Ischemic Heart Disease + Coronary Artery Disease Flashcards
(47 cards)
What are the types of CV diseases?
Ischemic heart disease
Cerebrovascular disease
Peripheral arterial disease
Venous thromboembolic disease
Heart failure
Arrhythmia
Presentation of coronary atherosclerosis
Silent disease for most patients
What is acute coronary syndrome (ACS)?
Feels like a “heart attack” (unstable angina, STEMI, NSTEMI)
What is angina?
Dull, retrosternal discomfort/ache/heaviness
May or may not radiate to jaw, neck, shoulders, arms
What is stable angina?
Oxygen demand exceeding supply
What is unstable angina?
Inadequate supply regardless of demand
What is fixed obstruction stable angina?
An increase in demand that cannot be accommodated with increased supply
What triggers fixed obstruction angina?
SNS activity (exercise, emotion, stress)
Exertion after a heavy meal
Metabolic demand (chills, fever, cold exposure)
Anemia (low oxygen content in blood)
What are some problems with stable angina?
Endothelial dysfunction (decrease in NO production)
Micro vascular dysfunction (poor response to NO)
Treatment for stable angina
Rest
Nitroglycerin as needed (decreases preload)
1st line: BB or CCB (DHP, non-DHP)
What is preload?
Degree to which the myocardium is stretched before it contracts
Increase preload = increase work of the heart
How can stable angina be diagnosed?
Exercise stress test - ST depression will appear on ECG
- T wave inversion is another sign
After diagnosis -> coronary angiogram - performed to evaluate coronary artery blood flow and identifies locations of narrowed vessels
What are is the core medication therapy for CAD?
(ABCDE)
Anti-platelets (ASA 81mg)
Blood pressure medications (Ramipril 10mg OD - ACE)
Cholesterol-lowering medications (Rosuvastatin 20mg OD)
Diabetes medications (metoprolol 100mg BID - BB)
Exercise/diet/lifestyle changes (nitroglycerin spray
What was seen in the HOPE trial 2000?
ACE slightly decreases BP BUT significantly decreases MI and stroke
How does BB help with angina and when is it first line?
Prevents angina through decrease in cardiac demand
First line for: angina prophylaxis, post MI, systolic HF
Why do we choose B1 selective over non-selective BB?
Non-selective have more AE including:
- erectile dysfunction
- peripheral circulation problems
- interaction both B-2 agonists (ventolin)
- avoid BB with ISA
Which drugs can mask hypoglycaemia?
BB
When should non-DHP CCBs be avoided?
Systolic dysfunction
Already using BB
Bradycardia or AV block
What are DHP CCBs role in angina therapy?
Can be safely combined with BB if symptoms persist
Good alternative as monotherapy for patients with bradycardia or intolerance to BB
What do we do if low BP and on an ACE?
Add nitro
What do we do for angina with high BP?
Add amlodapine (DHP CCB)
What do we do for angina and high HR?
Increase metoprolol dose (BB)
What should be done if pain continues after anti-angina therapy?
An angiogram
What are the 2 possible approaches if an obstruction is found?
Medical therapy - continue with drugs
Revascularization - coronary artery bypass grafting, percutaneous coronary intervention (PCI) (angioplasty/stent implantation), fibrinolytic medications (for acute emergencies and smaller towns)
