Coronary Artery Disease: Chronic Stable Angina

Question 1

What percentage does the lesion diameter need to take up in order to be considered clinically considered, how much to get symptoms

Answer 1

Greater than 50% (classified as obstructive), 70%

Question 2

What are classical symptoms of heart attack/CAD

Answer 2

substernal chest heaviness or discombort, radiates to left arm or left jaw, last 30 seconds to 30 mins, relieved with rest and/or nitroglycerin

Question 3

What are atypical symptoms of heart attack/CAD

Answer 3

Nausea, Diaphoresis, Epigastric burning, dizziness

Question 4

What is key about stable angina

Answer 4

Reproducible with CONSISTENT amount of activity, relieved in a CONSISTENT manner, CONSISTENT frequency

Question 5

What are characteristics of unstable angina

Answer 5

Happens at rest, Symptoms last longer than 20 mins, less activity but increased frequency

Question 6

What are the treatment goals

Answer 6

Terminate acute angina attacks and prevent further recurrences

Question 7

What are modifiable risk factors for CAD

Answer 7

Smoking cessation/ treatment of HTN, Dyliplidemia, DM/ lifestyle modifications with diet, weight loss, and exercise

Question 8

What are pharmacological therapies that will relieve symptoms

Answer 8

Beta Blockers, Calcium channel blockers, Nitrates, Ranolazine

Question 9

What are pharmacological therapies that will reduce major adverse cardiac events

Answer 9

ACEIs or ARBs, Antiplatelets, Beta-blockers, Statins, Anticoagulants

Question 10

What are factors that would decrease oxygen supply therefore increasing CAD symptoms

Answer 10

Low arterial oxygen, less diastolic filling time, less coronary blood flow

Question 11

What are factors that would increase oxygen demand therefore increasing CAD symptoms

Answer 11

Increased preload, increased double product, increased myocardial contractility, increased ventricular wall tension

Question 12

What is double product

Answer 12

HR x SBP

Question 13

What is MOA of beta blockers in the treatment of angina

Answer 13

Increased O2 supply through increeased diastolic filling time, decreased heart rate, Decreased contractility

Question 14

T/F: For people who have had a heart attack starting a beta-blocker has proof that it prolongs life and lowers ischemic events

Answer 14

True

Question 15

What is the goal resting HR for using beta blockers, exercise

Answer 15

60 BPM, less than 100 BPM

Question 16

What is the MOA of calcium channel blockers to treat angina

Answer 16

Arterial/coronary vasodilation, Increased O2 supply through increased diastolic filling time, decreased HR, Decreased O2 demand by decreasing BP

Question 17

T/F: Dihydropyridines cause vasodilation and decrease contractility while non-Dihydropyridines primarily affect vascular smooth muscle resulting in vasodilation

Answer 17

False: Dihydropyridines primarily affect vascular smooth muscle resulting in vasodilation while non-Dihydropyridines cause vasodilation and decrease contractility

Question 18

What is the clinical use of Calcium Channel Blockers in Angina

Answer 18

Chronic prophylaxis

Question 19

Why should DHP CCBs never be used as monotherapy for angina

Answer 19

Cause reflex tachycardia with the vasodilation

Question 20

What combination should be avoided with regards to non-DHP CCBs

Answer 20

Beta-blockers

Question 21

T/F: Beta blockers should be avoided in patients who have congestive heart failure

Answer 21

True

Question 22

What is the MOA for nitrates in the treatment of angina

Answer 22

Increase O2 supply by coronary vasodilation, decrease O2 demand by decreasing preload

Question 23

What are the clinical uses for Nitrates

Answer 23

Acute relief on anginal symptoms, chronic prophylaxis of angina

Question 24

What nitrate medications are used for acute relief, chronic prophylaxis

Answer 24

Nitroglycerin sublingual tablets/ Isosorbide mononitrate and nitroglycerin transdermal patch

Question 25

What should a patient do if there is no improvement or worsening symptoms

Answer 25

If no improvement after 5 mins take another and call 911

Question 26

T/F: Short term and long term nitrates can be used together

Answer 26

True

Question 27

What drug is the last resort in angina treatment

Answer 27

Ranolazine

Question 28

What is the MOA ACEIs and ARBs have in angina

Answer 28

Reduce plasminogen activator inhibitor-I activity shifting local fibronylytic states more towards lysis instead of clot formation

Question 29

T/F: ACEs and ARBs are not anti-anginals

Answer 29

True

Question 30

What medication is indicated in all patients with CAD, why, what can be used as an alternative or used with aspirin

Answer 30

Aspirin, lowers risk of MI and death, Clopidogrel

Question 31

What are drugs that will not reduce major cardio adverse events

Answer 31

Rosiglatizone, Estrogen therapy, Vitamin C, E, B12, B6, garlic, selnium, chromium

Question 32

What are the ABCDEs in treatment of chronic stable angina

Answer 32

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