STABLE ANGINA

PECTORIS

Andi Alif Buanama N

C111 09 768

DEFINITION
Stable angina: clinical syndrome characterized by discomfort in
chest, jaw, shoulder, back or arms
Elicited by exertion or emotional stress
Relieved by rest or nitroglycerin
Terms is usually confined to cases in which the syndrome can
be attributed to myocardial ischaemia

EPIDEMIOLOGY
The prevalence of angina increases sharply with age in both
sexes from 0.11% in women aged 4554 to 1015% in
women aged 6574 and from 25% in men aged 4554 to 10
20% in men aged 6574.
Therefore, it can be estimated that in most European countries,
20 00040 000 individuals of the population per million
suffer from angina.

PATHOPHYSIOLOGY OF ANGINA

SYMPTOMS OF STABLE ANGINA PECTORIS

The pain or discomfort:
Occurs when the heart must work harder, usually during physical
exertion
Doesn't come as a surprise, and episodes of pain tend to be alike
Usually lasts a short time (5 minutes or less)
Is relieved by rest or medicine
May feel like gas or indigestion
May feel like chest pain that spreads to the arms, back, or other areas

ALGORITHM FOR THE INITIAL

EVALUATION OF PATIENTS WITH
CLINICAL SYMPTOMS OF ANGINA
(1)

CLASSIFICATION OF ANGINA

ANTI ANGINAL DRUGS

Aims of treatment
To improve prognosis by preventing myocardial infarction and death
Reduce plague progression
Stabilize plaque
Prevent thrombosis if endothelial dysfunction or plaque rupture occur
To mininize or abolish symptoms

PHARMALOGICAL AGENTS TO REDUCE SYMPTOMS AND ISCHEMIA

NITRATES
Short acting nitrates
Rapidly acting formulations of nitroglycerin provide effective symptom relief
in connection with attacks of angina pectoris, and may be used for
situational prophylaxis.
The pain relieving and anti-ischaemic effects are related to venodilatation
and reduced diastolic filling of the heart (reduced intracardiac pressure),
which promotes subendocardial perfusion.
Long acting nitrates
Treatment with long-acting nitrates reduces the frequency and severity of
anginal attacks, and may increase exercise tolerance.
Studies of long acting nitrate treatment after myocardial infarction have
failed to show prognostic benefit.
Due to nitrate tolerance, patients treated with long acting nitrates should
have a nitrate free interval each day to preserve the therapeutic effects.

ANTITHROMBOTIC DRUGS
Antiplatelet therapy to prevent coronary thrombosis is indicated, due
to a favourable ratio between benefit and risk in patients with
stable CAD.
Low-dose aspirin is the drug of choice in most cases, and clopidogrel
may be considered for some patients.

Low-dose aspirin
Aspirin remains the cornerstone of pharmacological prevention of arterial
thrombosis.
It acts via irreversible inhibition of platelet COX-1 and thus thromboxane
production, which is normally complete with chronic dosing 75 mg/day.
Clopidogrel
Compared with aspirin 325 mg/day, clopidogrel 75 mg/day was slightly more
effective (ARR 0.51% per year; P 0.043) in preventing cardiovascular
complications in high risk patients.
Gastrointestinal haemorrhage was only slightly less common with clopidogrel
when compared with aspirin treatment
Clopidogrel is much more expensive than aspirin, but may be considered in
aspirin intolerant patients with significant risks of arterial thrombosis.

B- BLOCKER
Beta-1 blockade by metoprolol or bisoprolol have been shown
to effectively reduce cardiac events in patients with
congestive heart failure.
A nonselective beta-blocker also blocks alpha-1 receptors, also
reduces risk of death and hospitalisations for cardiovascular
causes in patients with heart failure

ALGORITHM OF TREATMENT

THANK YOU