浙江大学医学院：《药理学》课程教学资源（PPT讲稿）抗心绞痛药 Antianginal Drugs

Part 6 Antianginal Drugs Organic nitrates βreceptor blockers Calcium channel blockers

Part 6 Antianginal Drugs • Organic nitrates •  receptor blockers • Calcium channel blockers

1. OVERVIEW brachiocephalic left subclavian artery vena cava eft pulmonary arteries right pulmonary arteries left pulmonary veins right pulmonary veins -left atrium aorta right atrium left cardiac supenor pulmonary vein vena cava trunk right coronary left coronary eft ventricle ght ventricle ngl inferior vena cava apex vena cava Coronary vessels: blood supply for the heart

Coronary vessels: blood supply for the heart 1. OVERVIEW

lumen of vessel coronary ulceration cholesterol plaque Coronary atherosclerosis: cause ot cardiac ischemia

Coronary atherosclerosis: cause of cardiac ischemia

endocardium myocardium base of heart (heart muscle) coronary vessel epicardium (visceral pericardium) parietal pericardium fibrous pericardium (pericardial sac apex of heart Distribution of coronary arteries in the heart

Distribution of coronary arteries in the heart

AV Contractile Oxygen State Difference OXYGEN OXYGEN DEMAND SUPPLY Regional Heart Myocardial Rate ≠ Distnbution Wall Coronary Tension Blood ISCHEMIA Flow Coronary LV Ventricular Vascular Aortic Pressure Volume Resistance Pressure Ischemia(angina pectoris ) imbalance between oxygen demand and supply

Ischemia (angina pectoris ): imbalance between oxygen demand and supply

1. OVERVIEW Classification of angina pectoris: Exertional angina(劳累性心绞痛) Stable angina(稳定性心绞痛) Initialonset 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)

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

1. OVERVIEW Myocardial oxygen demand is chiefly determined by: Contractile State Contractility OXYGEN DEMAND Heart rate Heart Rate Wall tension Preload(venous return Wall Afterload (arteriolar resistance) Tension LV Ventricular Pressure Volume afterload preload

Myocardial oxygen demand is chiefly determined by: • Contractility • Heart rate • Wall tension • Preload (venous return ) • Afterload (arteriolar resistance) 1. OVERVIEW afterload preload

1. OVERVIEW Myocardial oxygen demand is diminished by. Reducing contractility Reducing heart rate Reducing the preload Wall tension↓ Reducing the afterload

Myocardial oxygen demand is diminished by: • Reducing contractility • Reducing heart rate • Reducing the preload • Reducing the afterload 1. OVERVIEW Wall tension 

1。 OVERVIEW nocardial oxygen AV Oxygen supply is chiefly Difference determined by: OXYGEN SUPPLY Regional Myocardial Distnbution Av oxyger n difference Regional myocardial Coronary Blood distribution Flow coronary blood flow vascularresistance, arterypressure Coronary Vascular Aortic Resistance Pressure

1. OVERVIEW •Myocardial oxygen supply is chiefly determined by: • AV oxygen difference • Regional myocardial distribution • coronary blood flow: • vascular resistance, artery pressure

1. OVERVIEW Effects of antianginal drugs Reducing oxygen demands Reducing heart rate and contractility Dilating systemic arteries and veins(l wall tension by lowering heart loads) Increasing oxygen supply Dilating conduct coronary arteries( t coronary blood flow) Promoting regional distribution(T in ischemic regions) Others: Anti-platelet coagulation and thrombus formation

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