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→ Cranial Syndrome Usually Characterized by Episodes of Paroxysm Of

→ Cranial Syndrome Usually Characterized by Episodes of Paroxysm Of

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Published by: maj on Oct 15, 2009
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ANGINA PECTORISANGINA PECTORIS
cranial syndrome usually characterized by episodes of cranial syndrome usually characterized by episodes of  paroxysm of the pain or pressure in the anterior chest.paroxysm of the pain or pressure in the anterior chest.
cause is insufficient coronary blood flow that results in lowcause is insufficient coronary blood flow that results in low oxygen supply.oxygen supply.
PathophysiologyPathophysiology
most common cause of angina pectoris ismost common cause of angina pectoris is atherosclerotic disease.atherosclerotic disease.
associated with significant obstruction of a majorassociated with significant obstruction of a major coronary artery.coronary artery.
Precipitating FactorsPrecipitating Factors
 
physical exertionphysical exertionexposure to coldexposure to coldeating heavy mealeating heavy mealstress or emotion provoking situationstress or emotion provoking situation
Clinical ManifestationsClinical Manifestations
Chest painChest pain
poorly localizedpoorly localized
may radiate to neck, jaw, shoulders & inner aspects of themay radiate to neck, jaw, shoulders & inner aspects of the upper armsupper arms
retrosternaretrosterna
TypesTypes
stable anginastable angina
 
predictable & consistent pain that occurs on exertionpredictable & consistent pain that occurs on exertion & relieved by rest.& relieved by rest.
unstable angina/ preinfarction angina/ crescendo anginaunstable angina/ preinfarction angina/ crescendo angina
 
 
symptoms occurs frequently, last longer pin. The threshold for painsymptoms occurs frequently, last longer pin. The threshold for pain is lower & pain occur at rest.is lower & pain occur at rest.
intractable/ refractory anginaintractable/ refractory angina
 
severe incapacitating chest pain.severe incapacitating chest pain.
variant anginavariant angina
 
pain at rest. ST segmentation elevation – caused of pain at rest. ST segmentation elevation – caused of  vasospasm.vasospasm.
silent ischemia/ obstructive ischemiasilent ischemia/ obstructive ischemia
 
no symptomsno symptoms
Medical ManagementMedical Management
objective:objective:
• decrease oxygen demand & increase oxygen• decrease oxygen demand & increase oxygen supplysupply
 
nitroglycerinnitroglycerin
 
remain the mainstay for treatment of angina toremain the mainstay for treatment of angina to decrease myocardial oxygen consumption w/c decrease ischemia &decrease myocardial oxygen consumption w/c decrease ischemia & pain.pain.
vasodilators (especially in high dose)vasodilators (especially in high dose)
administered to decrease cardial oxygen consumption w/c decreaseadministered to decrease cardial oxygen consumption w/c decrease ischemia & pain.ischemia & pain.Decrease pre & afterloadDecrease pre & afterload
sublingual/ spraysublingual/ spray
 
alleviates the pain after 3mins.alleviates the pain after 3mins.
RemindersReminders
Nitroglycerin effectNitroglycerin effect
hypotensionhypotensionIf the symptoms is free, nitroglycerin is switched to topical preparationIf the symptoms is free, nitroglycerin is switched to topical preparationMouth should be moistMouth should be moistSaliva is not swallowed until the nitroglycerin is dissolvedSaliva is not swallowed until the nitroglycerin is dissolved
If severe, patient crush the tablet between the teeth toIf severe, patient crush the tablet between the teeth to hasten the absorptionhasten the absorption
TopicalTopical
IVIV
given if there is recurring symptoms of ischemiagiven if there is recurring symptoms of ischemia
for unstable anginafor unstable angina
Beta-adrenergic blocking agentsBeta-adrenergic blocking agents
Propanolol, Metaprolol, AtenololPropanolol, Metaprolol, Atenolol
blocks the beta-adrenergic sympathetic stimulation to theblocks the beta-adrenergic sympathetic stimulation to the heart.heart.
this help to control chest pain & delays the onset of this help to control chest pain & delays the onset of  ischemia during work exercise.ischemia during work exercise.
produce the cardiac mortality, recurrent angina,produce the cardiac mortality, recurrent angina, infarction.infarction.
Side effects:Side effects:
hypotensionhypotensionbradycardiabradycardiaadvance atrioventricular blockadvance atrioventricular blockdecompensated failuredecompensated failurehyperlipidemiahyperlipidemiadecreased libidodecreased libido
 
