Ischemic Heart Disease and Acute Coronary Syndrome

Questions and Answers

What are common adverse effects of beta blockers?

Dizziness (correct)

Increased heart rate

Bradycardia (correct)

Constipation (correct)

Beta blockers are used in the treatment of heart failure.

True

What should beta blockers not be used in?

People with asthma

Beta blockers that only block ______ receptors are known as selective beta blockers.

beta 1 Signup and view all the answers

Match the following beta blockers with their characteristics:

Atenolol = Selective beta blocker Bisoprolol = Selective beta blocker Metoprolol = Selective beta blocker Propranolol = Non-selective beta blocker Signup and view all the answers

What is a possible requirement for beta blockers?

Relieving angina or preventing migraines Signup and view all the answers

What is the primary function of the liver?

Adjust doses carefully based on response and side effects, except atenolol, which is mainly removed by the kidneys. Signup and view all the answers

What should be done regarding beta-blockers before and during surgery?

Keep taking beta-blockers Signup and view all the answers

What should treatment begin with for elderly patients?

A lower dose. Signup and view all the answers

It is safe to use atenolol during the early stages of pregnancy.

False Signup and view all the answers

What common adverse reaction is associated with beta-blockers?

Bradycardia Signup and view all the answers

What condition can result from hypotension?

Low blood pressure. Signup and view all the answers

Orthostatic hypotension refers to a sudden increase in blood pressure when standing up.

False Signup and view all the answers

What should be monitored when taking medications like carvedilol and labetalol?

Dizziness or fainting due to a sudden drop in blood pressure. Signup and view all the answers

What can transient worsening of heart failure symptoms include?

Increased shortness of breath Signup and view all the answers

What are common side effects associated with Broncho spasm and dyspnea?

Tightening of the airways Signup and view all the answers

What condition causes cold extremities due to reduced blood flow?

Cold extremities Signup and view all the answers

Fatigue, dizziness, and abnormal vision can be indicative of alterations in glucose and lipid metabolism.

True Signup and view all the answers

Which of the following are considered infrequent or rare side effects?

Impotence Signup and view all the answers

___ is a common side effect of acetylsalicylic acid.

Nausea Signup and view all the answers

What is a common contraindication for taking aspirin?

Allergic reaction Signup and view all the answers

Which conditions are indicated for administering aspirin?

Acute coronary syndrome Signup and view all the answers

What should you do if you feel dizzy while taking beta blockers?

Get up gradually from sitting or lying down. Signup and view all the answers

You can stop taking beta blockers suddenly without consulting your doctor.

False Signup and view all the answers

Which of the following conditions indicates caution when using beta blockers? (Select all that apply)

Asthma Signup and view all the answers

What type of beta blockers are preferred for people with type 2 diabetes?

Beta1-selective beta blockers. Signup and view all the answers

Beta blockers can hide symptoms of hyperthyroidism.

True Signup and view all the answers

What should not be done if someone is in shock due to heart problems?

Use beta blockers Signup and view all the answers

What might happen to kidney function quality when taking beta blockers?

It might worsen or slow. Signup and view all the answers

Myasthenia gravis symptoms can worsen with beta blockers.

True Signup and view all the answers

What is the effect of beta blockers on blood sugar levels?

They can hide signs of low blood sugar Signup and view all the answers

Which of these beta blockers are less likely to cause problems in patients with asthma?

Metoprolol Signup and view all the answers

What is ischemic heart disease?

A condition where the heart is starved of oxygen due to reduced blood supply as a result of narrowed coronary arteries. Signup and view all the answers

What does nitrate do in the cell?

Mimics the activity of nitric oxide. Signup and view all the answers

What is acute coronary syndrome?

A condition related to sudden reduced blood flow to the heart muscle. Signup and view all the answers

What is the prevalence of coronary heart disease in Australia?

More than 2% of Australians live with coronary heart disease. Signup and view all the answers

What is the effect of increased cGMP?

Allows the smooth muscle of the blood vessels to relax. Signup and view all the answers

The rate of people with coronary heart disease has been increasing over time.

False Signup and view all the answers

Nitrate causes vasodilation in blood vessels.

True Signup and view all the answers

Adverse effects of nitrates include __________.

headache, flushing, and palpitations. Signup and view all the answers

What proportion of deaths is coronary heart disease responsible for?

One in ten of all deaths. Signup and view all the answers

What should patients do before taking nitrates?

Sit down to avoid orthostatic hypotension Signup and view all the answers

How many Australians lose their life to coronary heart disease each day?

