Term
acute coronary syndrome (ACS) |
|
Definition
unstable angina-->non-transmural MI-->transmural (acute) MI |
|
|
Term
Unstable angina is characterized by... |
|
Definition
ST depression no enzyme release |
|
|
Term
non-transmural MI is characterized by... |
|
Definition
ST depression, T wave inversion or normal no Q waves release of enzymes (CPK, LDH, +/- troponin) |
|
|
Term
transmural (acute) MI is characterized by... |
|
Definition
ST elevation Q waves present release of enzymes (CPK, LDH, troponin) |
|
|
Term
2 major activities of myocardial cells |
|
Definition
contraction relaxation
both require oxygen! |
|
|
Term
Increases in O2 demand can only be met by... |
|
Definition
increased coronary blood flow |
|
|
Term
The coronary blood flow occurs during ________. The _______ of this important for determining blood flow. |
|
Definition
|
|
Term
Angina and possibly cardiac damage occurs when... |
|
Definition
the O2 supply cannot keep up with the energy requirements of the heart. |
|
|
Term
Myocardial ischemia occurs when... |
|
Definition
myocardial oxygen demand exceeds myocardial oxygen supply |
|
|
Term
nitrovasodilator mechanism of action |
|
Definition
relax almost all smooth muscle by releasing NO which then stimulates the release of cGMP |
|
|
Term
primary response to nitrovasodilator |
|
Definition
peripheral venodilation (especially in large veins) |
|
|
Term
secondary response to nitrovasodilator |
|
Definition
|
|
Term
third response to nitrovasodilator |
|
Definition
increased oxygen supply to ischemic areas of myocardium |
|
|
Term
How does peripheral venodilation of large veins aid in anginal attacks? |
|
Definition
reduces venous return which reduces CO preload and thus myocardial workload |
|
|
Term
How does arteriolar dilation aid in anginal attacks? |
|
Definition
reduces cardiac afterload and thus myocardial workload and oxygen demand |
|
|
Term
|
Definition
acute angina attack Prinzmetals angina (relief of coronary artery vasospasm) |
|
|
Term
Direct infusion of NTG into the heart does/does not relieve angina. |
|
Definition
|
|
Term
dose for short-acting NTG |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
1. 1st tab SL, wait 5 min 2. If pain remains, take 2nd tab, wait 5 min. 3. If pain remains, take 3rd tab, wait 5 min. 4. If pain remains, go to ER! |
|
|
Term
long-acting nitrovasodilators |
|
Definition
isosorbide dinitrate isosorbide mononitrate |
|
|
Term
To minimize development of tolerance, ensure daily NTG-free interval of __________ is provided. |
|
Definition
|
|
Term
During administration of SL tabs or TL spray, pt should... |
|
Definition
rest, preferably in the sitting position |
|
|
Term
NTG undergoes extensive... |
|
Definition
first pass hepatic metabolism |
|
|
Term
|
Definition
attack of angina via "stealing effect" |
|
|
Term
|
Definition
headache, postural hypotension, reflex tachycardia and/or contractility |
|
|
Term
|
Definition
|
|
Term
mechanism of PDE-5 inhibitor and NTG drug interaction |
|
Definition
PDE-5 inhibitors lead to reduced breakdown of cGMP
nitrates enhance production of cGMP
dramatically enhanced vascular effects, including severe hypotension |
|
|
Term
beta blocker mechanism of action in angina |
|
Definition
reduce heart rate and increase duration of diastole, which allows more coronary perfusion |
|
|
Term
By blocking the effects of _______________ on the heart, beta blockers reduce contractility. |
|
Definition
|
|
Term
Reduction in contractility reduces LV wall tension, resulting in... |
|
Definition
lower myocardial O2 demand |
|
|
Term
Beta blockers decrease the ____________ and raise the ___________. |
|
Definition
frequency of anginal episodes; anginal threshold |
|
|
Term
What do beta blockers do for post-MI pts? |
|
Definition
reduce mortality and re-infarction |
|
|
Term
Abrupt withdrawal of beta blockers can precipitate... |
|
Definition
unstable angina and MI in pts with chronic CAD |
|
|
Term
beta blocker therapeutic uses |
|
Definition
|
|
Term
cardioselective beta blockers |
|
Definition
atenolol metoprolol nevibolol |
|
|
Term
non-cardioselective beta blockers |
|
Definition
|
|
Term
beta blocker contraindications |
|
Definition
Prinzmetals angina asthma acute CHF |
|
|
Term
primary cardiac calcium channel blockers |
|
Definition
|
|
Term
For BP control, rate the effectiveness of calcium channel blockers. |
|
Definition
DHPs (nifedepine) much better than diltiazem=verapamil |
|
|
Term
For myocardial tissue, rate the effectiveness of calcium channel blockers. |
|
Definition
verapamil may be slightly better than diltiazem, but both are much better than DHPs (nifedipine) |
|
|
Term
|
Definition
peripheral edema, headache, flushing, palpitations, gingival hyperplasia, constipation |
|
|
Term
|
Definition
-occurs in pts with non-narrowed coronary vessels -have atherosclerosis but nothing that causes much constriction -usually constrict and spasm in the AM causing reduced blood flow |
|
|
Term
possibilities in treating Prinzmetals angina |
|
Definition
-nitrates (reduce spasm) -CCBs (relax smooth muscle-->reduce spasm) -beta blockers (will NOT reduce spasm) |
|
|
Term
official treatment of Prinzmetals angina |
|
Definition
1. CCB (DHPs such as nifedipine and amlodipine reduce frequency) 2. nitrates (good for acute symptoms or long-acting nitrates if CCBs don't work) |
|
|
Term
Why is clopidogrel (Plavix) preferred over aspirin in treatment of angina? |
|
Definition
no effect on prostaglandings -if loop diuretic is being used -if kidney disease is present |
|
|
Term
What drug is approved for treatment of unstable angina when angioplasty or atherectomy is planned within 24 hours? |
|
Definition
|
|
Term
____ and ______ are beneficial for ACS. |
|
Definition
|
|
Term
ER protocol for chest pain |
|
Definition
|
|
Term
ACS treatment guidelines (chronic meds) |
|
Definition
ASA clopidogrel ACE inhibitor betea blocker |
|
|