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Antianginal Drugs

59-291 Section 3, Lecture 5. Antianginal Drugs. Ischemic Heart Disease Angina pectoris Chronic condition, episodic chest discomfort Occurs during transient coronary ischemia Myocardial infarction Acute and complete occlusion of a coronary artery Due to coronary thrombosis.

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Antianginal Drugs

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  1. 59-291 Section 3, Lecture 5 Antianginal Drugs • Ischemic Heart Disease • Angina pectoris • Chronic condition, episodic chest discomfort • Occurs during transient coronary ischemia • Myocardial infarction • Acute and complete occlusion of a coronary artery • Due to coronary thrombosis

  2. Angina- episodic chest pains as a result of transient coronary ischemia (as opposed to myocardial infarction which is acute and complete occlusion of a coronary artery . • angina (heavy weight or pressure or pain in the chest) occurs when blood (oxygen, nutrient) supply to the heart is limited as a result of : • disruption of coronary blood flow because of vasospasm or platelet aggregation • increased demand for oxygen evoked by physical exertions • a combination of both

  3. Vasospasm at rest or during sleep If the frequency and severity increases- forerunner to a MI If symptoms remains the same and angina occurs under similar circumstances

  4. Drugs employed: Typical Variant MI Stable Unstable Organic nitrite and nitrates ++ ++ ++ + Ca2+-channel blockers ++ 0 to ++ +++ 0 - adrenergic Antagonists ++ ++ 0 +++ Aspirin + +++ 0 +++ Fibrinolytic drugs 0 0 0 +++ Antianginal drugs : -O2increase supply and/or lower demand Myocardial O2 supply: Coronary blood flow, regional flow distribution Myocarial O2 –demand: amount of energy required to support the work of the heart Cardiac work influenced by: heart rate, heart contractility, myocardial wall tension

  5. Vasodilators- organic compounds containing ONO or ONO2 (prodrugs)all release NO upon interacting with serum components.

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