This document discusses angina pectoris, or chest pain caused by reduced blood flow to the heart. It defines three main types of angina - stable, unstable, and variant (Prinzmetal's angina). Stable angina occurs with exertion and is relieved by rest, while unstable angina happens more frequently and is less responsive to treatment. Variant angina involves coronary artery spasms, often occurring at certain times. The document outlines symptoms, risk factors, initiating factors, and common drug treatments for angina, including nitrates like nitroglycerin and calcium channel blockers.

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Angina Pectoris
- is recurring acute chest pain or discomfort
resulting from decreased blood supply to the
heart muscle(myocardial ischemia). Angina
occurs when the heart’s need for oxygen
increases beyond the level of oxygen available
from the blood nourishing the heart. Angina is a
common symptom for coronary heart disease
(CHD). The symptoms of angina include mild or
severe pain, pressure, or discomfort in the
chest, the pain is generally described as a
feeling of a squeezing, strangling, heaviness, or
suffocation sensation in the chest.

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3 Types of Angina
 Stable
 Unstable
 Variant

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3 Types of Angina
 Stable
Effort-induced pain from physical activity or
emotional stress
Relieved by rest
Predictable and reproducible
 Unstable
 Variant

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3 Types of Angina
 Stable
 Unstable
Pain occurs with increasing frequency
Diminishes patient’s ability to work
Has decreasing response to therapy
May signal an oncoming MI
 Variant

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3 Types of Angina
 Stable
 Unstable
 Variant
Pain due to coronary artery spasm
Pain may occur at certain times of the day, but is
not stress induced

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Prinzmetal's Angina
- Prinzmetal’s or variant angina is caused by
a vasospasm, a spasm that narrows the
coronary artery and lessens the blood flow to
the heart.
- Prinzmetal's Angina usually occurs in
arteries already narrowed by
atherolsclerosis, in fact most people with it
have severe coronary
atherosclerosis in at least one major vessel.
stable and unstable angina, Prinzmetal's
Angina usually occurs when a person is at
rest or sleep and not after physical exertion
or emotional stress.

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 Microvascular Angina
Microvascular angina, or Syndrome X,
occurs when the patient experiences chest
pain but has no apparent coronary artery
blockage. This condition results from poor
functioning of the tiny blood vessels that
nourish the heart, arms and legs.
Microvascular angina can occur during
exercise or at rest. Reduced vasodilator
capacity of the coronary microvessels is
thought to be a cause of angina during
exercise, but the mechanism of angina at
rest is not known.

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Symptoms of Angina
 Severe chest discomfort (heaviness, pressure,
tightness, choking, squeezing)
 Sweating
 Dizziness
 Dyspnea

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Risk Factors for Angina
 Advanced age
 Coronary artery disease
 Hypertension
 Increased serum glucose levels (diabetes)
 Increased serum lipoprotein levels
 Obesity
 Smoking
 Type A personality

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Initiating Factors of an Attack
 Cold weather
 Emotions
 Heavy meals
 Hypoglycemia
 Pain
 Smoking

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Discussion
Explain why some of these factors may
initiate an angina attack: cold weather,
emotions, heavy meals, hypoglycemia,
pain, smoking.

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Discussion
Explain why some of these factors may
initiate an angina attack.
Answer: cold weather – tension in the
muscles, possible decrease in blood
flow….

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Nitrates
 Most commonly used drugs for angina
 Relax vascular smooth muscle and cause
vasodilation
 Helps with pulmonary edema in CHF

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Agents for Angina
Nitrates
 isosorbide dinitrate (Dilatrate-SR, Isordil)
 isosorbide mononitrate (Imdur, Ismo)
 nitroglycerin (Minitran, Nitrolingual, Nitrostat)
Drug
List

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nitroglycerin (Minitran, Nitrolingual,
Nitrostat)
 Drug of choice for acute attacks
Spray and tablets taken sublingually
 May also be used as a prophylaxis
 If using a patch, it should not remain on the
skin for a full 24 hours, there needs to be
free time

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nitroglycerin’s Side Effects
 Severe headache
 Orthostatic hypotension
 Flushing

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nitroglycerin Dispensing Issues
 Tablets must be dispensed in the original
amber glass bottle
 Medication should be refilled every 3 months
and discard any remaining drug
Warning!

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Calcium Channel Blockers
 Relaxes vascular smooth muscle
 Some of these drugs should be taken with
food and caffeine should be limited
 Constipation is most common side effect

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Agents for Angina
Calcium Channel Blockers
 amlodipine (Norvasc)
 bepridil (Vascor)
 diltiazem (Cardizem, Dilacor XR)
 felodipine (Plendil)
 isradipine (DynaCirc)
Drug
List

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Agents for Angina
Calcium Channel Blockers
 nicardipine (Cardene)
 nifedipine (Procardia)
 nisoldipine (Sular)
 verapamil (Calan, Covera HS, Isoptin,
Verelan)
Beta Blockers – Table 12.5
Drug
List

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verapamil (Covera HS)
 Timed-release product designed for bedtime
dose
 Drug is pumped out of 2 holes in the tablet
 Patients may see a ghost tablet in the stool

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Beta Blockers and Angina
 Effective in slowing the heart rate, decreasing
myocardial contractility, and lowering blood
pressure

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