44 Questions
What is the primary cause of angina?
Atherosclerotic disease of the coronary arteries
Which term is used interchangeably with atherosclerotic disease of the coronary arteries?
Ischemic heart disease (IHD)
What effect does spasms of vascular smooth muscle have on cardiac blood flow?
Reduces it
What happens if there is an imbalance in myocardial oxygen supply?
Decreased blood flow to the heart muscle
What is the most common form of angina?
Classic or typical angina
What triggers typical angina pectoris?
High levels of stress
Which type of angina occurs when the heart is working harder than usual?
Stable angina
How is typical angina pectoris promptly relieved?
By physical rest
Variant (Prinzmetal's) angina is the most common form of angina.
False
Stable angina occurs when the heart is working harder than usual.
True
Unstable angina has a regular pattern.
False
Typical angina pectoris can be promptly relieved by rest or nitroglycerin.
True
What is the primary effect of 𝛃-blockers in the treatment of angina?
Decrease oxygen demands of the myocardium
Why are β-blockers not recommended in patients with vasospastic angina (Prinzmetal)?
They worsen symptoms and are ineffective
Why should agents with intrinsic sympathomimetic activity (ISA) be avoided in patients with angina?
They are ineffective and may worsen symptoms
When are 𝛃-blockers recommended as initial antianginal therapy?
In all patients unless contraindicated
What is the primary effect of calcium channel blockers in the treatment of angina?
Decreased arteriolar vasodilatation
Why can calcium channel blockers be used in the treatment of effort-induced angina and vasospastic angina?
They increase oxygen supply to the heart
What is the primary reason for using β-blockers in the treatment of angina?
Decreased oxygen demand
What is the effect of calcium channel blockers on cardiac blood flow?
Decreased arteriolar vasodilatation
Which type of angina is effectively treated with the vasodilatory effect of amlodipine and nifedipine?
Variant angina
Which type of calcium channel blockers directly slow atrioventricular (AV) conduction and are used in the treatment of stable angina?
Verapamil and diltiazem
What is the primary effect of non-dihydropyridine calcium channel blockers in the treatment of angina?
Vasodilation
What is the primary effect of dihydropyridine calcium channel blockers in the treatment of variant angina?
Vasodilation of coronary arteries
How do organic nitrates relax vascular smooth muscle?
By converting to nitrite ions and then nitric oxide, which activates guanylate cyclase
What is the primary effect of nitrates such as nitroglycerin on the coronary vasculature?
Reducing preload
What is the role of guanylate cyclase in the mechanism of action of organic nitrates?
It increases cells' cyclic guanosine monophosphate (cGMP)
What effect does organic nitrates have on the large veins?
Cause dilation and reduce preload
Organic nitrates relax vascular smooth muscle by converting to nitric oxide, which activates guanylate cyclase and increases cGMP.
True
Nitrates such as nitroglycerin cause dilation of the large veins, reducing preload and the work of the heart.
True
Stable angina occurs when the heart is working harder than usual.
False
Variant (Prinzmetal's) angina is the most common form of angina.
False
What is the primary adverse effect of nitrates?
Headache
Which route of nitroglycerin administration has no hepatic first-pass effect?
Sublingual
What is the primary reason for the rapid development of tolerance to nitrates?
Desensitization of blood vessels to vasodilation
Which effect is NOT associated with organic nitrates?
Reduction in heart rate
Oral nitroglycerin is the preferred route for relief of an acute angina attack.
False
Nitrates such as nitroglycerin do not cause postural hypotension or facial flushing.
False
Tolerance to the actions of nitrates develops slowly as the blood vessels become desensitized to vasodilation.
False
Nitroglycerin administered sublingually has a rapid onset of action.
True
What is the therapeutic use of a sodium channel blocker like ranolazine?
Treatment of chronic angina
What is a potential side effect of sodium channel blockers like ranolazine?
Prolongation of the QT interval
How does a sodium channel blocker like ranolazine improve the oxygen supply and demand equation?
By inhibiting the late phase of the sodium current
What is the primary mechanism of action of sodium channel blockers like ranolazine?
Inhibition of the late phase of the sodium current
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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