Antianginal Drugs Ischemic Heart Disease Angina pectoris 59-291 Section 3, Lecture 5 Antianginal Drugs Ischemic Heart Disease Angina pectoris Chronic condition, episodic chest discomfort Occurs during transient coronary ischemia Myocardial infarction Acute and complete occlusion of a coronary artery Due to coronary thrombosis

Angina- episodic chest pains as a result of transient coronary ischemia (as opposed to myocardial infarction which is acute and complete occlusion of a coronary artery . angina (heavy weight or pressure or pain in the chest) occurs when blood (oxygen, nutrient) supply to the heart is limited as a result of : disruption of coronary blood flow because of vasospasm or platelet aggregation increased demand for oxygen evoked by physical exertions a combination of both

Vasospasm at rest or during sleep If the frequency and severity increases- forerunner to a MI If symptoms remains the same and angina occurs under similar circumstances

Drugs employed: Typical Variant MI Stable Unstable Organic nitrite and nitrates ++ ++ ++ + Ca2+-channel blockers ++ 0 to ++ +++ 0 - adrenergic Antagonists ++ ++ 0 +++ Aspirin + +++ 0 +++ Fibrinolytic drugs 0 0 0 +++ Antianginal drugs : -O2 increase supply and/or lower demand Myocardial O2 supply: Coronary blood flow, regional flow distribution Myocarial O2 –demand: amount of energy required to support the work of the heart Cardiac work influenced by: heart rate, heart contractility, myocardial wall tension

Vasodilators- organic compounds containing ONO or ONO2 (prodrugs) all release NO upon interacting with serum components.