clinical aspects of cardiovascular disease Flashcards
ezetimibe
Inhibits cholesterol absorption by enterocytes and augments expression of liver LDL receptors
When added to statins further reduces LDL-C by 15–20%
PCSKg inhibitors
PCSK9 binds to LDL receptors and promotes their intracellular degradation
Inhibiting PCSK9 can decrease LDL-C substantially
PCSK9 inhibitors in addition to statins achieves much lower LDL-C levels than was previously possible, and this further reduction conferred greater CVD benefit
Evolocumab, Alirocumab
aspirin
Irreversibly binds to the enzyme cyclo-oxygenase
Inhibits platelet synthesis of thromboxane A2
Inhibits platelet adhesion and aggregation
Platelets thereafter unable to synthesise new cyclo-oxgenase however endothelial cells can
At higher doses can inhibit prostacyclin production
(Prostacyclin inhibits platelet aggregation)
Dose:-
300mg in acute setting
75mg daily maintenance dose
what conditions is aspirin used for
Angina
Myocardial Infarction
Embolic / Thrombotic CVA
Transient Ischaemic Attack (TIA)
Percutaneous coronary intervention
Prevent miscarriage in pro-thrombotic conditions
Analgesia
adverse reactions of aspirin
-gastrointestinal irritation
- skin rash
- gastric erosions/bleeding
- bronchospasm
contraindications
- under 16s
- breast feeding mothers
- peptic ulceration
haemophilia
anti-ishaemic drugs- nitrates
Short acting nitrate for angina relief
GTN Spray sublingual administration or nitroglycerin tablet
SE – Headache, Dizziness
Long acting nitrate for angina prophylaxis
Isosorbide mononitrate or isosorbide dinitrate
Oral preparation or transdermal patch
Losses efficacy with prolonged administration
Need nitrate free period
SE – hypotension, headache, flushing
anti-ischaemic drugs, beta blockers
Slow heart rate and decrease myocardial oxygen demand
Aim for heart rate 55-60bpm
Most commonly used are bisoprolol, atenolol, carvedilol
Don’t stop abruptly
SE - fatigue, depression, bradycardia, heart block, bronchospasm, peripheral vasoconstriction, postural hypotension, impotence, and masking of hypoglycaemia symptoms
myocardial infarction presenting symptoms
Chest pain
Retrosternal, crushing, severe, heavy
Radiates to arm, neck, jaw
Often nausea and vomiting
Sweaty
No chest pain – diabetics, elderly
Atypical symptoms
Especially inferior infarcts (upper GI symptoms)
Angor Animi
clinical signs of myocardial infarction
Clutching chest
Sweating
Tachypnoea (If concomitant heart failure)
Tachycardia / Bradycardia
Hypertensive / Hypotension
Murmurs
Third heart sound
Fine inspiratory crepitations
