12.2 A Flashcards
How is angina pectoris best described?
as discomfort in the chest or related areas
Angina pectoris is typically located where?
retrosternal but it may radiate to jaw, neck, shoulders, back, or arms
Angina pectoris is typically relieved with what?
rest or nitroglycerine
What is stable angina pectoris?
there has been no change in frequency, duration, precipitating factors, etc. in the past 60 days
More than half of those with CAD have experienced what other two issues?
angina pectoris and/or MI
The mainstay of treatment for CAD is what?
lipid lowering therapy
The best lipid lowering therapy for CAD is what?
a statin
What are PCSK9 inhibitors?
a monoclonal antibody that inhbits LDL receptor degradation, thus increasing LDL extraction from the blood and lowering blood cholesterol
What is alirocumab?
a PCSK9 inhibitor that reduces cholesterol
How effective are PCSK9 inhibitors?
shown to significantly reduce LDL levels in one year but outcome studies are still underway
Statins have what benefit over PCSK9 inhibitors?
in addition to lowering LDL, they lower triglycerides and raise HDL levels to a modest degree
What are the effects of niacin on lipid levels?
lowers LDL and cholesterol while raising HDL
What are fibrates, bile acid resins, and absorption inhibitors?
lipid lowering agents to be used as supplements to another lipid lowering treatment
What are the side effects of statins?
- myalgia/muscle complaints most common
- potentially serious myopathy
- elevated liver function tests and the potential for hepatotoxicity
PCSK9 inhibitors have what side effects?
nasopharyngitis, injection site reactions, joint pain
Fibrates have what side effects?
myopathy
Niacin has what side effects?
flushing and heptatoxicity
What are the four statin benefit groups?
- known ASCVD
- elevated LDL
- diabetics
- adults with risk of ASCVD
The Framingham Heart Study demonstrated what?
linked obesity to increased risk of heart failure
What are the three common acute coronary syndromes?
unstable angina
- non-ST segment elevation MI (NSTEMI)
- ST segment elevation MI (STEMI)
What are some possible medical therapies for CAD other than statins?
- aspirin
- beta blockers
- ACE inhibitors
- angiotensin receptor blockers
- thienopyridines
How can one modify their risk of CAD?
- smoking cessation
- dietary modification
- exercise
- cardiac rehab
- BP control
- diabetic control
Beta blockers are contraindicated by what?
asthma, severe COPD, bradycardia, advanced heart block
Beta blockers most often have what side effect?
fatigue
Clopidogrel, prasugrel, and ticagrelor are what?
alternatives for patients allergic to aspirin
ACE inhibitors are particularly beneficial for what class of post-MI patients?
those with LV systolic dysfunction (a limited ejection fraction)
How are ACE inhibitors disease modifying?
they prevent adverse cardiac remodeling
What are the side effects of ACE inhibitors?
cough and more rarely, angioedema
What is the benefit of giving nitrates? The drawback?
they reduce angina but are not disease modifying
STEMIs can be treated in what two ways?
PCI or fibrinolysis
NSTEMIs can be treated in what two ways?
conservatively with medical management or with PCI of the culprit vessel and medical management
Fibrinolytics is indicated for what?
STEMIs and acute ischemic stroke
Alteplase, reteplase, and tenecteplase are examples of what?
fibrinolytics
How do fibrinolytics work?
by converting proenzyme plasminogen to plasmin and relieving clots
What is the major risk of fibrinolytics?
intracranial bleeding
What is the primary anticoagulant used to treat acute coronary syndromes?
heparin
When is heparin given for ACS?
- those with high risk of embolization after STEMI
- thrombus propagation prevention with NSTEMI
What must be done when treating someone with heparin?
monitor their platelet counts daily
What is a distal protection PCI?
used to prevent embolic material from going downstream
What is intracoronary thrombectomy PCI?
use of a catheter to suck out the thrombus
What are some surgical options for those with CAD?
- coronary artery bypass grafting (CABG)
- valve repair/replacement
CABG patches are always used to treat unstable angina or NSTEMI when what is true?
they have left main disease
For multivessel CAD, the best treatment is what?
CABG patch
The most common causes of heart failure are what?
- CAD/ischemic heart disease
- hypertension
- valve dysfunction
What are the available disease modifying agents for heart failure?
- beta blockers
- ACE inhibitors/ARBs
- aldosterone antagonists
- hydralazine/isosorbide dinitrate combo
What are some symptomatic treatments available for heart failure?
- vasodilators
- loop diuretics
- nitrates
- digoxin
What is furosemide?
a loop diuretic used for symptomatic relief of heart failure
What is enalapril?
an ACE inhibitor used to treat heart failure
What is captopril?
an ACE inhibitor used to treat heart failure
What are valsartan and candesartan?
angiotensin receptor blcokers
Aldosterone blockades for heart failure are contraindicated for what?
those with renal disease or elevated sodium potassium because they elevate potassium
What are loop diuretics?
- improve renal performance to remove excess salt and water retention
- symptomatic relief of heart failure
Bradydysrhythmias are treated with what?
a pacemaker
What is a dual chamber pacemaker?
a pacemaker with leads in both the right atrium and ventricle
What is cardiac resynchronization therapy?
- aka biventricular pacing
- intended to restore synchronous right and left ventricular conduction
Cardiac resynchronization therapy is indicated for what patients?
- significant heart failure symptoms despite optimal medical therapy
- ejection fraction <35%
- delayed intraventricular conduction, particularly a left bundle branch block
Where does the lead go for the left ventricle in cardiac resynchronization therapy?
in the coronary vein because it would pose a clotting risk if it were in the left ventricle
ACE inhibitors affect what determinant of ventricular function?
afterload
Diuretics and nitrates affect what determinant of ventricular function?
preload
What are ICDs?
implantable cardioverter defibrillators
What are the primary prevention indications for ICDs?
- persistently low ejection fraction despite medical therapy
- hypertrophic cardiomyopathy with high risk of sudden cardiac death
ICDs are indicated for what secondary prevention following what?
- resuscitated sudden cardiac arrest not associated with acute MI
- hemodynamically significant sustained vtach or vfib
