Atherosclerotic Cardiovascular Disease Overview

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Questions and Answers

What is a primary therapeutic effect of fibrinolytics?

Reducing blood pressure significantly

Stabilizing clot formation

Enhancing platelet aggregation

Promoting conversion of plasminogen to plasmin (correct)

Which of the following adverse effects is commonly associated with fibrinolytic agents?

Hypertension

Dizziness

Orolingual angioedema (correct)

Tachycardia

When administering nitrates, what is necessary to reduce the risk of tolerance?

Increased dose

Co-administration with beta-blockers

A nitrate-free period (correct)

Continuous use without breaks

Which of the following statements about PDE5 inhibitors is true?

Their use contraindicates nitrates due to hypotension risk. Signup and view all the answers

Which of the following fibrinolytic agents is known for its rapid onset of action?

Tenecteplase Signup and view all the answers

What primarily characterizes angina pectoris?

Discomfort in the chest, jaw, shoulder, back, or arm Signup and view all the answers

Which condition results when the heart experiences inadequate oxygen supply?

Myocardial ischemia Signup and view all the answers

What must the heart do even when blood supply is inadequate?

Continue contracting to pump blood Signup and view all the answers

Angina occurs when myocardial oxygen demand exceeds which of the following?

Myocardial oxygen delivery Signup and view all the answers

What directly governs myocardial oxygen demand?

Workload the heart is required to do Signup and view all the answers

Which of the following can increase myocardial oxygen demand?

Increased venous return Signup and view all the answers

What are the consequences of myocardial ischemia?

Increased tissue damage and painful stimuli release Signup and view all the answers

Referred pain from angina occurs because pain signals from the heart:

Cross paths with other sensory neurons Signup and view all the answers

What is a primary characteristic of atherosclerosis?

Thickening or hardening of the arteries Signup and view all the answers

Which of the following symptoms is NOT typically associated with atherosclerotic cardiovascular disease (ASCVD)?

Fever and chills Signup and view all the answers

Which class of medication is commonly used to lower cholesterol levels in patients with ASCVD?

Statins Signup and view all the answers

What is one of the possible adverse effects of nitrates when used in the treatment of myocardial ischemia?

Headaches Signup and view all the answers

What is the mechanism of action for calcium channel blockers in treating heart conditions?

Block calcium from entering the cells Signup and view all the answers

In the pathophysiology of ASCVD, which risk factor is considered non-modifiable?

Age Signup and view all the answers

Which pharmacological treatment is primarily used for acute angina attacks?

Nitrates Signup and view all the answers

What defines the condition of angina pectoris?

Severe chest pain or discomfort due to reduced blood flow to the heart Signup and view all the answers

What is one of the ways to treat angina by decreasing oxygen demand?

Decreasing venous return Signup and view all the answers

Which factor primarily controls myocardial oxygen supply?

Coronary arterial blood flow Signup and view all the answers

What is stable angina primarily associated with?

Increased myocardial workload Signup and view all the answers

What is a common characteristic of unstable angina?

It causes chest pain at rest. Signup and view all the answers

Which treatment option is effective in preventing vasospasms associated with angina?

Dilation of coronary arteries Signup and view all the answers

What occurs during stable angina at rest?

Myocardial oxygen supply is sufficient. Signup and view all the answers

Which of the following describes variant angina?

Often occurs at rest without physical exertion Signup and view all the answers

What is indicated if stable angina is present due to atherosclerotic narrowing?

Significant occlusion around 70% of the artery Signup and view all the answers

What is the primary function of nitric oxide (NO) released from organic nitrates?

To cause relaxation of vascular smooth muscle cells Signup and view all the answers

How does cyclic GMP (cGMP) induce relaxation of smooth muscle cells?

By dephosphorylating myosin light chain Signup and view all the answers

What effect do organic nitrates primarily have at low doses?

Predominantly dilate veins Signup and view all the answers

What is required to prevent tolerance development to organic nitrates?

Incorporation of a 'nitrate-free' period Signup and view all the answers

What happens to mitochondrial aldehyde dehydrogenase (mtALDH) after prolonged exposure to organic nitrates?

It becomes damaged and inactive Signup and view all the answers

What role does organic nitrates play in myocardial oxygen demand and supply?

Decrease demand and increase supply Signup and view all the answers

After how many hours of exposure does tolerance to nitrates typically occur?

12 - 24 hours Signup and view all the answers

What enzyme is activated by nitric oxide to produce cyclic GMP?

