Angina

Angina

Angina

A.pectoris-
 Transient myocardial ischemia.
 It is dueto
1) obstruction of coronary blood flow by atheroma.

2) coronary arterial spasm.

Factors worsen angina-
1 exercise
2 anemia
3 tachycardia
4 HTN



5 hyperthyroidism
6 aortic stenosis
7 aortic reguqitation
8 arrythmias

      C/F -
 History-
1 Retrosternal pain brought on exertion. Relived by rest n sublingual nitrates. It is squeezing,aching. Pain radiates to left arm.
2 angina decubitus is pain while lying flat.
3 Nocturnl angina in aortic regurgitation.There is paroxysmal nocturnal anginal pain with nightmares, dyspnoea, palpitation,skin flushing
4 prinzmetls angina pain which becomes capriciously dueto coronary arterial spasm n ST segment elevation.

PHYSICAL EXAM-

1 rise in BP n heart rate.
2 Fourth heart sound
3 Murmur of mitral regurgitation
4 dyskinetic segment around the apex.
5 paradoxial spliting of 2nd heart sound
6 relive of pain by carotid sinus massage.

    INVESTIGATION-
1 ECG -Reverssible ST segment depression or elivation with or without T wave inversion.

2 Myocardial perfusion scaning using radioactive thallium.

3 echo cardiography n radionuclide scaning pool.

4 coronary arteriography

5 intra vascular ultra sound

     MANAGEMENT-
  3 phases
1 assesment of severity of disease n extent
2 measures to control symptoms
3 measures to improve life expectancy.

GENERAL
1 proper explanation abt disease.
2 avoid walking after meals,in cold.Against wimd.
3 hyperlipidemia treated with drugs n diet
4 control of HTN n DM

DRUGS
1 nitrtes
2 beta adreno receptor antagonist.
3 calcium antgonist
4 plateltes inhibitors.

Nitrates-
glyceryl nitrates(500micro gm) sublingualy.
GTN acts by arteriolar n venous dilatation.
ISOSORBIDE  DINITRATE(10-20mg) three-6 times day.
ISOSORBIDE MONONITRATE.

BETA BLOCKERS-
they reduce myocardial O2 demand by reducing hert rate.
PROPRANOLOL(20mg/3times day)
cardioselective METOPROLOL n ATENELOL.

Ca antagonist-
NIFEDIPIN
VERAPAMIL(40-80mg/3time)

ANTIPLATE agents-
ASPIRIN(75-150mg/day)
CLPIDOGREL

   SURGICAL
 CORONARY ARERY BYPASS GRAFTING.-length of pts saphenous vein is anastomoses to aorta at one end n coronary vessels distal to stenosis to other.
PERCUTANEOUS CORONARY Intervanation.-
(PTCA)percutaneous transluminal coronary angioplasty dilatation of coronary artery stenosis by a small balloon introduced percutaneously via an arterial catheter.