hypoglycemiahypoglycemia
if given intravenously for an acuteif given intravenously for an acute cardiac eventcardiac event∙ ECG, BP ,HR monitored∙ ECG, BP ,HR monitored
Caution:Caution:
not to stop abruptlynot to stop abruptlydecrease gradual over several daysdecrease gradual over several days
Mode of ActionMode of Action
 
conductionconduction
 
HR &HR &
heart contractionheart contraction
 
workloadworkload
relax blood vesselsrelax blood vessels
 
BPBP
 
coronary perfusioncoronary perfusion
dilating the coronary arteriesdilating the coronary arteries
most commonly drug use are Amlodipine, verapamil, Diltiazemmost commonly drug use are Amlodipine, verapamil, Diltiazemuse of Nifidepine was found poorly tolerated % to increase the risk of use of Nifidepine was found poorly tolerated % to increase the risk of  MI in patient w/ hypertension & the risk of death in patient with ACSMI in patient w/ hypertension & the risk of death in patient with ACSfirst generation calcium channel blockers should take w/ cautionfirst generation calcium channel blockers should take w/ caution especially patient w/ HFespecially patient w/ HF
Amlodopine & FelodipineAmlodopine & Felodipine
Antiplatelet & AnticoagulantAntiplatelet & Anticoagulant MedicationsMedications
AspirinAspirin
prevents platelet activation & reduces the incidence of MI & death inprevents platelet activation & reduces the incidence of MI & death in patients w/ CAD. 160-325mg Dose of aspirin should be given to thepatients w/ CAD. 160-325mg Dose of aspirin should be given to the patient w/ angina & then 81-325mg/daypatient w/ angina & then 81-325mg/day
causes intestinal upset & bleeding, treatment for helicobacter pyloricauses intestinal upset & bleeding, treatment for helicobacter pylori & use of H2-blockers (Cimetidine, Famotidine, Ranitidine,& use of H2-blockers (Cimetidine, Famotidine, Ranitidine, Misoprostol) should be considered to allow continued aspirin.Misoprostol) should be considered to allow continued aspirin.
Clopidogrel & TiclodipineClopidogrel & Ticlodipine
given if the patient is allergic to aspiringiven if the patient is allergic to aspirin
take few days to achieve their antiplatelet effecttake few days to achieve their antiplatelet effect
given with aspirin in patient w/ high risk for MI &given with aspirin in patient w/ high risk for MI & GI upset, N&V, diarrhea &GI upset, N&V, diarrhea &
neutrophil level.neutrophil level.
HeparinHeparin
prevents the blood clotsprevents the blood clots
use alone in treating patients w/ unstable angina, reduces theuse alone in treating patients w/ unstable angina, reduces the occurrence of anginaoccurrence of angina
if cardiac eventif cardiac event
patient is hospitalized & IV bolus of heparin &patient is hospitalized & IV bolus of heparin & continuous infusion / IV bolus every 4-6hrscontinuous infusion / IV bolus every 4-6hrs
Heparin is given in base on result of activated partial thromboplastinHeparin is given in base on result of activated partial thromboplastin time (aPTT)time (aPTT)
Heparin is therapeutic when the aPTT is 1.5-2 times the normal aPTTHeparin is therapeutic when the aPTT is 1.5-2 times the normal aPTT

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