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cardiovascular > SIHD and Angina > Flashcards

SIHD and Angina Flashcards

1
Q

what does SIHD stand for

A

stable ischemic heart disease

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2
Q

what are the 3 golden things to remember about angina

A

stable angina comes on almost exclusively on exertion

stable angina more common in people with high CV risk

treatment is symptomatic (treating the symptoms - felling better), However disease modification effects prognosis

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3
Q

what is the definition of angina

A

literally pain - but adopted to mean chest pain (myocardial ischemia without necrosis)

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4
Q

what causes the chest pain (myocardial ischemia)

A

a mis-match between O2 supply and demand

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5
Q

what are causes of stable angina (remember - myocardial ischemia) - how common are they

A

obstructive coronary atheroma CORONARY STENOSIS - v. common

coronary artery spasm - uncommon

coronary inflammation/ arteritis - v. rare

Anaemia - have to be very severally anaemic

or due LVH (left ventricular hypertrophy) and having a lack of O2 to supply it

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6
Q

when does myocardial O2 demand increase - increased HR and BP

A

exercise, cold weather, anxiety/emotional and after a large meal

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7
Q

how is angina diagnosed

A

by the HISTORY

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8
Q

what should be red flags for angina in the history

A

S - site - retrosternal (front of chest)

O - onset - exertion

C - character - tight band, pressure

R - radiation - chest mainly, maybe down the left arm

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9
Q

what happens to someone with angina when they rest or take GTN

A

a rapid improvement in the chest pain/ tightness

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10
Q

what are the nonmodifiable risk factors for angina

A

old age, male, family history, genetic factors

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11
Q

what are the modifiable risk factors for angina

A

smoking

lifestyle - exercise and diet

control of conditions
diabetes mellitus
hypertension
hyperlipidaemia

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12
Q

what is GTN

A

a smooth muscle dilator

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13
Q

what must you always do to people with chest pain

A

you must examine people with chest pain to rule out more sever conditions

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14
Q

what is a fairly useful test for finding the underlying cause of the angina

A

full blood count and lipid profile

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15
Q

what are the 3 main ways to test and confirm it is angina

A

reproduce symptoms - exercise test - ST depression

demonstrate ischemia

demonstrated dysfunction

both done by CT scan or invasive angiogram (can lead to thrombus)

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16
Q

what are the 3 effects of the treatments

A

disease modification to improve prognosis

treating the symptoms

surgery

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17
Q

what are the 3 treatment strategies

A

addressing risk factors

medicines

revascularisation - surgery

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18
Q

when is revascularisation (surgery) undertaken

A

when the symptoms are not controlled

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19
Q

what medicines influence disease progression - when would they be used

A

statins - if high cholesterol

ACE inhibitors - if high CV risk and atheroma

aspirin - protects epithelium - put on in genera

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20
Q

what medicines can be used for symptom relief

A

beta blockers

nitrates - GTN - vasodilation

Ca2+ channel blockers - vasodilation

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21
Q

in relation to angina what would statins be used for

A

reduce LDL cholesterol deposition in atheroma

stabilise atheroma

and can lead to stabilisation/ regression

Disease mod

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22
Q

in relation to angina what would ACE inhibitors be used for

A

lowers B

if increased CV risk and atheroma

stabilises endothelium and also reduces plaque rupture

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23
Q

in relation to angina what would aspirin be used for

A

may not directly effect plaque

but stops platelet aggregation

protects endothelium

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24
Q

in relation to angina what would beta blockers be used for

A

Reduced myocardial work and have anti-arrhythmic effects

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25
Q

in relation to angina what would Ca2+ channel blockers be used for

A

produce vasodilation

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26
Q

what would nitrates be used for angina

A

GTN (Glycerine trinitrate)

Used as short or prolonged acting patches or tablets to increase vasodilation

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27
Q

what are the revascularisation options

A

PCI - percutaneous coronary intervention

coronary artery bypass surgery

28
Q

what is PCI - is it effective

A

squash atheroma with balloon, stent to keep the vessel open

it is effective for symptom relief but no effect in disease modification

29
Q

what is coronary artery bypass

A

putting in vessels from elsewhere bypassing the effected vessels

a more extensive surgery

but produces better long term effects

30
Q

what are the acute coronary syndromes

A

MI - STEMI, NSTEMI

unstable angina pectoris

31
Q

what are the stable coronary artery diseases

A

angina pectoris

silent ischaemia

32
Q

what does Stable coronary artery disease (SCAD) result as

A

a mismatch between myocardial blood/ oxygen supply and demand

33
Q

how do drugs correct the supply and demand imbalance

A

decrease O2 demand
-reduce HR

  • reduce myocardial contractility
  • reduced afterload

increase the O2 supply

34
Q

what are the rate limiting drugs

decrease demand

A

beta-adrenoceptor antagonists (beta blockers)

ivabradine

calcium channel blockers

35
Q

what are the vasodilators (increase supply)

