Angina Overview and Types

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Questions and Answers

How does Ranolazine work to alleviate angina symptoms?

By improving oxygen intake in the lungs

By inhibiting persistent sodium currents to lower intracellular calcium (correct)

By blocking calcium channels to reduce heart muscle tension

By increasing heart rate to enhance blood flow

What is the primary purpose of using a transdermal nitroglycerin patch for the treatment of angina?

To decrease heart's oxygen requirements (correct)

To stabilize blood pressure during angina episodes

To eliminate the need for other medications

To increase heart rate during exercise

In patients with stable angina, when should nitrate-free intervals ideally occur?

10 pm to 10 am (correct)

8 am to 8 pm

4 pm to 4 am

12 pm to 12 am

What is a significant physiological factor affecting the timing of nitrate-free intervals in patients with rest angina?

Circadian catecholamine surges Signup and view all the answers

During which time frame should patients with rest angina ideally use their nitrate patch?

4 am to 4 pm Signup and view all the answers

What is the primary function of dihydropyridine calcium channel blockers like amlodipine?

To act as an arteriolar vasodilator Signup and view all the answers

What is a potential side effect associated with the use of calcium channel blockers?

Gingival hyperplasia Signup and view all the answers

Which non-dihydropyridine has a greater negative inotropic effect than amlodipine?

Verapamil Signup and view all the answers

What should be avoided when using non-dihydropyridine calcium channel blockers?

Patients with pre-existing depressed cardiac function Signup and view all the answers

What is the main mechanism of action for nitrates used in treating angina?

Increases cyclic guanosine monophosphate (cGMP) Signup and view all the answers

Which drug is classified as a dihydropyridine calcium channel blocker?

Amlodipine Signup and view all the answers

Which type of angina is non-dihydropyridine calcium channel blocker particularly useful for?

Rest angina Signup and view all the answers

What effect do nitrates primarily have on the cardiovascular system?

Dilate veins Signup and view all the answers

What is the primary benefit of β-blockers in patients who have had a prior myocardial infarction (MI)?

Reduce death risk and myocardial infarction Signup and view all the answers

Which β-blocker is the prototype and is not cardio-selective?

Propranolol Signup and view all the answers

What is a significant contraindication for the use of β-blockers?

Asthma Signup and view all the answers

Which class of drugs is primarily used as arteriolar vasodilators?

Calcium channel blockers Signup and view all the answers

What effect do calcium channel blockers (CCBs) have on myocardial oxygen demand during effort-induced angina?

Reduce myocardial oxygen demand Signup and view all the answers

Which calcium channel blocker is primarily effective in relaxing coronary arteries and improving vasospastic angina?

Nifedipine Signup and view all the answers

What is the recommended approach for discontinuing β-blocker therapy to avoid complications?

Gradually reduce the dose over 2 to 3 weeks Signup and view all the answers

Which non-dihydropyridine calcium channel blocker primarily affects myocardial cells?

Verapamil Signup and view all the answers

What is the primary mechanism by which nitrates alleviate angina symptoms?

Decreasing venous return to the heart Signup and view all the answers

What is the onset of action for sublingual nitroglycerin?

1 minute Signup and view all the answers

How do nitrates primarily affect blood vessels?

By facilitating vasodilation through cGMP elevation Signup and view all the answers

What adverse effect is most commonly associated with the use of nitrates?

Headache Signup and view all the answers

Which of the following routes minimizes first-pass metabolism for nitroglycerin?

Sublingual Signup and view all the answers

What is the effect of high doses of nitrates?

Postural hypotension and facial flushing Signup and view all the answers

What should patients undergoing treatment with long-acting nitrates avoid?

Combining with phosphodiesterase type 5 inhibitors Signup and view all the answers

Why is the development of tolerance to nitrates concerning?

It becomes ineffective in managing angina symptoms Signup and view all the answers

What characterizes stable angina?

Is relieved by rest or nitroglycerin. Signup and view all the answers

Which type of angina is known to be caused by coronary artery spasm?

