Lecture notes
Cardiovascular System 6: Antianginal Drugs
- Module
- Systems of the Body 1
- Institution
- University Of Bristol (UOB)
A detailed summary of different types of angina and the preventative drugs used for treatment.
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ANTIANGINAL DRUGSAngina – chest pain/discomfort as coronary circulation is deprived of oxygen via narrowing.
CAUSES
Restriction in blood supply.
Severe anaemia.
Vasospasm in coronary arteries (drugs).
Atheroma (fat lump in vessels).
Thrombus (blood clot in artery).
TYPES OF ANGINA
1. Chronic Stable Angina (exercise induced).
2. Unstable Angina (rupture of atherosclerotic plaque, blood clot forming).
3. Prinzmetal’s (angina inversa) – due to vasospasm.
STABLE ANGINA – Decrease in diameter of blood vessel with a deposit of lipid content, no
rupturing of endothelium.
UNSTABLE ANGINA – Have a thrombus which breaks through blood vessel and can cause a
heart attack.
Genetic Hypercholesterolemia – linked to myocardial infarctions.
Increase in HDL/LDL ratio (with statins) can reduce heart attack incidence.
Key to remember for HDL/LDL’s is that low LDL levels is not as important as maintaining a
high HDL/LDL ratio.
ATHEROMA
Damage to endothelium, allowing cholesterol accumulation (inflammatory
response).
Monocyte invasion then follows which are in turn converted to foam cells (filled
with lipids).
Foam cell degeneration occurs; stimulating calcium salt deposition causing stiffness.
PREVENTION
1. HMG CoA Reductase Inhibitors
HMG CoA Reductase enzyme is the rate limiting step in production of
cholesterol.
Lovastatin and Atorvastatin inhibit this enzyme; therefore, leading to
reduced cholesterol and increased LDL receptor expression, which reduces
LDL levels in blood.
Irreversible inhibition and administer one tablet a day.
Side effect: Rhabdomyolysis.
2. Fibrates
Agonists of PPAR-alpha receptor.
Increase Beta-oxidation in liver, HDL and lipoprotein lipase activity.
Examples: Bexafibrate and Ciprofibrate.
Side effects: Increased risk of gallstones and rhabdomyolysis.
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