Intro

Question 1

When does myocardial ischemia occur?

Answer 1

Occurs when myocardial oxygen demand exceeds oxygen supply

Question 2

What are types of drugs that increase myocardial supply of oxygen?

Answer 2

• Vasodilators (especially Ca+2 channel blockers)
• Statins and antithrombotics

Question 3

What are types of drugs that decrease myocardial demand of oxygen?

Answer 3

• Beta blockers
• Ca+2 channel blockers
• Organic Nitrates (Nitro-vasodilators)

Question 4

What does a transient reduction in oxygen supply to the heart leading to ischemia known as?

Answer 4

Angina Pectoris

Question 5

Which factors affect myocardial oxygen demand?

Answer 5

There are four major factors that determine myocardial work and therefore myocardial oxygen demand:

●Heart rate
●Systolic blood pressure (the clinical marker of afterload)
●Myocardial wall tension or stress (the product of ventricular end-diastolic volume or preload and myocardial muscle mass)
●Myocardial contractility

Question 6

Which factors affect myocardial oxygen supply?

Answer 6

Determined primarily be coronary blood flow, but occasionally these factors also influence it:
- The oxygen carrying capacity of the blood, which is affected by a variety of factors including oxygen tension and the hemoglobin concentration
- The degree of oxygen unloading from hemoglobin to the tissues, which is related to 2,3 diphosphoglycerate levels

Question 7

Which factors affect coronary artery blood flow delivered to the myocardium?

Answer 7

• Coronary artery diameter and tone (resistance)
• Collateral blood flow
• Perfusion pressure which is determined by the pressure gradients from the aorta to the coronary arteries. Coronary blood flow from the epicardium to endocardial capillaries is determined by the left ventricular end-diastolic pressure
• Heart rate, which affects the duration of diastole, with the percent of diastolic time decreasing as the heart rate increases

Question 8

When does coronary artery blood flow occur?

Answer 8

Coronary artery flow primarily occurs during diastole

Question 9

What is the main mechanism of drugs used in stable angina?

Answer 9

• In patients with typical exercise-induced angina on the basis of CAD, nitrovasodilators, β blockers , and Ca2+ channel blockers improve the balance of myocardial O2 supply and O2 demand principally by reducing myocardial O2 demand by decreasing
  heart rate, myocardial contractility, or ventricular wall stress
• Increased O2 supply by dilating the coronary vasculature may play an additional role

Question 10

What is first line therapy for ischemic heart disease

Answer 10

First line of therapy is Ca2+ channel blockers and the second
line is Nitro-vasodilators in association with first-line treatment.

Question 11

Which of the type of drugs used to reduce myocardial oxygen demand have shown to decrease mortality in ischemic heart disease and how?

Answer 11

Beta blockers is only drug shown to decrease mortality from ischemic heart disease by reducing the rate of sudden cardiac death associated with myocardial ischemia/infarction

Question 12

What causes angina pectoris?

Answer 12

Caused by transient episodes of myocardial ischemia that are due to an imbalance in the myocardial oxygen supply-demand relationship

Question 13

What types of angina can be found?

Answer 13

Three main types:
- Stable angina (exertional angina)
- Unstable angina
- Variant angina (Prinzmetal angina)

Question 14

What happens in variant angina?

Answer 14

Focal or diffuse
coronary vasospasm episodically reduces coronary flow.

Question 15

Which types of drugs are used in the treatment of Angina?

Answer 15

Principal pharmacological agents used in the treatment of angina are
nitrovasodilators, β blockers, and Ca2+ channel blockers

Question 16

What are strategies used for ACSs with unstable angina?

Answer 16

Strategies include the use of antiplatelet agents and heparin, often accompanied by efforts to restore flow by mechanical means, including percutaneous coronary interventions using coronary stents, or (less commonly) emergency coronary bypass surgery

Question 17

Principal therapeutic aim in variant angina?

Answer 17

To prevent coronary
vasospasm