Angina pectoris

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1. ANGINA PECTORIS AKSHAY AGRAWAL

2. Defination Epidemiology Classification Etiology Pathophysiology Clinical Features Risk factors Diagnosis Treatment

3. Angina is the symptom complex caused by transient myocardial ischaemia and is a clinical syndrome rather than a disease. Definition

4. It may occur whenever there is an imbalance between myocardial oxygen supply and demand

5. Epidemiology Occurs in both men and women of any age but commonly middle age and older adults .

6. Classification Stable or typical Angina Prinzmetal’s Variant Angina Unstable Angina Microvascular Angina

7. 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

8. Pathophysiology Myocardial ischemia results from imbalance between myocardial energy supply(oxygen and energy substrates like glucose and free fatty acids)and myocardial oxygen demand.

9. 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.

10. 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 .

11. Breathlessness Chest Discomfort Nausea Fatigue Dizziness Profuse sweating Anxiety

12. 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 .

13. Coronary Angiogram Blood Test – Increased cardiac enzymes like Troponin

14. Risk Factors Physical Exertion Cold exposure Intense emotions Heavy meals Hypertension

15. Diabetes mellitus Smoking Left ventricular dysfunction Obesity Arterial disease – Peripheral vascular diseases Anaemia Thyrotoxicosis

16. 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

17. 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

18. Reference Textbook of Pathology by Harshmohan – sixth edition 2010 Davidson’s Principles and practice of Medicine by Brain R Walker Nicki R . Colledge – 21 st edition 2010

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