antianginaldrugs抗心绞痛药 ppt课件知识讲稿.pptVIP

Part 6 Antianginal Drugs;;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);Myocardial oxygen demand is chiefly determined by: Contractility Heart rate Wall tension Preload (venous return ) Afterload (arteriolar resistance) ;Myocardial oxygen demand is diminished by: Reducing contractility Reducing heart rate Reducing the preload Reducing the afterload;1. OVERVIEW;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 ;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: collateral circulation ? reducing wall tension: blood flow in ischemic subendocardial area ?;Influence of organic nitrates and dipyridamole on the blood supply of ischemic area;Mechanism of the effect of nitroglycerin and other nitrates;Mechanism of the effect of nitroglycerin and other nitrates;B. Clinical uses Angina pectoris: all kinds, especially stable type Heart failure：reducing heart loads due to vasodilation C. Adverse reactions Increase in heart rate and contractility Sympto