Angina and treatment principles/goals

Question 1

Types

Answer 1

Unstable
Variant
Exertional

Question 2

Variant (vasospastic, Prinzmetal’s) angina

Answer 2

reduction in coronary flow due to vasospasm
(not increase in demand)

Normal coronary angiograms
–rarely catches spasm in action

excellent prognosis

Question 3

approaches for treatment

Answer 3

1. increase blood flow (increase supply)
2. Reduce myocardial O2 consumption (demand)
   –negative chronotropic effect (HR)
   –negative inotropic effect (contractility)
   –Decreased ventricular workload (wall stress)
   ……Reduced preload (venodilation)
   ……Reduced afterload (vasodilation)
3. prevent platelet deposition/aggregation
   (aspirin)

Question 4

To increase supply…

Answer 4

increase time spent in diastole
–negative chronotropy (decrease HR)

Squeeze the arteries less during systole
–negative inotropy (decrease contractility)

Question 5

So, decreasing heart work (via decreasing HR or contractility) helps angina by…

Answer 5

1. decreasing demand

2. increasing supply