Stable Ischemic Heart Disease (SIHD) Flashcards
What is Stable Ischemic Heart Disease (SIHD)?
ischemia (lack of oxygen due to poor blood supply) in the myocardium due to atherosclerosis plaque formation associated with stable angina (predicable chest pain associated with physical activity)
How is stable ischemic heart disease diagnosed?
-electrocardiogram (ECG)
-echocardiogram
-stress test
-coronary angiography
What are the risk factors for SIHD?
-smoking
-hypertension
-hyperlipidemia
-diabetes
-obesity
-sedentary lifestyle
-psychosocial factors (ex. stress)
-sex (male)
-age (older)
-family history or genetic composition
-environmental influences
What can be done to reduce cardiovascular risk?
-BP control
-lipid management
-diabetes management
-physical activity
-dietary modifications
-weight management
-smoking cessation
What is the indication of Nitroglycerin in SIHD?
symptom control in acute attacks (onset 1-3 min) or prophylactic 5-10 min before attack-provoking activities
What is the dosing of sublingual Nitroglycerin?
take 1 dose promptly- if chest pain continues or worsens after 5 minutes call 911, while waiting continue to take dose every 5 min for max of 3 doses
What are important counseling points for sublingual Nitroglycerin tablets?
-place under tongue and allow to dissolve
-do NOT chew, crush, or swallow
-store tightly in original container at room temp, protect from light, heat and moisture
-good through product expiration
What drugs may be used for prophylactic treatment for stable ischemic heart disease (SIHD)?
-beta blockers
-calcium channel blockers
-nitrates
-ranolazine
What is the first line treatment for symptom prophylaxis in SIHD?
beta blockers
Who are ideal candidates for beta blockers in SIHD?
-angina associated with exercise
-HTN
-history of MI
-history of supraventricular arrhythmias
-anxiety
-history of HF
What beta blockers are FDA approved for angina?
-atenolol
-metoprolol succinate/tartate
-nadolol
-propranolol
What is the goal resting HR when using beta blocker in SIHD?
50-60 beats/min
What is the risk of abruptly stopping beta blockers?
increase severity of number of pain episodes and MI
What are the adverse effects of beta blockers?
-bradycardia and heart block
-hypotension
-central nervous system (fatigue, depression, cognitive changes)
-sexual dysfunction
What is the indication of calcium channel blockers (CCBs)?
-alternative to beta blockers (2nd line)
-first line for variant angina (Prinzmental’s angina)
Who are ideal candidates for calcium channel blockers in SIHD?
-contraindication to beta blockers
-inadequate response to beta blocker monotherapy
-variant angina (prinzmetal angina)
-coexisting conduction system disease
-presence of peripheral vascular disease
-HTN
What are the adverse effects of calcium channel blockers?
-peripheral edema
-constipation
-bradycardia (non DHP)
-reflex tachycardia (DHP)
-rash
-headache
-dizziness
What is the indication of long-acting Nitrates?
long-term prophylaxis in combination with beta blocker or calcium channel blocker
What is Nitrate tolerance?
when used alone tolerance can develop so drug free interval needed (10-14h)- event more likely to occur during this time, use in combo therapy
What are the counseling points of Nitrate transdermal patch?
12h on, then 12h off
What are the adverse effects of Nitrates?
-headache (most common, contributes to discontinuation)
-hypotension
-dizziness
-GI disturbances (nausea)
What are the drug interactions of Nitrates?
phosphodiesterase inhibitors lead to profound hypotension
What is the indication of Ranolazine?
alternative prophylactic therapy (useful for pt with bradycardia or low BP) or adjunct to other anti-ischemic agents
What are the adverse effects of Ranolazine?
-dizziness
-headache
-constipation
-nausea
What are the warnings of Ranolazine?
-QTc prolongation
-hepatic impairment (may increase ranolazine levels)
-renal impairment (avoid use in severe renal impairment)
What are the drug interactions of Ranolazine?
-CYP3A4, CYP2D6, P-glycoprotein (potential to increase ranolazine concentrations)= limit dose with moderate inhibitors of CYP3A4, diltiazem, verapamil
-avoid combination with other QTc prolonging agents
What is the use of Ivabradine in SIHD?
heart failure agent used off label for stable angina in combination with beta blocker or calcium channel blocker but discontinue if no improvement within 3 months of initiation or if HR < 50 bpm
What other drugs may be given to minimize disease progression?
-antiplatelet therapy (aspirin or clopidogrel)
-statin
-antihypertensive therapy (1st line beta blocker, ACEI or ARB)
What is the goal BP for patient with SIHD?
<130/80mmHg
What non-pharmaceutical procedures can be done with patient with SIHD?
-coronary bypass graft (CABG)
-percutaneous coronary intervention (PCI)
