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ا📙_ ANGINA PICTORIS
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💎_ #ANGINA
💎_ #Managment

📖_Angina Pictoris⑶

🔰_*Management*

🔹 _*Modify risk factors*:
🔻_stop smoking 🔻_encourage exercise
🔻_weight loss
🔻_Control hypertension, diabetes, etc., 
see section⇊.
( _Cardiovascular medicine_---- _cardiovascular health_ )
🔻_If total cholesterol & gt;
4mmol/L 
➫give a statin
📖_see section⇊.
( _Clinical chemistry➺ hyperlipidemia_ )

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🔹_*Aspirin*:
(75–150mg/24h) 
reduces mortality by 34%.

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🔹_*B-blockers*:
➫eg atenolol 
50–100mg/24h PO
reduce symptoms unless contraindicated⇊
➭asthma
➭COPD
➭LVF
➭bradycardia
➭coronary artery spasm

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🔹_*Nitrates*:
🔻_for symptoms
➫give GTN spray or sublingual tabs
up to every ½h.
🔻_Prophylaxis:
➫give regular oral nitrate
eg ➭isosorbide mononitrate 
20–40mg PO bd
(have an 8h nitrate-free period to prevent tolerance) 
or slow-release nitrate (eg Imdur® 60mg/24h).
🔻_Alternatives:
adhesive nitrate skin patches or buccal pills.
🔻_SE:
➫headaches
➫BP↓

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🔹_*Long-acting calcium antagonists*:
➫amlodipine 
10mg/24h

➫diltiazem-MR 
90–180mg/12h PO.
➭They are particularly useful if there is a contraindication to β-blockers.

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🔹_*K+ channel activator*:
➫eg nicorandil 10–30mg/12h PO
if still not controlled

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🔹_*Others*:
🔻_ivabradine inhibits the pacemaker (‘funny’) current in the SA node and thus reduces heart rate
➫Useful in those who cannot take a β-blocker, having similar efficacy
🔻_Trimetazidine inhibits fatty acid oxidation, leading the myocardium to use glucose, which is more efficient
🔻_Ranolazine inhibits the late Na+ current
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☢_Unstable angina requires admission and urgent treatment:
➫emergencies
📖see section⇊.
_Emergencies----acute management of ACS without ST-segment elevation_
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🌐_Read more...👇🏻
Angina Pictoris - http://bestmedicalteam.blogspot.com/2017/03/angina-pictoris_17.html

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📚_*Reference ⇊*
Oxford handbook of clinical medicine 9edation
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✍🏻l_Abdulbast Al-gabry
💐💐💐
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🌺BEST MEDICAL TEAM💐
💐💐..
With Regards
👤l_Abdulbast Algabry 🌺
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