CAD, ACS, HF Flashcards
What do ACS and CAD have in common?
Both examples of an ischaemic heart disease
Stable angina = CAD or ACS?
CAD. Coronary artery disease
Name 3 different drug classes used in stable angina
Nitrates (to increase blood supply), statins (treat underlying atherosclerosis) and antithrombotics (to prevent ACS)
Why is unstable angina transient?
Pain is only present when there is a blood clot on top of a plaque which restricts blood flow even further. Body usually capable of clearing the clot
How to differentiate between NSTEMI and unstable angina?
Enzyme analysis. NSTEMI will have elevations but angina won’t
Name the best enzyme for ACS analysis / diagnosis?
Creatine kinase MB
Which enzyme rises the quickest?
GP-BB
NSTEMI appearance on ECG?
Slight depression of ST segment
Why is there an elevation in ST on the ECG of a STEMI?
It indicates a large portion of the heart muscle is damaged
What are the first medications an MI patient would receive?
Aspirin 300mg, GTN, pain relief
When can fibrinolytics be used?
Within the first 4.5 hours
When is PCI an option?
Within 30-90 minutes of the MI
Define CABG
Coronary artery bypass grafting. A surgery that grafts in new vessels to bypass the blockage in the heart
Indication of left sided HF?
Oedema in the legs
Compare congestive heart failure and heart failure
CHF involves both sides usually. HF is just the left ventricle
Name two compensatory mechanisms for heart failure (reduced cardiac output)
Increase in SNS activity, activation of RAAS
Name the two goals of pharmacological treatment in HF
Improve the ability of the heart to contract
Reduce the workload of the heart
MOA of loop diuretics?
They block the Na/K/Cl transporter in the loop of henle which reduces the reabsorption of these ions
When are diuretics used in HF?
When there is oedema
When are ACE inhibitors used in heart failure?
When there is no oedema present, just low left ventricle function
Do ace inhibitors reduce preload or afterload?
Both
Name an aldosterone antagonist
Spirinolactone
Name a class of drugs that reduces mortality in HF patients
Beta blockers
Which inotropic drug inhibits the Na/K ATPase pump?
Digoxin
Name a vasodilator
Nitrates like Isosorbide mononitrate or GTN
Name 2 beta agonists used in HF
Dobutamine and dopamine
Why would beta agonists be useful in HF?
They increase contractility without increasing the rate.
Which drugs are only used short term in advanced heart failure and why?
Beta agonists like dobutamine. They increase circulation in the short term but do not improve mortality and can actually increase myocardial oxygen demand
Name a drug that inhibits the funny channel
Ivabradine
Which drug is used in patients maxed out on ace-i’s, ARBs and beta blockers?
Ivabradine
MOA of ivabradine?
Blocks the funny channel, which delays the action potential. This reduces HR without having any other cardiac effects
Why do MI patients need beta blockers and ACE inhibitors?
To reduce the myocardial oxygen demand by reducing load on the heart
Which enzyme is the slowest to rise
Creatine kinase MB
