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The research focused on nitrates and sulfhydryl compounds with their various pharmacological types and their effect on heart disease (angina pectoris) because they pose a fatal danger and threaten people's lives, especially in the city of Samawah / Iraq, because the city was exposed to environmental pollution, fuels, wars, social life, poverty and the psychology of the individual, these factors On the increase in the death rate of patients, and sudden cardiac arrest and heart failure, the most prominent of which was angina pectoris. The research period was for a year 2022-2023. We randomly collected 950 patients of both sexes, especially after the age of 40 years, who start having heart symptoms in Samawah General Teaching Hospital and the Specialized Center for Diabetes. and endocrine,Through daily work using and developing nitrates and their effectiveness for patients of all kinds, and trying to avoid the barrier tolerance that loses the action of nitrates and the depletion of sulfhydryl’s from cells, we used to , (ACE Inhibitors , B-Blockers , Ca+2 Channel blockers , Angiotensin II Receptor, Antihistamine ,diuretic , Anti serotine ,Aspirin (platelet inhibitor, Anticoagulants , Thrombolytic Agents ,Antidepressants, syrup Anti sputum NAC (N-Acetyl cysteine ) In addition to various drugs for the treatment of angina pectoris and drugs for chronic diseases that accompany the most deadly diseases in the development of heart diseases, in different and calculated doses, but all attempts were disappointing. The effect of depletion of the sulfhydryl compound (SH grup) was depleted by the cells, Except in cases of seizure, intermittent exercise, and stress, effort , nitroglycerin is clear and beneficial. However, repeated and continuous exposure to high doses of organic nitrates leads to a noticeable attenuation in most of its side effects, such as a decrease in the ability of vascular smooth muscles to convert nitroglycerin into nitrogen oxide, or true vascular endurance, we used Multiple and multiplying mechanisms to benefit from nitrates for angina pectoris Diagnosis, treatment, and outcome, with the formula: Patient condition = therapeutic dose = heart attack = benefit from nitrates. It leads to the emergence of symptoms of angina, so the treatment was carried out as part of a comprehensive treatment program, And the most effective approach to nitrates to restore the response is to interrupt treatment 6-8 hours (rest period), which allows to restore efficacy. Most patients after the age of 40 years who suffer from heart diseases and chronic and accompanying (diagnostic-therapeutic program) found it 90% of patients when taking nitrates and patients Those who suffer from coronary arteries to dilate and widen and with narrowing of blood vessels, the benefit was ±85% (the diameter of the vessel in the coronary artery was 200 micrometers, the response was high, while those of < 100 respond to the minimum), and the myocardial oxygen demand decreased ±65%, while the angina Unstable pectoralis ( Acute coronary syndrome (ACS) >>> (I.C.U ( plays a major anti-platelet role (platelet inhibitors, Anticoagulants, Thrombolytic Agent ), so nitrates, beta-blockers, and calcium channel blockers are additionally effective. As for stenting (PCI) and cardiac surgery, a procedure to save the patient's life, the effect of nitrates was ±60% , As for urgent myocardial infraction(MI ) >>> (I.C.U ( Although nitroglycerin is commonly given to relieve ischemic pain, all practical evidence indicates that nitrates improve mortality by 40%, a small percentage. According to the American Association / American College of Cardiology (AHA / ACC)) nitrates should not be used in the case of low blood pressure because the direct cause of myocardial infarction is intracoronary thrombosis, so reperfusion treatments are very important and coronary interventions (PCI) uses stents, thrombolytic and platelets Patient life-saving ± 80% , As for the case of congestive heart failure, nitrates are not recommended and do not improve the death rate. Only isosorbide dinitrite (binary) can be given at night only. It can improve (orthopnea), reduce low voltage(effort) on the ventricles, reduce pulmonary congestion, and increase cardiac output in patients at a rate of ± 2% with extreme caution. As for Angina All stable types benefited from nitrates by 80% ± , As an adjuvant within the treatment of angina pectoris. Those who did not respond to nitrates were replaced with calcium channel blocker , diltiazem, or carvedilol. It is not recommended to give nitrates and sudden withdrawal from them due to the emergence of side effects, instability of the patient, common headache, shortness of breath, and distance, Risk factors and control of chronic and accompanying diseases ± 70% It was very useful and effective for patients, The general rate of stability of cardiac conditions within the program ± 75% .
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