Angina Overview & Hemodynamic Targets
Module 1 · Visual Summary
The Supply-Demand Imbalance
Demand Up
Heart rate, contractility, and wall stress rise together with exertion or stress
Supply Limited
Coronary perfusion pressure, vascular resistance, and diastolic filling time govern how much blood reaches the heart muscle
Result
When demand exceeds supply, myocardial ischemia and angina occur
Three Subtypes of Angina
Fixed Supply Limitation
Stable Exertional
- Fixed atherosclerotic stenosis
- Predictable with exertion
- Relieved by rest or nitroglycerin
Pure Supply Failure
Vasospastic
- Coronary artery spasm
- Rest, early morning pattern
- Beta-blockers contraindicated
Small Vessel Disease
Microvascular
- Epicardial arteries normal
- Impaired microvascular dilation
- More common in postmenopausal women
Canadian Cardiovascular Society Classification
| Class | Clinical Description |
|---|
| I | Angina only with strenuous or prolonged exertion |
| II | Slight limitation; angina with brisk walking or stairs |
| III | Marked limitation; angina after one to two blocks |
| IV | Angina with any activity, possibly at rest |
The Four Pharmacological Levers
Lever 1
Preload Reduction
Organic nitrates
Lever 2
Afterload Reduction
Dihydropyridine calcium channel blockers
Lever 3
Heart Rate Reduction
Beta-blockers, non-dihydropyridine calcium channel blockers
Lever 4
Coronary Vasodilation
Nitrates, calcium channel blockers