Angina Pectoris
Presented by
S.Shajith khan
Pharm.D 2nd year
20408118
Definition
Angina pectoris is the medical term for chest pain or discomfort due to
coronary heart disease. It occurs when the heart muscle doesn't get as
much blood as it needs. This usually happens because one or more of
the heart's arteries is narrowed or blocked, also called ischemia.
Angina usually causes uncomfortable pressure, fullness, squeezing or
pain in the center of the chest. You may also feel the discomfort in
your neck, jaw, shoulder, back or arm. (Many types of chest discomfort
— like heartburn, lung infection or inflammation — aren‘t related to
angina.) Angina in women can be different than in men.
Symptoms
•A pressing, squeezing, or crushing pain, usually in the chest
under your breastbone
•Pain that may also occur in your upper back, both arms, neck,
or ear lobes
•Chest pain that spreads to your arms, shoulders, jaw, neck, or
back
•Shortness of breath
•Weakness
•Tiredness (fatigue)
•Feeling faint
Causes
•Heart attack
•A blockage in a major artery of your lungs (pulmonary
embolism)
•An enlarged or thickened heart (hypertrophic
cardiomyopathy)
•Narrowing of a valve in the main part of your heart (aortic
stenosis)
•Swelling of the sac around your heart (pericarditis)
•Tearing in the wall of your aorta, the largest artery in your
body (aortic dissection)
RISK FACTORS OF ANGINA PECTORIS
• uncontrolled diabetes
• high level of bad cholesterol
• Obesity
• Excessive alcohol consumption
• smoking
• physical inactive
• having a history of cardiovascular disease
• unhealthy workout
• living in extreme hot or cold conditions
Classification of Angina
• Stable angina occurs when increased physical activity (e.g.,
hurrying across a street or climbing a long stairs) which creates
a greater demand for oxygen-rich blood to reach heart tissue.
• Unstable angina occurs with lesser degrees 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 blood clot at
the site of a ruptured plaque in a coronary artery.
Others type of angina include
• Variant angina occurs at any time nearly always when person is resting.
Attacks can be very painful and usually happen between midnight and 8
am. It is caused by the spasm in the coronary arteries. The spasm usually
occur very close to blockage.
• Micro-vascular angina is recently discovered syndrome, patients with this
condition experiences chest pain but have no apparent coronary artery
blockade.
• Causes are spasms within the walls of these very small arterial blood vessels
causes reduced blood flow to the heart muscle leading to a type of chest
pain referred to as micro-vascular angina.
• May occur with the shortness of breath, sleep problem, fatigue and lack of
energy.
Epidemiology
-The crude annual incidence of angina pectoris
(95% confidence interval) was 0.83 (0.66 to 1.0)
per thousand population aged 31-70 years; the
rates were 1.13 (0.85 to 1.40) for men and 0.53
(0.33 to 0.72) for women
Pathophysiology
Angina pectoris typically occurs when myocardial oxygen demand exceeds
myocardial oxygen supply (perfusion).
• The underlying pathologic condition of this mismatch invariably is the presence of
atherosclerosis in one or more of the epicardial coronary artery (conductance
vessels).
Collateral blood vessels (i.e., side branches of a coronary artery that join one of the
three principal arteries or connect two points along the same artery) may offer
protection against myocardial ischemia.
• These usually are very small and have no function in the normal heart. If blood flow
is obstructed, however, collateral vessels assume more importance and can restore
some myocardial blood flow. When myocardial oxygen demand is increased
excessively, however, collateral blood flow usually is insufficient, and angina or other
myocardial ischemia syndromes develop.
Patient details and history
A 58 years old male patient came to hospital complaining of chest pain , left
shoulder and hand pain,and burning sensation in chest.
Past medical history : hypertension
Past medication history : under the treatment of telmisartan since 10 years
Social history :married , non alcoholic and no smoking
Family History: Father died of "heart problems" at the age of 52.
Allergies: None
Physical examination
WEIGTH ; 92 kg
BP : 162\90mmHg
PR : 90pm
CVS : S1S2+ve murmurs heard
RS : B\L NVBS+
CNS : Conscious and oriented
Temperature : Afebrile
LAB TESTS
LIPID PROFILE TEST
Assessment
PROVISIONAL DIAGNOSIS OF ANGINA PECTOR
DIAGNOSIS
Chest radiography: Usually normal in AP but may show cardiomegaly in patients with
previous MI, ischemic
cardiomyopathy, pericardial effusion or pulmonary edema.
• Gradient exercise stress testing: This is the most widely used test for the evaluation of
patients presenting with the chest pain and can be performed alone and in conjunction
with echocardiography or myocardial perfusion scintography
• Coronary artery calcium (CAC) scoring by fast CT: The primary fast CT methods for this
application are EBCT and MDCT
ECG: It defects and record the electrical activity of heart. Certain electrical patterns
that the ECG detects can suggest whether CAD is likely. However, some people with
angina have a normal ECG. The ECG is usually normal between attacks. During an
attack there may be a transient ST segment depression. If the angina is provoked by
exertion, an exercise stress ECG should be performed Blood Tests:
Blood tests check the levels of certain fats, cholesterol, sugar, and proteins in blood.
Abnormal levels may indicate risk factors for CAD
DRUG CHAT
Drugs Dose Frequency
Ivf NS Q6H
Atorvastatin 20mg 0-0-1
Asparin 80mg 1-0-0
omeprazole 20mg 0-0-1
carvedilol 12.5mg 1-0-1
PATIENT COUNSELLING
• ABOUT DISEASE
Periodic screening for hypertension and other cardiac risks Educating patient
about the risks leading after an attack of angina.
• ABOUT LIFESTYLE MODIFICATION
Drink lots of water.
Less physical activity.
Take iron rich balanced diet. Adequate fluid intake.
Avoid excess salt & FATTY intake.
GOALS ACHEVED
• RETRO STERNAL PAIN HAS BEEN CONTROLLED
• SING AND SYMPTOMS WERE REDUCED
• PATIENTS CONDITION BECAME BETTER
THANK YOU