AntianginalDrugs抗心绞痛药__培训课件.ppt

Part 6 Antianginal Drugs Organic nitrates ?? receptor blockers Calcium channel blockers Coronary vessels: blood supply for the heart 1. OVERVIEW Coronary atherosclerosis: cause of cardiac ischemia Distribution of coronary arteries in the heart Ischemia (angina pectoris ): imbalance between oxygen demand and supply Classification of angina pectoris: Exertional angina (劳累性心绞痛) Stable angina (稳定性心绞痛) Initial onset angina (初发型心绞痛) Accelerated angina (恶化性心绞痛) Spontaneous angina (自发性心绞痛) Angina decubitus (卧位型心绞痛) Variant or vasospastic angina (变异性[痉挛性]心绞痛) Acute coronary insufficiency (急性冠脉功能不全) Postinfarction angina (梗死后心绞痛) Mixed angina (混合性心绞痛) Unstable angina (不稳定性心绞痛) 1. OVERVIEW Myocardial oxygen demand is chiefly determined by: Contractility Heart rate Wall tension Preload (venous return ) Afterload (arteriolar resistance) 1. OVERVIEW preload afterload Myocardial oxygen demand is diminished by: Reducing contractility Reducing heart rate Reducing the preload Reducing the afterload 1. OVERVIEW Wall tension ? 1. OVERVIEW Myocardial oxygen supply is chiefly determined by: AV oxygen difference Regional myocardial distribution coronary blood flow: vascular resistance, artery pressure Effects of antianginal drugs: Reducing oxygen demands Reducing heart rate and contractility Dilating systemic arteries and veins ( ? wall tension by lowering heart loads) Increasing oxygen supply Dilating conduct coronary arteries ( ? coronary blood flow) Promoting regional distribution ( ? in ischemic regions) Others: Anti- platelet coagulation and thrombus formation 1. OVERVIEW 2.1 Nitrates Nitroglycerin (硝酸甘油) A. Pharmacological actions Dilating vessels and reducing heart loads wall tension ?; reflex tachycardia Redistribution of coronary circulation dilating conduct artery: co