Angina pectoris acute attack

Nitroglycerin has long been used for the treatment of acute attack of angina pectoris, and its stable analogs are available to prevent the anginal attack. Nitrovaso-dilators such as sodium nitropmsside liberate NO from their molecules in the tissue (thus, called NO donors) and elicit actions via cyclic GMP like those seen with endogenously synthesized NO. 

Acute relief of an attack of angina pectoris or prophylaxis of angina pectoris... 

On the other hand, insufficient NO production also causes serious medical problems. Many diseases such as hypertension, atherosclerosis and restenosis involve a deficiency of NO production. Therefore, a compound that can release NO under specific conditions can be used therapeutically to palliate NO underproduction. In fact, the best known NO donor, glyceryl trinitrate, has been used for over a century to relieve acute attacks of angina pectoris. 

Adrenoceptor blockade is a rational approach to the treatment of angina pectoris, since an increase in sympathetic nervous system activity is a common feature in acute anginal attacks. Based on their ability to reduce oxygen demand, all (3-blockers tested so far have also been shown to be effective in the treatment of second-... 

A 60-year-old man comes into the office complaining of chest pains that primarily occur in the early morning and do not appear to be associated with stress or exercise. Following coronary angiography and a positive ergonovine test you determine that this patient has angina pectoris as a result of coronary artery spasm. How would you (1) treat the patient to alleviate the acute attacks when they occur and (2) treat chronically to prevent their reoccurrence ... 

It is indicated in acute attacks (sublingually) and chronic prophylaxis (orally) of angina pectoris and coronary insufficiency. In acute myocardial infarction, CHF and acute LVF. 

It is indicated in pulmonary hypertension, prophylaxis of angina pectoris, post myocardial infarction therapy, CHF and acute LVF. It is not recommended for acute attacks of angina. 

Indications. An indication for nifedipine is angina pectoris (p.318). In angina pectoris, it is effective when given either prophylacti-cally or during acute attacks. Adverse effects are palpitation (reflex tachycardia due to hypotension), headache, and pretibial edema. 

In the past, the difficulties presented in the administration of drugs in the treatment of hypertensive emergencies were largely overcome with the use of nifedipine administered sublingually. The onset of action was rapid, and the drug was also used sublingually for the treatment of acute attacks of angina pectoris. Presently, two types of formulation of nifedipine are available, both intended primarily for peroral administration. The sustained-release formulation is... 

Angina pectoris strictly translated is pain in the pectoral region of the chest. Usually this is referred to simply as angina and the typical presentation is that of a crushing pain in the upper left side of the chest which may radiate into the neck or down the left arm. The pain is usually severe and often produces significant distress in the sufferer. This is referred pain that is brought about because of insufficient blood flow to the myocardium. In severe cases, it may be a symptom of acute coronary thrombosis (heart attack). 

Nitroglycerin is indicated for initial relief of acute angina pectoris and for prophylaxis to prevent or minimize anginal attacks when taken immediately before stressful events. Nitroglycerin has the following molecular structure ... 

Death In a registry-based study of 58 465 Swedish patients with diabetes aspirin significantly increased the risk of death in those without cardiovascular disease (previous or acute myocardial infarction, angina pectoris, ischemic stroke, transient ischemic attack, intermittent claudication, previous coronary artery bypass graft surgery, or percutaneous coronary intervention) by 17% (95% Cl = 1, 36) at age 50 years and by 29% (95% Cl = 16, 43) at age 85 years [70 ]. In elderly patients with diabetes with cardiovascular disease who used aspirin there was a non-significant trend towards reduced mortality, by 11% at age 85 years. The risk of serious bleeding was also increased by aspirin in those without cardiovascular disease and reduced by aspirin in those with cardiovascular disease. 

A similarly interesting case is that of a 68 year old male patient who was first seen in 1958 with symptoms of marked myocardial ischemia and electrocardiographic evidence of an old inferior myocardial infarction. Insulin dependent diabetes melli-tus had been present since 1932. In spite of diabetic control with diet and insulin in this subject, lipemia (approximately 2 gm neutral fat per 100 ml plasma) persisted and abdominal colics recurred. With heparin and later Depot-Thrombocid his neutral lipids ranged between 300—500 mg per 100 ml and clinical symptoms (angina pectoris and episodes of abdominal pain) improved considerably. An additional feature in this patient was gout with uric acid levels above 9 mg per 100 ml and attacks of acute gouty arthritis on several occasions between 1958 and 1959. 

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