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Angina > Angina > Flashcards

Angina Flashcards

1
Q

Angina (definition)

A
  • Chest pain due to inadequate delivery of oxygen to the cardiac muscle.
  • Imbalance between cardiac oxygen supply and cardiac oxygen demands
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2
Q

Ischemia

A

Deficient supply of blood to a body part that is due to obstruction of the inflow of arterial blood.

  • in some individuals the ischemia is not accompanied by pain (slient angina)
  • In severe cases the pain migrates to the left arm
  • Pain is caused by accumulation of metabolites in the myocardium
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3
Q

Angina (characteristics)

A

You will have:

  • ST depression, T wave depression (85% of the time); or ST elevation, T wave elevation (much less common)
  • Increase in troponin C
  • Decreased cardiac contraction
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4
Q

Coronary circulation

A
  • The heart has a smaller blood supply compared to its O2 demand
    1. Arterial pressure
    1. Cardiac cycle- flow occurs mainly in Diastole and less during systole.
    1. Direct sensitivity of arterioles to aneaerobic metabolites (adenosine and ADP)
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5
Q

Stable angina

A 
-chronic stable angina- exertional
(O2 demand > than the O2 supply)
-most common
- cause:  artherosclerotic narrowing
Treatment Goal:  Increase O2 supply and decrease O2 demand
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6
Q

Unstable angina

A
  • worsening of stable
  • -AMI
  • sudden death
  • O2 supply decreased when demand is unchanged (at rest)
  • Causes: plaque rupture
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7
Q

Variant angina (Prinzmetal’s)

A

Recurrent episodes of RESTING pain with REVERSABLE ST elevation and preserved exercise tolerance
-Cause: Coronary vasospasm
TREATMENT GOAL: Increase O2 Supply

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8
Q

Risks for Ischemic Heart Disease

A
  • HTN
  • smoking
  • hyperlipidemia
  • hyperglycemia
  • male
  • post menopausal female ( low estrogen)
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9
Q

Angina precipitating factors

A
  • Exercise
  • Stress
  • Sex
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10
Q

Purpose of treatment

A
  • relieve symptoms
  • stop the disease process
  • regression of the process
  • prevent MI
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11
Q

Basis of Drug Therapy

A 
Decrease the O2 demand by reducing workload:
-decrease HR
-decrease force of contraction
-decrease afterload
Increasing the SUPPLY of O2
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12
Q

Antianginal Drugs (6 classes)

A
  • Nitrates
  • Beta antagonists
  • Calcium channel blockers
  • Ranolazine
  • Antithrombotic
  • Anti lipidemic
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13
Q

Organic Nitrates (MOA)

A
  • relaxation of smooth muscle, mostly venous but some arterial dilation as well
  • nitrate (NO2) is converted to NO, causes an increase in cGMP formation which leads to Ca2+ sequestration (prevents contraction / mechanism of vasodilation)
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14
Q

Nitrates (therapeutic effects)

A
  • Arteriolar dilation (decreases afterload)
  • Venous dilation (decreases preload)
  • relieves vasospasm
  • redistrubutes myocardial blood flow
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15
Q

Nitrates Side Effects

A

-headache
-hypotension
-fainting risk
Contraindicated : hypersensitivity, hypotension, Increased ICP, constrictive pericarditis/ tamponade, severe anemia

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16
Q

Nitrates FYI

A
  • dose/effect is inversely related to vessel diameter; smallest dose will dilate veins, largest dose needed for arteriolar dilation
  • tolerance can develop
  • extensive 1st pass metabolism
  • stimulation of SNS
  • may ellicit angina attack “steeling effect/ reflex tachy”
17
Q

Isorbide (isordil)

A
  • organic nitrate
  • SE: flushing methlaemoglobinaemia (at high doses only), headache, orthostatic hypotension

-interaction with phosphodiesterase 5 inhibitors (sildenafil/VIAGRA): DO NOT USE WITH NITRATES: (nitrates increase cyclic CMP; phosphodiesterase-5 inhibitors increase cGMP by preventing its breakdown; phosphodiesterase 5 breaks down cGMP)

18
Q

Beta blockers (effects)

A

-blockade of sympathetic stimulation
-decrease HR
-decrease contractility
-decrease systolic wall tension
- Increases time spent in diastole / prolonging perfusion
Decrease incidence of MI in patients with CAD

19
Q

Beta blockers (therapeutic use)

A

-angina
-post MI
-CHF
Contraindicated in prinzmetal’s angina
Avoid non selective in patients with asthma (bronchospasm)

20
Q

Beta blockers (Side effects)

A
  • fatigue
  • lethargy
  • impotence
  • bradycardia
  • bronchospasm
21
Q

Calcium channel blockers (ther. effects)

A
  • decrease HR
  • decrease contraction (limits Ca entry during plateau)
  • inhibits ectopic beats

-decreases afterload (arterial vasodilation)

22
Q

Calcium channel blockers (list)

A
  • nifedipine (works only on vascular NOT heart)
  • diltiazem
  • verapamil
  • bepridil
23
Q

Calcium Channel Blockers (therapeutic uses)

A
  • angina
  • variant angina
  • HF
  • HTN in SAH hemorrhage
  • arrhythmias
24
Q

Calcium Channel Blockers (side effects)

A

-dizziness
-flushing
-headache
-transient hypotension
-per. edema
-bradycardia
-AV block
Do not use with beta blocker combo due to INcrease risk of AV block

25
Q

Ranolazine (Ranexa)

A
  • treatment of chronic stable angina
  • blocker of late Na+ channels
  • metabolized by cytochrome 450(CYP3A4)
  • 3 days to become effective
  • Do not use in patients with prolonged QT, hepatic or renal impairment
  • Do not combine with dlitiazem (decreases absorption), or potent CYP3 inhibitors (ketoconozale, simvastatin)
26
Q

Ranolazine Side Effects

A
  • constipation
  • dizziness
  • headache
  • nausea
  • peripheral edema
  • asthenia (loss of strength)
27
Q

other agents for Angina

A
  • ASA 325 mg/day

- statins

28
Q

Nitrates and beta blocker combo

A

nitrates attenuate adverse cardiovascular effects of beta blockers. Beta blockers inhibit the tachy and positive inotropic effects of nitrates

29
Q

nitrates and calcium channel blockers

A
  • only in supervised clinics
  • use for severe exertional or vasospastic angina
  • severe hypotension and bradycardia can occur
30
Q

Beta blocker and calcium channel blockers

A
  • only in patients with heart disease when with nifedipine or amiodipine are used (they work only on vascular).
  • Do not combine with calcium blockers that work on heart because of AV BLOCK

Angina (1 decks)

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