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Angina Pectoris- is recurring acute chest pain or discomfort
resulting from decreased blood supply to the heart muscle(myocardial ischemia). Angina occurs when the heart’s need for oxygen increases beyond the level of oxygen available from the blood nourishing the heart. Angina is a common symptom for coronary heart disease (CHD). The symptoms of angina include mild or severe pain, pressure, or discomfort in the chest, the pain is generally described as a feeling of a squeezing, strangling, heaviness, or suffocation sensation in the chest.
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3 Types of Angina
Stable
Unstable
Variant
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3 Types of Angina Stable
Effort-induced pain from physical activity or emotional stress
Relieved by restPredictable and reproducible
Unstable
Variant
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3 Types of Angina
Stable Unstable
Pain occurs with increasing frequencyDiminishes patient’s ability to workHas decreasing response to therapyMay signal an oncoming MI
Variant
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3 Types of Angina
Stable Unstable Variant
Pain due to coronary artery spasmPain may occur at certain times of the
day, but is not stress induced
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Prinzmetal's Angina
- Prinzmetal’s or variant angina is caused by a vasospasm, a spasm that narrows the coronary artery and lessens the blood flow to the heart.
- Prinzmetal's Angina usually occurs in arteries already narrowed by atherolsclerosis, in fact most people with it have severe coronary atherosclerosis in at least one major vessel. stable and unstable angina, Prinzmetal's Angina usually occurs when a person is at rest or sleep and not after physical exertion or emotional stress.
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Microvascular Angina Microvascular angina, or Syndrome X, occurs when the patient experiences chest pain but has no apparent coronary artery blockage. This condition results from poor functioning of the tiny blood vessels that nourish the heart, arms and legs. Microvascular angina can occur during exercise or at rest. Reduced vasodilator capacity of the coronary microvessels is thought to be a cause of angina during exercise, but the mechanism of angina at rest is not known.
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Symptoms of Angina
Severe chest discomfort (heaviness, pressure, tightness, choking, squeezing)
Sweating Dizziness Dyspnea
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Risk Factors for Angina
Advanced age Coronary artery disease Hypertension Increased serum glucose levels
(diabetes) Increased serum lipoprotein levels Obesity Smoking Type A personality
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Initiating Factors of an Attack Cold weather Emotions Heavy meals Hypoglycemia Pain Smoking
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Discussion
Explain why some of these factors may initiate an angina attack: cold weather, emotions, heavy meals, hypoglycemia, pain, smoking.
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Discussion
Explain why some of these factors may initiate an angina attack.
Answer: cold weather – tension in the muscles, possible decrease in blood flow….
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Nitrates
Most commonly used drugs for angina
Relax vascular smooth muscle and cause vasodilation
Helps with pulmonary edema in CHF
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Agents for AnginaNitrates
isosorbide dinitrate (Dilatrate-SR, Isordil)
isosorbide mononitrate (Imdur, Ismo) nitroglycerin (Minitran, Nitrolingual,
Nitrostat)
Drug List
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nitroglycerin (Minitran, Nitrolingual, Nitrostat) Drug of choice for acute attacks
Spray and tablets taken sublingually May also be used as a prophylaxis If using a patch, it should not
remain on the skin for a full 24 hours, there needs to be free time
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nitroglycerin’s Side Effects Severe headache Orthostatic hypotension Flushing
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nitroglycerin Dispensing Issues
Tablets must be dispensed in the original amber glass bottle
Medication should be refilled every 3 months and discard any remaining drug
Warning!
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Calcium Channel Blockers Relaxes vascular smooth muscle
Some of these drugs should be taken with food and caffeine should be limited
Constipation is most common side effect
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Agents for AnginaCalcium Channel Blockers
amlodipine (Norvasc) bepridil (Vascor) diltiazem (Cardizem, Dilacor XR) felodipine (Plendil) isradipine (DynaCirc)
Drug List
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Agents for AnginaCalcium Channel Blockers
nicardipine (Cardene) nifedipine (Procardia) nisoldipine (Sular) verapamil (Calan, Covera HS,
Isoptin, Verelan)Beta Blockers – Table 12.5
Drug List
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verapamil (Covera HS)
Timed-release product designed for bedtime dose
Drug is pumped out of 2 holes in the tablet
Patients may see a ghost tablet in the stool
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Beta Blockers and Angina Effective in slowing the heart rate,
decreasing myocardial contractility, and lowering blood pressure
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Thank You for Listening!