3.1 Nitrates & Antianginals

Angina

Chest pain or discomfort due to reduced blood flow to the heart muscle.

Stable Angina

Predictable chest pain induced by exertion or exercise, relieved by rest or nitroglycerin.

Unstable Angina

Unpredictable chest pain due to ruptured coronary artery plaque, occurring at rest or with activity, not relieved by rest or nitroglycerin.

Prinzmetal Angina

Variant angina caused by coronary vasospasm, often occurring at rest and associated with ST-segment elevation.

Syndrome X

Also known as microvascular angina, characterized by exertional angina with normal coronary arteries and caused by microvascular dysfunction.

Nitrates

Medications that act as vasodilators, reducing preload and afterload, and increasing blood flow to ischemic areas.

Nitric Oxide (NO)

A short-lived vasodilating free radical that helps regulate blood vessel constriction and dilation.

Short Acting Nitrates

Medications like sublingual nitroglycerin used for acute angina relief, with a rapid onset of action.

Long Acting Nitrates

Medications such as isosorbide dinitrate used to prevent angina attacks, requiring a nitrate-free period to avoid tolerance.

Metabolic Antianginals

Agents like Ranolazine that modulate metabolism without major hemodynamic effects, indicated for chronic effort angina.

Beta Blockers (BBs)

Antianginal agents that provide negative heart rate and inotropic effects, reducing myocardial oxygen demand.

Calcium Channel Blockers (CCBs)

Antianginals that act as vasodilators and reduce preload, also decreasing myocardial oxygen demand.

Phosphodiesterase-5 Inhibitors

Medications that interact with nitrates, including vardenafil, tadalafil, and sildenafil, used for severe pulmonary hypertension.

Side Effects of Nitrates

Common adverse effects include hypotension, headache, syncope, tachycardia, and methemoglobinemia.

Contraindications for Nitrates

Conditions such as hypertrophic obstructive cardiomyopathy (HOCM), concurrent use of sildenafil, and right ventricular myocardial infarction (RVMI).