Treatment of Angina Flashcards
What is coronary blood flow?
The heart needs blood as well, this blood gives the heart O2 and nutrients.
Blood flow to the heart is regulated by the ___ of the heart
by the needs of the heart ex. exercise = higher workload = higher O2 consumption
How does the heart get more blood when it needs it?
The coronary arteries in the heart dilate.
What happens when the heart doesn’t get the O2 it needs?
O2 deprivation -> decreased heart muscle strength -> acute heart failure.
What is a symptom of insufficient coronary blood flow?
Muscle pain in the heart
What is angina / angina pectoris?
Chest pain, caused by insufficient O2 to the heart
What are the risk factors of Angina/coronary artery disease?
Diabetes
Hypertension
High Cholesterol
Obesity
Sedentary lifestyle
Tobacco use
Stress
Genetics
What are symptoms of angina/coronary artery disease?
Chest pain/discomfort
Pain in shoulders, back, arms, neck etc
Nausea
Shortness of breath
Fatigue
Sweating
Dizziness
What are the 3 different types of angina pectoris?
Atheroscloerotic
Vasospastic
Unstable
What is atherosclerotic angina?
It’s the most common form
Caused by irreversible atherosclerotic obstruction of the coronary arteries
(plaque buildup)
Pain caused by exertion
What is vasospastic angina?
Angina caused by a spasm of the coronary vessel
Can occur any time
Usually occurs at a sight of atherosclerotic plaque buildup
What is unstable angina?
Angina caused by both atherosclerotic plaque and platelet aggregation plus a vasospasm
This is usually a precursor to a heart attack
What determines a person’s cardiac O2 consumption?
Their preload
Their heart rate
Their contractility
Their afterload
How do you treat angina?
By restoring the balance between O2 available and O2 required.
How is O2 demand reduced?
By reducing the cardiac output or the PVR
How is the O2 supply to the heart increased?
By increasing the coronary blood flow
What vasodilators are given to help treat angina?
Nitroglycerin and vermaphil
What is nitroglycerin?
Nitroglycerine comes in many forms
The nitrate groups are converted to NO which increases cGMP levels
cGMP relaxes smooth muscles (vasodilation)
NITROGLYCERINE prefers veins and coronary arteries
What are the overarching effects of nitroglycerin?
Decreased venous return
Decreased PVR
Dilation of coronary arteries
Overall lowers O2 requirement and raises O2 delivery
What are the toxicities of nitroglycerine?
Hypotension
Tachycardia due to a potential reflexive raise in SNS activity
Headaches
What is a con of nitroglycerine?
Humans develop a tolerance to nitroglycerine
What is Sildenafil and why is it important?
Sildenafil is viagra
Sildenafil inhibits phosphodiesterase which breaks down cGMP
if you take Viagra with a nitrate like nitroglycerine your cGMP will skyrocket causing hypotension and potential heart attacks.
Wait 24hrs between Viagra and nitrates.
How does verapamil work?
It prevents Ca+2 from entering cardiac muscle cells and blood vessel smooth muscle cells.
Vasodilation + lowered cardiac contractility = lowered O2 requirement
What is verapamil?
A Ca+2 channel blocker (a vasodilator)
What beta-blockers are used to treat angina?
Propranolol and metoprolol
What do propranolol and metoprolol do to the heart?
Beta-blockers reduce heart rate and contraction force = less O2 requirement
What are the issues with using beta blockers to treat angina?
Dangerous in patients with bradycardia
Non-selective beta-blockers cant be used in patients with asthma
How is angina clinically managed?
Reduce risk factors before medication
How are acute attacks of angina treated?
With sublingual nitrates
What are the monotherapy options for treating angina?
In hypertensive patients
Ca+2 blockers or Beta-blockers
In normotensive patients - Long-acting nitrates
What are combination therapy treatment methods for angina?
Calcium blockers + Beta-blockers + (maybe nitrates)
