STABLE ANGINA

PECTORIS

Liya sari astuti

C11109767

Definition

Stable
Stable angina:
angina: clinical
clinical syndrome
syndrome
characterized
characterized by
by discomfort
discomfort in
in chest,
chest, jaw,
jaw,
shoulder,
shoulder, back
back or
or arms
arms

Elicited
Elicited by
by exertion
exertion or
or emotional
emotional stress
stress

Relieved
Relieved by
by rest
rest or
or nitroglycerin
nitroglycerin

Terms
Terms is
is usually
usually confined
confined to
to cases
cases in
in
which
which the
the syndrome
syndrome can
can be
be attributed
attributed to
to
myocardial
myocardial ischaemia
ischaemia

Epidemiology

The
The prevalence
prevalence of
of angina
angina increases
increases
sharply
sharply with
with age
age in
in both
both sexes
sexes from
from 0.1
0.1
1%
1% in
in women
women aged
aged 4554
4554 to
to 1015%
1015% in
in
women
women aged
aged 6574
6574 and
and from
from 25%
25% in
in
men
men aged
aged 4554
4554 to
to 1020%
1020% in
in men
men aged
aged
6574.
6574.
Therefore,
Therefore, itit can
can be
be estimated
estimated that
that in
in
most
most European
European countries,
countries, 20
20 00040
00040 000
000
individuals
individuals of
of the
the population
population per
per million
million
suffer
suffer from
from angina.
angina.

Pathophysiology of Angina

Symptoms of Stable Angina

Pectoris

The
The pain
pain or
or discomfort:
discomfort:

Occurs
Occurs when
when the
the heart
heart must
must work
work harder,
harder,

usually
usually during
during physical
physical exertion
exertion

Doesn't
Doesn't come
come as
as aa surprise,
surprise, and
and episodes
episodes of
of
pain
pain tend
tend to
to be
be alike
alike

Usually
Usually lasts
lasts aa short
short time
time (5
(5 minutes
minutes or
or less)
less)

Is
Is relieved
relieved by
by rest
rest or
or medicine
medicine

May
May feel
feel like
like gas
gas or
or indigestion
indigestion

May
May feel
feel like
like chest
chest pain
pain that
that spreads
spreads to
to the
the
arms,
arms, back,
back, or
or other
other areas
areas

Algorithm for the initial

evaluation of patients with
clinical symptoms of angina (1)

Classification of Angina

Anti Anginal Drugs

Aims
Aims of
of treatment
treatment

To
To improve
improve prognosis
prognosis by
by preventing
preventing

myocardial
myocardial infarction
infarction and
and death
death

Reduce
Reduce plague
plague progression
progression
Stabilize
Stabilize plaque
plaque
Prevent
Prevent thrombosis
thrombosis ifif endothelial
endothelial dysfunction
dysfunction or
or

plaque
plaque rupture
rupture occur
occur

To
To mininize
mininize or
or abolish
abolish symptoms
symptoms

Pharmalogical agents to reduce

symptoms and ischemia

Nitrates

Short
Short acting
acting nitrates
nitrates

Rapidly acting formulations of nitroglycerin provide effective

Rapidly acting formulations of nitroglycerin provide effective

symptom
symptomrelief
reliefin
inconnection
connectionwith
withattacks
attacksof
ofangina
anginapectoris,
pectoris,
and
andmay
maybe
beused
usedfor
forsituational
situationalprophylaxis.
prophylaxis.
The pain relieving and anti-ischaemic effects are related to
The pain relieving and anti-ischaemic effects are related to
venodilatation
venodilatationand
andreduced
reduceddiastolic
diastolicfilling
fillingof
ofthe
theheart
heart(reduced
(reduced
intracardiac
intracardiacpressure),
pressure),which
whichpromotes
promotessubendocardial
subendocardial
perfusion.
perfusion.

Long
Long acting
acting nitrates
nitrates

Treatment with long-acting nitrates reduces the frequency and

Treatment with long-acting nitrates reduces the frequency and

severity
severityof
ofanginal
anginalattacks,
attacks,and
andmay
mayincrease
increaseexercise
exercisetolerance.
tolerance.
Studies of long acting nitrate treatment after myocardial
Studies of long acting nitrate treatment after myocardial
infarction
infarctionhave
havefailed
failedto
toshow
showprognostic
prognosticbenefit.
benefit.
Due to nitrate tolerance, patients treated with long acting
Due to nitrate tolerance, patients treated with long acting
nitrates
nitratesshould
shouldhave
haveaanitrate
nitratefree
freeinterval
intervaleach
eachday
dayto
to
preserve
preservethe
thetherapeutic
therapeuticeffects.
effects.

Antithrombotic drugs

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

Low-dose
Low-dose aspirin
aspirin

Aspirin remains the cornerstone of pharmacological prevention

Aspirin remains the cornerstone of pharmacological prevention

of
ofarterial
arterialthrombosis.
thrombosis.
It acts via irreversible inhibition of platelet COX-1 and thus
It acts via irreversible inhibition of platelet COX-1 and thus
thromboxane
thromboxaneproduction,
production,which
whichisisnormally
normallycomplete
completewith
with
chronic
chronicdosing
dosing75
75mg/day.
mg/day.

Clopidogrel
Clopidogrel

Compared with aspirin 325 mg/day, clopidogrel 75 mg/day

Compared with aspirin 325 mg/day, clopidogrel 75 mg/day

was
wasslightly
slightlymore
moreeffective
effective(ARR
(ARR0.51%
0.51%per
peryear;
year;PP
0.043)
0.043)in
in
preventing
preventingcardiovascular
cardiovascularcomplications
complicationsin
inhigh
highrisk
riskpatients.
patients.
Gastrointestinal haemorrhage was only slightly less common
Gastrointestinal haemorrhage was only slightly less common
with
withclopidogrel
clopidogrelwhen
whencompared
comparedwith
withaspirin
aspirintreatment
treatment
Clopidogrel is much more expensive than aspirin, but may be
Clopidogrel is much more expensive than aspirin, but may be
considered
consideredin
inaspirin
aspirinintolerant
intolerantpatients
patientswith
withsignificant
significantrisks
risks
of
ofarterial
arterialthrombosis.
thrombosis.

B- Blocker

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

Algorithm of treatment

THANK YOU