Angina pectoris exertional

Evidence-Based Recommendations for Treatment of Stable Exertional Angina Pectoris... 

Bray CL, Jain S, Faragher EB, Myers A, Myers P, MacIntyre P, Rae A, Goldman M, and Alcorn M (1991) A comparison of buccal nitroglycerin and sublingual nitroglycerin in the prophylaxis and treatment of exertional (situation-evoked) angina pectoris. Eur. Heart J. 12 Suppl A 16-20. 

Gyceryl trinitrate is a vasodilator drug used for the relief of cardiac pain on exertion - angina pectoris. 

Angina pectoris Propranolol decreases O2 requirement and work of heart muscle and therefore is effective in reducing the chest pain on exertion which occurs in angina. 

The calcium channel blockers currently used to treat angina pectoris are listed in Table 22-3. Although the chemistry and exact mechanism of action of each drug are somewhat distinct, all of these agents exert their effects by limiting calcium entry into specific cardiovascular tissues. Certain calcium channel blockers are said to be selective if they affect vascular smooth muscle, but have little or no affect on the heart. Nonselective calcium channel blockers affect the vasculature and inhibit calcium entry into cardiac muscle cells. Individual agents are discussed below. 

Angina pectoris describes the classic symptoms of chest pain, and is caused by transient myocardial ischaemia. In stable angina, the blood flow through the coronary arteries may be limited due to the development of atherosclerotic plaques that restrict blood and therefore oxygen to the cardiac muscle myocardium. Episodes of angina are typically caused by exertion or emotion and are relieved by rest. 

Cardiac work furthermore depends strongly on the state of the circulation system physical rest or work demand appropriate cardiac performance the level of mean blood pressure is an additional decisive factor. Chronic elevation of afterload leads to myocardial insuf ciency. Therefore, all blood pressure-lowering drugs can have an important therapeutic influence on the myocardium. Vasodilator substances (e.g., nitrates) lower the venous return and/or peripheral resistance and, hence, exert a favorable effect in angina pectoris or heart failure. 

Patients A/lth angina pectoris or coronary artery disease should limit their exertion... 

This ginseng exerts a major effect on the cardiovascular system. It dilates the coronary vessels and reduces vascular resistance, which results in increased coronary flow and decreased blood pressure. Chinese traditional medicine used this ginseng to arrest bleeding, remove blood stasis, and relieve pain. Recent studies have shown that, in the treatment of angina pectoris, this herb can produce a 95.5% improvement in symptoms. The herb usually can stop bleeding in cases of respiratory bleeding or vomiting of blood. 

Patients suffering from angina pectoris should also use glyceryl trinitrate or isosorbide dinitrate as usual for pre-exertional prophylaxis 10 min before intercourse. They should be aware of the potentially fatal interaction of sildenafil (Viagra) with nitrates (see above, p. 545). 

Beta-adrenergic blocking agents are effective for the prophylactic therapy of exertional angina pectoris by reducing heart rate and the force of myocardial contraction. However, verapamil, nifedipine, and diltiazem are also effective for the prophylactic treatment of stable exertional angina. The combination therapy with beta-blockers and calcium-entry blockers is well tolerated, effective, and safe. 

Morphine may exert its well-known therapeutic effect in the treatment of angina pectoris and acute myocardial infarction by decreasing preload, inotropy, and chronotropy, thus favorably altering determinants of myocardial consumption and helping to relieve ischemia. Morphine... 

Angina of effort, ciassic angina, atheroscierotic angina Angina pectoris (crushing, strangling chest pain) that is precipitated by exertion and caused by increased Oj demand that cannot be met because of irreversible atherosclerotic obstruction of coronary arteries... 

Vasopressor drugs (vasodilators) are chiefly those employed for angina pectoris, cerebral or peripheral vascular disorders. Besides, there are a plethora of drug substances belonging to certain other classes, treated elsewhere in this text, do also exert vasoconstrictor as well as cardiostimulator activity which may be judiciously and appropriately employed to increase the prevailing blood pressure under suitable eonditions. 

It exerts vasodilator properties and is used in angina pectoris, heart failure and myocardial infarction. 

Emetine is emetic in oral doses of 10 to 20 mg. at higher dosage it depresses the heart and produces dilation of the coronary vessels, hence the suggestion that it be used in the treatment of angina pectoris (75). The emetic action is preserved by injection (chlorohydrate with dogs) even with simultaneous intravenous injection of procaine (76). It exerts a paralytic action on non-striated muscles and especially on the intestines... 

A synthetic coumarin derivative, carbochromene (76), has been applied to the treatment of angina pectoris [500]. This compound has a pronounced and sustained action on the coronary vessels, increasing the blood flow and oxygen by the heart muscle without exerting unwanted hemodynamic side-effects on blood pressure and peripheral circulation. 

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