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3921 > 2 > Flashcards

2 Flashcards

1
Q

What are some major sites of blockage of coronary blood flow

A

Circumflex artery
Right coronary artery
Left anterior descending artery

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2
Q

What are two main causes of CAD

A

1) Atherosclerosis causing transient ischaemia

2) Coronary thrombosis (ruptured aetherosclerotic plaque causing occlusion)

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3
Q

Is angina a symptom or disease

A

Symptom

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4
Q

What does angina indiciate

A

Imbalance between oxygen supply and demand of heart

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5
Q

What is oxygen supply determined by (2)

A

Oxygen carrying capacity of the blood

Coronary blood flow that delivers oxygen to heart

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6
Q

What is oxygen demand determined by

A

Cardiac workload:

1) heart rate
2) cardiac contractility
3) BP

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7
Q

How is oxygen supply increased

A

Vasodilators

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8
Q

How is oxygen supply decrased

A

CAD

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9
Q

How is oxygen demand increased

A

Increased:
HR
force of contraction
BP (hypertension)

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10
Q

How is oxygen demand decreased

A

Nitrates and CCBs (decreased pre-load)

CCBs and B-blockers (decreased cardiac workload)

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11
Q

What are symptoms of angina

A

Heavy weight or pressure on the chest, pain in chest arm or neck

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12
Q

When can angina occur

A 
Exertion (stable)
Ruptured plaque (unstable)
Vasospasm (variant)
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13
Q

Why does CBF only occur during diastole

A

Pressure exerted by myocardium on coronary vessels during diastole > perfusion pressure

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14
Q

What occurs to diastole when heart rate increases

A

Shortens by a greater amount of systole

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15
Q

What is effective perfusion pressure equal

A

Difference between aortic and ventricular pressure

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16
Q

What receptors do large coronary vessels express vs small vessels

A

alpha1

beta2

17
Q

What are coronary vessels also innervated by outside of the sympathetic nerves

A

Purinergic, peptidergic and nitrergic nerves

18
Q

Which two drug classes are cardiac depressants

A

B-blockers and CCBs

19
Q

How do cardiac depressants work (2)

A

1) Reduce myocardial oxygen consumption

2) Increase myocardial perfusion by increasing duration of diastole

20
Q

Which two drug classes are vasodilators

A

Nitrates and CCBs

21
Q

How do vasodilators work

A

Dilate coronary arteries

22
Q

Which vessel type do nitrates also dilate that CCBs don’t

A

venous capacitance vessels

23
Q

What is the acute treatment of angina (2)

A

Rest

GTN tablets or spray

24
Q

How are nitrates metabolised

A

To release NO which activates guanyl cyclase to produce cGMP

25
Q

What is a fast acting vs short acting nitrate

A

GTN

Isosorbide dinitrate

26
Q

How do nitrates affect the three types of blood vessels

A

Coronary arteries - increase oxygen supply to heart
Arterial resistance - reduces total peripheral resistance and afterload
Venous capacitance vessels: decreases venous return and preload

27
Q

Common side effects and limitations of nitrates (6)

A 
Headache
Facial flushing
Postural hypotension
Dizziness
Tachycardia
Tolerance
28
Q

What are two b1 selective blockers

A

Atenolol (Tenormin)

Metoprolol (Betaloc)

29
Q

Common side effects of b1 selective blockers

A

Bradycardia
Bronchospasm/constriction (due to blocking circulating adrenaline)
Vasoconstriction (blocks B2) and fatigue

30
Q

What are contraindications of B blockers (4)

A

Asthma/COPD
Cardiac failure or heart failure
Raynaud’s disease
IDDM

31
Q

Three classes of CCBs

A

Dihydropyridines
Phenylakylamines
Benzothiazepines

32
Q

Which class of CCB does not block cardiac L-type Ca2+ channels

A

Dihydropyridines

33
Q

How do CCBs work

A

All bind to and block L-type Ca2+ in vascular smooth muscle, reducing systemic arterial pressure
Increases CBF
Block cardiac L-type Ca2+

34
Q

Side effects of CCBs (3)

A

Flushing
Headache
Reflex tachycardia

35
Q

Three emerging therapies

A

Inhibition of Na+ current (ranolazine)
Stimulation of ATP-activated K+ channels + nitrate action (nicorandil: Ikorel)
Inhibition of f channels (ivabradine: Coralan)

3921 (22 decks)

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