Cardiac Dysfunction Angina

Question 1

What is Angina Pectoris?

Answer 1

= literary “pain in the chest” due to cardiac ischemia (dec blood flow and O2 to heart) and hypoxia (deficiency in O2 to tissues)

Question 2

How do you treat Angina Pectoris?

Answer 2

• use organic nitrites (for vasodilation, and resolve O2 deficiency, reducing heart workload, therefore pain)
• use Ca channel blockers (dec heart work)
• use β-adrenergic Blocking agents (dec HR and workload by vasodilation)
• use drug combination (for additive effects)

Question 3

Amyl nitrite
Nitroglycerin
Isosorbide dinitrate

Answer 3

• Organic Nitrates (provide NO)
• inc cGMP
• vasodilation
• inc blood flow
• resolve O2 deficiency

Extra-cardiac Actions

• dec preload and afterload
• dec bp
• dec CO
• dec workload
• dec O2 demand of heart
• O2 deficit resolution

Question 4

Verapamil
Diltiazem
Nifedipine
Amlodipine

Answer 4

Ca Channel Blockers
Heart:
- dec Ca influx into ventricular cells
- dec contractility - dec CO - dec bp
- dec workload of heart
- dec O2 demand on heart
- resolution of O2 deficit

Vascular:

• vasodilation
• dec afterload - dec bp
• dec work done by heart

Question 5

β1 selective
Atenolol
Metaprolol
Pindolol

β1 & β2
Propranolol

Answer 5

β-adrenergic Blocking agents

• dec HR
• dec work by heart - dec O2 demand
• resolution to O2 deficit

Question 6

β-blocker and nitrate or Ca channel blocker

Answer 6

Drug Combinations
- β-blocker prevent reflex tachycardia (good, speed)
- β2-blocker will vasoconstrict (bad, inc R, inc bp)
- Nitrate will vasodilate (good)
Additive Effect

Question 7

Nitrate and Ca channel blocker

Answer 7

Drug Combinations
- nitrate = vasodilation, dec preload
- Ca blocker = vasodilation, dec afterload
Additive Effect