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Ahmed Abuelhana
Associate. Staff & PG Researcher of Clinical pharmacy, School of pharmacy,
Ulster University, United Kingdome (UK)
Ass. Lecturer of Clinical pharmacy,
Misr University for Science & Technology (MUST), Egypt
Honorary Director Of Pharmacy Consultation & Training Center ,MUST
Consultant and Scientific coordinator at CCHR

Angina Pectoris

Angina Pectoris
Definition
Insufficient blood ( O2 ) supply to the coronaries
Description of pain
Oppressive sensation at the central chest behind the sternum often
radiating to the jaw. neck and inside the arm , ppted by emotions ,
cold weather and excercises.
Mechanism of pain
Shifting of the metabolism from aerobic into anaerobic
respiration
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Causes of angina
1- syphilitic aortitis
2- aortic valve diseases
3- severe anemia
4- reflex tachycardia ( paroxysmal tachycardia
5- etc
6- .etc
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Types of angina
1- Chronic stable angina ( exertional angina )
2- Unstable angina ( preinfarction

angina )

3- prinzmetal angina ( variant angina )

4- Crescendos angina
5- Dreaming angina ( Nocturnal angina )
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Angina occurs when O2

demand is higher than
the coronary blood
supply

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The problem can be treated

either by :
1- Decreasing demand( by slow HR, reduce after
loading and reduce preload )
2- Increasing coronary supply ( by dilating
coronary and decrease HR)

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Diagnosis of Angina
1- Symptoms of patient ( chest pain .)
2- Stress ECG test ( ST segment depression & T
wave elevation
3- Stress Thallium 201 Myocardial perfusion
imaging

4- Cardiac catheterization

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Drugs that can control angina

1- Organic nitrates
2- B- blockers
3- Ca++ channel blockers

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Other medications
1- K+ channel activator ( nicorandil )
2- Statins ( HMG co A reductase )
3- ACE inhibitors
4- Ranolazine ( inhibit late Na Channel and

reduce ionic imbalance during

ischemia )

5- Aspirin, clopidogril, heparin , warfarin.

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Pharmacotherapy Protocol

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