Angina Pectoris Overview and Types
84 Questions
0 Views

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to lesson

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the primary symptom associated with angina pectoris?

  • Dizziness and fainting
  • Severe headache
  • Shortness of breath
  • Sudden pain beneath the sternum (correct)

    • Which of the following medications is NOT classified as an antianginal drug?

  • Metoprolol
  • Nitroglycerin
  • Ranolazine
  • Aspirin (correct)

    • What is the goal of drug therapy in the treatment of angina pectoris?

  • To increase heart rate
  • To lower blood pressure
  • To enhance blood flow to the brain
  • To prevent myocardial ischemia and anginal pain (correct)

    • What is the predominant form of angina pectoris discussed in the provided content?

    <p>Chronic stable angina</p> Signup and view all the answers

    Which of the following is a common cause of angina pectoris?

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

    What class of drug is verapamil classified as?

    <p>Calcium channel blocker</p> Signup and view all the answers

    Ranolazine is primarily used in combination with which type of drugs?

    <p>Antianginal drugs</p> Signup and view all the answers

    Which of the following accurately describes unstable angina?

    <p>A sudden and unpredictable episode of chest pain</p> Signup and view all the answers

    What is a significant benefit of smoking cessation in patients at risk for cardiovascular issues?

    <p>It significantly decreases cardiovascular risk.</p> Signup and view all the answers

    What is the recommended target blood pressure for patients with hypertension according to the guidelines?

    <p>130/80 mm Hg or less</p> Signup and view all the answers

    What effect does physical inactivity have on patients with chronic stable angina?

    <p>It increases anginal symptoms.</p> Signup and view all the answers

    What condition substantially elevates cardiovascular mortality risk, particularly in type 1 diabetes?

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

    What initial therapy is prescribed for managing vasospastic angina?

    <p>A calcium channel blocker or long-acting nitrate</p> Signup and view all the answers

    How often should patients engage in moderate-intensity exercise according to the guidelines?

    <p>30 to 60 minutes, 3 to 4 times a week</p> Signup and view all the answers

    Which of the following is NOT an effective treatment for vasospastic angina?

    <p>Beta-blocker</p> Signup and view all the answers

    What should be a consideration for patients performing exercise in light of their condition?

    <p>Moderate- to high-risk patients should have medically supervised exercise.</p> Signup and view all the answers

    What is the primary action of nitroglycerin on veins?

    <p>It causes vasodilation</p> Signup and view all the answers

    Which of the following correctly describes a mechanism by which nitroglycerin decreases cardiac oxygen demand?

    <p>By decreasing venous return to the heart</p> Signup and view all the answers

    In patients with stable angina, how does nitroglycerin primarily alleviate pain?

    <p>By reducing cardiac oxygen demand</p> Signup and view all the answers

    What is a significant adverse effect associated with nitroglycerin usage?

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

    Why does nitroglycerin cause orthostatic hypotension?

    <p>It pools blood in the veins</p> Signup and view all the answers

    What mechanism can prevent nitroglycerin-induced reflex tachycardia?

    <p>Pretreatment with a β blocker</p> Signup and view all the answers

    What is a common route of administration for nitroglycerin due to its lipid solubility?

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

    What adverse effect occurs as a result of rapid inactivation of nitroglycerin?

    <p>Short duration of action</p> Signup and view all the answers

    Which effect of nitroglycerin is primarily observed in patients with variant angina?

    <p>Relaxation of coronary artery spasm</p> Signup and view all the answers

    What is one of the mechanisms behind tolerance to nitroglycerin?

    <p>Depletion of sulfhydryl groups</p> Signup and view all the answers

    Concurrent use of which of the following can intensify the hypotensive effects of nitroglycerin?

    <p>Calcium channel blockers</p> Signup and view all the answers

    Which substance is required for the conversion of nitrate to its active form, nitric oxide?

    <p>Sulfhydryl groups</p> Signup and view all the answers

    What happens when nitroglycerin is injected directly into atherosclerotic coronary arteries during an anginal attack?

