Treatment of Angina

Question 1

What is coronary blood flow?

Answer 1

The heart needs blood as well, this blood gives the heart O2 and nutrients.

Question 2

Blood flow to the heart is regulated by the ___ of the heart

Answer 2

by the needs of the heart ex. exercise = higher workload = higher O2 consumption

Question 3

How does the heart get more blood when it needs it?

Answer 3

The coronary arteries in the heart dilate.

Question 4

What happens when the heart doesn’t get the O2 it needs?

Answer 4

O2 deprivation -> decreased heart muscle strength -> acute heart failure.

Question 5

What is a symptom of insufficient coronary blood flow?

Answer 5

Muscle pain in the heart

Question 6

What is angina / angina pectoris?

Answer 6

Chest pain, caused by insufficient O2 to the heart

Question 7

What are the risk factors of Angina/coronary artery disease?

Answer 7

Diabetes
Hypertension
High Cholesterol
Obesity
Sedentary lifestyle
Tobacco use
Stress
Genetics

Question 8

What are symptoms of angina/coronary artery disease?

Answer 8

Chest pain/discomfort
Pain in shoulders, back, arms, neck etc
Nausea
Shortness of breath
Fatigue
Sweating
Dizziness

Question 9

What are the 3 different types of angina pectoris?

Answer 9

Atheroscloerotic

Vasospastic

Unstable

Question 10

What is atherosclerotic angina?

Answer 10

It’s the most common form

Caused by irreversible atherosclerotic obstruction of the coronary arteries

(plaque buildup)

Pain caused by exertion

Question 11

What is vasospastic angina?

Answer 11

Angina caused by a spasm of the coronary vessel

Can occur any time

Usually occurs at a sight of atherosclerotic plaque buildup

Question 12

What is unstable angina?

Answer 12

Angina caused by both atherosclerotic plaque and platelet aggregation plus a vasospasm

This is usually a precursor to a heart attack

Question 13

What determines a person’s cardiac O2 consumption?

Answer 13

Their preload

Their heart rate

Their contractility

Their afterload

Question 14

How do you treat angina?

Answer 14

By restoring the balance between O2 available and O2 required.

Question 15

How is O2 demand reduced?

Answer 15

By reducing the cardiac output or the PVR

Question 16

How is the O2 supply to the heart increased?

Answer 16

By increasing the coronary blood flow

Question 17

What vasodilators are given to help treat angina?

Answer 17

Nitroglycerin and vermaphil

Question 18

What is nitroglycerin?

Answer 18

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

Question 19

What are the overarching effects of nitroglycerin?

Answer 19

Decreased venous return

Decreased PVR

Dilation of coronary arteries

Overall lowers O2 requirement and raises O2 delivery

Question 20

What are the toxicities of nitroglycerine?

Answer 20

Hypotension

Tachycardia due to a potential reflexive raise in SNS activity

Headaches

Question 21

What is a con of nitroglycerine?

Answer 21

Humans develop a tolerance to nitroglycerine

Question 22

What is Sildenafil and why is it important?

Answer 22

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.

Question 23

How does verapamil work?

Answer 23

It prevents Ca+2 from entering cardiac muscle cells and blood vessel smooth muscle cells.

Vasodilation + lowered cardiac contractility = lowered O2 requirement

Question 24

What is verapamil?

Answer 24

A Ca+2 channel blocker (a vasodilator)

Question 25

What beta-blockers are used to treat angina?

Answer 25

Propranolol and metoprolol

Question 26

What do propranolol and metoprolol do to the heart?

Answer 26

Beta-blockers reduce heart rate and contraction force = less O2 requirement

Question 27

What are the issues with using beta blockers to treat angina?

Answer 27

Dangerous in patients with bradycardia

Non-selective beta-blockers cant be used in patients with asthma

Question 28

How is angina clinically managed?

Answer 28

Reduce risk factors before medication

Question 29

How are acute attacks of angina treated?

Answer 29

With sublingual nitrates

Question 30

What are the monotherapy options for treating angina?

Answer 30

In hypertensive patients

Ca+2 blockers or Beta-blockers

In normotensive patients - Long-acting nitrates

Question 31

What are combination therapy treatment methods for angina?

Answer 31

Calcium blockers + Beta-blockers + (maybe nitrates)