pectoris: a- stable, b- unstable. 3- MI: atransmural, b- non transmural. 4- post infarction sclerosis. 5- arrythmia. 6- heart failure. Class of angina: 1- stable or exertional angina. 2- unstable nagina: a- new onset unstable angina, bprogressive unstable ang, c- prinzmetal or variant angina. Stable angi stage: 1: attack during extreme work, 2- attack in common condition as walking > 500 m , climbing >1 floor, third attack appear by walking 100-500 m c, climibing<1 floor. 4 stage; attack during slight activity or at rest: 2 types: angina decubitus: ang in lying position increase preload on heart, nocturnal ang: during Rem sleep. Diagnos: most impo based on clinical symptoms & risk factors. ECG in 50 % of cases during attacks we see horizontal depression of St indicating ischemia. Subendocardial --. Depression of St, transmural-> elevation of St. Triangular T sometimes is seen. Changes sen during attack only. Additional symp indicate otherdiseases. If pure ang normal blod analysis. May be hypovolemia, hyperlipidemia. Stress test shows typical overload, we can reveal St elevation or depression, running of ventricular tachycardia. Also T wave disorders, left branch block St eleva or depression, arrythmia, clinics & add signs: dec BP. Contraindication to stress test: 1- unstable ang, 2- fresh Mi, aneurysm of left ventricule 4- fibrillation 5- high temp, 6disease leading to heart failure, 7- atrial fibrillation. TTT of stable angina: 1- nitrates, beta blockers, ca chanel blockers. Nitrates: nitroglyc has potent dilatory effect on middle sized art & vein, dec preload, rapid effect. For unstable angina: concentra of nitrates must be constant in blood. For stable ang: stage 1 no need to use it for long duration, in stage 2 use it from 1- 4 times. In stage 3 nitrates + other drugs 4times, in stage 4 obligatory use nitrates + other nitroglycerine in solution for progressive form, used in hospital better. Contraind: stroke or apoplexy, open-angle glaucoma, encephalitis, severe hypertension. Beta blockers: decrese demand of O2 but do not dilate coronary artery. They dilate periphery vessels, Dec symp, reduce plasma rennin. Selective drug as atenolol, metoprolol propranolol from 10-40 mg, tablet everage dose 80 mg/day. Effect last for 1-2 days side effect: bradycardia, av-block, dec Bp. Ca blockers: movrask an antiginal new drug. 3 group: veropamil, deltiazem, corenfar. Verapamil dec contractility & demand, widen coronary vessels, avoid spasm, increase delay bradycardia, potent peripheral vasodilators. Prohibited in blocks, hypotension, marked heart failure, estreme bradycardia or tachycardia. The other drugs distribute tone in coronary vessels dec spasm ex: depiridamol/ for stable ang: second stage; beta blocker permanently + aspirin. Third stage beta , nitrates+ aspirin, fourth all group in big dose. Drugs that increase metabolism of heart
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