On average around 50 people every day. Signup and view all the answers

What should a patient do if their angina pain persists for more than 10 minutes?

Call an ambulance for transfer to hospital. Signup and view all the answers

What is the difference between acute and stable angina?

Stable angina lasts for 10 minutes or less and is relieved with rest. Acute angina may not have a predictable pattern. Signup and view all the answers

Angina is a symptom and disease by itself known as _____ angina.

stable Signup and view all the answers

Verapamil and Diltiazem are types of calcium channel blockers.

True Signup and view all the answers

Which of the following are risk factors for angina? (Select all that apply)

Cigarette smoking Signup and view all the answers

What are contraindications for beta-blockers?

Bradycardia and sick sinus syndrome. Signup and view all the answers

What should patients avoid while taking nitrates?

Making sudden position changes Signup and view all the answers

What is the recommended management for a patient with angina presenting with acute chest pain?

Stop and rest, take a dose of angina medicine if symptoms do not improve, and call emergency services if symptoms persist. Signup and view all the answers

Diltiazem has a great effect on _________.

smooth muscle tissue. Signup and view all the answers

Which medications are used as pharmacological management for stable angina? (Select all that apply)

Aspirin Signup and view all the answers

What is unstable angina?

Occurs when blood supply is interrupted without cell death. Signup and view all the answers

Calcium channel blockers can potentially cause bradycardia.

True Signup and view all the answers

What are common signs and symptoms of acute coronary syndrome? (Select all that apply)

Shortness of breath Signup and view all the answers

Thrombolytic therapy is used to treat NSTEMI.

False Signup and view all the answers

What is the first choice of treatment for patients presenting with STEMI?

Re-establishing blood flow in the occluded coronary artery. Signup and view all the answers

What are the signs of myocardial infarction?

Chest pain, discomfort in upper body, shortness of breath, sweating, dizziness. Signup and view all the answers

What action should be taken if angina is not relieved within 10 minutes?

Call emergency services (000). Signup and view all the answers

What is the importance of nitrate-free intervals?

To preserve medication effectiveness and prevent tolerance. Signup and view all the answers

Study Notes

Ischemic Heart Disease (IHD) and Acute Coronary Syndromes (ACS)

Ischemic heart disease is characterized by inadequate oxygen supply to the heart due to narrowed coronary arteries.
Angina pectoris arises from reduced blood flow and is a symptom of IHD; not all cases of IHD involve ACS.
Acute coronary syndrome refers to sudden decreased blood flow to the heart muscle, potentially causing damage.

Acute Coronary Syndrome (ACS)

ACS encompasses various myocardial infarctions and acute angina; recognized by new or worsening symptoms.
Classifications within ACS include Non-ST Segment Elevation Myocardial Infarction (NSTEMI) and ST Segment Elevation Myocardial Infarction (STEMI).
NSTEMI tends to be less damaging than STEMI but both present similar symptoms.

Prevalence and Demographics of Coronary Heart Disease (CHD) in Australia

Over 2% of Australians have CHD; men are twice as likely as women to be affected.
The prevalence of CHD has decreased over time.
CHD accounts for approximately 10% of all deaths in Australia, with roughly 50 people dying from it daily (one every 30 minutes).
Daily, over 400 Australians are hospitalized for CHD.

Angina: Types and Characteristics

Stable Angina: Brief chest discomfort (≤10 minutes) relieved by rest; caused by exertion or stress.
Symptoms include chest, neck, arm pain, and shortness of breath, often precipitated by physical activities or heavy meals.
Affects 3.36% of Australians; more common in older populations, with prevalence rising significantly after age 55.

Prinzmetal Angina

Characterized by spasms in coronary arteries, leading to non-exertional chest pain, predominantly in younger individuals.
Risk factors include smoking, certain medications, and lifestyle factors.

Management of Angina

Immediate rest to alleviate symptoms; if unrelieved, use of prescribed angina medications.
Urgent medical help if symptoms persist or worsen.
Recommended pharmacology includes aspirin, nitrates for vasodilation, and lifestyle changes to mitigate risk factors.

Categories of Management for Cardiac Events

Beta-blockers: First-line therapy, particularly for those without ventricular dysfunction; helps reduce recurrence of angina.
Calcium channel blockers: Used if beta-blockers are intolerable, with specific medications for varying patient profiles.
Nitrates: Required for angina management, with specific doses and importance of nitrate-free intervals to avoid tolerance.

Acute Coronary Syndromes Diagnosis and Treatment

Diagnosis relies on ECG and troponin level tests, with acute symptoms often requiring immediate hospital referral.
Early intervention is crucial; reperfusion strategies employed within 12 hours can greatly impact outcomes.

