Chronic stable angina Dr Taban Internist & cardiologist.
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Chronic stable angina Dr Taban Internist & cardiologist
MAGNITUDE OF THE PROBLEM Lifetime risk of CAD after 40Y: Men = 49% Women =32% 52% cardiac death One of six all death
Stable Angina. Not new onset Not at rest chest pain The commonest cause isADVANCED ATHEROSCELEROSIS The commonest cause is ADVANCED ATHEROSCELEROSIS Not new exacerbated 3
Chest pain caused by transient myocardial ischemia due to an imbalance between myocardial oxygen supply and demand. Chest pain caused by transient myocardial ischemia due to an imbalance between myocardial oxygen supply and demand. 4
Management of Stable Angina ( 1) identification and treatment of associated diseases that can precipitate or worsen angina; (2) reduction of coronary risk factors; (3) application of general and nonpharmacological methods, with particular attention to adjustments in life style; (4) pharmacological management; (5) revascularization by percutaneous catheter-based techniques or by coronary bypass surgery
Stop smoking Reduce weight Treat Hypertension, Hypercholestrolimia and Diabetes AVOIDSevereexertion Heavy mealEmotionsCold Weather General measures 20 Graduated exercise may open new collaterals
Treatment of an acute attack of angina Sublingual nitroglycerin (0.5 mg ) or isosorbide dinitrate (5 mg ) Sublingual nitroglycerin (0.5 mg ) or isosorbide dinitrate (5 mg ) or Oral spray nitroglycerin (0.4 mg/metered dose), isosorbide dinitrate(1.25 mg/metered dose) Relief within 1-3 min. Persistence of pain Repeat nitroglycerin at 5 min. interval (3 tab. max.) Relief not relieved Infarction HOSPITALIZATION
What are the antianginal drugs? Organic nitrates. Calcium channel blockers. - adrenoceptor blockers.