Angina-
- Episodic chest pain resulting from transient myocardial ischemia.
- It occurs due to an imbalance between myocardial oxygen demand and supply.
- Atherosclerosis in the coronary arteries is the most common cause.
- Attacks get provoked by exercise,emotional disturbances,heavy meals.
- Pathology-Due to atherosclerotic plug in coronay arteries the blood supply to sub endocardial region gets affected and as the blood starts filling the ventricles the sub endocardial crunch develops during the diastole and pain is felt.
- All drugs administered reduces the cardiac workload.
- Signs and symptoms-Pain in chest radiating to the neck and left arm
- Stable angina-Attack happens Occasionally on exertion and get relieved by rest.
- Unstable angina-Attacks that become quite frequent or attacks which don't get resolved by rest.
- Prinzmetal's angina-Angina happening due to spasm in coronary vessels.Attacks happen during sleeping and even at rest.
- Angina can further lead to Myocardial infarction and Heart failure
- ECG changes-Angina shows ST segment depression and T wave inversion.
- Drug regime-Trinitrogylcerin,Aspirin,clopodegrel,Beta blockers,Calcium channel blockers.
- TNG,Aspirin,Beta blockers form the main stay of drug regime.
- TNG(0.5mg) placed under the tongue and is crushed by teeth will relieve anginal attack with in 2-3 min and effect will remain for 10-30 min.Sub lingual Aerosol sprays are also available that don't get detoriated.
- TNG detoriate on exposure so it should be replaced after about 8 weeks of opening the bottle.It should produce headache(side effect) ,if it doesn't than it means that TNG has been detoriated and should be replaced.
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