cyanide poisoning
Nitrite ion +
hemoglobin =
methemoglobin
Cyanide poisoning:
cytochrome iron
complexing by CNMethemoglobin has
high affinity for CN-

18.

Toxicities
Orthostatic
Tolerance:
hypotension
-tachyphylaxis
Tachycardia
-Monday disease
Throbbing headache
Contraindicated if
intracranial pressure
is elevated

19.

Clinical use
Immediate treatment
of angina
prophylaxis

20.

Calcium channel-blocking drugs
• The important one is L-type channel
• Ca2+ for contracton

21.

Calcium channel-blocking drugs
• Dihydropyridines (nifedipine)
• Nondihydropyridines (ierapamil, diltazem)
• Orally actie

22.

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.

Toxicity
Cardiac depression
Nifedepine increases
the
risk of MI
Flushing
Dizziness
Nausea
Constipation
Peripheral edema

25.

Clinical uses
Hypertension
Angina
Tachyarrhythmias
Migraine
Raynaud's
phenomenon

26.

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 drugs
Ranolazine:
- reduces a late Na current
- reduces diastolic tension, cardiac contractlity, work
- prolongs QT
- for angina

29.

Other drugs
Trimetazidine:
-pFOX inhibitor
-inhibits the faty acid oxidaton
-for ischemia

30.

Other drugs
Perhexiline:
-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

33.

Thanks!