Soluble guanylyl cyclase Signup and view all the answers

Study Notes

Atherosclerotic Cardiovascular Disease (ASCVD)

ASCVD is a major health concern and involves the thickening or hardening of the arteries due to plaque build-up.
This plaque build-up can occur in various arteries, including the coronary, cerebral, iliac, and femoral arteries, as well as the aorta.
This can lead to a range of health issues like coronary heart disease (CHD), stroke, and peripheral arterial disease (PAD).
Common symptoms of ASCVD include chest pain or pressure, shortness of breath, headache, weakness in extremities, leg pain during walking, and fatigue.

ASCVD Treatment Options

Several pharmacological agents are used to treat and prevent ASCVD.
These include ACE inhibitors, aldosterone antagonists, calcium channel blockers, statins, anticoagulants, antiplatelets, beta-blockers, nitrates, ranolazine, and fibrinolytics.

Angina Pectoris

Angina pectoris is a common symptom of ischemic heart disease, characterized by chest discomfort that can radiate to the jaw, shoulder, back, or arm.
It occurs due to insufficient blood flow to the heart, leading to myocardial ischemia.
The heart cannot rest when experiencing inadequate oxygen supply, which results in tissue damage and pain signals transmitted to the brain.
Angina pectoris occurs when the heart's oxygen demand surpasses its oxygen supply.

Treatment Approaches For Angina Pectoris

To treat angina pectoris, strategies focus on either reducing oxygen demand or increasing oxygen supply.
Factors that impact myocardial oxygen demand include heart rate, contractility, and venous return.
Increasing venous return leads to an increase in cardiac output, which in turn increases oxygen demand.

Myocardial Oxygen Supply

The heart extracts a high percentage of oxygen from blood (approximately 70%).
To improve myocardial oxygen supply, coronary arterial blood flow must be increased.
Inadequate coronary blood flow can be caused by factors like atherosclerotic narrowing, coronary artery spasms, or microthromboses.

Angina Pectoris Classifications

Three main classifications of angina pectoris exist:
- Stable angina: Occurs with increased myocardial workload (e.g., exercise, stress) and usually resolves with rest or sublingual nitroglycerin. It is typically caused by a significant narrowing of coronary arteries (>70%).
- Variant angina: Characterized by chest pain at rest and often associated with coronary artery spasms.
- Unstable angina: Chest pain that occurs at rest or with minimal exertion and indicates a more severe and unstable condition.

Organic Nitrates

Organic nitrates can be denitrated to release nitric oxide (NO), a potent vasodilator.
NO activates soluble guanylyl cyclase (sGC), which converts GTP into cyclic GMP (cGMP).
cGMP leads to the relaxation of vascular smooth muscle cells.
Low doses of organic nitrates primarily affect veins, increasing venous capacitance, decreasing venous return, and minimally affecting arterial blood pressure.
At higher doses, organic nitrates dilate both arteries and veins, including coronary arteries, leading to increased coronary blood flow.

Therapeutic Effects of Organic Nitrates

Organic nitrates reduce myocardial oxygen demand by dilating veins and decreasing preload.
They also increase myocardial oxygen supply by dilating coronary arteries.

Drug Tolerance to Nitrates

Organic nitrates are denitrated by mitochondrial aldehyde dehydrogenase (mtALDH).
Prolonged exposure to organic nitrates can damage mtALDH, leading to reduced drug bioactivation and tolerance.
To minimize tolerance, nitrate-free periods are necessary.
Strategies include non-symmetrical dosing intervals, once-daily administration of long-acting preparations, or removing sustained-release patches at bedtime.
Tolerance typically develops between 4-6 hours after nitrate exposure.

Fibrinolytics

Fibrinolytics promote the conversion of plasminogen to plasmin, initiating fibrinolysis (the breakdown of blood clots).
They are crucial for the treatment of acute coronary syndromes, including heart attacks.
Commonly used fibrinolytics include alteplase, reteplase, and tenecteplase.

Adverse Effects of Fibrinolytics

The most significant adverse effect of fibrinolytics is bleeding.
Other potential side effects include bruising, nausea, vomiting, and orolingual angioedema.

Drug Interactions and Contraindications of Fibrinolytics

Fibrinolytics can interact with other anticoagulants and antiplatelets, increasing the risk of bleeding.
There are absolute and relative contraindications to fibrinolytic use, which will be discussed in detail in the course.

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Description

This quiz provides insight into Atherosclerotic Cardiovascular Disease (ASCVD), its symptoms, and treatment options. Learn about the impact of plaque build-up in arteries and the pharmacological agents used in treatment. Test your knowledge on the relationship between ASCVD and related conditions like angina pectoris.