Coronary Artery Disease: Chronic Stable Angina Flashcards
What percentage does the lesion diameter need to take up in order to be considered clinically considered, how much to get symptoms
Greater than 50% (classified as obstructive), 70%
What are classical symptoms of heart attack/CAD
substernal chest heaviness or discombort, radiates to left arm or left jaw, last 30 seconds to 30 mins, relieved with rest and/or nitroglycerin
What are atypical symptoms of heart attack/CAD
Nausea, Diaphoresis, Epigastric burning, dizziness
What is key about stable angina
Reproducible with CONSISTENT amount of activity, relieved in a CONSISTENT manner, CONSISTENT frequency
What are characteristics of unstable angina
Happens at rest, Symptoms last longer than 20 mins, less activity but increased frequency
What are the treatment goals
Terminate acute angina attacks and prevent further recurrences
What are modifiable risk factors for CAD
Smoking cessation/ treatment of HTN, Dyliplidemia, DM/ lifestyle modifications with diet, weight loss, and exercise
What are pharmacological therapies that will relieve symptoms
Beta Blockers, Calcium channel blockers, Nitrates, Ranolazine
What are pharmacological therapies that will reduce major adverse cardiac events
ACEIs or ARBs, Antiplatelets, Beta-blockers, Statins, Anticoagulants
What are factors that would decrease oxygen supply therefore increasing CAD symptoms
Low arterial oxygen, less diastolic filling time, less coronary blood flow
What are factors that would increase oxygen demand therefore increasing CAD symptoms
Increased preload, increased double product, increased myocardial contractility, increased ventricular wall tension
What is double product
HR x SBP
What is MOA of beta blockers in the treatment of angina
Increased O2 supply through increeased diastolic filling time, decreased heart rate, Decreased contractility
T/F: For people who have had a heart attack starting a beta-blocker has proof that it prolongs life and lowers ischemic events
True
What is the goal resting HR for using beta blockers, exercise
60 BPM, less than 100 BPM
What is the MOA of calcium channel blockers to treat angina
Arterial/coronary vasodilation, Increased O2 supply through increased diastolic filling time, decreased HR, Decreased O2 demand by decreasing BP
T/F: Dihydropyridines cause vasodilation and decrease contractility while non-Dihydropyridines primarily affect vascular smooth muscle resulting in vasodilation
False: Dihydropyridines primarily affect vascular smooth muscle resulting in vasodilation while non-Dihydropyridines cause vasodilation and decrease contractility
What is the clinical use of Calcium Channel Blockers in Angina
Chronic prophylaxis
Why should DHP CCBs never be used as monotherapy for angina
Cause reflex tachycardia with the vasodilation
What combination should be avoided with regards to non-DHP CCBs
Beta-blockers
T/F: Beta blockers should be avoided in patients who have congestive heart failure
True
What is the MOA for nitrates in the treatment of angina
Increase O2 supply by coronary vasodilation, decrease O2 demand by decreasing preload
What are the clinical uses for Nitrates
Acute relief on anginal symptoms, chronic prophylaxis of angina
What nitrate medications are used for acute relief, chronic prophylaxis
Nitroglycerin sublingual tablets/ Isosorbide mononitrate and nitroglycerin transdermal patch
What should a patient do if there is no improvement or worsening symptoms
If no improvement after 5 mins take another and call 911
T/F: Short term and long term nitrates can be used together
True
What drug is the last resort in angina treatment
Ranolazine
What is the MOA ACEIs and ARBs have in angina
Reduce plasminogen activator inhibitor-I activity shifting local fibronylytic states more towards lysis instead of clot formation
T/F: ACEs and ARBs are not anti-anginals
True
What medication is indicated in all patients with CAD, why, what can be used as an alternative or used with aspirin
Aspirin, lowers risk of MI and death, Clopidogrel
What are drugs that will not reduce major cardio adverse events
Rosiglatizone, Estrogen therapy, Vitamin C, E, B12, B6, garlic, selnium, chromium
What are the ABCDEs in treatment of chronic stable angina
A: Aspirin plus Antianguinal Rx
B: Beta blockers plus BP control
C: Cessastion of cigarettes and control of cholesterol
D: Diet modification and control of diabetes
E: Education and Exercise
