Angina pectoris diagnosis and treatmnt by herbsFinal.pptx

about angina pectoris and its dignosis and treatment, about angina pectoris and its dignosis and treatment

1. Angina Prepared By: Neama Mohamed Abdelwahed 1

2. Content : 1-Introduction 2-Sign and Symptoms 3-Causes 4-Types 5-Risk factor for angina 6-Diagnosis 7-Preventive care 8-Treatment Approach 9-Case in clinic 10-References 2

3. 3 Introduction The term Angina Pectoris is applied to varying forms of transient chest discomfort that are attributable to insufficient myocardial oxygen. The heart is the pump responsible for circulating blood throughout the body. Myocardium is the heart muscle that contracts to pump that blood and like any other muscle . Angina pectoris describes the discomfort , pain, or any other symptoms that occur when blood flow to heart muscle cells is not enough to meet its energy needs.

4. 4 The classic description of angina is a crushing pain that radiates around the chest and sometimes downs the arm or into the back, which is usually aggravated by exertion or stress. Angina is a warning sign that the heart muscle is not getting adequate blood supply and oxygen . If unheeded it may lead to heart attack or myocardial infarction . Angina isn’t a disease; it’s a symptom of an underlying heart problem. Angina usually is a symptom of Coronary Heart Disease (CHD ).(1)

5. 5 Sign and Symptoms Chest pressure radiates down the arm, into the neck or jaw. However, patients may use different words to describe the pain, tightness and ache. The location may be in the chest; instead it may be described in the upper abdomen , back, arms, shoulder, or neck. Breath shortness, nausea /vomiting, light headache.(1)

6. 6 Causes According to (NHS); The National Health Service in England. Angina is usually caused by the arteries supplying blood to the heart muscles becoming narrowed by a build-up of fatty substances. This is called atherosclerosis . The chest pain is caused by reduced blood flow to the heart muscles. It's not usually life threatening, but it's a warning sign that you could be at risk of a heart attack or stroke.

7. 7 Types Stable Angina The pain is predictable and present only during exertion or extreme emotional distress, and it disappears with rest . Stable angina isn't a heart attack more likely to happen in the future .(1)

8. 8 Unstable Angina It may occur more often and be more severe than stable angina. The unstable angina can occur with or may be without physical exertion, and rest may not relieve the pain. The angina may occur frequently, more easily at rest condition , feel more severe and last longer although this type of angina can often be relieved with drugs because it is unstable and may lead to a heart attack. Intense treatment is required. This type of angina is a sign that a heart attack may happen soon.(1)

9. 9 Variant Angina ( Vasospastic or Prinzmetal’s Angina) This is when angina occurs at rest specially during sleeping or when exposed to cold temperatures. Symptoms are mainly caused by the decreased blood flow to the heart muscle from a spasm of the coronary artery. The majority of people with this type of angina also have coronary artery disease CAD .(1)

10. 10 Risk factor for angina Elevated serum cholesterol Elevated systolic and diastolic blood pressure Increased relative body weight Smoking Diabetes mellitus Low physical activity during leisure time Dyspnea Some psychosocial factors (e.g. depression, anxiety, and post-traumatic distress )(5)

11. 11 Diagnosis Your doctor may run several tests to determine the cause of your chest pain. Electrocardiogram (ECG). Stress test. Coronary catheterization. Electron beam computed tomography ( EBCT)scan. Cardiovascular magnetic resonance imaging(MRI)

12. 12 Tobacco smoking must be avoided Preventive care You can help prevent angina by following lifestyle modification. Healthy diet reduces risk. Maintaining or obtaining a healthy weight (defined as body mass index < 25 kg/m2) is very important ( food plant-based diet ) Regular physical activity Blood pressure (BP) control Management of hypercholesterolaemia Reducing stress and enhances quality of life ( 6)

13. 13 Treatment Approach Lifestyle Changing your diet, exercising regularly, and practicing relaxation techniques to reduce your response to stress can help improve blood flow to your heart and reduce angina. These steps can also help treat your risk factors for heart disease.

14. 14 Diet A diet low in saturated fat and high in whole grains , fruits, and vegetables will help your heart and also keep your weight under control. The American Heart Association recommends that you do the following to prevent or treat heart disease: Eat a variety of nutritious foods, especially whole grains, fruits and vegetables , and low fat dairy products Eat at least 2 servings of fish per week, particularly fish high in omega-3 fats, such as salmon, trout , and herring . Limit sodium intake to 1,500 mg per day .

15. 15 Reduce your consumption of beverages and foods with added sugars. Burn as many calories as you take in. Get at least 30 minutes of exercise most days (or,better still, every day). If you cannot find a 30-minute block of time for exercise, aim for three 10-minute sessions during the course of the day. Limit alcohol intake to 2 drinks per day for men and 1 drink per day for women.

