Angina Quiz
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Questions and Answers

What is the primary cause of angina?

  • Spasms of vascular smooth muscle
  • Atherosclerotic disease of the coronary arteries (correct)
  • Narrowing and stiffening of the heart muscle
  • Imbalance in myocardial oxygen supply

    • Which term is used interchangeably with atherosclerotic disease of the coronary arteries?

  • Plaque narrows and stiffens
  • Vascular smooth muscle spasms
  • Myocardial oxygen supply
  • Ischemic heart disease (IHD) (correct)

    • What effect does spasms of vascular smooth muscle have on cardiac blood flow?

  • Causes no change
  • Increases it
  • Reduces it (correct)
  • Stiffens the arteries

    • What happens if there is an imbalance in myocardial oxygen supply?

    <p>Decreased blood flow to the heart muscle</p> Signup and view all the answers

    What is the most common form of angina?

    <p>Classic or typical angina</p> Signup and view all the answers

    What triggers typical angina pectoris?

    <p>High levels of stress</p> Signup and view all the answers

    Which type of angina occurs when the heart is working harder than usual?

    <p>Stable angina</p> Signup and view all the answers

    How is typical angina pectoris promptly relieved?

    <p>By physical rest</p> Signup and view all the answers

    Variant (Prinzmetal's) angina is the most common form of angina.

    <p>False</p> Signup and view all the answers

    Stable angina occurs when the heart is working harder than usual.

    <p>True</p> Signup and view all the answers

    Unstable angina has a regular pattern.

    <p>False</p> Signup and view all the answers

    Typical angina pectoris can be promptly relieved by rest or nitroglycerin.

    <p>True</p> Signup and view all the answers

    What is the primary effect of 𝛃-blockers in the treatment of angina?

    <p>Decrease oxygen demands of the myocardium</p> Signup and view all the answers

    Why are β-blockers not recommended in patients with vasospastic angina (Prinzmetal)?

    <p>They worsen symptoms and are ineffective</p> Signup and view all the answers

    Why should agents with intrinsic sympathomimetic activity (ISA) be avoided in patients with angina?

    <p>They are ineffective and may worsen symptoms</p> Signup and view all the answers

    When are 𝛃-blockers recommended as initial antianginal therapy?

    <p>In all patients unless contraindicated</p> Signup and view all the answers

    What is the primary effect of calcium channel blockers in the treatment of angina?

    <p>Decreased arteriolar vasodilatation</p> Signup and view all the answers

    Why can calcium channel blockers be used in the treatment of effort-induced angina and vasospastic angina?

    <p>They increase oxygen supply to the heart</p> Signup and view all the answers

    What is the primary reason for using β-blockers in the treatment of angina?

    <p>Decreased oxygen demand</p> Signup and view all the answers

    What is the effect of calcium channel blockers on cardiac blood flow?

    <p>Decreased arteriolar vasodilatation</p> Signup and view all the answers

    Which type of angina is effectively treated with the vasodilatory effect of amlodipine and nifedipine?

    <p>Variant angina</p> Signup and view all the answers

    Which type of calcium channel blockers directly slow atrioventricular (AV) conduction and are used in the treatment of stable angina?

    <p>Verapamil and diltiazem</p> Signup and view all the answers

    What is the primary effect of non-dihydropyridine calcium channel blockers in the treatment of angina?

    <p>Vasodilation</p> Signup and view all the answers

    What is the primary effect of dihydropyridine calcium channel blockers in the treatment of variant angina?

    <p>Vasodilation of coronary arteries</p> Signup and view all the answers

    How do organic nitrates relax vascular smooth muscle?

    <p>By converting to nitrite ions and then nitric oxide, which activates guanylate cyclase</p> Signup and view all the answers

    What is the primary effect of nitrates such as nitroglycerin on the coronary vasculature?

    <p>Reducing preload</p> Signup and view all the answers

    What is the role of guanylate cyclase in the mechanism of action of organic nitrates?

    <p>It increases cells' cyclic guanosine monophosphate (cGMP)</p> Signup and view all the answers

    What effect does organic nitrates have on the large veins?

    <p>Cause dilation and reduce preload</p> Signup and view all the answers

    Organic nitrates relax vascular smooth muscle by converting to nitric oxide, which activates guanylate cyclase and increases cGMP.

    <p>True</p> Signup and view all the answers

    Nitrates such as nitroglycerin cause dilation of the large veins, reducing preload and the work of the heart.

    <p>True</p> Signup and view all the answers

    Stable angina occurs when the heart is working harder than usual.

