chapter 28 angina Flashcards
1
Q
supply reduction to hrt
A
- hemodynamic factors: increased resistance coronary vessels, hypotension, decreased blood volume–ACE inhibitors, beta blocker, calcium channel blockers are used for vasodilatory actions
- cardiac factors: decreased diastolic filling time, increased HR, valve incompliance–beta blockers and CCB used to decreased HR
- hematological factors: o2 content in blood, pH of blood, anemia
- systemic orders: shock–reduce blood flow or available o2
2
Q
demand increase in hrt
A
- high systolic bp which increases work of hrt from left ventricle to systemic circulation–ACE inhibitors, beta blockers, CCBs work to decrease BP
- increased ventricular volume increases work of left ventricle to move more volume–ACE inhibitors work to reduce Na+ and H2O retention
- ventricular hypertrophy–ACE inhibitors decrease remodeling
- increased HR from exercise, stress, hyperthyroidism, fever, anemia, hyperviscosity
- increased contractility response–beta blockers, CCBs have negative inotropic effects
3
Q
treatment of angina
A
- lifestyle changes
- surgical interventions: stents, cath, bypass
- drug management: ASA, beta blockers, CCBs, ACE inhibitors, nitrates
4
Q
coronary vasodilators for angina
A
- serve to increase myocardial o2 supply (decrease preload) my dilatation
- nitrates: nitroglycerin, isorbide
- an increased dose will dilate arterial walls and therefore decrease afterload
- coronary arteries may dilate but only if NO athersclerosis
- contraindicated: extremely low BP
- pregnancy category C
5
Q
beta blockers for angina
A
- recommended as initial therapy unless contraindicated
- drug of choice for exertional angina
- main role to preventing recurrence of MIs in pt. with CAD
- decrease force of myocardial contractility and HR
- decreases systemic vascular resistance and BP (afterload)
- decreases o2 demand
- contraindicated: pt with severe uncontrolled reactive airway dz of COPD (if unstable), or vasospastic angina
6
Q
calcium channel blockers for angina
A
- decrease o2 demand
- drug of choice when coronary artery vasospasm is suspected for angina
- cause smooth muscle relaxation–decreasing afterload
- may cause coronary vasodilation–but not if atherosclerotic
7
Q
ACE inhibitors for angina
A
- recommended for symptomatic patients with chronic stable angina to prevent MI, death, and reduction of symptoms
- increases o2 supply and decreases o2 demand
- contraindicated for pt. with hx of asthma
- decreases peripheral vascular resistance –decreases afterload
- decreases Na+ and H2O retention–decrease preload
- pt with DM and angina should be on for kidney protection
8
Q
ARBs for angina
A
- recommended for pts with CAD, DM, HTN, and those with lt. ventricular systolic dysfunction if unable to tolerate ACE
- ACE and ARB combo may be needed for uncontrolled HTN or insufficient vasodilation however not routine practice to combine
9
Q
grading of angina
A
class I: proven CAD without symptoms; angina occurs with strenuous, rapid, prolonged exertion at work or recreation; no limitation to ADLs class II: angina with unusually strenuous physical exertion; slight limitation to ADLs; angina occurs with exercise--walking up stairs rapidly, under emotional stress class III: angina during routine physical stress; marked limitations to ADLs, angina occurs walking 1-2 blocks, climbing stairs at a normal pace class IV: angina during minimal activity/rest; inability to do ADLs without discomfort. Angina at rest.
10
Q
long-acting nitrates
A
- used for patients unable to tolerate beta blockers
- Isosorbide BID/TID
- nitrate free time: 10-12 hrs. a day to prevent nitrate tolerance (usually during least amount of episodes of angina)
11
Q
multi drug therapy for angina
A
- long acting nitrates and CCB are rarely combined d/t of ADRs and extremely low BP
- ACE and beta blockers are good for elderly in HF
- don’t use CCB on pts with CHF d/t exacerbation
- combining drugs allow decrease of dose of each
12
Q
angina
A
- 3 types: chronic stable, unstable, and prinzmetal’s angina
- chronic: aka exertional angina, o2 demand increases d/t narrowing and thickening arterial walls and can’t dilate; assoc. with physical exertion
- symptoms: chest/arm pain/discomfort
- assoc. with CAD
- caused by o2 demand>o2 supply
13
Q
supply reduction to hrt
A
- hemodynamic factors: increased resistance coronary vessels, hypotension, decreased blood volume–ACE inhibitors, beta blocker, calcium channel blockers are used for vasodilatory actions
- cardiac factors: decreased diastolic filling time, increased HR, valve incompliance–beta blockers and CCB used to decreased HR
- hematological factors: o2 content in blood, pH of blood, anemia
- systemic orders: shock–reduce blood flow or available o2
14
Q
demand increase in hrt
A
- high systolic bp which increases work of hrt from left ventricle to systemic circulation–ACE inhibitors, beta blockers, CCBs work to decrease BP
- increased ventricular volume increases work of left ventricle to move more volume–ACE inhibitors work to reduce Na+ and H2O retention
- ventricular hypertrophy–ACE inhibitors decrease remodeling
- increased HR from exercise, stress, hyperthyroidism, fever, anemia, hyperviscosity
- increased contractility response–beta blockers, CCBs have negative inotropic effects
15
Q
treatment of angina
A
- lifestyle changes
- surgical interventions: stents, cath, bypass
- drug management: ASA, beta blockers, CCBs, ACE inhibitors, nitrates
