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Flashcards in Angina Deck (17):

Angina pectoris

Sudden pain beneath the sternum, often radiating to left shoulder and arm; oxygen supply to the heart is insufficient to meet oxygen demands


Goals of angina drug therapy

Prevention of myocardial infarction and death, prevention of myocardial ischemia and anginal pain


Drugs for Angina Pectoris

Three families of antianginal agents: organic nitrates, beta blockers, calcium channel blockers
-Ranolazine: can be combined with other drugs, newer drug with limited indications


Determinants of Cardiac Oxygen: Oxygen demand

Heart rate, myocardial contractility, intramyocardial wall tension (preload/afterload)


Determinants of Cardiac Oxygen: Oxygen Supply

Myocardial blood flow, myocardial perfusion only in diastole


Chronic Stable Angina (Exertional)

Pathophysiology: Emotional excitement, large meals, cold exposure, Coronary artery disease (CAD)
Treatment strategy: increase cardiac oxygen supply, decrease oxygen demand
Therapeutic agents (provide symptomatic relief): organic nitrates, beta blockers, calcium channel blockers, ranolazine
Nondrug therapy: avoid factors that can precipitate angina, decrease risk factors


Variant Angina (Prinzmetal's: Vasospastic)

Pathophysiology: coronary artery spasm
Treatment strategy: increasing cardiac oxygen supply
Therapeutic agents: calcium channel blockers, organic nitrates


Unstable Angina: Medical Emergency

Severe CAD complicated by vasospasm;
Pathophysiology: symptoms of angina at rest, new onset exertional angina, intensification of existing angina
Treatment strategy: maintain oxygen supply, decrease oxygen demand


Therapeutic agents for acute management of unstable angina

Anti-ischemic therapy, antiplatelet therapy, anticoagulant therapy


Anti-ischemic therapy

Nitroglycerin, beta blocker, supplemental O2, IV morphine, ACE inhibitors


Antiplatelet/anticoagulant therapy

Aspirin (indefinitely): clopidogrel (plavix), abciximab (reopro), eptifibatide (integrilin); anticoagulant therapy: subcutaneous LMW heparin or IB unfractionated heparin


Organic Nitrates

Nitroglycerin: stable and variant angina, vasodilator
Adverse effects: headache, orthostatic hypotension, reflex tachycardia


Beta Blockers

Decrease cardiac oxygen demand (propranolol, metoprolol)
Adverse effects: bradycardia, decreased AV conduction, reduction of contractility, asthmatic effects, use with caution in pt with diabetes, insomnia, depression, bizarre dreams, sexual dysfunction


Calcium Channel Blockers

Verapamil, diltiazem, nifedipine; block calcium channels in vascular smooth muscle (VSM), used for stable and variant angina
Adverse effects: dilation of peripheral arterioles, reflex tachycardia, hypotension, beta blockers, bradycardia, heart failure, AV block



Belongs to first new class of antianginal agents approved in more than 25 years; benefits modest and greater in men than in women, does not reduce heart rate, blood pressure, or vascular resistance; can prolong QT; multiple drug interactions
-Exact mechanisms unknown, not a first line therapy; combine with first-line agents for inadequate respone to other first-line medications


Revascularization Therapy

Coronary artery bypass graft (CABG) surgery, percutaneous transluminal coronary angioplasty (PTCA), comparison of CABG surgery with percutaneous coronary intervention (PCI)


Drugs used to Prevent Myocardial Infarction and Death

Antiplatelet drugs, cholesterol-lowering drugs, angiotensin-converting enzyme (ACE) inhibitors, antianginal agents