Presented by-

ABHISHEK MAJI
SOUBHIK GHOSH
ARNAB MONDAL
1.DEFINATION

2.EPIDEMIOLOGY

3.CLASSIFICATION

4.CAUSES

5.SIGN&SYMPTOMS

6.PATHOPHYSIOLOGY

7.DIOGNOSIS

8.RISK FACTOR

9.TREATMENT
 ANGINA PECTORIS is a disease marked by brief
sudden attack of chest pain or discomfort caused
by deficient oxygen of heart muscles usually due to
impaired blood flow to the heart.
Occurs in both man and women of any age
but commonly middle age and older adults.
1.STABLE TYPE ANGINA.

Also known as effort angina

a typical preparation of angina is that of chest discomfort and
associated symptom precipitated by some activity(running,walking etc)
with minimum or non-existent symptoms at rest or after administration of
sublingual nitrogiycerin.usually last a short time (5 min or less).

2.UNSTABLE TYPE ANGINA

Unstable angina is more dangerous then stable. It occur 8 & rest

or with exertion or stress. The pain worsens in frequency and
severity.
Unstable angina can lead to heart attack , heart failure or
arrhythmias . These can be life threating condition.
3. PRIZNMETAL’S VARIANT ANGINA

It caused by vasospasm a narrowing of coronary arteries due to constriction

of smooth tissue in the vessel walls.

4.MICRO VASCULAR ANGINA

Occurs due to spasm with in the wall of coronary artery blood vessels.
1.STABLE ANGINA- usually triggered by physical extortion .

•Climb stairs
•Exercise or walk
•Other factors such as
•Emotional stress. •Cold temperature.
•Heavy meal •smoking

2.UNSTABLE ANGINA –it can quickly block or reduce flow through a

narrowing blood flow to heart muscle. Principle cause are-

•Fatty deposits in a blood vessel rupture .

•Formation of blood clot.

3.PRINZMETAL’S ANGINA-This type of angina is caused
by a spasm in a coronary artery .
•Emotional stress.
•Smoking.
•use of illegal drug ,like cocaine may trigger this type of angina.

4.MICRO VASCULAR ANGINA-causes of it -

•Spasm due to atheroscelerosis.

1. Chest discomfort rather than actual pain.

2. The discomfort is usually described as –

• pressure
•Heaviness
•Squeezing
•Burning
•Choking sensation
3.apart from the discomfort may also be experienced in
Epigastrium back, neck area, jaw or shoulders.

4.breathlessness
5.nausea\
6.fatigue
7.dizzininess
8.profuse sweating
9.anxiety
 Myocardial ischemia results from imbalance between
myocardial energy supply(oxygen & energy substrates like
glucose and fatty acid) and myocardial oxygen demand

 A fixed reduction in the diameter of the coronary arteries by

at least 70% leads to reduction in coronary blood flow.

 Inability of increase the blood flow or oxygen extraction,

together with elevated myocardial demand leads to angina.
1. ECG (Electrocardiogram)-
It detects and records the electrical activity of the heart .
•During an anginal attack the ECG may show –
1. S-T phase depression .
2. T- phase inversion.
3. Ventricular arrythmia .
2. EXERCISE TEST/ STRESS TEST-

• Used to measure heart’s responds to exercise.

•Patient asked to walk on a treadmill.
•Alternatively the patient receives an injection of a
radioisotope , which makes the heart visible to a special
linked camera.
•But doesn’t identify the exactly where and how the
coronary arteries are blocked .

3. CHEST X- RAY-

•Performed to rule out any lung disease or heart damage that may be
causing the pain.
•Also may reveal enlargement of heart.
4.CARDIAC ANGIOGRAPHY-
•Coronary angiography uses X-RAY imaging to examine the inside of
heart’s blood vessels.
•A cathereter is snaked through arteries till it reaches the heart.
•A fluid is pumped.
•So the arteries & heart are clearly visible.

5 BLOOD TEST-
•Blood test for amount of lipids within the blood.
•Because lipids major cause of anginal attack.
•Lipid profile for 1:HDL 2:LDL 3:TRIGLYCERIDES.

6. CARDIAC MRI-

•In a cardiac MRI you lie on a table inside a long tube like mechine
that produces detailed images of your heart’s structure and it’s blood
vessels.
1. Use of tobbaco

2. Diabetes

3. High blood pressure

4. High blood cholesterol

5. Family history of heart disease

6. Obesity

7. Stress

8. Lack of exercise

9. Older age
 3 Classes of drugs are used -

1.NITRATES
2.β-ADRENOCEPTOR ANTAGONISTS.
3.CALCIUM CHANNEL ANTAGONISTS.
4.ANTI PLATELET DRUGS.

NITRATES

o Prodrugs
o sources of Nitric Oxide.
eg-Nitroglycerine ( Minitran ,Nitrolingual ,Nitrostat)
Isosorbide Mononitrate ( Imdur, Ismo)
Isosorbide Dinitrate ( Dilatrate ,SR, Isobil ).
 CALCIUM CHANNELS BLOCKERS-

o Relaxes vascular smooth muscle.

oSome of these drugs should be taken with food and caffeine should
be limitade.
oConstipation is most common side effect-

DRUG LIST
eg- i) amlodipine.
ii) bepridil.
iii) diltiazem.
iv) felodipine
v) nifedipine
vi) verapamil.
β-ADRENERGIC ANTAGONISTS-

oBeta blockers work by blocking the effect of the hormone

epinephrine ,also known as adrenaline.

DRUG LIST
Eg-Atenolol
Acebutolol.
Nadolol
Metoprolol
Propanolol.

ANTI PLATELET DRUG-

oCertain drugs can help in prevent blood clots formation by stick together
DRUG LIST

Eg- Aspirin Ticagrelor

Clopidogrel, Prasugrel