ANGINA PECTORIS

AKSHAY AGRAWAL
1.Defination
2.Epidemiology
3.Classification
4.Etiology
5.Pathophysiology
6.Clinical Features
7.Risk factors
8.Diagnosis
9.Treatment
 Definition
 Angina is the symptom complex caused

by transient myocardial ischaemia

and is a clinical syndrome rather

than a disease.
 It may occur whenever

there is an imbalance

between myocardial oxygen

supply and demand

Epidemiology
 Occurs in both men and women of any age but

commonly middle age and older adults.

 Classification

1. Stable or typical Angina

2. Prinzmetal’s Variant Angina

3. Unstable Angina

4. Microvascular Angina
 Etiology
 Atherosclerosis
Coronary artery spasm
Use of cocaine
Blockage of coronary artery by blood clot or compression
Inflammation or infection of coronary artery
Injury to coronary artery
Poor functioning of tiny blood vessels
Pathophysiology
Myocardial ischemia results from imbalance between

myocardial energy supply(oxygen and energy substrates

like glucose and free fatty acids)and myocardial oxygen

demand.
 Or a fixed reduction in the diameter of the

coronary arteries by at least 70% leads to reduction

in coronary blood flow.

 Inability to increase oxygen extraction or

coronary blood flow, together with elevated

myocardial demand, leads to angina.

Clinical Features
Pain - over sternum and spreads

down the left arm

also to backsides , upper abdomen,

neck , jaw or even teeth.

Type –dull ache , heaviness or

a crushing sensation .
Breathlessness

Chest Discomfort

Nausea

Fatigue

Dizziness

Profuse sweating

Anxiety
Investigations

Resting ECG – Usually normal but during pain there

will be elevation or depression of ST segment with
or without T wave inversion.

Exercise ECG - >1mm of flat or down sloping ST

depression .
Coronary Angiogram

Blood Test – Increased cardiac enzymes

like Troponin
Risk Factors
Physical Exertion

Cold exposure

Intense emotions

Heavy meals

Hypertension
Diabetes mellitus

Smoking

Left ventricular dysfunction

Obesity

Arterial disease – Peripheral vascular

diseases

Anaemia

Thyrotoxicosis
Treatment
A . Medical

Antiplatelet therapy –Aspirin , clopidogrel Reduces risk of MI

Antianginal drug therapy –

Nitrates – glyceryl trinitrates , isosorbide mononitrate

Beta blockers – metaprolol ,atenolol

Calcium channel blockers – nifidipine ,amlodipine

Potassium channel activators – nicorandil

B. Surgical

 Percutaneous Coronary Intervention

 Coronary Artery Bypass Grafting

C. General measures

 Do not smoke

 Reduce overweight

 Regular exercise

 Avoid severe exertion after heavy mealor in very cold

weather
Reference
Textbook of Pathology by Harshmohan – sixth

edition 2010

Davidson’s Principles and practice of Medicine

by Brain R Walker

Nicki R . Colledge – 21st edition 2010

THANK YOU