Term
| acute coronary syndrome (ACS) |
|
Definition
| unstable angina-->non-transmural MI-->transmural (acute) MI |
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|
Term
| Unstable angina is characterized by... |
|
Definition
ST depression
no enzyme release |
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|
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) |
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|
Term
| 2 major activities of myocardial cells |
|
Definition
contraction
relaxation
both require oxygen! |
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Term
| Increases in O2 demand can only be met by... |
|
Definition
| increased coronary blood flow |
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|
Term
| The coronary blood flow occurs during ________. The _______ of this important for determining blood flow. |
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Definition
|
|
Term
| Angina and possibly cardiac damage occurs when... |
|
Definition
| the O2 supply cannot keep up with the energy requirements of the heart. |
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|
Term
| Myocardial ischemia occurs when... |
|
Definition
| myocardial oxygen demand exceeds myocardial oxygen supply |
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|
Term
| nitrovasodilator mechanism of action |
|
Definition
| relax almost all smooth muscle by releasing NO which then stimulates the release of cGMP |
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|
Term
| primary response to nitrovasodilator |
|
Definition
| peripheral venodilation (especially in large veins) |
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|
Term
| secondary response to nitrovasodilator |
|
Definition
|
|
Term
| third response to nitrovasodilator |
|
Definition
| increased oxygen supply to ischemic areas of myocardium |
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|
Term
| How does peripheral venodilation of large veins aid in anginal attacks? |
|
Definition
| reduces venous return which reduces CO preload and thus myocardial workload |
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|
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) |
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|
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 |
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|
Term
| To minimize development of tolerance, ensure daily NTG-free interval of __________ is provided. |
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Definition
|
|
Term
| During administration of SL tabs or TL spray, pt should... |
|
Definition
| rest, preferably in the sitting position |
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|
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 |
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|
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 |
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|
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) |
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|
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 |
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|
