Angina Pectoris

definition

and location

sudden pain in sternum

--refered pain in left shoulder, arm and jaw

d/t oxygen supply failing to meet demand

prinzmetal's angina

-weird spasm (vasospastic)

categories of 

antianginal agents

nitrates

beta blockers

calcium channel blockers

+ other (ranolazine)

Antianginal Agents

nitrates

mechanism of action

--nitrate binds to sulfhydryl group= nitric oxide-> cyclic GMP->vasodilation

for exertional angina: dec O2 demand

for vagrent angina: inc O2 supply

-metabolized QUICKLY in liver (T 5min)

---large first pass effect

Antianginal Agents

Nitrates

ADRs

headache

orthostatic hypotension

reflex tachycardia 

(BB or CCB to control)

also: rapid tolerance and interactions

Antianginal Agents

Beta Blocker 

overview

decrease O2 demand

-excertional angina only

-ADRS

dec HR, contractility and BP

also contraindication with asthma and diabetes

Antianginal Agents

Calcium Channel Blockers

overview

excertional: dec O2 demans

variant: inc O2 supply

----- usually VERAPAMIL AND DILTIZEM

-ADRs

constipation, reflex tachy and cardiac effect

Antianginal Agents

Ranolazine

-pervention of high intracellular [ca]

reduces cardiac work (dec heart pumping)

-currently used in prophylaxis

-ORAL

-ADRs

dizziness, prolonged QT (v. repolarization)

Approach to 

treatment

sublingual nitroglycerine-> add BB-> add or substitute CCB-> add long acting nitrate

-last consider revascularization