ANGINA PECTORIS

AKSHAY AGRAWAL

1.Defination2.Epidemiology3.Classification4.Etiology5.Pathophysiology6.Clinical Features7.Risk factors8.Diagnosis9.Treatment

Angina is the symptom complex caused

by transient myocardial ischaemia

and is a clinical syndrome rather

than a disease.

Definition

It may occur whenever

there is an imbalance

between myocardial oxygen

supply and demand

Epidemiology

Occurs in both men and women of any age but

commonly middle age and older adults.

Classification

1. Stable or typical Angina

2. Prinzmetal’s Variant Angina

3. Unstable Angina

4. Microvascular Angina

Etiology

Atherosclerosis

Coronary artery spasm

Use of cocaine

Blockage of coronary artery by blood clot or compression

Inflammation or infection of coronary artery

Injury to coronary artery

Poor functioning of tiny blood vessels

Pathophysiology

Myocardial ischemia results from imbalance between

myocardial energy supply(oxygen and energy substrates

like glucose and free fatty acids)and myocardial oxygen

demand.

Or a fixed reduction in the diameter of the

coronary arteries by at least 70% leads to reduction

in coronary blood flow.

Inability to increase oxygen extraction or

coronary blood flow, together with elevated

myocardial demand, leads to angina.

Clinical Features

Pain - over sternum and spreads

down the left arm

also to backsides , upper abdomen,

neck , jaw or even teeth.

Type –dull ache , heaviness or

a crushing sensation .

Breathlessness

Chest Discomfort

Nausea

Fatigue

Dizziness

Profuse sweating

Anxiety

Investigations

Resting ECG – Usually normal but during pain there

will be elevation or depression of ST segment with

or without T wave inversion.

Exercise ECG - >1mm of flat or down sloping ST

depression .

Coronary Angiogram

Blood Test – Increased cardiac enzymes

like Troponin

Risk Factors

Physical Exertion

Cold exposure

Intense emotions

Heavy meals

Hypertension

Diabetes mellitus

Smoking

Left ventricular dysfunction

Obesity

Arterial disease – Peripheral vascular diseases

Anaemia

Thyrotoxicosis

Treatment

A . Medical

Antiplatelet therapy –Aspirin , clopidogrel Reduces risk of MI

Antianginal drug therapy –

Nitrates – glyceryl trinitrates , isosorbide mononitrate

Beta blockers – metaprolol ,atenolol

Calcium channel blockers – nifidipine ,amlodipine

Potassium channel activators – nicorandil

B. Surgical

Percutaneous Coronary Intervention

Coronary Artery Bypass Grafting

C. General measures

Do not smoke

Reduce overweight

Regular exercise

Avoid severe exertion after heavy mealor in very cold

weather

Reference

Textbook of Pathology by Harshmohan – sixth

edition 2010

Davidson’s Principles and practice of Medicine

by Brain R Walker

Nicki R . Colledge – 21st edition 2010

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