DEFINITION, TYPES, PATHOPHYSIOLOGY, DIAGNOSIS, & MANAGEMENT

1. Presented by,
Anjali.c
I year M.Pharm,
Department of pharmacy practice,
Grace college of pharmacy

2.  CONTENTS:
1. Definition
2. Types
3. Epidemiology
4. Etiology
5. Etiopathogenesis
6. Pathophysiology
7. Clinical manifestations
8. Diagnosis
9. Management:
 Non-pharmacological
 Pharmacological

3. DEFINITION
 The term angina pectoris is applied to various forms
of transient chest discomfort that are attributable to
insufficient myocardial oxygen.

4. TYPES
 STABLE OR TYPICAL ANGINA
 PRINZMETAL’S VARIANT ANGINA(VASOSPASTIC)
 UNSTABLE OR CRESCENDO ANGINA
 ANGINA DECUBITUS(NOCTURNAL ANGINA)

5. EPIDEMIOLOGY
• Angina due to ischemic heart disease affects
approximately 112 million people (1.6% of the
population)
 slightly more common in men than women (1.7% to
1.5%)
 The prevalence of angina rises with increasing age

6. ETIOLOGICAL FACTORS:
 Major risk factors
 Other medical problems
 medications
 Other cardiac problems

7. ETIOPATHOGENESIS:
 Coronary Atherosclerosis
 Superadded changes in coronary atherosclerosis
 Non-atherosclerotic causes.

8.  PATHOPHYSIOLOGY
Atherosclerosis Arterial spasm Atherosclerosis+Plaque split+Thrombus
gradual sudden not usually reversible
Obstruction sudden reversible occlusion
obstruction
ISCHAEMIA
Hypoxia
Reduced oxygen demand Angina
Thrombolysis Unstable angina

9. CLINICAL MANIFESTATIONS
•Chest pain / chest discomfort

10. • Dyspnea
• Fatigue
• Increased sweating
• Weakness
• pluse rate and the blood pressure increases
• Palpitation

11. DIAGNOSIS:
 EXERCISE TOLERANCE TESTING
 CARDIAC IMAGING
 ECHOCARDIOGRAPHY

12. MANAGEMENT:
1.NON-PHARMACOLOGICAL:
Counselling and education of patients
Life style modification
Smoking cessation
Avoid Alcohol intake
Diet and nutrition
Salt restriction

13.  REVASCULARIZATION-
 PCI:Percutaneous coronary intervention
 PTCA:Percutaneous transmural coronary angioplasty
 CABG:Coronary artery bypass grafting
 PCI versus CABG is the By pass Angioplasty
Revascularization (BARI)

14. PERCUTANEOUS TRANSLUMINAL CORONARYANGIOPLASTY
(PTCA)

15. CORONARY ARTERY
BYPASS GRAFT (CABG)

16. PHARMACOLOGICAL TREATMENT
Anti anginal drugs:
 1)nitrates
 2)Beta blockers
 3)calcium channel blockers
 4)potassium channel opener
 5)others

17. TREATMENT ALGORITHM FOR ANGINA
Stable angina unstable angina
Aspirin ,GTN
spary,Statins
beta blockers
+ or – regular nitrates
Add:CCB,+-
nicorandil
Consider
revascularisation
Pre hospital or on
arrival
GTN ,aspirin
During hospital
admission
Add:clopidogrel,beta
blockers
revascularization
Long term: