Angina

K H A L I D M O H A M M E D A L M U TAWA
219032786, 47
GROUP: 4
 Case summary :

62 Y.O.
Ischemic
Overweight
Male Stroke D.M. 2 Hypertension

Heavy Smoker Metformin Thiazide

2
Objective:
1 Which treatment measurement do you recommended?
Step 1: Patient’s Problem:
Diagnosis: stable angina.

Angina is a chest pain or

discomfort caused by myocardial
ischemia in patients with stable
coronary artery disease
occurs when the heart muscle
doesn't get enough oxygen-rich blood
Step 2: Goal Of Therapy:
Aim is to relieve the symptoms, reduce ischemia, and prevent
complications.
 Step 3:Relevant Treatment Options:
Non-pharmaceutical treatment:
Life style modifications:

Eating healthy
Weight loss
food

Stop smoking Exercise

 Step 3:Relevant Treatment Options:
Pharmaceutical Treatment:
V C A

Vasodilator: Beta blocker: Calcium channel Anti-angina drugs:

blockers:
Glyceryl trinitrate, Bisoprolol (it reduce Nicorandil ( it
isosorbide mononitrate (it’s HR, BP and reduce Verapamil , diltiazem, causes
used to manage the acute amlodipine
attacks ).
myocardial oxygen peripheral and
consumption). coronary
vasodilation ).
Surgical Treatment:

If the symptoms persist despite the

medical therapy.

Percutaneous coronary Coronary artery bypass

intervention (PCI). grafting (CABG).
Surgical Treatment:

Percutaneous coronary intervention (PCI):

Dilating a coronary artery by introducing
an inflatable balloon and metallic stent into
the
arterial circulation via femoral or brachial
artery
Use: single vessel disease or multi-vessels
< 65 years old.
Surgical Treatment:

Coronary artery bypass grafting (CABG):

Autologous veins or arteries anastomosed to
the ascending aorta and to the native coronary
arteries distal to the area of stenosis.

Use: multi-vessels > 65 years old.

Step 4: Patient’s Specific Choice:

Acute attack: vasodilator

( glyceryl trinitrate ).

Calcium channel blockers

( diltiazem hydrochloride ).
 Step5: Practical Effectuation:
Non-pharmaceutical:

1) Weight loss.
2) Eating healthy food.

Pharmaceutical:

1) Vasodilator :( glyceryl trinitrate ) 0.3 mg

tablet sublingual.
2) Calcium channel blockers:
(diltiazem hydrochloride)
60 mg\ 3 times a day.
 Step5: Practical Effectuation:
Patient information ( side effects, instructions ):
Side effects of glyceryl trinitrate:

Dizziness . Headache. Nausea.

 Step5: Practical Effectuation:
Side effects of diltiazem:

Bradycardia Dizziness Headache Gastro-intestinal

disturbance

Instructions: Take the tablets after a meal.

Step5: Practical Effectuation:
Policies for existing drugs:
I. The patient will continue with
using:
II. Metformin 850 mg/ 3 times
daily ( for controlling his
diabetes ).
III. Ramipril 10 mg/ once daily
( ACEI for controlling his
hypertension ).
IV. Aspirin 100 mg/ once daily
( antiplatelet ) .
V. Simvastatin 40mg/ once daily ( to
reduce LDL cholesterol ).
Step6: Follow Up:

Appointment after 4 weeks to

assess the response of the
treatment.
The patient can contact
Us at any time if there is a new
symptoms.
Summary:

1- Our aim is to relieve the symptoms,

reduce ischemia, and prevent complications.

2- Life Style Modification

3- Acute attack: vasodilator

( glyceryl trinitrate ).
References
●Kumar & clark’s , Clinical medicine, 9th edition, chapter
23.

• BNF75.

• Dr. Emad Al Khoufi’s Lecture