目的
- Describe angina etiologies (狭心症の病因
- Discuss the pathophysiology of angina (病態生理
- Review the pharmacology of angina treatments, including: (薬物治療）
語彙
Orthostatic hyportension, Contraindications など
Pathophysiology
- Oxygen Demand : •Wall Stress•Intraventricular pressure •Ventricular radius (volume)•Wall thickness •Heart rate Contractility
- Oxygen Supply: Coronary blood flow→ Vascular resistance
Drug Classes
Nitrates, Beta-blockers, Calcium channel blockers, Ranolazine
Treatment algorithm
•Angina of Effort: Beta-blockers, CCBs, long-acting nitrates
•Vasospastic Angina: Nitrates, CCBs •NOT beta-blockers or surgery
•Unstable Angina: •Antiplatelet therapy (clopirogrel [US: Plavix] and aspirin)•Heparin or LMWH (ex. Enoxaparin [US: Lovenox]) •With PCI/stenting: abciximab•ACE-I, statins, nitrates, beta-blockers, and CCBs
Shimpei section – Management of Stable Angina
● Objectives
Understand primary goals of treatment for stable angina (安定型狭心症の治療の目的を学ぶ)
Design both non-pharmacologic and pharmacologic treatment plan (非薬物療法と薬物療法の治療プランを計画できる)
● Goals of Treatment
① Relieve acute symptoms 急性症状を緩和する
② Prevent further chest pain episodes 虚血の予防
③ Minimize treatment adverse effects 副作用の最小化
④ Prevent complications such as MI or death 合併症の予防
●Management of stable angina (安定型狭心症治療について）
QOL↑
Nitroglycerin s/l for acute treatment. Also, use long-acting nitrates, beta-blockers and/or long acting CCB for chronic treatment.
Mortality↓
ACE, anti-platelets and statin for most patients.
