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1. Left Main Coronary
2. Right Coronary
3. Circumflex
4. Left Anterior Descending

1. Chronic Coronary Artery Disease

-Stable Angina

2.  Acute Coronary Syndromes

-Unstable Angina

-Non-ST Elevation Myocardial Infarction

-ST Elevation Myocardial Infarction

• Plaque that has formed ruptures
• Platelet aggregation
• Thrombus formation
• Unopposed vasoconstriction

• Lumen narrowed by atherosclerotic plaque
• Inappropriate vasoconstriction (caused by endothelial damage)

• No overt plaques
• Intense vasospasm --> results in ischemia

1. Non-Q wave (non-ST elevation) Myocardial Infarction

OR

2.  Q wave (ST elevation) Myocardial Infarction

Chronic Coronary Artery Disease (Stable Angina)

Treatment Goal:

1. Dilation of venous capacitance vessels: results in reduced venous return, lower ventricular filling pressure (preload), decreases ventricular wall tension, reduces myocardial O2 demand
2. Aterial dilation: results in reduced resistance to ventricular emptying (afterload), decrease cardiac work, reduced myocardial O2 demand
3. Blood flow through collateral vessels improved: results in increased blood supply to ischemic areas of myocardium

Due to excessive vasodilation:

1. headache
2. hypotension
3. dizziness
4. reflex tachycardia

1. PDE 5 Inhibitors: sildenafil (viagra)

-in the presence of PDE5 inhibitor, nitrates cause profound increases in cGMP and can cause dramatic reduction in blood pressure

1. Tolerance can develop if there is a sustained high plasma nitrate concentration

To prevent nitrate tolerance, skin patch should be removed for at least 12-14hrs each day

1. Angina (all)
2. Congestive Heart Failure (nitroglycerin, isosorbide dinitrate)
3. Non-ST-Segment-Elevation Myocardial Infarction
4. Acute Myocardial Infarction

1. Artery dilation: results in reduced resistance to ventricular emptying (afterload), decreased cardiac work, reduced myocardial O2 demand (requires higher concentrations), little effect on most venous beds
2. Actions in cardiac cells: verapamil and diltiazem depress the rate of SA node pacemaker and slow AV conduction
3. Increase coronary blood flow: nifedipine, verapamil, diltiazem

1. DHP: dizziness, hypotension, headache, flushing, nausea
2. Nifedipine (immediate-releasing formula): worsening of angina due to coronary steal and/or reflex tachycardia
3. Verapamil and Diltiazem: bradycardia, transient asystole

1. Verapamil and a Beta Blocker can cause AV block and/or severe depression of ventricular function
2. The use of verapamil to treat digitalis toxicity is contraindicated; AV nodal conduction disturbances may be exacerbated

1. Thought to block the trans-cellular late Na+ current --> by altering [Na+]i level, ranolazine blocks Na+ dependent Ca2+ channels, thus preventing Ca2+ overload
2. Does not significantly alter HR or BP
3. Used in combination with other antianginal drugs
4. Decrease angina episodes and increase exercise tolerance 

1. Known to increase the QT interval on the EKG
2. Dizziness
3. Headache
4. Constipation
5. Nausea/vomiting

1. CYP3A Inhibitors: diltiazem, verapamil, grapefuit juice
2. Inhibitors of P-glycoprotein: amiodarone, clarithromycin, cyclosporin
3. Risk of additive QT prolongation: quinidine (class Ia), dofetilide, sotalol, amiodarone (class III)

1. Chronic Stable Angina refractory to other antianginal drugs
2. Acute coronary syndrome: Unstable Angina, NSTEMI