Cards cards! Flashcards
Chronic stable angina
Strongest predictor of survival?
LVEF
Do you go straight to angio now days?
Not really, try and medically manage first, unless high risk features or symptoms not adequately controlled
What type of ca channel blocker do you use for anti angina?
Dihydropyridine! Amlodipine Felodipine Nifedipine SR (NOT fast as increase mortality) Not neg inotropic
Dont use nifedipine in severe AS, HOCM, HF
Action of dihydropyridine vs non dihydropyridine Ca ch blockers?
Dihydropyr- systemic AND CORONARY vasodilator. Not neg inotropic
Non-dihyro- arteriolar vasodilation
centrally acting to reduce HR, BP, contractility, prolong diastole. Neg inotropes
How does nicorandil work?
Arterial and venous vasodilator- systemic and coronary. Acts by stimulating cGMP formation to eventually reduce sensitivity of smooth muscle to calcium
Can use with calcium channel blockers in angina if nitrate intolerant. also reduces CV events!
Flushing and palpitations
Perhexiline MOA
favours anaerobic metabolism in active myocytes so reduces myocardial oxygen demand
Inhibits mitocondrial carnitus palmityltransferase
metab via 2D6
Is CTCA a viable alternative to exercise testing in people with chest pain?
Yes, non inferior in terms of outcomes
Also reduces number of people who go on to have a normal angiogram
Which three things good if TG still high after statins?
Nicotinic acid
Fenofibrate
Fish oil
Which three things good if Chol still high after MAX tolerated statin?
add or sub
ezetimibe
nicotinic acid
bile acid binding resin
Who would you treat out of moderate risk CV category?
Maouri, south asian, middle eastern
FH CVD premature
BP over 160
Start a statin and BP lowering therapy
heart failure is mostly attributable to WHAT according to Framingham?
hypertension
Cilostazol in PVD- how work?
Phosphodiesterase 3 inhibitor
Can cause rebound tachy and cannot give in CCF
Have to stop pre-op
In au for rest pain or evidence of necrosis
How is carvedilol different from the other beta blockers?
not just Beta 1 but also beta 2, alpha 1, vasodilatory and antioxidant effects
Digoxin in heart failure
Decrease hospitalisation
Improve symptoms
need to use at low levels- 0.5-0.8 in heart failure
When do you start spiron post MI?
MUST be within 14 days
on PBS if LVEF under 40% within 3-14 days post MI
How does spiro give you breasts?
Increases testosterone to oestradiol production
Decreases testosterone production in testes
Displace testosterone from SHBG and so increase clearance
How does hydralazine work?
Selective arterial vasodilator–>reduce afterload
How does ISMN work?
Converted to NO in cells–>increase cGMP–> veno and vasodilation–>reduce preload and afterload.
Is diltiazem dihydro or non dihydro
In between in selectivity
Reduce BP without inducing reflex tachy
What E-Eprime is normal?
Less than 8
What do alpha 1 receptors do?
all post synaptic smooth muscle vasoconstriction skin vasoconstriction abdominal viscera vasoconstricition GU/GI sphincter constriction mydriasis
NORAD more
alpha 2 do what?
mixed effects smooth muscle
increase amylase
increase AV node conduction- dromotropic
glycogenolysis, inhibit insulin release
ADRENALINE more
Beta 1 receptors do what?
inotrope chronotrope increase amylase dromotropic glycogenolysis
ISOPREN more than ADREN
Beta2 receptors do what?
ISOPREN more than ADREN SM relaxation vasodilation skeletal muscle hypokalaemia uterine relaxation