Angina Flashcards by Beth E

What is angina?

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

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Most common causes?

Obstruction or spasm of coronary arteries

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What are some other causes of angina?

anaemia, abnormal heart rhythms, heart failure

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What is the cause stable angina?

occurs due to atheromatous plaque with fibrous cap in coronary artery

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What are the symptoms or stable angina?

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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What is the cause of unstable angina?

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

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When does Vasospastic angina usually occur

at rest, at night

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What are the symptoms of unstable angina?

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

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What are the symptoms of unstable angina?

more severe than stable, occurs at rest, gets worse

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

Coronary vasodilation - not sufficient to overcome

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

unstable angina

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Which other conditions are types of acute coronary syndrome?

STEMI and NSTEMI

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Which form of angina can lead to a heart attack?

unstable angina

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What is microvascular angina (cardiac syndrome X)

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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What is microvascular angina (cardiac syndrome X)?

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

unknown. endothelial dysfunction - microvasculature is constricted.

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List some of the aims of drug treatment

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

short acting nitrate

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What is the first step of ongoing prophylaxis?

beta blocker or calcium channel blocker

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What is the second step of ongoing prophylaxis?

beta blocker and vascular selective calcium channel blocker

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What is the third step of ongoing prophylaxis?

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

What is the effect of ivabrandine?

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

What is the effect of beta blockers?

reduce contractility and heart rate

What do nitrates do?

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

Which drug could be used to reduce wall tension?

ranolazine

Calcium channel blockers do what?

- 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

What is the cellular mechanism of organic nitrates?

nitric oxide donor

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

GTN (glyceryl trinitrate)

How is GTN taken?

sublingually

Name a long acting organic nitrate

isosorbide nitrate

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

tolerance develops

How can tolerance of organic nitrates be avoided?

daily 8 hour drug free period (eg at night)

True or false, organic nitrates selectively dilate arteries

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

What are the major actions of organic nitrates?

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

What are the minor actions of organic nitrates?

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

Name four side effects of organic nitrates

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

How is GTN metabolised?

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

give an example of a beta 1 selective beta blocker

bisoprolol

what is the mechanism of beta blockers?

inhibit sympathetic stimulation of heart and decrease renin release

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

verapamil

Which calcium channel blocker gives the best effect of vasodilation?

DHPs - dihydropyridine

In which type of angina are beta blockers contraindicated?

vasospastic angina

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

calcium channel blockers

How do Katp channel activators relax vascular smooth muscle?

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

Give the name of a Katp channel activator

nicorandil

What is the action of ivabrandine?

blocks funny current to decrease heart rate

How does the mechanism of ivabrandine work?

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.

How do statins work?

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

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?

percutaneous coronary intervention

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

pieces of saphenous vein or diverted internal mammary artery

What type of patients would get CABG instead of PCI?

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