Now let's look at drugs for
angina pectoris. Now,
I have heard people say this multiple
different ways. So,
I'm not sure on your part of the country, I've
heard everything from angina, to angina.
So however you want to say it, I
just usually say chest pain,
but the official diagnosis
is angina pectoris,
or however you want to pronounce it.
Now, there are 4 families
of antianginal agents.
These are drugs that we use
to treat chest pain.
So as we're starting to look at the drugs,
I just want you to tell yourself,
"Hey, listen, there are only 4 families
or groups of drugs that we're going
to talk about in this video."
So let's look at the first one.
It's the one that everyone sees on TV, right?
We're going to look at organic nitrates.
An example of that, first of the
4 families is nitroglycerin.
The second of the 4 families
are beta blockers,
like propranolol, metoprolol.
Those -- both end in "olol."
Remember, that's a clue when
you're studying medications.
The generic name of beta blockers
have that "olol" response.
Next, is calcium channel blockers.
1 example is verapamil.
So, that will help us also
in treating chest pain.
So we've talked about the first 3 families:
nitrates, beta blockers, and
calcium channel blockers.
Now, you probably heard of nitrates
before you watch this video.
Beta blockers, if you've looked at
our videos on hypertension,
we've already talked about those, as
we have calcium channel blockers.
But we're going to talk
a little bit differently
about the application of these
medications when we're talking
about treating chest pain.
The fourth group may actually
be the newest to you,
because it's the newest to us, ranolazine.
This is a new drug and it's got
some limited indications,
but when it's used appropriately,
it can be quite helpful.
It's now approved as a first line
therapy for chest pain.
So it's moving up in the ranks. We usually
combine it with other drugs.
So there you have it.
Before we start rolling into this, you've
got the framework to look at.
You can tell yourself, "There's 4
families of drugs
that we use for chest pain: nitrates,
beta blockers, calcium channel
blockers, and ranolazine.
That's all there is. Now let's break
each one of these families down.
Now, angina pectoris, there are 3 types.
So we talked about 4 different types of
drugs that we use to treat chest pain,
but I want you to focus on the concept of
3 different types of chest pain.
They have different causes --
they all 3 hurt, but they
have different causes,
and so, that's what we want to focus on
so you understand why we treat them
just a little bit differently.
Now, you've got prinzmetal angina, which
is also known as variant angina.
So write the word "variant" above
that first red box.
Those are caused by vasospasms,
where the vessels just --
they just, literally, spasm. They clamp down,
which is why it's in a supply ischemia.
Supply means we're having a supply issue.
There's not an appropriate amount of
blood getting to the heart tissue.
Ischemia means there's still hope.
If we can educate our patients and
we can intervene quick enough,
hopefully, we can restore blood
supply to that tissue,
and keep healthy heart tissue.
Now, the next 2 are similar, but I'm going
to walk you through how it's different.
Chronic stable angina is usually caused
because they've got some
coronary artery disease, those arteries
are kind of filled up with some plaque,
and that means they did something,
chronic stable angina.
In my part of the country, this always
happens in the winter.
We see a lot of cases in the ER where
we get a random snow
and somebody gets the bright idea to
go out and shovel their driveway
for the first time in years.
So they really exert themselves.
Well, because of that extra activity,
that extra demand
that they've placed on their heart, they
end up having chest pain.
That's because they don't have fantastic
blood supply to their heart,
but for normal daily life, it's okay.
But then when they go and
do the manly thing,
and try and shovel their driveway,
they end up putting a greater
demand on their heart,
and that's why chronic stable angina
is considered demand ischemia.
Now the last one, they've cleverly putting –
"they've cleverly putting" --
they've cleverly placed a triangle
for you there with a
big exclamation point in it.
You can further circle and star that,
whatever format works for you,
because this isn't a medical emergency.
This is a life-threatening emergency.
When we say unstable angina,
now this is someone who maybe
had chronic stable angina
or maybe did not,
but at this point, it's caused by a
thrombus, that means a clot.
So if they had some coronary artery
disease, something broke off,
traveled through the blood supply.
Now just become a plug or a stopper.
And so, this is something that needs
huge attention, right?
This is the -- someone who goes straight
to the front of the line.
They come in in an ambulance, or
if they walk into our ER,
and they show us these signs and symptoms,
they get taken right back to
a bed immediately.
Because it's a supply ischemia that's going
to quickly turn into infarction
if we don't intervene because we don't
just have a spasm,
like we do in variant angina.
We don't just have a demand ischemia,
where if I can get you to lay
down and relax
and just take some simple medications,
you're probably going to feel better.
This is, "Oh my goodness, the blood supply
has been cut off to the heart muscle.
This is an emergency,"
because we've got to do
because it's a supply issue that cannot be
fixed unless we deal with that clot.