Angina Pectoris
Definition Types
Spasmodic, choking or suffocating chest pain Stable angina
predictable/consistent pain occurs on
Paophysiology exertion, relieved by rest/nitro
Unstable angina
caused by atherosclerotic disease Preinfarction angina/crescendo angina
symptoms increase in frequency/severity
r/t obstruction of at least one major not always received with rest or nitro
coronary artery
blockage creates ischemia Intractable or refractory angina
Oxygen demand greater than supply severe incapacitating chest pain
Variant angina
Clinical manifestation aka. Prinzmetal angina
tightness, choking, heavy sensation in chest pain at rest with reversible ST elevation
radiating pain to neck, jaw, shoulders, back/left arm cause: coronary artery spasm
ilent ischemia
may feel impending doom and anxious objective ischemia with no pain reported
diabetic patients may not have severe pain
because autonomic neuropathy blunts pain
Treatment
goal to decrease myocardial oxygen demand and increase oxygen supply
medicationÔs
Þrst being nitroglycerin
Medications
Nitroglycerin
oxygen
beta adrenergic blockers BP, HR
reduce and control risk factors metoprolol, atenolol
calcium channel blockers BP
reperfusion therapy Amlodipine, Diltiazem
percutaneous transluminal anti-platelet
coronary angioplasty (PTCA) aspirin, clopidogrel, prasugrel, Ticagrelor
anticoagulants
Coronary artery stent
heparin
Coronary artery bypass graft (CABG)
low molecular weight heparins: enoxaparin, dalteparin
glycoprotein IIb/IIa
decreases platelet aggregation
Definition Types
Spasmodic, choking or suffocating chest pain Stable angina
predictable/consistent pain occurs on
Paophysiology exertion, relieved by rest/nitro
Unstable angina
caused by atherosclerotic disease Preinfarction angina/crescendo angina
symptoms increase in frequency/severity
r/t obstruction of at least one major not always received with rest or nitro
coronary artery
blockage creates ischemia Intractable or refractory angina
Oxygen demand greater than supply severe incapacitating chest pain
Variant angina
Clinical manifestation aka. Prinzmetal angina
tightness, choking, heavy sensation in chest pain at rest with reversible ST elevation
radiating pain to neck, jaw, shoulders, back/left arm cause: coronary artery spasm
ilent ischemia
may feel impending doom and anxious objective ischemia with no pain reported
diabetic patients may not have severe pain
because autonomic neuropathy blunts pain
Treatment
goal to decrease myocardial oxygen demand and increase oxygen supply
medicationÔs
Þrst being nitroglycerin
Medications
Nitroglycerin
oxygen
beta adrenergic blockers BP, HR
reduce and control risk factors metoprolol, atenolol
calcium channel blockers BP
reperfusion therapy Amlodipine, Diltiazem
percutaneous transluminal anti-platelet
coronary angioplasty (PTCA) aspirin, clopidogrel, prasugrel, Ticagrelor
anticoagulants
Coronary artery stent
heparin
Coronary artery bypass graft (CABG)
low molecular weight heparins: enoxaparin, dalteparin
glycoprotein IIb/IIa
decreases platelet aggregation
