11 Stable Angina

Symptoms

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• stable, no thrombus, not ruptured

• exercise: more O2 demand, not enough supply

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• coronary arteries supplied in diastole

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Angina Physiology

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• faster HR, more O2 demand, less O2 delivered

Treatment

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• less O2 demand

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• partial: can worsen angina symptoms

• Agonizing plastic bugle: acebutolol (a selective beta-1 antagonist with partial agonist activity)

• Agonizing pin: pindolol (a nonselective beta blocker with partial agonist activity)

• Popping failing heart: beta blockers with partial agonist activity (e.g. pindolol, acebutolol) should be avoided in patients with heart failure or a history of MI

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• negative ionotropic effects can cause systolic dysfunction: acute HF

• Calci yum: CCB

• L-shaped handle: calcium channel blockers target voltage gated L-type calcium channels

• Dairy: dihydropyridines

• Non-dairy: nondihydropyridines

• Smooth muscle tile: dihydropyridines block L-type calcium channels in smooth muscle

• Cardiac muscle tile: non-dihydropyridines block L-type calcium channels in cardiac muscle

• Dippin' station: -dipine suffix of dihydropyridines (e.g. nifedipine, amlodipine, nicardipine)

• Dilated dairy nozzle: dihydropyridines cause vasodilation

• Dilated coronary crown: dihydropyridines (e.g. amlodipine, felodipine) dilate coronary arteries

• Reduced load: dihydropyridines reduce afterload

• Weak kid at the non-dairy: non-dihydropyridines decrease cardiac contractility

• Music notes: non-dihydropyridines decrease activity at the SA and AV nodes

• Low dangling heart watch: inhibition of the SA node by non-dihydropyridines causes bradycardia

• Discarded oxygen: non-dihydropyridines decrease myocardial oxygen demand

• Knife cutting heart: nifedipine can exacerbate myocardial ischemia due to reflex tachycardia - avoid in patients with unstable angina or MI (shorter acting, higher SE)

• Failing heart balloon locked out of store: CCBs can worsen heart failure (increased sympathetic activity and decreased contractility)

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• coronary arteries supplied in diastole

Prinzmetal

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• ergonovine: alpha agonist

Coronary Steal

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• pts on stress tests: give vasodilators that preferentially dilate healthy territories > coronary steal > can be picked up on tracers (usually won't precipitate EKG/symptoms changes)

• Don’t phoster disinterest: phosphodiesterase inhibitors (e.g. dipyridamole, cilostazol)

• Phosphodiesterase inhibitors increase cAMP, impairing platelet function

• Two pyramids: dipyridamole (an antiplatelet phosphodiesterase inhibitor)