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Theme 3 > Ischaemic Heart Disease Treatment > Flashcards

Ischaemic Heart Disease Treatment Flashcards

1
Q

Definition of IHD:

A

Narrowing of lumen of coronary arteries - imbalance

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2
Q 
Regulation of cardiac workload 
EDV 
HR 
Contractility 
TPR
A
  • End Diastolic Volume (preload) regulated by sympathetic system, RAAS, (contractility of venules; RAAS (Na+ and H2O retention)
    • Heart Rate (sympathetic system/ Ca2+)
    • Contractility (sympathetic system/Ca2+)
    • Total peripheral resistance (sympathetic system, RAAS)
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3
Q

Imbalance in demand and supply

A

Increase HR, force and TPR = Decrease thrombus, atheroma and vasoconstriction

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4
Q

Stable angina definition

A

Predictable pattern of pain

Relieved by rest and worse during exercise

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5
Q

Nitrate action

A

Increase cGMP = Decrease calcium and ventilation

Increase NO = dilate some CA

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6
Q

Nitrate side effects

A
  • Postural hypotension
    • Reflex tachycardia
    • Headache
    • Dizziness
    • E.g. Gylceryl trinitrate (GTN)
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7
Q

Reflex tachycardia

A

Due to sympathetic NS

In response to change in blood flow or blood pressure

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8
Q

Beta blocker action

A

Decrease frequency and force of contraction

Inhibit renin release from kidney and inhibit RAAS

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9
Q

Beta blocker side effects

A
  • Bronchoconstriction
    • Fatigue
    • Contraindicated in patients with peripheral vascular disease
    • Potential bradycardia
    • E.g. bisoprolol
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10
Q

Calcium ion channel antagonists

A

Decrease frequency and force contraction (phenylalkylamine/benzothiazepines)

Increase arteriole dilation (dihydropyridines)

Decrease Cardiac workload

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11
Q

Ivabradine

A

Blocks pacemaker current in nodal tissue of heart

Side effects:
◦ Luminous phenomena (Ih) in retina
◦ Blurred vision
◦ dizziness

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12
Q

Ivabradine decrease cardiac rate

A

Reduce Na+ entry through If channels and slow depolarisation of SAN and reduce firing frequency

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13
Q

Isosorbide mononitrate

A

Long acting nitrate

Decrease preload

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14
Q

Ranolazine

A

Reduce work done by heart

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15
Q

Trimetazidine

A

◦ Rebalances energy metabolism in the cell

◦ Preferentially moves potassium in the heart muscle cells to use glucose and not fatty acids

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16
Q

Reduce hypercholesterolemia

A

Drugs designed to inhibit uptake from GI tract or reduce production in liver

17
Q

Statins

A

Decrease production of cholesterol in liver by inhibiting HMG CoA enzyme

Stimulate liver cells to express LDL receptors and allow liver cells to scavenge LDL-C from plasma

18
Q

Antiplatelet agents

A

Antiplatelet agents (aspirin/clopidogrel)

19
Q

ACE inhibitors

A

Eg. Ramipril

Decrease heart workload

20
Q

ARBs (losartan)

A

Decrease heart work load

21
Q

Prasugrel

A

pro-drug like clopidogrel and needs to be activated in the liver

22
Q

MI diagnosis

A
  • Pain
    • Sweating
    • Tachycardia
    • Cold clammy skin
23
Q

MI treatment

A

• Beta blockers
◦ Decrease cardiac workload, prevents arrhythmias E.g. metoprolol/bisoprolol-short acting
• ACE inhibitors
◦ Decrease cardiac workload, prevents remodelling development of heart failure E.g. Ramipril
• Anticoagulant
◦ In case of long term bed rest, prevents thrombus formation E.g. warfarin

24
Q

Metoprolol/bisoprolol-short acting

A

Decrease cardiac workload - prevent arrhythmias
Beta blocker
MI treatment

25
Q

Ramipril

A

ACE inhibitor
Decrease cardiac workload
Prevent remodelling development of HF
MI treatment

26
Q

Warfarin

A

Anticoagulant

In case of long term bed rest, prevent thrombus formation

27
Q

Digoxin

A

Binds Na+/K+ ATPase and inhibits action
Increase levels of Na+ ions inside the heart muscle
Increase inhibits Na+/Ca2+ exchanger - build up of Ca2+ ions

28
Q

Treatment of dysrhythmias

A

Amiodarone

K+ channel blocker that increase refractory period of ventricular myocytes and can terminate arrhythmias

29
Q

Amiodarone

A

K+ channel blocker that increase refractory period of ventricular myocytes and can terminate arrhythmias
Treat dysrhythmias

30
Q

Nitrate-cGMP pathway

A 
Guanylyl Cyclase (GTP -> cGMP) 
Sildenafil -> PDE (cGMP -> GMP)
31
Q

Acetylcholine and bradykinin

A

Increase Ca2+ entry in cell

  • > NOS (L-arg-> NO)
  • > sGC (GTP -> cGMP) = relaxation
32
Q

Peripheral vascular disease contraindicated with

A

Calcium channel antagonists

33
Q

Contraindication with BB (asthmatics) -> CCBs

A

Verapamil

Diltiazem

34
Q

Cardiac selective CCBs can cause

A

Bradycardia

Heart Block

35
Q

CCBs mechanism of action

A

Block L-type channel in SAN and AVN
Slow rate of depolarisation
Decrease ventricle contractn

36
Q

Luminous phenomena in retina

A

Ivabradine

37
Q

Antiplatelet agent mechanism of action

A

Release ADP which acts on P2Y12 receptors to stimulate platelet expression of GPIIb/IIIa

Theme 3 (16 decks)

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