Mehl. angina + emergency/urgency Flashcards
Chest pain that occurs predictably with exercise?
Stable angina
Due to atherosclerotic plaques causing >70% occlusion; can be calcific.
Stable angina
Stable angina, ST on ECG?
Classically causes ST depressions on ECG.
Stable angina, Tx??
Nitrates (e.g., sublingual isosorbide dinitrate) used as Tx -> nitrates “donate” nitric oxide (NO) that upregulates guanylyl cyclase within venous smooth muscle -> increased cGMP -> relaxation of venous smooth muscle -> increased venous pooling of blood -> decreased venous return -> decreased myocardial oxygen demand -> mitigation of chest pain
Stable angina. Nitrates are contraindicated with?
PDE-5 inhibitors (e.g., Viagra) due to risk of low blood pressure.
Stable angina.
Sodium nitroprusside used for hypertensive emergencies dilates arterioles in addition to the veins. If USMLE asks you where this drug acts, choose arterioles.
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Sodium nitroprusside dilates what?
dilates arterioles in addition to the veins. If USMLE asks you where this drug acts, choose arterioles.
used for hypertensive emergencies
Chest pain that is unpredictable and can occur at rest.?
Unstable angina
Due to partial rupture of atherosclerotic plaque leading to partial occlusion.?
Unstable angina
Unstable angina. ST on ECG?
ST depressions on ECG
Unstable angina. 2CK NBME for patient with unstable angina drug?
Diltiazem is answer on new 2CK NBME for patient with unstable angina.
Unstable angina. what need to do?
Patients need cardiac catheterization.
Vasospastic angina that occurs at rest (i.e., watching TV or while sleeping) in younger adults; it is not caused by atherosclerosis.?
Prinzmetal angina (variant angina pectoris)
Prinzmetal angina (variant angina pectoris). ECG?
ST elevations are seen on ECG.
You must know that Prinzmetal is also known as variant angina pectoris. There is an NBME Q that gives vignette of Prinzmetal, but answer is “variant angina pectoris.”
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Prinzmetal angina (variant angina pectoris). Tx? 2
Treatment is nitrates (can cause coronary artery dilation unrelated to the venous pooling effects)
OR
dihydropyridine calcium channel blockers (e.g., nifedipine).
Prinzmetal angina (variant angina pectoris). what is contraindicated? 2
Avoid a1-agonists in these patients (cause vasoconstriction), as well as non-selective b-blockers like propranolol (can cause unopposed alfa effects).
Hypertensive Emergency + urgency.
Urgency CP?
HTN >180/120 + no signs of end-organ damage.
Hypertensive Emergency + urgency.
Urgency target BP?
Blood pressure should be brought under 160/100 by 24-48 hours.
Hypertensive Emergency + urgency.
Urgency Tx? 4
Drugs used are IV sodium nitroprusside, IV nicardipine, IV labetalol, and oral captopril.
Hypertensive Emergency + urgency. Emergency. CP?
HTN >180/120 + signs of end-organ damage.
Hypertensive Emergency + urgency. Emergency - organ damage?
The latter can be hypertensive encephalopathy (confusion), nephropathy (poor renal function tests), retinopathy, acute heart failure, etc.
Hypertensive Emergency + urgency. Emergency - target BP?
Blood pressure should be brought under 160/100 by 24-48 hours.
Hypertensive Emergency + urgency. Emergency - how to decrease BP?
BP should be ̄ by no more than 20-25% in the first hour, as drastic ̄ can compromise perfusion to the brain and vital organs.
Hypertensive Emergency + urgency. Emergency Tx? 4
Drugs used are IV sodium nitroprusside, IV nicardipine, IV labetalol, and oral captopril.
