Treatment of Angina Flashcards Preview

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Flashcards in Treatment of Angina Deck (33)
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1
Q

what shrinks the window between systole

A

• Shorteningdiastole
– e.g. increased heart rate
• Increased ventricular end diastolic pressure
– e.g. aortic valve stenosis
• Reduced diastolic arterial pressure
– e.g. mitral or aortic valve incompetence, heart failure

2
Q

Coronary ischaemia

A

usually the result of atherosclerosis

– Causes angina

3
Q

Sudden ischaemia

A

usually caused by thrombosis

- may result in cardiac infarction

4
Q

Coronary spasms

A

sometimes causes angina

– “variant” angina

5
Q

Cellular calcium over load results from ischaemia

A

– may cause cell death and dysrhythmias

6
Q

Angina Pectoris

A

• Chest pain due to inadequate supply of oxygen to the heart – Typicallysevereandcrushing
– “Tight, constricting, dull or heavy”–SIGN Guidelines

7
Q

Characteristic distribution of pain

A

– Often retrosternal, or left side of chest and can radiate to left arm,
neck, jaw and back
– Brought on by exertion, cold or excitement
– Thought chemical factors that cause pain in skeletal muscle (i.eK+,H+ and adenosine) are responsible

8
Q

stable angina

A

– Predictable chest pain on exertion

– Caused by a fixed narrowing of the coronary arteries

9
Q

• Unstable Angina

A

– Occurs at rest and with less exertion than stable angina
– Associated with a thrombus around a ruptured atheromatous plaque
but without complete occlusion of the vessel (similar to MI)

10
Q

• Variant (Prinzmetal) Angina

A

– Uncommon
– Caused by coronary artery spasm
– Not completely understood, but sometimes associated with atherosclerosis

11
Q

Treatments to reduce chest pain symptoms

A
– Beta-blockers
– Nitrates
–Calcium channel antagonists
– Nirocandil 
– Ivabradine 
– Ranolazine
12
Q

Treatments to prolong survival

A
– Beta-blockers
– Aspirin
– Statins
- (Angiotensin Converting Enzyme Inhibitors) 
– (Angiotensin II Receptor Blockers)
13
Q

Treatment of symptoms

A

Offer short-acting nitrate for preventing/treating episodes of angina.

14
Q

Offer first-line treatment:

A

– Usually a β-blocker, but a calcium channel blocker (CCB)
can be considered if not optimal

If bode ineffective the other option is contraindicated, nicornadil or ivabradine

15
Q

Antianginal drugs

A

• Mainly work by ↓ the metabolic demand of the muscle
• Organic nitrates, nicorandil and calcium antagonists are vasodilators
– ↓ preload or afterload
• b-blockers and ivabradine slow down the heart – ↓ the metabolic demand of the muscle

16
Q

Glyceryl trinitrate and isosorbide mononitrate

A

– Powerful vasodilators
– Work by being metabolised to nitric oxide (NO) and relax smooth muscle (particular vascular smooth muscle)
– Act on veins to ↓ cardiac preload
• Higher concentrations can affect arteries,↓a Herload
– ↓ cardiac workload is helped by dilaIon of collateral coronary vessels

17
Q

– ↓ cardiac workload is helped by dilaIon of collateral coronary vessels

A
  • Improves distribution of coronary blood flow towards ischaemic areas
  • Dilation of constricted coronary vessels is particularly beneficial in variant angina
18
Q

Clinical Uses of Organic Nitrates in Angina - stable angina

A

– Prevention by sublingual glyceryl trinitrate shortly before
exertion or isosorbide mononitrate long before

19
Q

Clinical Uses of Organic Nitrates in Angina - unstable angina

A

– intravenous glyceryl trinitrate (GTN)

20
Q

Clinical Uses of Organic Nitrates in acute heart failure

A

– intravenous GTN

21
Q

Clinical Uses of Organic Nitrates in Chronic Heart Failure(CHF)

A

– isosorbide mononitrate with hydralazine in patients of African American origin especially, (or patient cannot tolerate more commonly used CHF drugs)

22
Q

b-blockers

A

• Important (first line treatment) in the prophylaxis and
treatment of stable and unstable angina
• ↓cardiac oxygen consumption by slowing the heart
• Also have an antidysrhythmic action
– reduce death after MI
• Bisoprolol,Atenolol

23
Q

Calcium Channel Blockers (CCBs)

A

• Two main types:
– Dihydropyridine derivatives, e.g.amlodipine and lercanidipine
– Rate-limiting, e.g.verapamil and diltiazem

24
Q

Action of Calcium Channel Blockers (CCBs)

A

• Preventing opening of voltage-gated L-type Ca2+ channels
– blockCa2+entry
– Mainly affect the heart and smooth muscle to inhibit calcium entry upon muscle cell depolarisation

• Vasodilator effect mainly on resistance vessels
– reducesafterload
– also dilate coronary vessels (important in variant angina)

25
Q

• Verapamil and diltiazem

A

can reduce and impair AV conduction and myocardial contractility

26
Q

– Amlodipine or lercanidipine

A

safe in patients with heart failure, used instead of a Beta-Blocker in Prinzmetal angina or alongside beta-blockers in most angina

27
Q

– Diltiazem or verapamil

A

used but contraindicated in heart failure, bradycardia, AV block or in presence of Beta-Blocker

28
Q

side effects of CCBs

A

– headache, constipation, ankle oedema

29
Q

• Antidysrhythmics

A

– Mainly verapamil
• Slows ventricular rate in rapid atrial fibrillation
• Prevents recurrence of supraventricular tachycardia(SVT)
• No effect on ventricular arrhythmias

30
Q

• Hypertension

A

– Mainly amlodipine or lercanidpine

31
Q

Potassium Channel Activators

A

• Nicorandil
– combines activation of potassium K+ATP channels
with nitrovasodilator actions
• Causes hyperpolarisation of vascular smooth muscle
– both an arterial and venous dilator
– causes headaches, flushing and dizziness
– used for patients who remain symptomatic despite optimal management with other drugs

32
Q

• Ivabradine

A

– Inhibits funny “f”-type channels in heart

– Reduces cardiac pacemaker activity •  inhibits heart rate

33
Q

• Ranolazine

A

– Unique anti-anginal used as a last resort