Angina

Question 0

Unstable angina

Answer 0

Getting longer frequency or duration of pain or with less exertion
Not fixed by rest (>20min) or NTG

Question 1

Stable angina

Answer 1

Fixed obstruction of coronary artery
Pain pattern is stable
Fixed by rest and NTG

Question 2

Prinzmetal angina

Answer 2

Caused by vasospasm
No effect from exertion
Fixed with NTG or Ca channel blockers

Question 3

Acute coronary syndrome

Answer 3

Atheromatous plaque ruptures
Inflammatory mediators activated, lipid pool forms, thrombin forms and propagates
Venous constriction and occlusion
Cardiac muscle dies
MI biomarkers releases

Question 4

Mixed angina

Answer 4

Pain during exertion and rest

Fixed obstruction with vasospasm or endothelial disruption

Question 5

Angina treatment strategies

Answer 5

Decrease O2 demand

Increase O2 delivery

Question 6

Affect of organic nitrates

Answer 6

Rapid decrease in myocardial O2 demand

Prompt relief of stable, unstable, And variant angina

Question 7

Organic nitrate side effects

Answer 7

Cyanide toxicity
Reflex tachycardia (increased O2 demand and decreased coronary perfusion oressure via diastolic filling)
Reflex positive inotrope (increased o2 demand)
High doses can lead to methemoglobinemia

Question 8

Methemoglobinemia

Answer 8

Tell physician
Give 1-2mg/kg (up to 50mg) methylene blue IV over 3-5min, gove absorbic acid, pure O2
If no change, patient is G6PD deficient so must give full tranfusion and hyperbaric O2

Question 9

Effect of Ronalazine (Ranexa)

Answer 9

Na channel blocker

Causes cardiac metabolism of carbs instead of fatty acids

Question 10

Effects of calcium channel blockers

Answer 10

Decrease afterload, decrease o2 consumption, dilates coronary arteries
Can worsen HF

Question 11

Effect of verapamil

Answer 11

Dramatically decreases impulse conduction through SA and AV nodes