Term
male gender
family history of premature CHD (male relative <55 yo, female relative <65 yo)
cigarette smoking
elevated LDL and low HDL cholesterol
hypertension
DM
obesity
physical inactivity |
|
Definition
| risk factors for developing stable angina |
|
|
Term
saturated fats <7% of total calories
cholesterol <200 mg/day
consume omega 3 fatty acids
limit Na intake
high consumption of fresh fruits and vegetables, low fat dairy |
|
Definition
| dietary modifications for patients with stable angina |
|
|
Term
|
Definition
used for acute treatment or prophylaxis of angina
0.3-0.4 mg every 5 minutes up to 3 doses
Call 911 after 1st dose if pain does not improve or worsens |
|
|
Term
|
Definition
1st line chronic prophylactic therapy for angina
patients will start and continue this therapy indefinitely
improves symptoms 80% of the time
slows progression to MI
improves survival post MI
target resting heart rate of 50-60 bpm
abrupt withdrawal can worsen angina or MI, must taper |
|
|
Term
|
Definition
indications: left ventricular ejection fraction < 40%, hypertension, DM, chronic kidney disease
reasonable to use in everyone with angina |
|
|
Term
calcium channel blockers
to reach goal HR use a non-DHP CCB
caution when combining CCB and BB (heart block or extreme bradycardia, fatigue) |
|
Definition
beneficial for the reduction of symptoms associated with angina
indications: BB are contraindicated or not tolerated, continued angina with BB, goal HR is not achieved with maximized BB |
|
|
Term
long acting nitrate therapy
must have nitrate free period (8-12 hours) to avoid nitrate tolerance
transdermal patches: 10-12 hours on, 12-14 hours off
isosorbide dinitrate: schedule with meals
isosorbide mononitrate: BID dosing give 7 hours apart, ER q24h |
|
Definition
| consider this therapy for continual angina after BB, CCB, and ACE inhibitors |
|
|
Term
|
Definition
last line therapy for anginal prevention
prolongs QT interval - obtain baseline and periodic EKG
metabolized by CYP450 3A (avoid concomitant use with diltiazem and verapamil
partial inhibitor of fatty acid oxidation |
|
|
Term
aspirin
contraindications: active liver disease, true aspirin allergy, aspirin trigger for pulmonary disease, recent GI bleed |
|
Definition
indicated for all patients with angina as primary prevention
75-162 mg po daily |
|
|
Term
influenza vaccine
pneumococcal vaccine |
|
Definition
| immunizations that patients with angina should get |
|
|
Term
| Prizmental (variant) angina |
|
Definition
develops in younger patients
smoking is a major risk factor
may be precipitated by hyperventilation, exercise, or cold; or no trigger at all
pain occurs typically in the early morning
not relieved by rest
rapid response to nitroglycerin
EKG shows elevated ST |
|
|
Term
smoking cessation
sublingual nitroglycerin
DHP CCB, non DHP CCB, or combination
long acting nitrate
do not use BB (may induce vasospasm)
risk of sudden death if arrhythmias present during attack. Must treat aggressively. |
|
Definition
| treatment for variant angina |
|
|
Term
24
48
combining PDE5 inhibitors and nitrates can cause life threatening hypotension
PDE5 inhibitors are safe after angina is controlled by antianginal drug other than nitrates |
|
Definition
( ) hour separation between sildenafil (viagra) or vardenafil (levitra) and a nitrate
( ) hour separation between tadalafil (cialis) and a nitrate |
|
|
