2. ISCHEMIA
Imbalance Between the supply( perfusion) and Demand of
Heart for the oxygenated blood
It comprises not only insufficiency of oxygen but also reduced
availability of Nutrient substrate
Reduction in coronary blood flow due to atherosclerotic
coronary arterial obstruction
3.
4.
5. ANGINA PECTORIS
Pain syndrome due to induction of n adverse oxygen demand/supply system in a portion of
myocardium . Insufficient supply of blood to heart muscle from narrowing of coronary artery
may cause angina
TYPES OF ANGINA
STABLE ANGINA
Occurs when increased physical activity ( hurrying across a street or climbing a
long stairs) which creates a greater demand for oxygen rich blood to reach heart muscle
UNSTABLE ANGINA
Occurs with lesser degree of exertion or while at rest unstable angina that occurs at
rest is the most serious form this type usually is caused by the formation of a ruptured plaque in
coronary artery
6. SYMPTOMS
Some people have silent ischemia
MI with sign& symptoms
Chest pain
Neck or joint pain
Shoulder or arm pain
Clammy skin
Nausea and vomiting
CAUSES
Coronary artery disease
Blood clot
Coronary spasm
9. MYOCARDIAL INFRACTION
MI defined as a condition which is caused by reduced blood flow
in a coronary artery due to atherosclerosis & occlusion of an artery by thrombus
formation
CLINICAL MANIFESTATIONS
Chest pain
Dyspnoea
Fatigue
increased sweating
Weakness
nausea
Light headness
10.
11. ISCHEMIC STROKE
Ischemia occurs when part of the brain results in death of brain cells
movement ,sensation ,or emotion controlled by affected area are lost or
impaired
RISK FACTORS
• Age
• Gender
• Heredity
• Hypertension
• obesity
12. PATHOPHYSIOLOGY
Brain requires continuous supply of oxygen and glucose for neurons to function
If blood flow is interrupted neuronal metabolism is altered in 30 sec it may
cause cell death
Arthrosclerosis can leads to thrombus formation and contribute emboli
TYPES OF STROKE
Ischemic
Thrombotic
Embolic
Haemorrhagic
17. ORGANIC NITRATES
Release of NO Radicle
Activation of Guanylate
cyclase
Activation of cyclic GMP
Dependent Kinase
DE phosphorylation of
myosin light chain
Vasodilation venules and
arterioles
19. CVS
Dilates veins more than arteries – Peripheral pooling of blood-
decreased venous return- preload of heart decreases- end diastolic
pressure reduces- decreased cardiac work
RENAL & SPLANCHINIC SYSTEM
Blood flow decreases to compensate for vasodilation
PHARMACOLOGICAL
ACTIONS
20. LUNGS
Decongest lungs by shifting blood to systemic circulation
SMOOTH MUSCLE
Bronchi, Biliary tract and oesophagus are relaxed
22. CLINICAL USES OF NITRATES
Treatment& prophylaxis of classical Angina
Treatment of variant Angina
Myocardial infraction
Treatment of arrhythmia
23. CALCIUM CHANNEL BLOCKER
These are the drugs protect tissue by inhibiting
the entry of calcium ions into cardiac and
smooth muscle cells of coronary and systemic
arterial beds
36. ANTIPLATELITE DRUGS
These are the drugs which interfere with platelet function and may useful in the
prophylaxis of thromboembolic disorders
MECHANISM OF ACTION
Platelet sticks to the damaged blood vessels and they stick to each other and
release ADP thromboxane A2 Which promotes further aggregation thus a
platelet plug is formed which traps the RBC s
Prostacyclin's synthesised in the intima of blood vessels is a strong inhibitor of
platelet aggregation
37. CLINICAL USES OF ANTI PLATELET DRUGS
Coronary artery disorders
primary & secondary prevention of angina
Cerebrovascular disorders
Coronary bypass implants
Venous thromboembolism
39. Competitively inhibiting HMG-CoA Reductase first enzymes of
HMG CoA Reductase pathway
which is able to produce mevalonate used in the production of
cholesterol
Reduce LDL Levels by 30% to 40%
Reduce HDL level by 2% to 15%
Reduce triglycerides by 10% to 30%
41. ADVERSE EFFECTS
o Mild transient GI disturbances
o Rash headache
o Myopathy
o Elevation of liver diseases
CLINICAL USES
Hyperlipidaemia
Coronary artery disorders
42. ACE INHIBITORS
ACE Inhibitors are produced its action by inhibiting Reni release
Renin Release
Angiotensinogen
Angiotensin 1
ACE inhibitors
Angiotensin11
Vasoconstriction
45. REFERENCE
Text book of pharmacology , fourth edition by H.P Rang &
M.M Dale Page no 291- 295
Essentials of medical pharmacology , third edition by K.D
Tripathi page no 476-481
Text Book of Robbins pathologic basis of disease –
Robbins, Cotran, Kumar , prisin