Pharmacology: angina

Question 1

The window for coronary blood flow:
- When does it happen, in terms of aortic and ventricular pressure?
- What 3 factors can reduce the window for coronary flow?

Answer 1

Aortic pressure > ventricular pressure
1. Increased HR
2. Increased ventricular pressure
3. Decreased aortic pressure

Question 2

What is angina pectoris?
What causes it?

Answer 2

Pain in the heart muscles
Insufficient oxygen supply to the heart relative to demand (coronary artery blockage, closed window for coronary flow, stress)
–>myocardial ischemia
–> muscle releases factors (eg. H+. K+, adenosine) which can stimulate or sensitize noiciceptors
–> Pain

Question 3

Angina pectoris symptoms:
- Chest pain: is it often severe, crushing, substernal, can radiate?
- Can SOB be present?
- How long does it usually last?
- What usually relieves it?
- When should urgent medical attention be sought?

Answer 3

Yes
Sometimes.
A few minutes; usually relieved by mediations or rest
Angina that is worsening, with chest pain lasting longer than a few minutes

Question 4

What are the 3 main types of angina?

Answer 4

Stable angina
Unstable angina
Variant angina

Question 5

Stable angina:
- What usually causes it?
- Is the pain acute or chronic?
- What can trigger the angina/pain?
- Treatment:
- Drug to treat main cause?
- Drug for prophylaxis?
- Drugs to treat symptoms?

Answer 5

Advanced, thick atheroscleortic plaque reduces coronary BF.
Chronic
Exertion/increased demand on the heart
Main cause: statins
Prophylaxis: aspirin (anti platelet, prevent future thrombi)
Reduce work of heart: organic nitrates, beta blockers, calcium channel blockers

Question 6

Unstable angina
- What usually causes it?
- Is it acute or chronic?
- Does it often arise without warning? Does the pain generally get worse?
- Treatment?

Answer 6

Presence of a ruptured atherosclerotic plaque
Acute
Yes, yes
Revascularise occluded vessels, give anti platelets to lessen the clot
Organic nitrates

Question 7

Variant angina
- What causes it?
- Is atherosclerosis involved?
- Is it common?
- Does it happen at rest?
- How to treat with drugs?

Answer 7

Spasm of the coronary artery
No
No
Yes
Vasodilators to keep the spasming BV open - calcium channel blockers, organic nitrates

Question 8

What are the modifiable risk factors for angina?

Answer 8

Smoking, obesity, hypertension, hyperlipidemia, diabetes

Question 9

What surgeries can treat angina?

Answer 9

Angioplasty and stents