2

Question 1

What are some major sites of blockage of coronary blood flow

Answer 1

Circumflex artery
Right coronary artery
Left anterior descending artery

Question 2

What are two main causes of CAD

Answer 2

1) Atherosclerosis causing transient ischaemia

2) Coronary thrombosis (ruptured aetherosclerotic plaque causing occlusion)

Question 3

Is angina a symptom or disease

Answer 3

Symptom

Question 4

What does angina indiciate

Answer 4

Imbalance between oxygen supply and demand of heart

Question 5

What is oxygen supply determined by (2)

Answer 5

Oxygen carrying capacity of the blood

Coronary blood flow that delivers oxygen to heart

Question 6

What is oxygen demand determined by

Answer 6

Cardiac workload:

1) heart rate
2) cardiac contractility
3) BP

Question 7

How is oxygen supply increased

Answer 7

Vasodilators

Question 8

How is oxygen supply decrased

Answer 8

CAD

Question 9

How is oxygen demand increased

Answer 9

Increased:
HR
force of contraction
BP (hypertension)

Question 10

How is oxygen demand decreased

Answer 10

Nitrates and CCBs (decreased pre-load)

CCBs and B-blockers (decreased cardiac workload)

Question 11

What are symptoms of angina

Answer 11

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

Question 12

When can angina occur

Answer 12

Exertion (stable)
Ruptured plaque (unstable)
Vasospasm (variant)

Question 13

Why does CBF only occur during diastole

Answer 13

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

Question 14

What occurs to diastole when heart rate increases

Answer 14

Shortens by a greater amount of systole

Question 15

What is effective perfusion pressure equal

Answer 15

Difference between aortic and ventricular pressure

Question 16

What receptors do large coronary vessels express vs small vessels

Answer 16

alpha1

beta2

Question 17

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

Answer 17

Purinergic, peptidergic and nitrergic nerves

Question 18

Which two drug classes are cardiac depressants

Answer 18

B-blockers and CCBs

Question 19

How do cardiac depressants work (2)

Answer 19

1) Reduce myocardial oxygen consumption

2) Increase myocardial perfusion by increasing duration of diastole

Question 20

Which two drug classes are vasodilators

Answer 20

Nitrates and CCBs

Question 21

How do vasodilators work

Answer 21

Dilate coronary arteries

Question 22

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

Answer 22

venous capacitance vessels

Question 23

What is the acute treatment of angina (2)

Answer 23

Rest

GTN tablets or spray

Question 24

How are nitrates metabolised

Answer 24

To release NO which activates guanyl cyclase to produce cGMP

Question 25

What is a fast acting vs short acting nitrate

Answer 25

GTN | Isosorbide dinitrate

Question 26

How do nitrates affect the three types of blood vessels

Answer 26

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

Question 27

Common side effects and limitations of nitrates (6)

Answer 27

``` Headache Facial flushing Postural hypotension Dizziness Tachycardia Tolerance ```

Question 28

What are two b1 selective blockers

Answer 28

Atenolol (Tenormin) | Metoprolol (Betaloc)

Question 29

Common side effects of b1 selective blockers

Answer 29

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

Question 30

What are contraindications of B blockers (4)

Answer 30

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

Question 31

Three classes of CCBs

Answer 31

Dihydropyridines Phenylakylamines Benzothiazepines

Question 32

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

Answer 32

Dihydropyridines

Question 33

How do CCBs work

Answer 33

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

Question 34

Side effects of CCBs (3)

Answer 34

Flushing Headache Reflex tachycardia

Question 35

Three emerging therapies

Answer 35

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