Slide APS Alif

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STABLE ANGINA

PECTORIS

Andi Alif Buanama N

C111 09 768



DEFINITION

Stal! an"ina# $lini$al %&nd'(m! $)a'a$t!'i*!d & di%$(mf('t in

$)!%t+ ,a-+ %)(uld!'+ a$. (' a'm% Elicited by exertion or emotional stress

Relieved by rest or nitroglycerin

T!'m% i% u%uall& $(n/n!d t( $a%!% in -)i$) t)! %&nd'(m! $an! att'iut!d t( m&($a'dial i%$)a!mia



EPIDEIOLOG

T)! 2'!3al!n$! (f an"ina in$'!a%!% %)a'2l& -it) a"! in (t)

%!4!% f'(m 0511 in -(m!n a"!d t( 101 in-(m!n a"!d 67 and f'(m : in m!n a"!d t( 10:0 in m!n a"!d 675

T)!'!f('!+ it $an ! !%timat!d t)at in m(%t Eu'(2!an $(unt'i!%+:0 0000 000 indi3idual% (f t)! 2(2ulati(n 2!' milli(n%u;!' f'(m an"ina5



PAT<OP<SIOLOG OF ANGINA



SPTOS OF STABLE ANGINA PECTORIS

T)! 2ain (' di%$(mf('t#

Occurs when the heart must work harder, usually during physicalexertion

Doesn't come as a surprise, and episodes of pain tend to be alike

Usually lasts a short time ! minutes or less"

#s relieved by rest or medicine

$ay feel like gas or indigestion

$ay feel like chest pain that spreads to the arms, back, or other areas



E=AL>ATION OF PATIENTS ?IT<CLINICAL SPTOS OF ANGINA

@1



CLASSIFICATION OF ANGINA



ANTI ANGINAL DR>GS

Aim% (f t'!atm!nt

%o improve prognosis by preventing myocardial infarction and death

Reduce plague progression

&tabilie pla(ue

)revent thrombosis if endothelial dysfunction or pla(ue rupture occur

%o mininie or abolish symptoms



P<ARALOGICAL AGENTS TO RED>CE SPTOS AND ISC<EIA



NITRATES

S)('t a$tin" nit'at!% Rapidly acting formulations of nitroglycerin provide e*ective symptom relief

in connection with attacks of angina pectoris, and may be used for+situational prophylaxis-

%he pain relieving and anti.ischaemic e*ects are related to venodilatationand reduced diastolic /lling of the heart reduced intracardiac pressure",which promotes subendocardial perfusion-

L(n" a$tin" nit'at!%

%reatment with long.acting nitrates reduces the fre(uency and severity ofanginal attacks, and may increase exercise tolerance-

&tudies of long acting nitrate treatment after myocardial infarction havefailed to show prognostic bene/t-

Due to nitrate tolerance, patients treated with long acting nitrates shouldhave a +nitrate free interval each day to preserve the therapeutic e*ects-



ANTIT<ROBOTIC DR>GS

Anti2lat!l!t t)!'a2& t( 2'!3!nt $('(na'& t)'(m(%i% i% indi$at!d+ du!t( a fa3(u'al! 'ati( !t-!!n !n!/t and 'i%. in 2ati!nt% -it)%tal! CAD5

L(-d(%! a%2i'in i% t)! d'u" (f $)(i$! in m(%t $a%!%+ and $l(2id("'!lma& ! $(n%id!'!d f(' %(m! 2ati!nt%5



L(-d(%! a%2i'in

0spirin remains the cornerstone of pharmacological prevention of arterialthrombosis-

#t acts via irreversible inhibition of platelet 1O2.3 and thus thromboxaneproduction, which is normally complete with chronic dosing 4! mg5day-

Cl(2id("'!l

1ompared with aspirin 67! mg5day, clopidogrel 4! mg5day was slightly more

e*ective 0RR 8-!39 per year: ) ; 8-8<6" in preventing cardiovascularcomplications in high risk patients-

=astrointestinal haemorrhage was only slightly less common with clopidogrelwhen compared with aspirin treatment

1lopidogrel is much more expensive than aspirin, but may be considered inaspirin intolerant patients with signi/cant risks of arterial thrombosis-



B BLOCER

B!ta1 l($.ad! & m!t(2'(l(l (' i%(2'(l(l )a3! !!n %)(-n

t( !;!$ti3!l& '!du$! $a'dia$ !3!nt% in 2ati!nt% -it)$(n"!%ti3! )!a't failu'!5

A n(n%!l!$ti3! !tal($.!' al%( l($.% al2)a1 '!$!2t('%+ al%('!du$!% 'i%. (f d!at) and )(%2itali%ati(n% f(' $a'di(3a%$ula'$au%!% in 2ati!nt% -it) )!a't failu'!



ALGORIT< OF TREATENT



T<AN O>

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