> For the complete documentation index, see [llms.txt](https://thisispiggy.gitbook.io/my-wiki/llms.txt). Markdown versions of documentation pages are available by appending `.md` to page URLs; this page is available as [Markdown](https://thisispiggy.gitbook.io/my-wiki/01-step-1/cardiology/11-stable-angina.md).

# 11 Stable Angina

## Symptoms

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Cardiology/stable%20angina%20symptoms,%20typical%20case,%20diagnosis%20how/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/9AT1j2u.jpg)

* stable, no thrombus, not ruptured
* exercise: more O2 demand, not enough supply

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Cardiology/stable%20angina%20treatment%20strategy/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/ujQfLHZ.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/3DFjPqm.jpg)

* coronary arteries supplied in diastole

![](https://f001.backblazeb2.com/file/wikiFiles/QXhHiPX.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/GYwO6YR.jpg)

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Cardiology/ignore/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/t3P1Nl9.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/iGO5EB3.jpg)

## Angina Physiology

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Cardiology/angina%20and%20diastole,%20HR,%20LVEDV%20changes.%20What%20are%20ejection%20time%20and%20MVO2)..

![](https://f001.backblazeb2.com/file/wikiFiles/FHBQYEz.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/QnsmBZv.jpg)

* faster HR, more O2 demand, less O2 delivered 

![](https://f001.backblazeb2.com/file/wikiFiles/YSv7AMR.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/qt5Hfr3.jpg)

## Treatment

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Cardiology/nitrates%20MOA,%20SE/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/qbpM0K6.jpg)

* less O2 demand

![](https://f001.backblazeb2.com/file/wikiFiles/nKjeO4y.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/A322r23.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/Zvfov3z.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/YpoAsaM.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/spbKTNK.jpg)

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Cardiology/BB%20moa%20in%20angina/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/Z0jzLAB.jpg)

* partial: can worsen angina symptoms

![](https://f001.backblazeb2.com/file/wikiFiles/H0Yoq4n.jpg)

* 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

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Cardiology/CCB%20MOA%20in%20angina,%20SE/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/kDzq66Z.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/3CuYZFr.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/wC52lZU.jpg)

* negative ionotropic effects can cause systolic dysfunction: acute HF

![](https://f001.backblazeb2.com/file/wikiFiles/LGVL6Nf.jpg)

* 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)

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Cardiology/antianginal%20therapy%20overview%20drugs%20and%20SE/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/pCRiiuX.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/QQusKtX.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/3DFjPqm.jpg)

* coronary arteries supplied in diastole

## Prinzmetal

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Cardiology/prinzmetal%20angina%20EKG,%20pathogenesis,%20symptoms,%20treatment,%20diagnosis/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/HXTYcOI.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/2HaUL8F.jpg)

* ergonovine: alpha agonist

## Coronary Steal

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Cardiology/what%20is%20coronary%20steal,%20useful%20how/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/MI9QpYn.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/18AtMaD.jpg)

* 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)

![](https://f001.backblazeb2.com/file/wikiFiles/hQDIxnA.jpg)

* Don’t phoster disinterest: phosphodiesterase inhibitors (e.g. dipyridamole, cilostazol)
* Phosphodiesterase inhibitors increase cAMP, impairing platelet function
* Two pyramids: dipyridamole (an antiplatelet phosphodiesterase inhibitor)