Angina

Question 1

What is angina?

Answer 1

chest pain/pressure caused by reduced blood flow to heart muscle

Question 2

Most common causes?

Answer 2

Obstruction or spasm of coronary arteries

Question 3

What are some other causes of angina?

Answer 3

anaemia, abnormal heart rhythms, heart failure

Question 4

What is the cause stable angina?

Answer 4

occurs due to atheromatous plaque with fibrous cap in coronary artery

Question 5

What are the symptoms or stable angina?

Answer 5

Pain, (can radiate to neck, shoulders, jaw, arms) tightness, squeezing, crushing feeling in chest. attacks have a trigger (such as stress or exercise) and stop within a few minutes of resting

Question 6

What is the cause of unstable angina?

Answer 6

due to transient formation of a non occulsive thrombus in a coronary artery

Question 7

When does Vasospastic angina usually occur

Answer 7

at rest, at night

Question 8

What are the symptoms of unstable angina?

Answer 8

due to transient formation of a non occulsive thrombus in a coronary artery

Question 9

What are the symptoms of unstable angina?

Answer 9

more severe than stable, occurs at rest, gets worse

Question 10

Sensory nerves release substance P during angina. What is its effect?

Answer 10

Coronary vasodilation - not sufficient to overcome

Question 11

Which type of angina is a form of acute coronary syndrome?

Answer 11

unstable angina

Question 12

Which other conditions are types of acute coronary syndrome?

Answer 12

STEMI and NSTEMI

Question 13

Which form of angina can lead to a heart attack?

Answer 13

unstable angina

Question 14

What is microvascular angina (cardiac syndrome X)

Answer 14

angina-like chest pain, in the context of normal epicardial coronary arteries on angiography. positive exercise test. more common in women.

Question 15

What is microvascular angina (cardiac syndrome X)?

Answer 15

angina-like chest pain, in the context of normal epicardial coronary arteries on angiography. positive exercise test. more common in women.

Question 16

What is the cause of microvascular angina (cardiac syndrome X)?

Answer 16

unknown. endothelial dysfunction - microvasculature is constricted.

Question 17

List some of the aims of drug treatment

Answer 17

• lower cardiac output to decrease oxygen demand
• increase oxygen supply to ischaemic zones by increasing blood flow in coronary arteries and decreasing heart rate
• prevent MI and atherosclerosis progression

Question 18

What drug is used for immediate relief / short term prevention?

Answer 18

short acting nitrate

Question 19

What is the first step of ongoing prophylaxis?

Answer 19

beta blocker or calcium channel blocker

Question 20

What is the second step of ongoing prophylaxis?

Answer 20

beta blocker and vascular selective calcium channel blocker

Question 21

What is the third step of ongoing prophylaxis?

Answer 21

beta blocker and vascular selective calcium channel blocker and other drugs (long acting nitrate, ivabrandine, nicorandil, ranolazine)

Question 22

What is the effect of ivabrandine?

Answer 22

slows heart by affecting SAN, leading to longer diastole, so heart muscle is more perfused

Question 23

What is the effect of beta blockers?

Answer 23

reduce contractility and heart rate

Question 24

What do nitrates do?

Answer 24

cut short angina attack, vasodilate coronary arteries, decrease CVP and preload

Question 25

Which drug could be used to reduce wall tension?

Answer 25

ranolazine

Question 26

Calcium channel blockers do what?

Answer 26

- Calcium channel blockers prevent calcium from entering cells of the heart and blood vessel walls, resulting in lower blood pressure. - Calcium channel blockers, also called calcium antagonists, relax and widen blood vessels by affecting the muscle cells in the arterial walls. - Some calcium channel blockers have the added benefit of slowing your heart rate, which can further reduce blood pressure, relieve chest pain (angina) and control an irregular heartbeat. - decrease reperfusion injury - decrease atheroma progressions

Question 27

What is the cellular mechanism of organic nitrates?

Answer 27

nitric oxide donor

Question 28

What is the name of the nitrate used for cutting short angina attacks?

Answer 28

GTN (glyceryl trinitrate)

Question 29

How is GTN taken?

Answer 29

sublingually

Question 30

Name a long acting organic nitrate

Answer 30

isosorbide nitrate

Question 31

Why is the effectiveness of organic nitrate limited to 12 hours?

Answer 31

tolerance develops

Question 32

How can tolerance of organic nitrates be avoided?

Answer 32

daily 8 hour drug free period (eg at night)

Question 33

True or false, organic nitrates selectively dilate arteries

Answer 33

False. They are selective venodilators and dont have as much effect on arteries.

Question 34

What are the major actions of organic nitrates?

Answer 34

relax venules and veins ---> decreased CVP ---> decreased wall tension ---> decreased cardiac O2 demand

Question 35

What are the minor actions of organic nitrates?

Answer 35

- dilate large coronary arteries --> increase blood flow through coronary collaterals - decrease TPR and afterload ---> decrease O2 demand

Question 36

Name four side effects of organic nitrates

Answer 36

- headache - facial fluching - decreased BP - increased heart rate

Question 37

How is GTN metabolised?

Answer 37

broken down by mitochondrial aldehyde dehydrogenase --->reactive oxygen species generated --> increased release of endothelin 1 (a vasocinstrictor) in arteries --> leads to tolerance of nitrates and selectivity for veins, as arteries dilate less

Question 38

give an example of a beta 1 selective beta blocker

Answer 38

bisoprolol

Question 39

what is the mechanism of beta blockers?

Answer 39

inhibit sympathetic stimulation of heart and decrease renin release

Question 40

which calcium channel blocker gives the best effect of negative inotropy?

Answer 40

verapamil

Question 41

Which calcium channel blocker gives the best effect of vasodilation?

Answer 41

DHPs - dihydropyridine

Question 42

In which type of angina are beta blockers contraindicated?

Answer 42

vasospastic angina

Question 43

In Prinzmetals's angina and mixed angina, which drug is useful in dilating coronary arteries?

Answer 43

calcium channel blockers

Question 44

How do Katp channel activators relax vascular smooth muscle?

Answer 44

- open atp-sensitive K+ channels in vascular smooth muscle cells - stimulate guanylate cyclase

Question 45

Give the name of a Katp channel activator

Answer 45

nicorandil

Question 46

What is the action of ivabrandine?

Answer 46

blocks funny current to decrease heart rate

Question 47

How does the mechanism of ivabrandine work?

Answer 47

enters open channel and binds. the binding of ivabrandine in the channel builds up when the channel is opening more frequently (use dependency) - so when HR increases, ivabradine blocks more.

Question 48

How do statins work?

Answer 48

- prevent cells making cholesterol by blocking HMG - CoA reductase enzyme - helps reabsorb cholesterol already in blood

Question 49

What is the name of the procedure in which a balloon is inflated in a coronary artery and a stent is inserted to decrease stenosis?

Answer 49

percutaneous coronary intervention

Question 50

What type of vessel is used in coronary artery bypass grafting?

Answer 50

pieces of saphenous vein or diverted internal mammary artery

Question 51

What type of patients would get CABG instead of PCI?

Answer 51

those with more serious/advanced coronary artery disease. e.g if all three main coronary arteries are stenosed