Introduction2.classfication劳累性心绞痛：心肌耗氧量增加时诱发。休息或硝酸甘油可以缓解。自发性心绞痛：与心肌耗氧量无明显关系。安静时也可以发生。硝酸甘油不能缓解。混合性心绞痛PATHOPHYSIOLOGYOFANGINA影响心肌耗氧量及供氧量的因素抗心绞痛药的共同作用机理Nitrates&Nitrites-blockersCalciumchannelblockersOthers1.NITRATES&NITRITES(硝酸酯类及亚硝酸酯类)Nitroglycerin(硝酸甘油)Isosorbidedinitrate(硝酸异山梨酯)Isosorbidemononitrate(单硝酸异山梨酯)Amylnitrite(亚硝酸戊酯)Pentaerythritol(季戊四醇)Mechanismofactionofnitrates,nitrites,andothersubstancesinvascularsmoothmusclecells.硝酸甘油(nitroglycerin)（1）DrugActionA.Decreasemyocardialoxygenrequirement舒张全身静脉和动脉改善左室顺应性：有利于血液从心外膜流向心内膜缺血区。B.Increaseoxygendelivery扩张冠状动脉：对较大冠脉也有舒张作用保护缺血的心肌细胞，减轻缺血损伤。扩张侧支循环C.ActiononplateletsTheincreaseincGMPthatresultsisresponsibleforadecreaseinplateletaggregation.Unfortunately,recentprospectivetrialshaveestablishednosurvivalbenefitwhennitroglycerinisusedinacutemyocardialinfarction.Incontrast,intravenousnitroglycerinmaybeofvalueinunstableangina,inpartthroughitsactiononplatelets.（2）ClinicalUse各种类型心绞痛：舌下含服急性心肌梗塞，减少梗死范围还可用于心衰、呼衰和肺动脉高压的患者OTHERNITRO-VASODILATORS2.BETA-BLOCKINGDRUG普萘洛尔(Propranolol)美托洛尔（metoprolol）阿替洛尔（atenolol）普萘洛尔(Propranolol)普萘洛尔(Propranolol)常用药物硝苯地平（1）Mechanism：Decreasemyocardialcontractileforce=>reducesmyocardialoxygenrequirements.Calciumchannelblockinarterialsmoothmuscle=>decreasesarterialandintraventricularpressure.Someofthesedrugs(eg,verapamil,diltiazem)alsopossessanonspecificantiadrenergiceffect,whichmaycontributetoperipheralvasodilationSmoothmuscle:Vascularsmoothmuscleappearstobethemostsensitive,butsimilarrelaxationcanbeshownforbronchiolar,gastrointestinal,anduterinesmoothmuscle.Inthevascularsystem,arteriolesappeartobemoresensitivethanveins;Dihydropyridines>diltiazemandverapamilCardiacmuscle（3）ClinicalUses：伴有支气管哮喘的患者有效。预防或治疗心绞痛，特别是变异型心绞痛疗效最佳。对稳定型心绞痛及急性心肌梗死等也有效。对心肌抑制作用较弱，较少诱发心衰。心肌缺血伴外周血管痉挛性疾病有效。其他抗心绞痛药物