Rest angina Signup and view all the answers

How does unstable angina differ from stable angina?

It occurs with increasing frequency and intensity. Signup and view all the answers

What is a significant risk factor for developing silent angina?

Diabetes Signup and view all the answers

Which statement is true regarding unstable angina?

It precedes myocardial infarction in most cases. Signup and view all the answers

What is the primary mechanism behind stable angina?

Fixed obstruction of coronary artery due to atherosclerosis. Signup and view all the answers

Which of the following is NOT a symptom of unstable angina?

Angina relieved by rest. Signup and view all the answers

What distinguishes silent angina from other types of angina?

It has no obvious symptoms. Signup and view all the answers

Study Notes

Angina Overview

Angina is chest pain caused by inadequate blood flow to the heart muscle
Can occur with minimal exertion, or even at rest
Symptoms can vary depending on the underlying cause
May present without any symptoms, especially in women, diabetic patients, and the elderly

Types of Angina

Stable angina: happens when there's a fixed obstruction in the coronary arteries
- Triggered by physical activity, emotional stress, or other demands on the heart
- Relieved by rest or nitroglycerin
Rest angina (Prinzmetal, variant or vasospastic angina): develops at rest
- Caused by spasms in the coronary arteries
- Individuals may have significant coronary atherosclerosis
- Usually responds well to coronary vasodilators
- Treatment includes nitroglycerin and calcium channel blockers
Unstable angina: considered a form of acute coronary syndrome
- Often requires hospital admission with aggressive treatment
- Symptoms: worsening chest pain with increasing frequency, duration, and intensity
- Pain is often unrelieved by rest or nitroglycerin

Treatment of Angina

Beta-Blockers
- Reduce myocardial oxygen demand
- Reduce risk of death and myocardial infarction in patients with a history of MI, and patients with hypertension and heart failure
- Common examples: metoprolol and atenolol
- Contraindications: asthma, COPD, diabetes, and severe bradycardia
- Must be discontinued gradually to avoid rebound heart attack, angina, and high blood pressure
Calcium Channel Blockers
- Dilate blood vessels by inhibiting calcium entry into smooth muscle cells
- Types: Dihydropyridines (e.g., nifedipine, amlodipine, felodipine) and non-dihydropyridines (e.g., verapamil, diltiazem)
- Amlodipine: Primarily acts on smooth muscle in peripheral blood vessels
- Verapamil: Mainly affects myocardial cells, reducing heart rate, contractility, and blood pressure
- Diltiazem: Intermediate in its action
- Non-dihydropyridine CCBs can worsen heart failure due to their negative impact on heart muscle contractility
Nitrates
- Used for stable, rest, and unstable angina
- Reduce myocardial oxygen demand by dilating veins and reducing preload
- Common examples: nitroglycerin, isosorbide dinitrate, isosorbide mononitrate
- Sublingual nitroglycerin is the preferred option for immediate relief of angina attacks
- Nitrates can be administered sublingually, transdermally, or orally
- Oral nitrates are less effective due to significant liver metabolism
- Adverse effects: headaches, hypotension, flushing, tachycardia
- Tolerance develops rapidly with long-term use
- "Nitrate-free intervals" are needed to restore sensitivity to the drug
- Example: Transdermal patches are worn for 12 hours and then removed for 12 hours
Ranolazine
- Inhibits persistent or late inward sodium current in heart muscle
- Reduces intracellular calcium levels
- Leads to decreased tension in the heart wall, reducing oxygen demand

Angina and Co-occurring Diseases

Knowledge of how to manage angina in patients with concomitant diseases (e.g., heart failure, hypertension, COPD) is essential

Treatment Algorithm for Stable Angina

Includes medical management, lifestyle modifications, and percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) if necessary
Ranolazine is an alternative drug for treatment of stable angina

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Description

This quiz explores the different types of angina, including stable, unstable, and rest angina. Understand the symptoms, triggers, and treatment options related to each type. Assess your knowledge of how these variations affect patients.