16. 16 Relaxation Relaxation techniques may help reduce stress, which can be a contributing factor to heart disease, and relieve chest pain. Such practices might include the use of meditation, progressive muscle relaxation , breathing exercises, yoga, self hypnosis, or biofeedback . +

17. 17 Medications For the treatment of stable angina, your doctor will likely recommend daily aspirin, as well as a combination of the following prescription medications: Nitroglycerin and oral nitrates : Temporarily dilate coronary arteries, allowing the heart to get more blood and oxygen. Beta-blockers: Slow heart rate and blood pressure, reducing the heart's need for oxygen. Never abruptly stop taking a beta-blocker, because serious side effects can occur . Talk to your doctor about how to slowly wean off of this drug. Beta-blockers include: Atenolol (Tenormin).

18. 18 Calcium-channel blockers: Slow heart rate and cause arteries to dilate. Calcium-channel blockers include Amlodipine (Norvasc ). Statins: Lower cholesterol, which is associated with a higher risk of heart attacks due to cardiovascular disease include simvastatin. Ranolazine ( Ranexa ): Due to potential side effects, this drug is used only when other antiangina drugs do not work. It is used with other anti-angina medications, such as betablockers or nitroglycerin. Recently, scientists have investigated Chinese Patent Medicines (CPM) as complementary therapies for angina symptoms with promising results.

19. 19 Surgery and Other Procedures If lifestyle changes and medications are not effective or if unstable angina develops, you may need coronary artery bypass graft surgery, angioplasty with stent placement, or another type of procedure to improve blood flow to your heart. Other procedures include transmyocardial laser revascularization (TMR) , which is usually done along with coronary artery bypass, and, for those who are not candidates for standard treatments, a procedure called enhanced external counter pulsation (EECP). Implanting a coronary device can help improve angina symptoms when patients are not candidates for traditional surgical options.

20. 20 Nutrition and Dietary Supplements Eat a well-balanced diet with plenty of whole grains , fruits, vegetables, and low-fat dairy products. If approved by your physician, make sure you exercise at least 30 minutes a day most days of the week . There are many supplements that can help reduce your chances of developing heart disease and its consequences, including angina. L-carnitine Coenzyme Q10 (CoQ10) Arginine or l-arginine Magnesium

21. 21 Mechanism of Action Active constituent Plant name Crataegus species (hawthorn): Berry and flowering tops extracts reduce angina attacks, lower blood pressure and serum cholesterol levels; improve blood and oxygen supply of heart by dilation of coronary vessels; improve metabolic processes in heart; improve cardiac energy metabolism, enhancing myocardial function with more-efficient use of oxygen; interact with key enzymes to enhance myocardial contractility (3) polyphenols e.g., epicatechin procyanidin B2 procyanidin B5 procyanidin C1 hyperoside isoquercitrin chlorogenic acid (2) Hawthorn’s berry (Crataegus) (fruits) chlorogenic acid epicatechin Herbal remedies

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23. 23 Mechanism of Action Active constituent Plant name reduce the frequency of angina Kudzu can cause side effects and interact with other drugs. It may also have hormone-like effects and potentially aggravate liver disease. DO NOT take kudzu without your doctor's supervision. contains a variety of isoflavones e.g. puerarin Daidzein daidzin Kudzu (Pueria lobota)

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25. 25 Mechanism of Action Active constituent Plant name improve ECG measurements reduce symptoms and frequency of acute angina attacks compared with nitroglycerin. You should only use suxiao jiuxin under the guidance of a qualified practitioner. Tetramethylpyrazine borneol Suxiao jiuxin wan

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27. 27 Mechanism of Action Active constituent Plant name it dilates coronary arteries, inhibits platelet aggregation, has a protective action on ischemic myocardium, enhancing the recovery of contractile force on reoxygenation. It also inhibits lipid peroxidation because of its free radical scavenging effects. diterpenoid quinones e.g. roykenone Herminone 7-o-acetyl-horminone and hydrophilic phenolic acids are its principal bioactive components. (4) Salvia miltiorrhiza (root) Three diterpenoid quinones

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29. 29 Mechanism of Action Active constituent Plant name Ginkgo was proved to have cardio-protective and cardiotonic properties and could improve hemodynamics and vascular function which results in decreasing the high blood pressure. You can find ginkgo in capsule, tablet, tincture, liquid extract or dried leaf form in most health food stores. It could be taken as a daily dose for prevention of heart diseases. Ginkgo biloba has two primary active ingredients at varying concentrations: terpene lactones ginkgolides diterpenes ginkgo flavone glycosides ginkgetin bilobetin sciadopitysin Ginkgo Biloba ( ( herb

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31. 31 Mechanism of Action Active constituent Plant name inhibit platelet aggregation in healthy participants and those with cardiovascular diseases lowering serum cholesterol, blood pressure, and oxidative stress. Allin Allicin Its content is high in allin, allicin, saponins, potassium, phosphorus, sulfur, zinc, selenium, Vitamin A, and Vitamin C. Allium sativum (Garlic) (rhizome) saponins

