Cardiovascular Flashcards
Examples of cardiac and vascular disorders:
- Ischemic heart disease
- Arteriosclerosis
- Angina
- Myocardial Infarction (MI)
- CHF
- HTN
- Orthostatic Hypotension (OH)
- Cardiac arrhythmias
- Arterial occlusive disease
- Peripheral vascular disease (PVD)
- Venous thrombosis
- DVT
- Pulmonary embolism (PE)
When does ischemia occur?
How does this affect the heart?
- When there is insufficient blood flow to tissue. Occurs in the heart when the O2 supply doesn’t meet the workload demand.
- Increase HR and contractility.
What’s the difference between CAD and PAD?
- CAD= Coronary artery disease
- PAD= Peripheral arterial disease
How many people does ischemic heart disease affect in the US?
12 million
What is chest pain caused by reduced blood flow to the heart called?
Angina pectoris
Angina is any condition that alters oxygen supply to the heart or any condition that increases the oxygen demand to the myocardium.
Examples of this:
- Increased O2 needs to the heart
- Increased cardiac output
- Reduced blood flow to the heart
- Triggers include:
- physical exertion
- increase in pulse rate or BP
- vasoconstriction
Ischemia angina is usually due to CAD or PAD?
CAD
How is angina described?
It is considered mild to moderate lasting usually - minutes, up to __ minutes.
What relieves angina?
- Squeezing, burning, pressing, heartburn, indigestion
- 1-3, 20
- Nitroglycerin
What are the three forms of angina?
- Exertional:
- occurs only when load is put on the heart
- Variant (Prinzmetal’s)
- Caused by coronary spasm, can occur at rest
- Would respond well to vasodilator
- Unstable
- Occurs before a MI
What are the most common drugs used to treat angina pectoris?
Vasodilators:
- Nitrates
- Calcium blockers
Cardiac Depressants:
- Calcium blockers
- Beta-blockers
What is different about nitrates?
What is their MOA?
- Work directly on vascular smooth muscle instead of through a receptor
- Decrease preload and afterload→ reduce workload of heart→ reduce O2 demand
What are the forms of nitrate?
What is the drug of choice for acute attacks?
- IV
- Sublingual-spray, chewable, and oral tablets
- Topical-transdermal patch
Drug of choice for acute attacks is sublingual
Nitrates don’t work on ____ but rather act directly on smooth muscle.
Alpha-1
Does isosorbide dinitrate (ISDN) or isosorbide mononitrate (ISMN) have a longer half life?
-ISMN (4-6 hours)
ISDN has a half life of 1 hour
What are the storage guidelines when it comes to nitrates?
What is the dosing of nitrates?
Storage:
- limit light exposure (keep in glass bottle)
- short shelf life (6m unopened, 3m opened)
- tingling sensation as drug dissolves= it is active
Dosing:
- After 1st dose, relief should occur within 1-2 minutes
- 2nd dose if symptoms still present after 5 minutes (up to 3 doses in 15 minutes)
- No relief= possible MI
What are the adverse effects of nitrates?
- reflex tachycardia
- dizziness
- OH
- weakness
Be concerned about FALLS.
When should patients start taking nitrates?
When they have symptoms, dont wait for a “more severe episode” to take meds.
What are the two other types of angina treatment?
B-blockers
Calcium channel blockers
Beta blockers are used for ______ angina along with __________ nitrates.
- stable
- short-acting
Both beta blocker and calcium channel blockers reduce ________ which in return reduces ________ which relieves angina.
- contractility
- O2 demand
Both beta blockers and CC blockers do what?
reduce workload of the heart
When a cardiac event is suspected, immediately chew _____ _________ coated aspirin
-325mg non-enteric coated aspirin
How many nitroglycerin doses can be administered in 15 minutes?
3
What determines the type of cardiac event?
What are the two types of cardiac events and what drugs are used for them?
-ECG determines the type of cardiac event
- STEMI
- thrombolytic agent
- NSTEMI
- heparin