New Paradigm of Anti Anginal Therapy - PowerPoint Presentation

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Uploaded On 2022-02-14

New Paradigm of Anti Anginal Therapy - PPT Presentation

drYerizal Karani SpPDSpJPK Angina Pectoris Angina pectoris sudden severe pressing chest pain or heaviness radiating to the neck jaw back and arms associated with diaphoresis tachypnea and nausea ID: 908835

blockers nitrates beta angina nitrates blockers angina beta onset reflex pectoris prevent produced fast nitrate flow hypotension demand supply

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New Paradigm of Anti Anginal Therapydr.Yerizal Karani SpPD,SpJP(K)

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Angina PectorisAngina pectoris  sudden severe pressing chest pain or heaviness radiating to the neck, jaw, back and arms 

associated with diaphoresis, tachypnea and nausea.

Angina



insufficient coronary flow to meet oxygen demands of the myocardium



precipitated by any activity/process that creates an imbalance in O

supply and demand

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Types of AnginaAngina occurs in three overlapping patterns:Stable anginaUnstable angina

Prinzmetal (variant) angina

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NitratNitrogliserin (gliseril trinitrat)  very fast onset sublingually  acute conditionIsosorbide dinitrate  fast onset sublingually (substitute of gliseril trinitrat)

Isosorbide mononitrate

 slow onset  used in preventing angina

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" Decrease in the effect of a drug

when administered in a long-acting form"

Nitrates Tolerance

Develops with all nitrates

Is dose-dependent

Disappears in 24 h. after stopping the drug

Tolerance can be avoided

Using the least effective dose

Creating discontinuous plasma levels

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WITH CAUTION:

Constrictive pericarditis

Intracranial hypertension

Hypertrophic cardiomyopathy

Nitrates Contraindications

Previous hypersensitivity

Hypotension ( < 80 mmHg)

AMI with low ventricular filling pressure

trimester of pregnancy

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Contraindication B-Blocker

Hypotension: BP < 100 mmHg

Bradycardia: HR < 50 bpm

Chronic bronchitis, ASTHMA

Severe chronic renal insufficiency

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Reasons for Using Nitrates and Beta Blockers in Combination in AnginaBeta Blockers prevent reflex tachycardia and contractility produced by nitrate-induced hypotension.

Nitrates prevent any coronary vasospasm produced by Beta Blockers.

Nitrates prevent increases in left ventricular filling pressure or preload resulting from the negative inotropic effects produced by Beta Blockers.

Nitrates and Beta Blockers both reduce myocardial oxygen consumption by different mechanisms.

Nitrates and Beta Blockers both increase subendocardial blood flow by different mechanisms

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Anti Anginal Effect

Nitrate

B-Blocker

CCB

Endocardial

blood flow