Anti-Anginal Therapy Flashcards
Myocardial oxygen demand is dependent on what?
Heart rate
Contractility
After load (blood pressure)
Pre load
Describe ‘after load’
like kinking a hose and letting water build up behind it - this is the blood pressure
what is contractility?
it is the ‘squeeze’ of the heart
What is the difference between stable and unstable angina ?
unstable = abrupt pattern change
stable= no change in symptoms over previous weeks - ex) for the last few years I get a pain in my chest when I walk
variant = usually stress related, patients develop coronary spasm
What are the classical symptoms of Angina?
Retrosternal discomfort, pressure like,
occurs with exertion, relieved by rest,
may radiate down arm or into neck.
Pathophysiology.
Usually associated with the presence of significant
obstructive coronary disease. (Stable disease,
unstable disease associated with plaque rupture)
what condition can mimic unstable angina?
oesophageal reflux
What are the most basic side effects of every damn drug out there ?
nausea
vomiting
diarrhea
skin rash
and “rarely agranulocytosis”
Describe the pathogenesis of Atherosclerotic Plaques
what are some of the risk factors for cardiovascular disease?
CBGE - does it lengthen survival?
No - it improves symptoms in patients who have not recovered well on medications/PCI- but it doesn’t make their life any longer
What is the initial prescription for someone with stable angina?
•
- A Aspirin and antianginal therapy
- B Beta blocker and blood pressure
- C Cigarette smoking and Cholesterol
- D Diet and Diabetes
- E Education and Exercise
if you reduce venous blood flow - what are you reducing?
reducing preload
what drugs are used in the treatment of ANGINA?
Nitrates
Beta adrenergic antagonists
Calcium channel blockers
what effect do organic nitrates have on smooth muscle?
In smooth muscle, the net result is reduced phosphorylation of myosin light chain, reduced calcium and vascular relaxation- therefore they decrease the preload
What concentration of nitrate should you give someone with angina?
At low concentrations nitrates act to decrease
the preload.
At higher concentrations nitrates also cause vasodilation
of large and medium-sized coronary arteries and can
Increase the blood supply to the myocardium.
