Coronary Artery Disease: Chronic Stable Angina Flashcards Preview

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Flashcards in Coronary Artery Disease: Chronic Stable Angina Deck (32)
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1
Q

What percentage does the lesion diameter need to take up in order to be considered clinically considered, how much to get symptoms

A

Greater than 50% (classified as obstructive), 70%

2
Q

What are classical symptoms of heart attack/CAD

A

substernal chest heaviness or discombort, radiates to left arm or left jaw, last 30 seconds to 30 mins, relieved with rest and/or nitroglycerin

3
Q

What are atypical symptoms of heart attack/CAD

A

Nausea, Diaphoresis, Epigastric burning, dizziness

4
Q

What is key about stable angina

A

Reproducible with CONSISTENT amount of activity, relieved in a CONSISTENT manner, CONSISTENT frequency

5
Q

What are characteristics of unstable angina

A

Happens at rest, Symptoms last longer than 20 mins, less activity but increased frequency

6
Q

What are the treatment goals

A

Terminate acute angina attacks and prevent further recurrences

7
Q

What are modifiable risk factors for CAD

A

Smoking cessation/ treatment of HTN, Dyliplidemia, DM/ lifestyle modifications with diet, weight loss, and exercise

8
Q

What are pharmacological therapies that will relieve symptoms

A

Beta Blockers, Calcium channel blockers, Nitrates, Ranolazine

9
Q

What are pharmacological therapies that will reduce major adverse cardiac events

A

ACEIs or ARBs, Antiplatelets, Beta-blockers, Statins, Anticoagulants

10
Q

What are factors that would decrease oxygen supply therefore increasing CAD symptoms

A

Low arterial oxygen, less diastolic filling time, less coronary blood flow

11
Q

What are factors that would increase oxygen demand therefore increasing CAD symptoms

A

Increased preload, increased double product, increased myocardial contractility, increased ventricular wall tension

12
Q

What is double product

A

HR x SBP

13
Q

What is MOA of beta blockers in the treatment of angina

A

Increased O2 supply through increeased diastolic filling time, decreased heart rate, Decreased contractility

14
Q

T/F: For people who have had a heart attack starting a beta-blocker has proof that it prolongs life and lowers ischemic events

A

True

15
Q

What is the goal resting HR for using beta blockers, exercise

A

60 BPM, less than 100 BPM

16
Q

What is the MOA of calcium channel blockers to treat angina

A

Arterial/coronary vasodilation, Increased O2 supply through increased diastolic filling time, decreased HR, Decreased O2 demand by decreasing BP

17
Q

T/F: Dihydropyridines cause vasodilation and decrease contractility while non-Dihydropyridines primarily affect vascular smooth muscle resulting in vasodilation

A

False: Dihydropyridines primarily affect vascular smooth muscle resulting in vasodilation while non-Dihydropyridines cause vasodilation and decrease contractility

18
Q

What is the clinical use of Calcium Channel Blockers in Angina

A

Chronic prophylaxis

19
Q

Why should DHP CCBs never be used as monotherapy for angina

A

Cause reflex tachycardia with the vasodilation

20
Q

What combination should be avoided with regards to non-DHP CCBs

A

Beta-blockers

21
Q

T/F: Beta blockers should be avoided in patients who have congestive heart failure

A

True

22
Q

What is the MOA for nitrates in the treatment of angina

A

Increase O2 supply by coronary vasodilation, decrease O2 demand by decreasing preload

23
Q

What are the clinical uses for Nitrates

A

Acute relief on anginal symptoms, chronic prophylaxis of angina

24
Q

What nitrate medications are used for acute relief, chronic prophylaxis

A

Nitroglycerin sublingual tablets/ Isosorbide mononitrate and nitroglycerin transdermal patch

25
Q

What should a patient do if there is no improvement or worsening symptoms

A

If no improvement after 5 mins take another and call 911

26
Q

T/F: Short term and long term nitrates can be used together

A

True

27
Q

What drug is the last resort in angina treatment

A

Ranolazine

28
Q

What is the MOA ACEIs and ARBs have in angina

A

Reduce plasminogen activator inhibitor-I activity shifting local fibronylytic states more towards lysis instead of clot formation

29
Q

T/F: ACEs and ARBs are not anti-anginals

A

True

30
Q

What medication is indicated in all patients with CAD, why, what can be used as an alternative or used with aspirin

A

Aspirin, lowers risk of MI and death, Clopidogrel

31
Q

What are drugs that will not reduce major cardio adverse events

A

Rosiglatizone, Estrogen therapy, Vitamin C, E, B12, B6, garlic, selnium, chromium

32
Q

What are the ABCDEs in treatment of chronic stable angina

A

A: Aspirin plus Antianguinal Rx
B: Beta blockers plus BP control
C: Cessastion of cigarettes and control of cholesterol
D: Diet modification and control of diabetes
E: Education and Exercise