CVS - Ischemic Heart Disease Flashcards by Richhpal Singh

Ischemic Heart disease can be classified into

Angina
MI

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Angina can be classified into

Classical Angina
Variant angina or Prinzmetal Angina or Vasospastic angina

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Classical Angina

Atherosclerosis in small coronary arteries
Chest pain only during exertion

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Aim of treatment in Classical Angina

Decrease work of heart

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Variant Angina

Spasm in main coronary artery
Chest pain even at rest

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Aim of treatment in Variant Angina

Dilation of coronary artery

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Drugs used in Angina

Nitrates
Calcium channel blockers
Potassium channel openers
Beta blockers

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Nitrates are metabolized to NO by which enzyme

Aldehyde dehydrogenase

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Nitrates acts by increasing

cGMP levels - which further stimulates Protein kinase a - activate MLCK - Leads to smooth muscle relaxation (Vasodilation)

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Nitrates include which drugs

Glyceryl trinitrate
Isosorbide dinitrate
Isosorbide mononitrate
Pentaerythrital tetranitrate
Amyl nitrite

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Nitrates which can be given sublingually, used in acute attack of Angina (DOC)

NTG
Isosorbide dinitrate

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Which nitrate have minimum first pass metabolism

Isosorbide mononitrate

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Longest acting Nitrate

Pentaerythrital tetranitrate

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Shortest acting nitrate

Amyl nitrite

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Nitrate free period should be atleast

6-8 hours
Can show tolerance if remains 24 hrs in blood

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Uses of Nitrates

A - Angina
B - Biliary Colic
C - Cyanide Poisoning
D - Dil ka Daura (MI)
E - Esophageal spasm
F - Failure (CHF)

Which nitrate can convert Hb to Methb and can reverse Cyanide Poisoning

Amyl nitrite + Sodium Thiosulfate to convert CyanmetHb to Sodium thiocyanate - passes from urine

Preferred antidote for Cyanide Posioning

Iv Hydroxycobalamin

Which drugs if given with Nitrates can cause severe Hypotension

Sildenafil
Tadalafil - PDE Inhibitors - can leads to high level of cGMP - Vasodilation

Calcium channel blockers used in Angina

Verapamil
Diltiazem
DHPs

Action of Verapamil and Diltiazem in Angina

Decreases preload nd Afterload
Decreases HR

Action of DHPs in Angina

Can cause tachycardia and can precipitates Angina
Normally not preferred

Side effects of Calcium channel blockers

Headache
Constipation
Gum hypertrophy

Drugs of Dihydropyridines(DHPs) group

Nifedipine
Clevidipine
Nimodipine
Nicardipine
Amlodipine
Clenidipine

Which DHPs are contraindicated in Anginal patients

Nifedipine Clevidipine - Shortest acting

Which DHP is Cerebroselective and used in Subarachnoid hemorrhage

Nimodipine

DOC in Hypertensive emergencies

Long acting DHPs Nicardipine Amlodipine

Potassium channel openers used in Angina

Releases NO NICORANDIL

Action of beta blockers in Angina

Decreases HR contraindicated in Variant Angina

Which drugs show Coronary steal Phenomenon

Vasodilation of only small coronary arteries H - Hydralazine I - Isoflurane D - Dipyridamole E - Enflurane

Bradycardiac agent that can be used in Angina

Ivabradine

Rho kinase inhibitor which is approved for angina

Fasudil

Metabolic modulators mechanism of action in Angina

Inhibits Fatty acid oxidation and let use glucose instead of fatty acids

Metabolic modulators drugs used in Angina

Trimetazidine Ranolazine - mainly acts as Na+ channel blocker

Characteristics of Myocardial Infarction

Severe pain Long duration Other associated symptoms

Treatment of STEMI

S - Streptokinase O - O2 N - Nitrate A - Aspirin M - Morphine

Drugs used in NSTEMI

M - Morphine O - O2 N - Nitrates A - Aspirin