Cardio - HF, CAD Flashcards
Name three determinants of myocardial oxygen demand
- wall stress
- hear rate
- contractillity
What is the mechanism of nitric oxide?
increase GTP -> cGMP
-> smooth muscle relaxation
What are the clinical uses(3) of nitrates and nitrites?
-chest pain in
angina and MI
-severe hypertension
-pulmonary edema
(No survival benefits in MI
only symptomatic treatment)
What are the contraindications(5) for nitrates and nitrites?
-hypotension <100mmHg, hypovolemia
-increased ICP, intracranial hemorrhage
-If high preload maintains CO
RV infarction
cardiac tamponade
hypertrophic cardiomyopathy
-use of PDE5 inhibitors(i.e Sildenafil)
-narrow angle glaucoma
What is the mechanism and use of Nicorandil?
- stimulating of guanylyl cyclase
- activation of K+ ATP channels and hyperpolarization
Use:
-stable angina
What are the different types of voltage gated calcium channels, and where are they found?
- L-type – cardiac muscle and smooth muscle
- T-type – neurons
- N-type – neurons
What is the mechanism of Dilitiazem and Verapamil?
Non-dihydropyridine Ca-channel blockers
- Verapamil is cardioselective
- Dilitiazem affects both vessels and myocardium
What is the mechanism of Amlodipine
Dihydropyridine Ca-channel blockers (DHP CCB)
smooth muscle
What are the effects(3) of Ca-channel blockers on the heart?
- reduction in contractility
- reduced firing rate in sinus node
- reduced AV conduction rate
What are the effects(3) of Ca-channel blockers on smooth muscles?
- vasodilation (arteries»_space; veins)
- cerebral blood vessels - nimodipine
- relaxation of bronchi, GIT, uterus
What are the clinical uses(6) of DHP CCB?
- hypertension
- stable angina
- variant angina (Prinzmetal’s)
- Raynaud’s phenomenon
- migraine
- preterm labor
What are the clinical uses(6) of non-DHP CCB?
- hypertension
- stable angina and acute coronary syndromes
- variant angina
- supraventricular arrhythmia(class IV antiarrhythmic)
- preventing cerebral vasospasm after subarachnoid hemorrhage (nimodypine, nicardipine)
- hypertrophic cardiomiopathy
Non-DHP CCBs should not be combined with which two classes of drugs?
- DHP CCBs
- B-blockers
What is the function of B-blockers in CAD?
- decreased heart rate, blood pressure, and contractility
- decrease mortality of patients with recent myocardial infarction
What are the contraindications(6) for B-blockers?
- bradykardia
- atrioventricular block type II and III
- decompensated heart failure, cardiogenic shock
- asthma ( COPD caution; may use cardioselective ß-
blockers) - severe peripheral vascular disease
- vasospastic angina (prefered CCB and nitrates)
What is the mechanism of Ivabradine?
What is the contraindication?
- selective sinus node If channel inhibitor
- specific heart rate-lowering agent
( no inotropic action)
Contraindicated in bradycardia
What is the mechanism of Ranolazine?
What is the contraindication?
Blocks late Na+ current in myocardium
-> less intracellular Ca ->
Contraindicated in liver cirrhosis
What is the mechanism of Trimetazidine?
What are the contraindications?(2)
inhibits fatty acid oxidation in myocardium
->glucose pathway requires less oxygen
Contraindicated in Parkinson and
severe renal impairment
In the prehospital management of MI, what does the pneumonic MONA LISA stand for?
M - Morphine
O - Oxygen (if SaO2 < 95%)
N - Nitrates to relieve pain, if pulmonary oedema, only if
SP>100mmHg
A - Aspirin loading dose of 150–300 mg orally or of 80–
150 mg i.v.
L - Loop diuretic if pulmonary oedema
I - I.v. access
S - if STEMI transport to PCI center/ immediate
thrombolysis (streptokinase)
A - Antiplatelets e.g. clopidogrel, depends on definitive
treatment
What drugs are used in the treatment of MI after PCI/thrombolysis?(6)
- aspirin (75-100mg)
- prasugrel/ ticagrelor/clopidogrel*
- β-blocker
- ACE inhibitors /ARB
- statins
- in selected patients: aldosterone antagonists, antiarrhythmics, oral anticoagulants, proton pump inhibitors etc
*up to a year, rest indefinitely
+ of course life style changes
What drugs are used in the treatment of MI before PCI/thrombolysis?
- anticoagulants:
unfractionated heparin
/ enoxaparin/ bivalirudin/ fondaparinux - antiplatelets (aspirin
+ prasugrel/ ticagrelor/clopidogrel
+/- abciximab/ eptifibatide/ tirofiban
What drugs are used in the treatment of acute heart failure?(5)
- Beta agonists
- Bipyridines
- Diuretics
- Natriuretic peptide
- Vasodilators (nitrates)
What drugs are used in the treatment of chronic heart failure?(6)
Increases survival:
- Beta blockers
- ACE inhibitors/ ARBs
- Aldosterone receptor antagonists
- Diuretics (antagonists of aldosterone)
Reduces symptoms:
- Diuretics (loop diuretics)
- Cardiac glycosides
- Vasodilators (hydralazine, nitrates)
What is the mechanism of Digoxin?
What is the effect on the heart?
inhibition of Na+/K+ ATP ase
inhibition of autonomic actions
-> increased contractility, less HR, less AV conduction
What are the clinical uses of Digoxin?(2)
- heart failure in combined therapy with ACEI,
beta-blockers, diuretics
(does not increase survival, reduces symptoms) - atrial fibrillation for the control of ventricular response
What are the adverse effects of Digoxin?(5)
- any type of arrythmia
- AV block
- sympathomimetic effects
- nausea,vomitin,diarrhea
- color vision disturbances#
Narrow therapeutic index
What are the contraindications for Digoxin?(9)
- bradycardia
- atrioventricular block (type II and III)
- severe ventricular arrhythmia
- hypokalemia, hypomagnesemia, hypercalcemia
- acute coronary syndromes
- preexcitation syndromes
- before direct current cardioversion
- hypertrophic cardiomyopathy with outflow tract
obstruction - cardiac amyloidosis
What is the mechanism of action for the bipyridines Inamrinone (amrinone) and Milrinone ?
What is the indication for use?
inhibiting phosphodiesterase isozyme 3 (PDE-3)
-> increased contractility+vasodilating effect
Indication: acute heart failure
What is the mechanism of Levosimendan?
What is the indication for use?
- sensitizing the troponin system to Ca+
- inhibiting phosphodiesterase isozyme 3 (PDE-3)
-> increased contractility without increasing myocardial
oxygen demand + vasodilating effect
Indication: acute heart failure
