Term
| what are 2 different ways to say coronary artery disease |
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Definition
ischemic heart disease
athlerosclerosis of epicardial vessels |
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Term
| when does coronary artery disease begin |
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Definition
| begins early in life, manifests middle aged and beyond |
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Term
| what are 5 manigestations of coronary artery disease |
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Definition
heart failure
arrhythmia
stroke
peripherial vascular disease
acute coronary artery disease |
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Term
| what are the 4 types of coronary artery disease |
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Definition
angina syndrome
stable (exercise induced) angina
prinzmetal (vasospastic) angina
unstable angina |
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Term
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Definition
| describes variation in manigestation of agonia and its symptoms |
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Term
| what are the symptoms of angina due to |
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Definition
| ischemic pain (angina equlivaents) and accumulation of metabolites in striated muscle |
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Term
| where is the pain in angina from most to least common 4 |
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Definition
anterior chest
left upper arm
left lower arm
neck pain |
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Term
| what causes vasospasm in CAD |
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Definition
| imbalance of oxygen use and delivery |
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Term
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Definition
| when myocardial requirement increases (like exercise0 coronary flow does not increase proportionally causing ischemia and pain |
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Term
| what is prinzmetal angina |
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Definition
oxygen delivery decreased due to reversible coronary vasospasm
not brought on by exertion or emotional stress not relieved by rest |
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Term
| EKG signs of prinzmetal angina |
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Definition
| ST elevation (injury marker) |
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Term
| cause of prinzmetal angina |
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Definition
| altered vasodilators (NO, prostacyclin) or vasoconstrictors (entothelial, ANG II) |
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Term
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Definition
| change in stable angina or angina at rest |
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Term
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Definition
| increased coronary tone or platelet clots on athlerosclerosis |
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Term
| what is the general approach to angina treatment |
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Definition
| tissue ischemia is thwarted using vasodilator or anti-vasoconstrictor drugs |
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Term
| what is the order of treatment and theory behind each in treatment/prevention of stable angina |
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Definition
1. BB: decrease myocardial O2 demand
2. CCB: vasodilation decreases coronary/peripherial resistance and heart O2 demand
3. nitrates: venodilation decreases proload and myocardial O2 demand |
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Term
| what are the tx of variant angina |
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Definition
nitrates: relax coronary vessels, reduces spasm
CCB: relax coronary vessels, reducing spasm |
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Term
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Definition
aspirin, heparin
DOC: nitroglycerin
BB
CCB |
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Term
| what is the tx of angina post MI |
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Definition
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Term
| what is the tx of angina with DM |
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Definition
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Term
| what is the tx of angina with LV dysfunction |
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Definition
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Term
| what is the tx of angina with CAD or LDL>130 |
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Definition
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Term
| what is the tx of angina with increased platelets |
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Definition
aspirin
clopidogerl
pasugrel |
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Term
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Definition
converte nitrate ions to NO
activates guanylyl cyclase
increases cAMP
increases protein kinase G
activates phosphatases
dephosphyorlyate myosin light chain
vasodilation |
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Term
| how is notroglycerin different at different doses |
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Definition
moderate: dilates large veins > pooling of blood > decreases proload
all doses: dilate coronary vessels > increased blood to heart muscle |
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Term
| administration and time of onset of nitroglycerin |
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Definition
sublingual 2 min
transdermal 12h on 12h off prophylaxis |
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Term
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Definition
headache: migraine caused by vasodilation
orthostatic hypotension
reflex tachycardia
rolerance/tachyphylaxis (avoid with 6-8h nitrate free interval) |
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Term
| how is isorbide mononitrate and isorbide dinitrate different from nitroglycerin |
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Definition
oral administration
longer onset and duration |
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Term
| interactions with nitro drugs |
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Definition
NEVER COMBINE WITH PHOSPHODIESTERASE INHIBITORS (slidenafil, vardenafil, tadalafil)
causes extreme hypotension and death
erectile dysfunction is common in people with CAD |
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Term
| what 3 BB are used for angina |
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Definition
propranolol
metoprolol
atenolol |
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Term
| what BB are not good for angina, why |
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Definition
| partial agonists (sympathomimetric) are less efective (pindolol, acebutolol) |
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Term
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Definition
decrease sympathetic tone, HR, contractability
block B1 receptors
reduce frequency and severity of angina |
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Term
| what are the CCB that work on angina and how |
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Definition
dihydropyridines: work on vessels, causes reflex tachycardia
verapmil and diltiazem: work on heart (preferred) |
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Term
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Definition
stop influx of Ca via L-Ca channels which stops calmodulin from turning Ca into Ca-calmoulin so it cannot activate myosin LC kinase and thus cannot cause contraction
vasodilation reduces coronary vasospasm and myocardial O2 demand
also used in raynaud's (vasospasm in cold) |
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Term
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Definition
| who knows, dosent reduce HR and BP |
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Term
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Definition
| adjunct therapy to BB, CCB, nitrates |
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Term
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Definition
| prolonged QT syndrome (causes torsades) |
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