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IHD:

Class: 1- acute coronary death.2- angina


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

are used: riboxin, probucal. If it is possible


surgical tt is indicated.

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