    <p>False</p> Signup and view all the answers

    Variant (Prinzmetal's) angina is the most common form of angina.

    <p>False</p> Signup and view all the answers

    What is the primary adverse effect of nitrates?

    <p>Headache</p> Signup and view all the answers

    Which route of nitroglycerin administration has no hepatic first-pass effect?

    <p>Sublingual</p> Signup and view all the answers

    What is the primary reason for the rapid development of tolerance to nitrates?

    <p>Desensitization of blood vessels to vasodilation</p> Signup and view all the answers

    Which effect is NOT associated with organic nitrates?

    <p>Reduction in heart rate</p> Signup and view all the answers

    Oral nitroglycerin is the preferred route for relief of an acute angina attack.

    <p>False</p> Signup and view all the answers

    Nitrates such as nitroglycerin do not cause postural hypotension or facial flushing.

    <p>False</p> Signup and view all the answers

    Tolerance to the actions of nitrates develops slowly as the blood vessels become desensitized to vasodilation.

    <p>False</p> Signup and view all the answers

    Nitroglycerin administered sublingually has a rapid onset of action.

    <p>True</p> Signup and view all the answers

    What is the therapeutic use of a sodium channel blocker like ranolazine?

    <p>Treatment of chronic angina</p> Signup and view all the answers

    What is a potential side effect of sodium channel blockers like ranolazine?

    <p>Prolongation of the QT interval</p> Signup and view all the answers

    How does a sodium channel blocker like ranolazine improve the oxygen supply and demand equation?

    <p>By inhibiting the late phase of the sodium current</p> Signup and view all the answers

    What is the primary mechanism of action of sodium channel blockers like ranolazine?

    <p>Inhibition of the late phase of the sodium current</p> Signup and view all the answers

    Study Notes

    Angina Overview

    • Primary cause of angina is reduced blood flow to the myocardium, often due to atherosclerosis.
    • Atherosclerotic disease in coronary arteries is interchangeably referred to as coronary artery disease (CAD).
    • Vascular smooth muscle spasms can result in transient reductions in cardiac blood flow, causing ischemia.

    Myocardial Oxygen Supply and Demand

    • An imbalance in myocardial oxygen supply leads to symptoms such as chest pain or discomfort.
    • Most common form of angina is stable angina, typically triggered by physical exertion or stress.

    Types of Angina

    • Stable angina occurs when the heart strain increases, like during exercise.
    • Typical angina pectoris can be quickly relieved by rest or administration of nitroglycerin.
    • Unstable angina presents irregular patterns and is more severe, potentially leading to a heart attack.
    • Variant (Prinzmetal's) angina occurs unpredictably due to blood vessel spasm.

    Treatment of Angina

    • β-blockers primarily reduce heart rate and myocardial oxygen demand, making them first-line treatments.
    • β-blockers are not suitable for vasospastic angina because they may worsen spasms.
    • Agents with intrinsic sympathomimetic activity should be avoided to prevent unpredictable effects on heart function.
    • β-blockers are recommended as initial antianginal therapy for stable angina patients.

    Calcium Channel Blockers

    • Primary effect of calcium channel blockers is to decrease myocardial oxygen demand and increase blood flow to the heart by relaxing smooth muscle.
    • They are effective in both effort-induced angina and vasospastic angina due to their vasodilatory properties.
    • Dihydropyridine calcium channel blockers (e.g., amlodipine, nifedipine) enhance vasodilation and reduce systemic vascular resistance.
    • Non-dihydropyridine calcium channel blockers directly slow AV conduction, useful in managing stable angina.

    Organic Nitrates

    • Organic nitrates, like nitroglycerin, relax vascular smooth muscle by converting into nitric oxide, which activates guanylate cyclase, and increases cGMP levels.
    • Nitrates mainly reduce preload by dilating large veins, resulting in decreased workload on the heart.
    • Common adverse effect of nitrates is headache; sublingual nitroglycerin accounts for rapid onset as it bypasses hepatic first-pass metabolism.
    • Tolerance to nitrates can develop, requiring periods of inactivity to maintain efficacy.

    Sodium Channel Blockers

    • Sodium channel blockers, such as ranolazine, are used to manage chronic angina by improving the overall oxygen supply and demand balance in the heart.
    • Side effects of sodium channel blockers may include constipation and dizziness.
    • Their primary mechanism of action involves inhibiting sodium influx into cardiac cells, enhancing myocardial efficiency.

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    Description

    Test your knowledge about angina, atherosclerosis, and coronary artery disease. Explore the causes and implications of decreased cardiac blood flow and myocardial oxygen supply imbalance.

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