Chronic stable angina

Question 1

What are the symptoms of angina?

Answer 1

discomfort, indigestion, breathlessness, fatigue, pain

pain due to imbalance of oxygen supply and demand

Question 2

why is angina caused?

Answer 2

due to narrowing of coronary artery

Question 3

What are the two goals of CSA management?

Answer 3

1. Manage Sx (improve supply or lower demand)

2. Reduce risk of MI or death

Question 4

How do we decrease O2 demand?

Answer 4

by decreasing HR, BP, force, preload/afterload

Question 5

What meds do we use to control Sx of CSA?

Answer 5

1. BB
2. CCB
3. Nitrates

Question 6

How does CCB decrease the O2 demand?

Answer 6

dilate arteries and veins

Question 7

What are the ADE of CCB

Answer 7

Non-dihydro: constipation, bradycardia

dihydro: peripheral oedema, palpitation, tachycardia, headache, flushing

Question 8

How does nitrate manage CSA?

Answer 8

by decreasing pre and afterload

Question 9

What d owe need to be careful about using nitrates?

Answer 9

we need nitrate free interval of 8-12hrs

Question 10

What combinations can we use for CSA?

Answer 10

BB+ dihydro
BB+ nitrate
BB+ dihydro + nitrate
verapamil/diltiazem + nitrate

Question 11

What combination should we avoid?

Answer 11

Any combination without BB

Question 12

What do we use to decrease CV events in CSA?

Answer 12

Aspirin, statin, ACEI

Question 13

How does aspirin and statin decrease cv event?

Answer 13

by decreasing vascular and coronary events

Question 14

How does ACEI decrease CV event?

Answer 14

decrease MI/stroke/death

Question 15

What if the drugs don’t work and stents are not options, what do we use?

Answer 15

ivabradine, nicorandil, perhexiline

Question 16

How does ivabradine slow down the heart rate?

Answer 16

it is an Na+ channel antagonist

Question 17

How does nicorandil slow down the heart rate?

Answer 17

by vasodilation (acts like nitrates)

Question 18

How does perhexiline slow down the heart rate?

Answer 18

increase glucose and lactate utilisation