A

calcium channel blockers

nitrates

36
Q

other than vasodilators and rate limiting drugs what are othe drug therapyies used for stable ischemic Heard disease

A

potassium channel openers

aspirin/cpopidogrel/tiagagrelor

cholesterol loweerinf agegnts

37
Q

what are beta blockers

A

Block the sympathetic system as reversible antagonists of the beta 1 and 2 receptors

decrease HR, contractility, CO and decrease BP

increase exercise threshold before angina

38
Q

what are examples of beta blockers

A

bisoprolol, atenolol

39
Q

what can sudden stopping of beta blockers do

A

may precipitate myocardial infarction

40
Q

what are the contraindications for beta blockers

A

asthma

PVD (peripheral vascular disease)

heart failure

bradycardia

41
Q

what are some adverse reactions of beta blockers

A

tiredness

impotence

bradycardia

bronchospasms

42
Q

what are some drug-drug interactions of beta blockers

A

hypertensive agents

other rate limiting drugs

cardiac failure when used negatively with inotropic agents

43
Q

what are some examples of calcium channel blockers

A

dil-ti-a-zem

ver-ap-a-mil

am-lod-i-pine

ni-fed-i-pine

44
Q

what do calcium chanel blockers do

A

prevent calcium influx into myocytes/smooth muscle around arteries

BLOCKS L-TYPE CALCIUM CHANNELS

45
Q

what is a example of a rate limiting Calcium channel blocker (what do they do)

A

diltiazem

verapamil

reduce HR and contractilty

46
Q

what are examples of vasodilation calcium channel blockers (what do they do)

A

amlodipine

NIFEDIPINE

reduce vascular tone and reduce afterload

47
Q

what are the contraindications for calcium

A

NEVER USE NIFEDIPINE IMMEDIATE RELEASE - contributes to acute MI/stroke

48
Q

what are some adverse drug reactions of calcium channel blockers

A

ankle oedema - and 20% of patients don’t respond to diuretics

headache

flushing

palpitation

49
Q

what is an example of nitrovasodilators

A

GTN

50
Q

what does GTN stand for

A

glyceryl trinitrate

51
Q

what do nitrovasodilators do

A

release NO which stimulated cGMP which produced smooth muscle relaxioant

reduces preload and afterload

52
Q

what are the uses of GTN

A

rapid angina treatment

prophylactic

avoid first pass metabolism

53
Q

when are IV nitrates used

A

along with heparin in the treatment of unstable angina

54
Q

what are the problems with nitrovasodilator

A

Tolerance to the effects of nitrate therapy can develop rapidly

55
Q

what are adrevrs drug reactions of GTN

A

hypotension

GTN syncope

56
Q

what is ivabradine

A

selective sinus node If channel inhibitor

Slows the diastolic depolarisation slope of the SA-node

reduced HR in turn myocardial O2 demand

57
Q

what is nicorandil

A

preconditioning drug

opens up ATP sensitive K+ channels - cardioprotrctive effect with out ischemia

58
Q

Low Dose Aspirin is the most common cause of what

A

admission with a GI bleed

59
Q

what is the prescribe 1st line treatment of angina

A

short acting nitrates

plus

beta blocker/ and or CCB

60
Q

what is the preventative treatment for stable coronary artery disease

A

lifestyle changes
risk factor control

aspirin
statins

ACE inhibitor is other cardiac conditions are present

61
Q

what are 2nd line drugs for angina relief

A

ivabradine or
niocorandil or
long acting nitrates

62
Q

what are 2nd line drugs for angina relief

A

ivabradine or
niocorandil or
long acting nitrates

63
Q

what is aspirin

A

Aspirin is a potent inhibitor of platelet thromboxane production

64
Q

what is thromboxane

A

stimulates platelet aggregation and vasoconstriction

65
Q

when can aspirin be used

A

Use for the symptomatic treatment of chronic stable angina in adults with normal sinus rhythm and heart rate ≥ 70 bpm.

66
Q

All patients with stable angina should be

A

consider ACE inhibitors

if atherosclerotic
consider long-term aspirin and statin therapy

67
Q

what is a common example of cholestrolo loweing agents

A

simvastatin

cardiovascular (26 decks)

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