{"id":6220,"date":"2021-08-24T02:57:48","date_gmt":"2021-08-24T00:57:48","guid":{"rendered":"https:\/\/meddists.com\/learn\/clinical\/cardiology\/debrecen-university\/angina-pectoris\/"},"modified":"2021-08-24T02:58:09","modified_gmt":"2021-08-24T00:58:09","slug":"angina-pectoris","status":"publish","type":"page","link":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/cardiology\/angina-pectoris\/","title":{"rendered":"Angina pectoris"},"content":{"rendered":"\n

Lifestyle modification<\/h3>\n<\/span>\n\n<\/span>\n

Pharmaceutical<\/h3>\n<\/span>\n\n\n

The treatment of angina is generally classified into prognosis-improving therapy <\/strong>and quality of life-improving therapy.<\/strong><\/p>\n\n\n<\/span>\n

Prognosis improving therapy<\/h4>\n<\/span>\n\n\n

There are 4 drug classes that can improve the prognosis of stable angina:<\/p>\n\n\n\n

  • ACE inhibitors<\/strong>
    • Perindopril <\/strong>and lisinopril<\/strong>
      • Long duration — 1x5mg<\/li><\/ul><\/li>
      • Ramipril<\/strong>
        • Shorter duration — 2x5mg<\/li><\/ul><\/li>
        • Captopril is no longer used because of its short duration of action
          • The first ACE inhibitor<\/li>
          • Used in hypertensive crisis<\/li><\/ul><\/li><\/ul><\/li>
          • Beta-blockers<\/strong>
            • Bisoprolol<\/strong>
              • Long duration — 1x5mg<\/li>
              • Used mostly in women due to erectile dysfunction in men<\/li>
              • Widely used by medical students before an exam to prevent tachycardia, trembling, and sweating (do not try this at home!<\/strong>)<\/li><\/ul><\/li>
              • Nebivolol<\/strong>
                • Vasodilatory beta-blocker (produces NO in endothelial cells), may cause peripheral reddening of the skin<\/li><\/ul><\/li><\/ul><\/li>
                • Statins<\/strong>
                  • Taken in the evening, as cholesterol synthesis is most prominent at night<\/li>
                  • Side effects:
                    • Elevation of transaminase enzyme<\/li>
                    • Muscular pain<\/li>
                    • Rhabdomyolysis (rare)<\/li><\/ul><\/li>
                    • Atorvastatin<\/strong>
                      • 1x20mg at the evening<\/li><\/ul><\/li>
                      • Rosuvastatin<\/strong>
                        • x2 more ponent than atorvastatin (1x10mg)<\/li><\/ul><\/li><\/ul><\/li>
                        • Thrombocyte-aggregation inhibitors<\/strong>
                          • Aspirin<\/strong>
                            • Irreversible acetylation of COX<\/li>
                            • Loading dose — 500mg<\/li>
                            • Maintenance dose — 100mg<\/li><\/ul><\/li>
                            • Clopidogrel<\/strong>
                              • In patients with GI problems<\/li>
                              • 300mg loading dose<\/li>
                              • 75mg maintenance dose<\/li><\/ul><\/li><\/ul><\/li><\/ul>\n\n\n<\/span>\n

                                Quality-of-life-improving therapy<\/h4>\n<\/span>\n\n\n
                                • Nitrates<\/strong>
                                  • Come in many forms:
                                    • Patches (long-term)<\/li>
                                    • Chewable tablets<\/li>
                                    • Spray
                                      • Superior to chewable tablets, since patients with an angina attack will suffer from xerostomia<\/li><\/ul><\/li><\/ul><\/li>
                                      • Nitrate should not be used continuously since the reducing agent (glutathione) is being used up, and we should give time for the liver to re-synthesize it<\/li><\/ul><\/li>
                                      • Calcium-channel blockers<\/strong>
                                        • Amlodipine<\/strong>
                                          • 1x5mg<\/li><\/ul><\/li><\/ul><\/li>
                                          • Funny-current channel inhibitor<\/strong>
                                            • Ivabradine<\/strong>
                                              • Won’t be effective in bradycardia<\/li>
                                              • 2x5mg<\/li><\/ul><\/li><\/ul><\/li><\/ul>\n\n\n<\/span>\n

                                                Device therapy<\/h4>\n<\/span>\n\n\n
                                                • PCI — Percutaneous coronary intervention<\/strong>
                                                  • Stent implantation<\/strong>
                                                    • Not suitable for patients with coronary arteries with a diameter of >2mm<\/li><\/ul><\/li>
                                                    • POBA — Plain old balloon angioplasty<\/strong><\/li><\/ul><\/li><\/ul>\n<\/span>

                                                      Lifestyle modification<\/h3>

                                                      Pharmaceutical<\/h3>

                                                      Prognosis improving therapy<\/h4>

                                                      Quality-of-life-improving therapy<\/h4>

                                                      Device therapy<\/h4><\/div>","protected":false},"excerpt":{"rendered":"

                                                      Lifestyle modification Pharmaceutical The treatment of angina is generally classified into prognosis-improving therapy and quality of life-improving therapy. Prognosis improving therapy There are 4 drug classes that can improve the prognosis of stable angina: ACE inhibitors Perindopril and lisinopril Long duration — 1x5mg Ramipril Shorter duration — 2x5mg Captopril is no longer used because of its short duration of […]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":410,"menu_order":2,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-6220","page","type-page","status-publish","hentry"],"yoast_head":"\nAngina pectoris – Meddists<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/cardiology\/angina-pectoris\/\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" 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