Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

3.23 > Lecture 11: Physiology And Pharmacology Of Angina > Flashcards

Lecture 11: Physiology And Pharmacology Of Angina Flashcards

1
Q

What is ischemia?

A

Insufficiency in blood supply

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the source of blood supply for the heart muscles?

A

The coronary arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What causes angina?

A

If the coronary arteries are blocked, the blood supply to the heart will reduce, which will result in chest pain - angina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is angina pectoris?

A

The result of ischemia caused by an imbalance between myocardial blood supply and oxygen demand

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What gender is angina more common in?

A

Woman

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Angina may occur by..?

A
  • Spasm
  • Atherosclerosis
  • Atherosclerosis with blood clot
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the main types of angina?

A
  • Stable
  • Unstable
  • Printmetals
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is stable angina?

A
  • Most common form
  • Caused by a fixed plaque
  • Can be prompted by exercise or factors that construct blood vessels or increase blood pressure
  • Doesn’t happen at rest
  • Responds well to meds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is unstable angina?

A
  • May occur at rest
  • More severe, lasts longer
  • Sign that a plaque has ruptured or a thrombus has formed
  • Does not respond to rest and meds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is prinzmetals angina?

A

Coronary artery spasm: sudden involuntary contraction of smooth muscle tissue or coronary artery
- The spasm temporarily narrows the coronary artery
- Causes transient impairment of coronary blood supply

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When does prinzmetals angina usually happen?

A

At rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the six different classes of stable angina?

A
  • Exertional angina
  • Anginal equivalent syndrome
  • Syndrome x
  • Silent ischaemia
  • Decubitis angina
  • Nocturnal angina
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is exertional or classical angina?

A
  • Arises from an increase in oxygen demand during exertion or emotion
  • Coronary arteries obstructions are not sufficient enough to go result in resting myocardial ischemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How do you get relief from exertional angina?

A

Rest and nitroglycerine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is anginal equivalent syndrome caused by?

A

Myocardial ischaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the symptoms of anginal equivalent syndrome?

A
  • Shortness of breath
  • Pain at a site other than the chest eg arm or jaw
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is syndrome X?

A
  • Typical, exertional angina with positive exercise stress test.
  • Anatomically normally coronary artieries
  • Reduced capacity of vasodilation in microvasculature
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is silent ischemia?

A

Myocardial ischemia without angina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How is silent ischemia diagnosed?

A
  • Holter monitor (records heart rate and rhthym over a 24 hour period)
  • Exercise testing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is decubitis angina?

A

Chest pain while the patient is lying down

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How does decubitis angina occur?

A

When gravity redistributes fluid in the body - redistribution makes the heart work harder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How is decubitis angina relieved?

A

By standing or sitting.

23
Q

What is nocturnal angina?

A
  • Awakes the patient from sleep
  • May be provoked by vivid dreams
24
Q

What can cause nocturnal angina?

A

Coronary artery spasms

25
Q

What are the eight causes of angina?

A
  1. Significant coronary atheroscelrotic lesion in the large epicardial coronary arteries with atleast a 50% reduction in arterial diameter
  2. Coronary spasm
  3. Abnormal constriction or deficient endothelial dependant relaxation of resistant vessels associated with diffuse vascular disease
  4. Increased extravasular forces, such as severe LV hypertrophy caused by hypertension, aortic stenosis, or hypertrophic cardiomyopathy, or increased LV diastolic pressures
  5. Reduction in the oxygen carrying capacity of blood, such as elevated carboxyhemoglobin or severe anemia
  6. Congenital anomilies or the origin and/ or course of the major epicaridal coronary arteries
  7. Coronary artery fibrosis after chest radiation
  8. Coronary artery intimal fibrosis following caridac transplantation
26
Q

What is used for a stable angina assessment?

A
  • History: Grading scale
  • Exercise testing
  • Electrocardiogram
27
Q

What is used for the classification of angina severity?

A

The canadian cardiovascular society grading scale

28
Q

What is class I angina?

A

Angina only during strenuous or prolonged physical activity

29
Q

What is class II angina?

A

Slight limitation, with angina only during vigorous physical activity

30
Q

What is class III angina?

A

Moderate limitation, symptoms with everyday living activities

31
Q

What is class IV angina?

A

Severe limitation, inability to perform any activity without angina or angina at rest

32
Q

What is the goal of exercise testing?

A

To induce a controlled, temporary ischemic state during clinical and ECG observation

33
Q

What can be used for exercise testing?

A
  • Treadmill
  • Bicycle
  • Bruce protocol
34
Q

How does ischaemia affect an ECG?

A

ST segment depression occurs with ischaemia and reverses when ischaemia disappears

35
Q

How does angina affect ECG?

A

May be normal

36
Q

What are the steps in atherosclerotic plaque and thrombus formation?

A
  1. Initial fatty streak
  2. Plaque enlarges
  3. Loss of endothelium and exposure of collagen
  4. Platelet adherence & activation
  5. Fibrin meshwork deposition with RBC entrapment
  6. More flow turbulence, more platelet adherence, more fibrin deposition
  7. Thrombus of attempting layers, fibrin and red blood cells
37
Q

What are the preventative factors for angina?

A
  • No smoking
  • Diet : reduce fat intake
  • Reduce alcohol
  • Regular ecercise/ weight control
38
Q

What is first line therapy of angina?

A

Beta blockers

39
Q

What should you add if beta blockers dont control symptoms of angina?

A

Calcium channel blocker, long acting nitrates or nicorandil

40
Q

What should you take for immediate relief of angina?

A

Sublingual GTN tablets or spray

41
Q

When do you refer a patient with angina to a cardiologist?

A

If the symptoms are not controlled on maximum theraputic doses of two drugs

42
Q

How do drugs for angina work?

A

Lower the oxygen demand of the heart by affecting blood pressure, venous return, heart rate and contractility

43
Q

Name beta adrenergic receptor blockers

A
  • Atenolol
  • Bisoprolol
  • Metoprolol
44
Q

How do beta adrenergic blockers work?

A

Decrease the oxygen demands of the myocardium by lowering the rate and the force of contraction of the heart

45
Q

Name calcium channel blockers?

A
  • Diltiazem
  • Amlodopine
  • Verapamil
46
Q

What happens when calcium enters a cell?

A

Contraction

47
Q

What do calcium channel blockers do?

A

Prevent entry of calcium into cells via L type calcium channels

48
Q

Why is calcium influx increaesd in ischemia?

A

Due to the membrane depolarization that hypoxia produces

49
Q

Give examples of nitrates (2)

A
  • Glyceryl trinitrate (GTN)
  • Isosorbide mononitrate
50
Q

How do nitrates work?

A
  • Relax coronary arteries by decreasing coronary vasoconstriction or spasm
  • Increase perfusion of the myocardium
  • Can release calcium in muscle
51
Q

Name a potassium channel activator

A

Nicorandil

52
Q

What does nicorandil do?

A

it opens potassium channels in the smooth muscle cells of the blood vessels, leading to hyperpolarization, which causes relaxation of the vessels. At the same time, it also releases nitric oxide, a potent vasodilator.

53
Q

What are the surgical treatments for angina? (3)

A
  • Stenting
  • Angioplasty
  • Bypass surgery
54
Q

How is angina diagnosed?

A
  • ECG
  • Exercise testing

3.23 (26 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions