Pharmacology: angina Flashcards
The window for coronary blood flow:
- When does it happen, in terms of aortic and ventricular pressure?
- What 3 factors can reduce the window for coronary flow?
Aortic pressure > ventricular pressure
1. Increased HR
2. Increased ventricular pressure
3. Decreased aortic pressure
What is angina pectoris?
What causes it?
Pain in the heart muscles
Insufficient oxygen supply to the heart relative to demand (coronary artery blockage, closed window for coronary flow, stress)
–>myocardial ischemia
–> muscle releases factors (eg. H+. K+, adenosine) which can stimulate or sensitize noiciceptors
–> Pain
Angina pectoris symptoms:
- Chest pain: is it often severe, crushing, substernal, can radiate?
- Can SOB be present?
- How long does it usually last?
- What usually relieves it?
- When should urgent medical attention be sought?
Yes
Sometimes.
A few minutes; usually relieved by mediations or rest
Angina that is worsening, with chest pain lasting longer than a few minutes
What are the 3 main types of angina?
Stable angina
Unstable angina
Variant angina
Stable angina:
- What usually causes it?
- Is the pain acute or chronic?
- What can trigger the angina/pain?
- Treatment:
- Drug to treat main cause?
- Drug for prophylaxis?
- Drugs to treat symptoms?
Advanced, thick atheroscleortic plaque reduces coronary BF.
Chronic
Exertion/increased demand on the heart
Main cause: statins
Prophylaxis: aspirin (anti platelet, prevent future thrombi)
Reduce work of heart: organic nitrates, beta blockers, calcium channel blockers
Unstable angina
- What usually causes it?
- Is it acute or chronic?
- Does it often arise without warning? Does the pain generally get worse?
- Treatment?
Presence of a ruptured atherosclerotic plaque
Acute
Yes, yes
Revascularise occluded vessels, give anti platelets to lessen the clot
Organic nitrates
Variant angina
- What causes it?
- Is atherosclerosis involved?
- Is it common?
- Does it happen at rest?
- How to treat with drugs?
Spasm of the coronary artery
No
No
Yes
Vasodilators to keep the spasming BV open - calcium channel blockers, organic nitrates
What are the modifiable risk factors for angina?
Smoking, obesity, hypertension, hyperlipidemia, diabetes
What surgeries can treat angina?
Angioplasty and stents