Ischaemic Heart Disease Treatment

Question 1

Definition of IHD:

Answer 1

Narrowing of lumen of coronary arteries - imbalance

Question 2

Regulation of cardiac workload 
EDV 
HR 
Contractility 
TPR

Answer 2

• End Diastolic Volume (preload) regulated by sympathetic system, RAAS, (contractility of venules; RAAS (Na+ and H2O retention)
  
  • Heart Rate (sympathetic system/ Ca2+)
  • Contractility (sympathetic system/Ca2+)
  • Total peripheral resistance (sympathetic system, RAAS)

Question 3

Imbalance in demand and supply

Answer 3

Increase HR, force and TPR = Decrease thrombus, atheroma and vasoconstriction

Question 4

Stable angina definition

Answer 4

Predictable pattern of pain

Relieved by rest and worse during exercise

Question 5

Nitrate action

Answer 5

Increase cGMP = Decrease calcium and ventilation

Increase NO = dilate some CA

Question 6

Nitrate side effects

Answer 6

• Postural hypotension
  
  • Reflex tachycardia
  • Headache
  • Dizziness
  • E.g. Gylceryl trinitrate (GTN)

Question 7

Reflex tachycardia

Answer 7

Due to sympathetic NS

In response to change in blood flow or blood pressure

Question 8

Beta blocker action

Answer 8

Decrease frequency and force of contraction

Inhibit renin release from kidney and inhibit RAAS

Question 9

Beta blocker side effects

Answer 9

• Bronchoconstriction
  
  • Fatigue
  • Contraindicated in patients with peripheral vascular disease
  • Potential bradycardia
  • E.g. bisoprolol

Question 10

Calcium ion channel antagonists

Answer 10

Decrease frequency and force contraction (phenylalkylamine/benzothiazepines)

Increase arteriole dilation (dihydropyridines)

Decrease Cardiac workload

Question 11

Ivabradine

Answer 11

Blocks pacemaker current in nodal tissue of heart

Side effects:
◦ Luminous phenomena (Ih) in retina
◦ Blurred vision
◦ dizziness

Question 12

Ivabradine decrease cardiac rate

Answer 12

Reduce Na+ entry through If channels and slow depolarisation of SAN and reduce firing frequency

Question 13

Isosorbide mononitrate

Answer 13

Long acting nitrate

Decrease preload

Question 14

Ranolazine

Answer 14

Reduce work done by heart

Question 15

Trimetazidine

Answer 15

◦ Rebalances energy metabolism in the cell

◦ Preferentially moves potassium in the heart muscle cells to use glucose and not fatty acids

Question 16

Reduce hypercholesterolemia

Answer 16

Drugs designed to inhibit uptake from GI tract or reduce production in liver

Question 17

Statins

Answer 17

Decrease production of cholesterol in liver by inhibiting HMG CoA enzyme

Stimulate liver cells to express LDL receptors and allow liver cells to scavenge LDL-C from plasma

Question 18

Antiplatelet agents

Answer 18

Antiplatelet agents (aspirin/clopidogrel)

Question 19

ACE inhibitors

Answer 19

Eg. Ramipril

Decrease heart workload

Question 20

ARBs (losartan)

Answer 20

Decrease heart work load

Question 21

Prasugrel

Answer 21

pro-drug like clopidogrel and needs to be activated in the liver

Question 22

MI diagnosis

Answer 22

• Pain
  
  • Sweating
  • Tachycardia
  • Cold clammy skin

Question 23

MI treatment

Answer 23

• Beta blockers
◦ Decrease cardiac workload, prevents arrhythmias E.g. metoprolol/bisoprolol-short acting
• ACE inhibitors
◦ Decrease cardiac workload, prevents remodelling development of heart failure E.g. Ramipril
• Anticoagulant
◦ In case of long term bed rest, prevents thrombus formation E.g. warfarin

Question 24

Metoprolol/bisoprolol-short acting

Answer 24

Decrease cardiac workload - prevent arrhythmias
Beta blocker
MI treatment

Question 25

Ramipril

Answer 25

ACE inhibitor Decrease cardiac workload Prevent remodelling development of HF MI treatment

Question 26

Warfarin

Answer 26

Anticoagulant | In case of long term bed rest, prevent thrombus formation

Question 27

Digoxin

Answer 27

Binds Na+/K+ ATPase and inhibits action Increase levels of Na+ ions inside the heart muscle Increase inhibits Na+/Ca2+ exchanger - build up of Ca2+ ions

Question 28

Treatment of dysrhythmias

Answer 28

Amiodarone | K+ channel blocker that increase refractory period of ventricular myocytes and can terminate arrhythmias

Question 29

Amiodarone

Answer 29

K+ channel blocker that increase refractory period of ventricular myocytes and can terminate arrhythmias Treat dysrhythmias

Question 30

Nitrate-cGMP pathway

Answer 30

``` Guanylyl Cyclase (GTP -> cGMP) Sildenafil -> PDE (cGMP -> GMP) ```

Question 31

Acetylcholine and bradykinin

Answer 31

Increase Ca2+ entry in cell - > NOS (L-arg-> NO) - > sGC (GTP -> cGMP) = relaxation

Question 32

Peripheral vascular disease contraindicated with

Answer 32

Calcium channel antagonists

Question 33

Contraindication with BB (asthmatics) -> CCBs

Answer 33

Verapamil | Diltiazem

Question 34

Cardiac selective CCBs can cause

Answer 34

Bradycardia | Heart Block

Question 35

CCBs mechanism of action

Answer 35

Block L-type channel in SAN and AVN Slow rate of depolarisation Decrease ventricle contractn

Question 36

Luminous phenomena in retina

Answer 36

Ivabradine

Question 37

Antiplatelet agent mechanism of action

Answer 37

Release ADP which acts on P2Y12 receptors to stimulate platelet expression of GPIIb/IIIa