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Supporting life > Angina > Flashcards

Angina Flashcards

1
Q

What is angina?

A

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

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2
Q

Most common causes?

A

Obstruction or spasm of coronary arteries

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3
Q

What are some other causes of angina?

A

anaemia, abnormal heart rhythms, heart failure

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4
Q

What is the cause stable angina?

A

occurs due to atheromatous plaque with fibrous cap in coronary artery

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5
Q

What are the symptoms or stable angina?

A

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

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6
Q

What is the cause of unstable angina?

A

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

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7
Q

When does Vasospastic angina usually occur

A

at rest, at night

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8
Q

What are the symptoms of unstable angina?

A

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

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9
Q

What are the symptoms of unstable angina?

A

more severe than stable, occurs at rest, gets worse

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10
Q

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

A

Coronary vasodilation - not sufficient to overcome

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11
Q

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

A

unstable angina

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12
Q

Which other conditions are types of acute coronary syndrome?

A

STEMI and NSTEMI

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13
Q

Which form of angina can lead to a heart attack?

A

unstable angina

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14
Q

What is microvascular angina (cardiac syndrome X)

A

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

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15
Q

What is microvascular angina (cardiac syndrome X)?

A

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

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16
Q

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

A

unknown. endothelial dysfunction - microvasculature is constricted.

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17
Q

List some of the aims of drug treatment

A
  • 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
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18
Q

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

A

short acting nitrate

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19
Q

What is the first step of ongoing prophylaxis?

A

beta blocker or calcium channel blocker

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20
Q

What is the second step of ongoing prophylaxis?

A

beta blocker and vascular selective calcium channel blocker

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21
Q

What is the third step of ongoing prophylaxis?

A

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

22
Q

What is the effect of ivabrandine?

A

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

23
Q

What is the effect of beta blockers?

A

reduce contractility and heart rate

24
Q

What do nitrates do?

A

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

25
Q

Which drug could be used to reduce wall tension?

A

ranolazine

26
Q

Calcium channel blockers do what?

A
  • 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
27
Q

What is the cellular mechanism of organic nitrates?

A

nitric oxide donor

28
Q

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

A

GTN (glyceryl trinitrate)

29
Q

How is GTN taken?

A

sublingually

30
Q

Name a long acting organic nitrate

A

isosorbide nitrate

31
Q

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

A

tolerance develops

32
Q

How can tolerance of organic nitrates be avoided?

A

daily 8 hour drug free period (eg at night)

33
Q

True or false, organic nitrates selectively dilate arteries

A

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

34
Q

What are the major actions of organic nitrates?

A

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

35
Q

What are the minor actions of organic nitrates?

A
  • dilate large coronary arteries –> increase blood flow through coronary collaterals
  • decrease TPR and afterload —> decrease O2 demand
36
Q

Name four side effects of organic nitrates

A
  • headache
  • facial fluching
  • decreased BP
  • increased heart rate
37
Q

How is GTN metabolised?

A

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

38
Q

give an example of a beta 1 selective beta blocker

A

bisoprolol

39
Q

what is the mechanism of beta blockers?

A

inhibit sympathetic stimulation of heart and decrease renin release

40
Q

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

A

verapamil

41
Q

Which calcium channel blocker gives the best effect of vasodilation?

A

DHPs - dihydropyridine

42
Q

In which type of angina are beta blockers contraindicated?

A

vasospastic angina

43
Q

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

A

calcium channel blockers

44
Q

How do Katp channel activators relax vascular smooth muscle?

A
  • open atp-sensitive K+ channels in vascular smooth muscle cells
  • stimulate guanylate cyclase
45
Q

Give the name of a Katp channel activator

A

nicorandil

46
Q

What is the action of ivabrandine?

A

blocks funny current to decrease heart rate

47
Q

How does the mechanism of ivabrandine work?

A

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.

48
Q

How do statins work?

A
  • prevent cells making cholesterol by blocking HMG - CoA reductase enzyme
  • helps reabsorb cholesterol already in blood
49
Q

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?

A

percutaneous coronary intervention

50
Q

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

A

pieces of saphenous vein or diverted internal mammary artery

51
Q

What type of patients would get CABG instead of PCI?

A

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

Supporting life (10 decks)

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