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)

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