Stable Ischemic HD, ACS, & Stroke (unfinished) Flashcards
What is the leading cause of ischemic heart disease?
Coronary artery disease (CAD)
List 2 kinds of Ischemic heart disease
1) Acute coronary syndrome (ACS)
2) Stable ischemic heart disease (SIHD)
Who has the highest mortality rates for CVDs?
1) African Americans / Black Americans
2) Men
1) Define Angina pectoris
2) What are 2 subtypes of Angina pectoris?
1) Imbalance between myocardial oxygen supply and myocardial oxygen demand (MVO2)
2) ACS and SIHD
(acute coronary syndrome + stable ischemic heart disease)
Differentiate between ACS and SIHD
1) ACS = Atherosclerotic plaque rupture and thrombus formation
2) SIHD = Plaques are stable, have a reduced lipid core, and a firm calcified covering; plaque produces a relatively fixed decrease in myocardial oxygen supply
Angina pectoris pathophys:
1) What may increase demand and precipitate angina?
2) Coronary plaques that occupy less than ____% to ____% of the vessel luminal diameter are often referred to as “nonobstructive”
1) Norepinephrine adrenergic stimulation of myocytes (related to oxygen demand)
2) 50% to 70%
Myocardial oxygen supply: List 2 factors other than coronary blood flow
1) Heart rate
2) Coronary collateral circulation
(like Arteriogenesis or Angiogenesis)
Angina pectoris:
1) Coronary vasospasm can cause what?
2) What is absent in Variant angina (Prinzmental’s angina)?
1) Variable-threshold angina
2) Do not have flow-obstructing atherosclerotic plaques
1) How would you relieve effort angina?
2) What about rest angina?
1) Rest + Nitroglycerin (NTG)
2) Nitroglycerin (NTG)
Angina pectoris:
1) What is generally the first line Tx?
2) What may be used to reduce symptoms concomitantly or as second line therapies?
3) What is recommended for the immediate relief of angina?
1) Beta-blockers
2) Calcium channel blockers and long-acting nitrates
3) Sublingual nitroglycerin or nitroglycerin spray
Starred Angina flowchart step 1: How do you Tx acute attacks?
SL nitroglycerin
Starred Angina flowchart step 2:
How do you Tx vasospastic angina if:
1) BP is less than 130/80mmHg
2) BP is >/= 130/80 mmHg
1) Add LA nitrate
2) Add CCB
What things should lifestyle modifications for SIHD target?
1) Lipid management
2) BP
3) DM
4) Physical activity
5) Weight mgmt
6) Smoking cessation
Lifestyle modifications for SIHD:
1) How should you target physical activity?
2) How much should pts try to reduce their weight?
1) 30-60 minutes of moderate-intensity aerobic activity at least 5 days and preferably 7 days per week
2) 5%-10% from baseline
SIHD Tx; Clopidogrel (Plavix; 2nd line):
1) Non-responsiveness to clopidogrel ranges from __ to ___%.
2) What does clopidogrel require? What is available because of this?
3) What is kinda contraindicated? What may you use instead?
1) 5% to 44%
2) Clopidogrel is a prodrug that requires activation by CYP2C19
-Genotyping available
3) Omeprazole associated with inhibition of CYP2C19; consider alternative
-Pantoprazole (Protonix) or lansoprazole (Prevacid)
SIHD Tx:
1) What is the BP goal?
2) For DM, AHA/ACC recommendations target an A1c of less than ___%.
3) What drug is used for DM? What dose?
1) Less than 130/80 mm Hg
2) 7%.
3) Metformin (Glucophage) 500mg – 2,000 mg PO Qday
What are 2 categories of drugs used for Sx management of SIHD?
1) B-Blockers
2) CCBs
Beta blockers for symptomatic relief of SIHD:
1) When would you use Metoprolol?
2) What else is effective in the management of angina?
1) β1-selective agents would be preferred in patients with chronic obstructive pulmonary disease, peripheral arterial disease, DM, dyslipidemias, and sexual dysfunction
2) Carvedilol
β-blockers for symptomatic relief of SIHD:
1) What are some side effects?
2) What is a precaution?
3) Name a contraindication
1) Fatigue, depression, insomnia, and general malaise are usually mild but among the most common reasons for treatment discontinuation
2) Abrupt withdrawal
3) HF
CCBs for SIHD symptomatic relief:
1) What are 2 side effects?
2) What are the side effects of Verapamil and Diltiazem?
3) What are the comorbidities?
1) Constipation and edema
2) Bradycardia, hypotension, atrioventricular block, and symptoms of LV depression (all bc they decrease CO)
3) Atrial fibrillation or HFpEF: verapamil or diltiazem
HFrEF: amlodipine and felodipine (no other CCBs); not commonly used
SIAHD Tx; Nitrates:
1) What is the MOA?
2) Higher doses may cause what? What will stop this risk?
1) Vasodilators
2) Arterial vasodilation, which may cause reflex tachycardia
-Taking with a beta-blocker
SIAHD Tx; Nitrates:
1) What are they contraindicated with?
2) Why?
1) Phosphodiesterase type 5 inhibitor (PDE5 inhibitor) (erectile dysfunction drug)
2) Can cause severe hypotension