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33. 33 Mechanism of Action Active constituent Plant name Stem bark was traditionally used in various cardiovascular diseases as it exerts positively inotropic, have a vasodilatory effect on coronary arteries, have antioxidant and lipid-lowering effects The active constituents isolated from the stem bark include triterpinoids e.g. arjuglycoside iii terminioc acid flavonoids e.g. arjunolone arjunone minerals. Terminalia arjuna ( ( bark

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35. 35 Mechanism of Action Active constituent Plant name It has a cardioprotective role; curcumin has antioxidant effects that prevent cardiovascular complications associated with diabetes, has antithrombotic, antiinflammatory, and lipid lowering effects. The main active constituents of the rhizome of Curcuma longa and other Curcuma spp . are curcumin demethoxycurcumin bisdemethoxycurcumin Curcuma longa (Turmeric) ( (rhizome

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37. 37 Mechanism of Action Active constituent Plant name It is used to treat angina and coronary heart disease, relieve myocardial ischemia, lower cholesterol, help control bleeding, reduce myocardial oxygen consumption, and increase coronary blood flow.(7) saponines ginsenosides notoginsenosides various organic acids including acetic acid dencichine amino acids and Sugars (7) San qi (Notoginseng Radix) (root) Ginsenosides

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39. 39 Mechanism of Action Active constituent Plant name is often prescribed in conjunction with nitric oxide donors for treating angina and other coronary heart diseases. The effect of chuan xiong on blood circulation may be due to active components senkyunolide A and ligustiliden.(8) The main active constituents of L. chuanxiong Hort include phalides - senkyunolide A, I -Z- ligustilide - neocnidilide -butylphthalide terpenes (8) Chuanxiong Rhizoma

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41. 41 Case in Clinic A 77-year-old woman presented with unstable angina. Her past medical history included hypertension, hyperlipidemia and remote tobacco use treated with atenolol 50 mg daily and simvastatin 20 mg daily . Over the two to three months prior to presenting , she developed gradually worsening chest pressure and shortness of breath to the point where she was unable to walk more than half of a city block or up one flight of stairs . Her symptoms resolved with rest . Coronary angiography revealed severe three-vessel disease, and a referral for coronary artery bypass graft surgery (CABG) was made.. Daily aspirin 81 mg and sublingual nitroglycerin as needed were added to her medication regimen . The patient chose, however, to not proceed with surgery and rather she chose to adopt a whole-food plant-based diet, which included all vegetables, fruits, whole grains, potatoes, beans, legumes and nuts. She eliminated all animal derived Products.

42. 42 Clopidogrel 75 mg daily was added to her medical regimen, simvastatin was replaced by a high-potency statin (atorvastatin 80 mg daily) and atenolol was replaced by carvedilol . Within one month of lifestyle change her symptoms had nearly resolved , and she was able to walk on a treadmill for up to 50 min without chest discomfort or dyspnea . Her total cholesterol decreased from 5.7 mmol/L to 3.2 mmol/L, and her LDL cholesterol decreased from 3.7 mmol/L to 1.5 mmol/L over three months . Four to five months after the initial lifestyle change, her adherence to a whole-food plant-based diet ended. She returned to her prior eating habits, which included chicken, fish, low fat dairy and other animal products multiple times per day. Although her medical regimen had not changed, her anginal symptoms returned within four to six weeks. She had chest discomfort with minimal exertion at a gym.

43. 43 References 1-Khatoon , Humera, Safila Naveed, and Kiran Shahid. "Knowledge and Awareness among Pharmacy Students about Angina Pectoris." The Global Journal of Pharmaceutical Research 3 (2014): 1926-1934. 2-https ://www.ncbi.nlm.nih.gov › articles › PMC6268084 2012 Dec; 17(12): 14490–14509. 3-https ://www.sciencedirect.com › topics › crataegus 2016 4-https ://www.ncbi.nlm.nih.gov › articles › PMC8781443 PeerJ . 2022; 10: e12726 5-https ://www.sciencedirect.com › science › article › Volume 40, Issue 3, 1987, Pages 265-275

44. 44 6-Winchester , David E., and Carl J. Pepine. "Angina treatments and prevention of cardiac events: an appraisal of the evidence." European Heart Journal Supplements 17.suppl_G (2015): G10-G18. 7-O’Brien , Kylie A., and Luis Vitetta. "The potential role of herbal medicines in the treatment of chronic stable angina pectoris: a review of key herbs, and as illustration, exploration of the Chinese herbal medicine approach." Botanics: Targets and Therapy (2013): 1-17. 8-Luo , Yun, et al. "Effects of herbal medicines on pain management." The American Journal of Chinese Medicine 48.01 (2020): 1-16 . 9-https:// www.stlukes-stl.com/health-content/medicine /33/000010.htm

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