Angina Pectoris and Pharmacologic Management

This set covers the definitions, types, clinical manifestations, and pharmacological treatments for angina pectoris as described in the lecture notes.

Angina Pectoris

A clinical syndrome characterized by episodes or paroxysms of pain or pressure in the anterior chest caused by insufficient coronary blood flow and decreased oxygen supply.

Stable Angina

Predictable and consistent pain occurring on exertion that is relieved by rest and/or nitroglycerin.

Unstable Angina

Also called preinfarction or crescendo angina; symptoms increase in frequency and severity and may not be relieved by rest or nitroglycerin.

Intractable or Refractory Angina

Severe, incapacitating chest pain.

Variant Angina (Prinzmetal's Angina)

Pain at rest accompanied by reversible ST-segment elevation, thought to be caused by coronary artery vasospasm.

Silent Ischemia

Objective evidence of ischemia, such as electrocardiographic changes during a stress test, reported without accompanying pain.

Retrosternal Area

The area deep in the chest behind the sternum where anginal pain is often felt.

Autonomic Neuropathy

A condition in patients with diabetes that can blunt nociceptor transmission, dulling the perception of pain during anginal episodes.

Dyspnea

A common presenting symptom of angina in older adults due to diminished pain transmission associated with aging.

Nitroglycerin

A potent vasodilator that reduces myocardial oxygen consumption by decreasing preload and, to a lesser extent, afterload.

Beta-Adrenergic Blocking Agents

Medications like metoprolol and atenolol that reduce heart rate, blood pressure, and myocardial contractility to balance oxygen demand and supply.

Negative Inotropic Effect

A decrease in the strength of myocardial contraction, a characteristic effect of calcium channel blockers including amlodipine and diltiazem.

Aspirin Dosage for New Angina

A dose of $162$ to $325\,mg$ is given at initial diagnosis, followed by a daily dose of $81$ to $325\,mg$.

Activated Partial Thromboplastin Time (aPTT)

A laboratory test used to monitor heparin therapy, with therapeutic values usually maintained at $2$ to $2.5$ times the normal value.

Heparin-Induced Thrombocytopenia (HIT)

An antibody-mediated reaction to heparin that results in a decreased platelet count or evidence of thrombosis.

Glycoprotein IIb/IIIa Agents

IV medications like abciximab or eptifibatide that prevent platelet aggregation by blocking receptors and the adhesion of fibrinogen.

Target Oxygen Saturation ($SpO_2$)

The clinical target for oxygen therapy in managing chest pain, typically maintained at $>95\%$ on room air.

Nitroglycerin Renewed Supply

Instruction to patients to replace their nitroglycerin supply every $6$ months to ensure the medication remains stable and volatile.