Ischemic Heart Disease & Acute Coronary Syndromes Flashcards
Define stable angina
also known as stable ischemic heart disease
associated with predictable chest pain, often brought on by exertion or emotional stress and relived within minutes by rest or with nitroglycerin
Define unstable angina
type of acute coronary syndrome
the chest pain increases (in frequency or duration) and is not relieved with nitroglycerin or rest
Define prinzmetal’s angina
chest pain due to vasospasm of coronary arteries; it is unpredictable and can occur at rest but is not usually associated with underlying CAD
Define acute coronary syndrome
acute chest pain that is severe and not relieved by rest or nitroglycerin; acute medical care is needed (includes UA, NSTEMI, STEMI)
Define silent ischemia
transient myocardial ischemia without symptoms of chest pain
common cause of stable angina or stable ischemic heart disease
atherosclerosis or CAD
recommended antiplatelet for IDK
ASA
What is the first line anti-anginal for IHD
beta-blockers
ASA MOA
binds irreversibly cyclooxygenase-1 and 2 (COX 1 and 2) enzymes which results in decreased prostaglandin and thromboxane A2 production. TXA2 is a potent vasoconstrictor and inducer of platelet aggregation.
Clopidogrel MOA
prodrug that irreversibly inhibits P2Y12 ADP-mediated platelet activation and aggregation
which cyp enzyme converts clopidogrel from its prodrug
Cyp2C19
DAPT for bare metal stent
1 month
DAPT for drug-eluting stent
6 months
DAPT post-CABG
12 months
Which drug should be avoided in prinzmetal’s angina
BB
Ranolazine MOA
selectively inhibits the late phase Na current and decreases intracellular Ca; may decrease myocardial oxygen demand by decreasing ventricular tension and O2 consumption
Nitroglycerin CI
concurrent use with PDE-5 inhibitor
-cause a decrease in BP
What is required when using a long acting nitrate to reduce tolerance
10-12 hour nitrate-free period
Define ACS
results from plaque buildup in the coronary arteries that causes sudden, reduced blood flow and an imbalance between myocardial oxygen supply and demand
3 things that ACS encompasses
NSTEMI
STEMI
UA
classic symptoms of ACS
chest pain lasting > 10 min
severe dyspnea
diaphoresis
pain can radiate to the arms, back, neck, jaw, epigastric
treatment for ACS
MONA-GAP-BA morphine oxygen nitrates asa
Gpllb/llla antagonist
anticoagulants
P2Y12 inhibitors
beta blockers
acei
Define PCI
coronary revascularization procedure that involves inflating a small balloon inside a coronary artery to widen it and improve blood flow. Usually metal mesh, called a stent is placed into the artery afterward to keep the artery owpen
MOA of morphine in ACS
produces arterial and venous dilation: leading to a decrease in myocardial O2 demand; provides pain relief
List GPllb/llla receptor antagonists (3)
abciximab
eptifibatide
trofiban
MOA GPllb/llla receptor antagonists in ACS
block fibrinogen from binding to the GPllb/llla receptors on platelets preventing platelet aggregationf
List P2Y12 inhibitors
clopidogrel
prasugrel
ticagrelor
Which P2Y12 inhibitors are irreversible
clopidogrel
prasugrel
CI to prasugrel
history of TIA or stroke
Fibrinolytics MOA
cause fibrinolysis (clot breakdown) by binding to fibrin in a thrombus (clot) and converting entrapped plasminogen to plasmin.
Fibrinolytics are only used for what
STEMI
time to deliver a PCI
90 minutes door-to-balloon-time
120 minutes of first medical contact
When should a fibrinolytic be administered
within 30 minutes of hospital arrival
List fibrinolytics (3)
alteplase
tenecteplase
reteplase
CI to finbrinolytics
history of recent stroke
prior ICH
severe uncontrolled HTN
