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PHAR 152 > Ischemic Heart Disease + Coronary Artery Disease > Flashcards

Ischemic Heart Disease + Coronary Artery Disease Flashcards

1
Q

What are the types of CV diseases?

A

Ischemic heart disease
Cerebrovascular disease
Peripheral arterial disease
Venous thromboembolic disease
Heart failure
Arrhythmia

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2
Q

Presentation of coronary atherosclerosis

A

Silent disease for most patients

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3
Q

What is acute coronary syndrome (ACS)?

A

Feels like a “heart attack” (unstable angina, STEMI, NSTEMI)

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4
Q

What is angina?

A

Dull, retrosternal discomfort/ache/heaviness
May or may not radiate to jaw, neck, shoulders, arms

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5
Q

What is stable angina?

A

Oxygen demand exceeding supply

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6
Q

What is unstable angina?

A

Inadequate supply regardless of demand

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7
Q

What is fixed obstruction stable angina?

A

An increase in demand that cannot be accommodated with increased supply

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8
Q

What triggers fixed obstruction angina?

A

SNS activity (exercise, emotion, stress)
Exertion after a heavy meal
Metabolic demand (chills, fever, cold exposure)
Anemia (low oxygen content in blood)

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9
Q

What are some problems with stable angina?

A

Endothelial dysfunction (decrease in NO production)
Micro vascular dysfunction (poor response to NO)

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10
Q

Treatment for stable angina

A

Rest
Nitroglycerin as needed (decreases preload)
1st line: BB or CCB (DHP, non-DHP)

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11
Q

What is preload?

A

Degree to which the myocardium is stretched before it contracts
Increase preload = increase work of the heart

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12
Q

How can stable angina be diagnosed?

A

Exercise stress test - ST depression will appear on ECG
- T wave inversion is another sign
After diagnosis -> coronary angiogram - performed to evaluate coronary artery blood flow and identifies locations of narrowed vessels

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13
Q

What are is the core medication therapy for CAD?

A

(ABCDE)
Anti-platelets (ASA 81mg)
Blood pressure medications (Ramipril 10mg OD - ACE)
Cholesterol-lowering medications (Rosuvastatin 20mg OD)
Diabetes medications (metoprolol 100mg BID - BB)
Exercise/diet/lifestyle changes (nitroglycerin spray

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14
Q

What was seen in the HOPE trial 2000?

A

ACE slightly decreases BP BUT significantly decreases MI and stroke

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15
Q

How does BB help with angina and when is it first line?

A

Prevents angina through decrease in cardiac demand
First line for: angina prophylaxis, post MI, systolic HF

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16
Q

Why do we choose B1 selective over non-selective BB?

A

Non-selective have more AE including:
- erectile dysfunction
- peripheral circulation problems
- interaction both B-2 agonists (ventolin)
- avoid BB with ISA

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17
Q

Which drugs can mask hypoglycaemia?

A

BB

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18
Q

When should non-DHP CCBs be avoided?

A

Systolic dysfunction
Already using BB
Bradycardia or AV block

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19
Q

What are DHP CCBs role in angina therapy?

A

Can be safely combined with BB if symptoms persist
Good alternative as monotherapy for patients with bradycardia or intolerance to BB

20
Q

What do we do if low BP and on an ACE?

A

Add nitro

21
Q

What do we do for angina with high BP?

A

Add amlodapine (DHP CCB)

22
Q

What do we do for angina and high HR?

A

Increase metoprolol dose (BB)

23
Q

What should be done if pain continues after anti-angina therapy?

A

An angiogram

24
Q

What are the 2 possible approaches if an obstruction is found?

A

Medical therapy - continue with drugs
Revascularization - coronary artery bypass grafting, percutaneous coronary intervention (PCI) (angioplasty/stent implantation), fibrinolytic medications (for acute emergencies and smaller towns)

25
Q

What is dual anti platelet therapy (DAPT)?

A

Use of ASA + a P2Y12 inhibitor (ADP inhibitor)
To prevent early stent thrombosis

26
Q

Longer DAPT = …

A

Increase risk of bleeding

27
Q

Shorter DAPT = …

A

Increase risk of event of stent thrombosis

28
Q

What is used fro elective PCI?

A

No risk of bleeding = DAPT for 6 months (ASA + clopidogrel)
High risk of bleeding = DAPT for 1 month if BMS, or 3 months if DES

29
Q

What are the two categories of acute coronary syndrome(ACS)?

A

Unstable angina
MI - further divided into:
- STEMI
- NSTEMI

30
Q

Common signs of ACS

A

Pressure/pain behind the sternum
Pain radiates to arms, neck and jaw
Persisted for over 5 minutes despite trying to rest

31
Q

Is ACS ruled out if the ECG is normal?

A

Yes

32
Q

What causes NSTEMI?

A

This is ST segment depression caused by coronary ischemia

33
Q

What causes STEMI?

A

This is ST segment elevation caused by complete coronary obstruction

34
Q

What else is present on an ECG in a patient who has had MI?

A

The Q wave - appears following MI

35
Q

What are the bio markers for cell death?

A

Cardiac troponins are the most sensitive and specific bio markers in the context of ACS

36
Q

What does increase levels of troponin in blood mean?

A

Cardiac cell death

37
Q

What is the treatment for ACS in ER setting?

A

Oxygen - if O2 is <90%
ASA +/- ADP inhibitor
S/L nitro
BB

38
Q

What do we do if a patient is experiencing STEMI?

A

Reperfusion within 12 hours (faster = less cell death)
PCI (within 2 hours) is the proffered method of reperfusion
Fibrinolytic medication (if past 2 hrs)

39
Q

What is the pre-PCI therapy?

A

ASA 81mg - 325mg if not already taking ASA 81MG
P2Y12 inhibitor (loading dose) - clopidogrel preferred for elective, Ticagrelor preferred for STEMI or NSTEMI
Anticoagulants - LMWH, UFH, bivalirudin (usually 2 anticoagulants are started)

40
Q

PCI medications needed for patients not taking ASA beforehand

A

ASA 325mg
Nitro spray
Metoprolol 25-50mg
Ticagrelor

41
Q

What are the drugs prescribed after STEMI/NSTEMI?

A

ASA 81mg
Ticagrelor
Bisoprolol (BB)
Ramipril (ACE)
Atorvastatin 80mg or rosuvastatin 40mg
D - something for diabetes
E - nitroglycerin for angina as needed

42
Q

Treatment for NSTEMI

A

Oxygen if O2 saturation <90%
ASA 325mg
Nitro spray
Metoprolol
IV anticoagulation

43
Q

How are PCIs used fro NSTEMI?

A

Not needed for emergency
Schedule for an elective PCI

44
Q

How is DAPT used in NSTEMI?

A

When there is no PCI done prescribe DAPT for 1 year

45
Q

What is atrial fibrillation

A

Arrhythmia of the atrium removing the atrial contraction altogether
Clots can form in the left atrium due to pooling of blood
These clots can embolism into the carotid artery and cause stroke

46
Q

What is an effective treatment for atrial fibrillation?

A

Anticoagulants

47
Q

What is the treatment for unstable angina?

A

Schedular for elective PCI(non urgent)
Treat exactly like stable angina: BB, ACE, statin

PHAR 152 (10 decks)

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