    <p>It does not relieve pain</p> Signup and view all the answers

    Which condition might necessitate the use of a short-acting nitrate during a nitrate-free interval?

    <p>Pain occurrence</p> Signup and view all the answers

    What is the primary therapeutic goal of administering nitroglycerin in angina treatment?

    <p>Reduction of the frequency and intensity of anginal attacks</p> Signup and view all the answers

    When should long-acting nitrates be withdrawn to avoid causing vasospasm?

    <p>Slowly over several days</p> Signup and view all the answers

    Which of the following medications is contraindicated when using nitroglycerin?

    <p>Phosphodiesterase type 5 inhibitors</p> Signup and view all the answers

    Which β blocker is considered particularly suitable for patients with asthma?

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

    What is a common side effect associated with the use of Isosorbide Mononitrate and Isosorbide Dinitrate?

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

    Which statement about β blockers is true?

    <p>They primarily reduce oxygen demand by blocking β1 receptors.</p> Signup and view all the answers

    What is the main effect of calcium channel blockers (CCBs) on blood vessels?

    <p>Arteriolar dilation and reduction of peripheral resistance</p> Signup and view all the answers

    Which drug is not effective against vasospastic angina?

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

    Which of the following is a primary pharmacological action of nitrates?

    <p>Relax coronary artery spasms</p> Signup and view all the answers

    How often should a drug-free interval be allowed when using long-acting nitrates?

    <p>12 hours</p> Signup and view all the answers

    What is the most preferred formulation of nitroglycerin for terminating an ongoing anginal attack?

    <p>Sublingual tablets or translingual spray</p> Signup and view all the answers

    Which class of drugs can block calcium channels in the heart, impacting heart rate and contractility?

    <p>Calcium channel blockers</p> Signup and view all the answers

    What potential outcomes occur when β blockers are discontinued abruptly?

    <p>Increased risk for myocardial infarction</p> Signup and view all the answers

    What percentage decrease in the risk for adverse cardiovascular events is associated with low-dose aspirin in patients with stable angina?

    <p>33%</p> Signup and view all the answers

    Which of the following drugs is recommended for most patients with established coronary artery disease (CAD)?

    <p>ACE inhibitors</p> Signup and view all the answers

    Which cholesterol-lowering drug was shown to decrease the risk for mortality by 35% in patients with established CAD?

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

    What is the primary goal of antianginal therapy?

    <p>Eliminate anginal pain</p> Signup and view all the answers

    Which drug class is preferred for baseline therapy in patients with angina, especially those with a prior myocardial infarction (MI)?

    <p>Beta blockers</p> Signup and view all the answers

    In what scenario should coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI) be considered in patients with stable angina?

    <p>After conservative treatment has been tried</p> Signup and view all the answers

    Which antianginal agent is recommended to avoid in patients with asthma?

    <p>Beta blockers</p> Signup and view all the answers

    What mechanism do beta blockers primarily use to manage angina?

    <p>Decrease heart rate and contractility</p> Signup and view all the answers

    What is a concern when using long-acting nitrates for angina management?

    <p>Tolerance can develop quickly</p> Signup and view all the answers

    Which of the following is a potential benefit of cholesterol-lowering drugs in CAD patients?

    <p>Stabilize atherosclerotic plaques</p> Signup and view all the answers

    What is the risk reduction in stroke associated with ramipril in patients with diabetes?

    <p>33%</p> Signup and view all the answers

    What is a recommended daily dose of aspirin for patients with stable angina?

    <p>75 to 162 mg</p> Signup and view all the answers

    What should be the first line of treatment for patients experiencing anginal pain?

    <p>Sublingual nitroglycerin plus long-acting antianginal drug</p> Signup and view all the answers

    What is a major cardiovascular effect of calcium channel blockers (CCBs) when dilating peripheral arterioles?

    <p>Decrease in blood pressure</p> Signup and view all the answers

    Which statement accurately describes the mechanism of action of ranolazine?

