Angina : Definition: Angina is chest pain or discomfort that occurs when an area of the heart is deprived of oxygen. It is typically described as a crushing or squeezing sensation in the chest and may radiate to the jaw, shoulders, arm or back. It is usually a symptom of underlying heart disease, such as coronary artery disease. Angina can be classified into two i.e Stable Angina and Unstable Angina
Stable Angina - Usually results from atherosclerotic plaques in the coronary arteries. Acute attacks of stable angina should be managed with (1) Nitrates - Glyceryl trinitrate, Isosorbide dinitrate
(2) Antiplatelet drugs - Aspirin
(3) Calcium-channel blockers - Verapamil , Diltiazem,Nifedipine, nicardipine, amlodipine, and felodipine
(4) Other antianginal drugs - Nicorandil and Ivabradine
Unstable Angina - usually due to plaque rupture and may occur either in patients with a history of stable angina or in those with previously silent coronary artery disease. Unstable angina (UA) (also "c
Atrial fibrillation : The ventricular rate in atrial fibrillation can be controlled with a beta-blocker or diltiazem.or verapamil. Digoxin is usually effective for controlling the rate at rest; it is also appropriate if atrial fibrillation is accompanied by congestive heart failure. If the rate at rest or during exercise cannot be controlled, diltiazem or verapamil may be combined with digoxin, but care is required if the ventricular function is diminished. In some cases, e.g. acute atrial fibrillation or paroxysmal atrial fibrillation, diltiazem or verapamil or a beta-blocker may be more appropriate than digoxin (see also Paroxysmal Supraventricular Tachycardia and Supraventricular Arrhythmias below). Anticoagulants are indicated especially in valvular or myocardial disease, and in the elderly; in the very elderly the overall benefit and risk needs careful assessment. Younger patients with lone atrial fibrillation in the absence of heart disease probably do not need anticoagulation. Aspirin is less effect than warfarin at preventing emboli but may be appropriate if there are no other risk factors for stroke; aspirin 75 mg may be used.
Atrial flutter : The ventricular rate at rest can sometimes be controlled with digoxin. Reversion to sinus rhythm (if indicated) may be achieved by appropriately synchronised d.c. shock. Alternatively, amiodarone may be used to restore sinus rhythm, and amiodarone or sotalol to maintain it. If the arrhythmia is long-standing a period of treatment with anticoagulants should be considered before cardioversion to avoid the complication of emboli.
Drugs used - Digoxin, Amiodarone and Sotalol