IHD Flashcards
Revision • GIT upset • Flushing (↓by aspirin) • Itching & pruritis • Glucose intolerance • Gouty arthritis the adverse effect of ?
Nicotinic acid !
lipol ysis inhibitor
classic angina mean >?
it is exertiona angina induced by exercice relrived by rest due to atherosclerosis and decrasing blood to muscle of heart causing :? sever paoin aqueezing and crushing»_space;
the st sdegment is depressed
Failure of coronary to dilate during exercise!
unstable angina definition ?
Acute coronay angina casued by formation of nonocclusive thrombous on top of the athersclerotic plaque felt in rest normal cardiac biomarker some ECG changes
pain during rest
حصلت جلطة وتكسرت بسرعة
النيترات بس بيأثر
لازم تعتبرة احتشاء
NSTEMI mean ?
it is Acute coronary syndrome casued by formation of an occlusive thrmobous on top of the atherosclerotic plaque with presence of alternative collaterals flowing blood
this causes high cardiac biomarkers and non elevate st gement
STEMI ?
it is Acute coronary syndrome casued by formation of an occlusive thrmobous on top of the atherosclerotic plaque withOUT presence of alternative collaterals flowing blood
high cardiac biomarkers and ELEVATED ST segment !
The first tiranngular triad in treatment of IHD ?
Main tratment of IDH
1-Nitrates
2-BB
2-ChB
BB # IN VASOSPASTIC ANGINA ?> WILL LEAD TO UNOPPODED ALPHA VASOCONSTRICTION
BUT IN THE ATHEROSCLEROSIS NO PROBLEM AS THE WALL IS RIGID
NITRATE ONLY ACUTE ATTACK SUBLKINGUAL OTHERS PROPHYLACTICS
• Nitroglycerin
• Isosorbide dinitrate
THE 2nd Triangular triad in treatment of the IHD ?
Adjucant treatment 1-Trimetazidine 2-Ivabradine 3-Renolazine طير
1- tirmettazidine
يقلل متطلبات القلب واستهلاكة للاكسحين عن طريق احويله لاستمداد الطاقة من الجلوكوز وليس الدهون الي بتستهلك اكسجين كتير في عملية الاكسدة بتاعتها
2 ivabradine
مع bb
in heart failure they are only -chronotropics not affecting the contractility
3- renolazine decrase na and ca current
لان الصوديوم هيطير دماغ القلب ! باستهلاكة وتنشيطه
The third triangular triad in treatment of IHD ?
Prophylactic tirad :
1- antiplatelets to prevent formation of throbosis on top of atherosclerosis Aspirin
Clopidogrel
2-hypolipidemic statins drugs to prevent the formation of atherosclerotic plaque
3-ACEI
All drugs used prophylactic prevent recurrent attack except NG & ISDN used also in acute attack (SL)
Show mechanism of the nitrates ?
it depends on the conversion of nitrate to NO then by adding SH group to Nitosothiol increasing guanylyly cyclase activity»_space; cGMP»_space; Leads to decresase of Ca in smooth muscles of blood vessels and Git casuing its relaxation
Antianginal effect ot nitrates?
it decrases o2 demand by its Venulodilator effect decrasing the VR and the EDV and preload and thus the wall tension and o2 demand
in high dose it has Arteriodilator effect decreasing the afterload an tpr
reflex tachycardia incrasing o2 demands
Incraesing the blood supply to ischemia areas how ?
this is by opeining collaterals and vasodilation of epicardial coronary branches casuing redisturibiton of blood to the subendocardial ischemic areas
the ischemia areas subendocardail branchsa are vasodilated due to accumulation of metabolites
Nitrates action on the Git and Blood ?
Relaxation of sphincter of oddi morphine is contraindicated in biliary colic
Relexation of lower esophageal sphincter in dysphagia
anti platelet effect
Indications of the Nitrates ?
1 - angina venulodilator and rediturbiator decresae demand and increase supply
2- MI to prevent extension of the infarction by decreasing demadn and increasing supply
3- Acute pulmonary edema VenuloD decreasing the VR and the preload decrasing blood to the congested Lung like loop diurtics the venodilators !
4-CHF ? IT IS VENULODILATOR decrasing preload and arteriodilator decrasing afterload thus lessens the burdens above the heart muscles in contraction !
nitrates and hudralazine if there is no ACEI RESPOONSE
Adverse effects of nittrates !
VD effects :
throbbing headche and flushing due to VD of extra cerebral vessels take aspirin
Postural hypotension : #with sildenafil
reflex tachycardia WORSEINING ANGINA give BB
• VC due to + adrenergic & RAS system
Tolerance due to depletion of SH gruop
_____________
Methemoglibinemia due to ferrous to ferric cyanosis
sudden withdrawal ? cause» rebound angina
HOCM hypertrophic obstructive cardiomyopathy prevnets taking the a digioxin nitrates ?
لو عملو توسيع للفينز هيقللوا الدم ويقللوا المخرج القلبي وهو اصلا قليل
rihgt ventricular infarction or anything decrasing cop prevnets taking the a digioxin nitrates ?
becasue it will decrease cop more by its venulodilator effect casuing perfusion problems
csaues severe hypotension