    <p>It reduces sodium and calcium accumulation in myocardial cells.</p> Signup and view all the answers

    What should be monitored frequently in patients with severe renal impairment taking ranolazine?

    <p>Blood pressure</p> Signup and view all the answers

    Which of the following drugs is contraindicated for use with ranolazine due to increasing the risk of torsades de pointes?

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

    Which CCB is considered the safest to use in combination with ranolazine?

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

    What is a notable effect of ranolazine that differentiates it from other antianginal drugs?

    <p>It does not reduce heart rate.</p> Signup and view all the answers

    What is the first-line therapeutic use of ranolazine in angina treatment?

    <p>First-line drug despite limited efficacy</p> Signup and view all the answers

    Which of the following side effects is associated with ranolazine?

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

    The major adverse effects of verapamil and diltiazem are primarily associated with which body system?

    <p>Cardiovascular system</p> Signup and view all the answers

    What is the typical dosing pattern for ranolazine?

    <p>500 mg twice daily</p> Signup and view all the answers

    Which organization was NOT involved in the creation of national guidelines for the management of chronic stable angina?

    <p>U.S. Preventive Services Task Force</p> Signup and view all the answers

    What is the primary objective in treating stable angina?

    <p>To prevent myocardial infarction and death</p> Signup and view all the answers

    Which anticoagulant is known to effectively decrease the risk for thrombus formation in coronary arteries?

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

    How does ranolazine affect exercise tolerance in clinical trials?

    <p>It modestly increases exercise tolerance.</p> Signup and view all the answers

    What primarily causes chronic stable angina?

    <p>Coronary artery disease</p> Signup and view all the answers

    Which of the following factors is least likely to trigger stable angina?

    <p>Watching television</p> Signup and view all the answers

    During exertion, what happens in a healthy heart compared to a heart with CAD?

    <p>Healthy heart maintains balance of oxygen supply and demand</p> Signup and view all the answers

    What is the primary goal of antianginal therapy for stable angina?

    <p>To decrease the intensity and frequency of anginal attacks</p> Signup and view all the answers

    Which class of drugs is primarily used to treat variant angina?

    <p>Calcium channel blockers</p> Signup and view all the answers

    Which therapeutic agent is NOT effective in treating variant angina?

    <p>Beta-blockers</p> Signup and view all the answers

    What common misconception may lead to mismanagement of stable angina?

    <p>Increasing oxygen supply is the main treatment</p> Signup and view all the answers

    What is an essential consideration for treating stable angina with antiplatelet drugs?

    <p>They are not necessary for all patients</p> Signup and view all the answers

    For patients with chronic stable angina, which lifestyle modification is crucial?

    <p>Regular aerobic exercise</p> Signup and view all the answers

    Nitroglycerin remains a primary choice in treating angina because it is:

    <p>Fast acting and effective</p> Signup and view all the answers

    What mechanism causes pain in variant angina?

    <p>Coronary artery spasm</p> Signup and view all the answers

    Which of the following is a significant risk factor for both stable and variant angina?

    <p>Sedentary lifestyle</p> Signup and view all the answers

    What treatment for variant angina differs from that of stable angina?

    <p>Focus on increasing oxygen supply</p> Signup and view all the answers

    What principle guides the treatment strategy for chronic stable angina?

    <p>Decreasing oxygen demand is key</p> Signup and view all the answers

    Study Notes

    Angina Pectoris: Overview

    • Angina pectoris is sudden chest pain, often radiating to the shoulder, arm, and jaw.
    • It's a symptom of insufficient oxygen supply to the heart, often due to coronary artery disease (CAD).
    • Over 10 million Americans have chronic stable angina, with ~500,000 new cases annually.
    • Angina treatment aims to prevent myocardial infarction (MI) and death, and relieve myocardial ischemia and pain.

    Types of Angina

    • Chronic stable angina (exertional angina): Pain triggered by exertion, emotional stress, or large meals. The underlying cause is CAD, where plaque buildup restricts blood flow.
    • Variant angina (Prinzmetal or vasospastic angina): Pain occurs at any time, even during rest or sleep. Caused by coronary artery spasm.

    Treatment Strategies for Stable Angina

    • Goal: Reduce anginal attack frequency and intensity.
    • Mechanism: Primarily decrease oxygen demand by affecting heart rate, contractility, afterload, and preload.
    • Drugs: Organic nitrates, beta blockers, calcium channel blockers (CCBs), and ranolazine.
    • Nondrug therapy: Avoid angina triggers, manage risk factors (smoking, hypertension, hyperlipidemia, sedentary lifestyle) through interventions like exercise and lifestyle changes.

    Treatment Strategies for Variant Angina

    • Goal: Reduce attacks by increasing oxygen supply.
    • Mechanism: Use vasodilators to prevent or relieve coronary artery spasm.
    • Drugs: CCBs and organic nitrates.

    Organic Nitrates (e.g., Nitroglycerin)

    • Mechanism: Cause vasodilation, primarily affecting veins to decrease venous return and preload, lowering oxygen demand.
    • Action in Stable Angina: Decreases venous return and ventricular filling, lowering preload.
    • Action in Variant Angina: Relaxes/prevents coronary artery spasm, raising oxygen supply.
    • Pharmacokinetics: Rapid hepatic metabolism, short half-life (5-7 minutes). Requires frequent redosing.
    • Adverse effects: Headache, hypotension, reflex tachycardia.
    • Tolerance: Rapid development with continuous use. Prevention involves intermittent use, allowing for at least 8 drug-free hours daily.
    • Uses: Acute angina attack treatment and short-term prophylaxis.

    Beta Blockers

    • Mechanism: Decrease cardiac oxygen demand by blocking β1 receptors, slowing heart rate and reducing contractility. Also lower afterload a bit.
    • Advantage: Decrease risk of death.
    • Use: First-line treatment for chronic stable angina.
    • Adverse Effects: Bradycardia (slow heartbeat), decreased atrioventricular (AV) conduction, contractility reduction, bronchoconstriction (use cautiously with asthma patients). Masking of hypoglycemia symptoms in diabetics.

    Calcium Channel Blockers (CCBs)

    • Mechanism: Dilate peripheral arterioles (reducing afterload) and sometimes coronary arteries too. Verapamil and diltiazem also slow heart rate.
    • Use: Treat both stable and variant angina.
    • Adverse Effects: Lower blood pressure, may stimulate reflex tachycardia. Be cautious in patients with bradycardia, heart failure, or AV block.

    Ranolazine

    • Mechanism: Does not lower heart rate or vascular resistance; possibly increases myocardial energy efficiency.
    • Use: Can supplement other antianginal drugs.
    • Adverse effects: QT prolongation, drug interactions (especially CYP3A4 inhibitors).

    Risk Factor Reduction

    • Key modifiable risks: Smoking cessation, aerobic exercise, hypertension treatment (130/80 mmHg or less), cholesterol management, blood glucose control in diabetics.

    Drug Selection and Management

    • Initial treatment often involves sublingual nitroglycerin plus a long-acting agent (beta blocker preferred for mortality reduction).
    • Sequential addition of drugs (beta blockers, CCBs, or nitrates) based on response
    • Consider revascularization (PCI, CABG) if medical therapy insufficient.
    • Specific treatment adjustments exist for those with comorbid conditions.

    Drug Interactions

    • Nitrates can intensify the effects of other blood pressure-lowering agents.
    • Certain drugs inhibit CYP3A4 and can increase ranolazine levels.
    • Some drugs prolong the QT interval, and patients taking ranolazine should avoid these to prevent Torsades de pointes.

    Studying That Suits You

    Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

    Quiz Team

    Description

    This quiz covers the essentials of angina pectoris, detailing its definition, types, and treatment strategies. It focuses on the differences between chronic stable angina and variant angina, along with therapeutic approaches for effective management. Enhance your understanding of this critical cardiovascular condition.

    More Like This

    Use Quizgecko on...
    Browser
    Open
    Browser
    Browser