Pharmacological Management in ACS

Standard treatment includes antiplatelet medications, such as aspirin and newer agents like clopidogrel and ticagrelor, adjusted based on bleeding risk.
Reperfusion therapy choices depend on symptom onset time; primary angioplasty is preferred if available within 90 minutes.

Discharge and Follow-Up Management

Continued monitoring for symptoms and adherence to medication and lifestyle changes is essential.
Innovations in pharmacotherapy and regular assessments can improve long-term outcomes.

Key Symptoms of ACS

Chest pressure or discomfort lasting over 10 minutes.
Pain radiating to other upper body parts and associated symptoms like shortness of breath, sweating, dizziness, or nausea.

Differential Diagnoses for Chest Pain

Conditions such as anxiety, gastroesophageal reflux disease (GERD), pulmonary embolism, or pneumonia may present similarly to ACS.

Importance of Timeliness in Treatment

Optimal timing for intervention after symptom onset significantly affects patient outcomes.
Assessments focus on restoring blood flow and managing the patient's overall cardiovascular health.### cGMP and Vascular Relaxation
Formation of cGMP and its increased levels allow smooth muscle relaxation in blood vessels.
Vasodilation enhances blood flow and improves oxygen supply to tissues.

Adverse Effects of Vasodilators

Common adverse effects include headaches, flushing, palpitations, and orthostatic hypotension.
Serious concerns involve peripheral edema, frequent angina, and dermatitis reactions.

Guidelines for Patients

Patients experiencing persistent pain for more than 10 minutes after taking glyceryl trinitrate should take a third dose and seek immediate medical attention.
It is advised that patients sit down before taking nitrates to prevent orthostatic hypotension.

Calcium Channel Blockers

Non-dihydropyridine calcium channel blockers include Diltiazem and Verapamil, effective for managing angina and hypertension.
Contraindications for Verapamil use include post-ACS patients and individuals with bradycardia or sick sinus syndrome.
Calcium channel blockers can lead to reduced heart rate and potential bradycardia.

Precautions and Interactions

Caution is required using calcium channel blockers with other cardiac medications to avoid exacerbating side effects.
Monitoring cardiac function is essential when these drugs are used alongside beta-blockers.

Beta Blockers

Beta blockers such as Atenolol and Bisoprolol are primarily used to treat hypertension, angina, MI, and tachyarrhythmias.
They should be avoided in patients with heart failure and conditions where bradycardia is present.

Common and Infrequent Adverse Effects

Common effects of beta blockers include fatigue, dizziness, and bradycardia.
Infrequent adverse reactions include atrioventricular block and exacerbation of heart failure symptoms.

Summary of Contraindications and Warnings

Cautious usage of beta blockers in patients with low blood pressure or recent myocardial infarction is suggested.
Each medication class has its profile of indications and contraindications that must be carefully considered in clinical practice.### Beta Blockers Overview
Beta blockers are medications used to manage cardiovascular conditions by reducing heart rate and blood pressure.
Examples include Atenolol and Metoprolol, typically dosed in 25 mg to 100 mg based on individual needs.

Uses

Indicated for myocardial infraction, reduced heart rate, and control of high blood pressure.
Can mitigate symptoms of heart failure when prescribed correctly.

Precautions

Important to avoid sudden cessation to prevent rebound effects, particularly in patients with heart conduction issues.
Monitor for dizziness, especially when starting or adjusting dosage; advise patients to rise slowly to prevent falls.

Contraindications

Not suitable for individuals with certain pre-existing conditions such as:
- Severe asthma
- Significant heart block or sick sinus syndrome
- Uncontrolled heart failure

Side Effects and Interactions

May induce bronchospasm, particularly in asthmatic patients.
Can mask symptoms of hypoglycemia, complicating diabetes management.
Risk of worsening heart failure, particularly in uncontrolled patients.

Special Considerations

Doses may need adjustment in those with renal impairment or bradycardia (slow heart rate).
Avoid use in acute shock situations, especially cardiogenic shock or hypovolemia.

Conditions Affecting Use

Hyperthyroidism: Beta blockers can obscure symptoms like tachycardia.
Pheochromocytoma: Potential to elevate blood pressure; alpha-blockers may be required initially.

Preferred Types

Beta1-selective blockers and those with additional alpha1-blocking activity (e.g., Carvedilol) are favored for patients with type 2 diabetes due to their lower risk of adverse metabolic effects.

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Description

This quiz explores the introduction and epidemiology of ischemic heart disease (IHD) and acute coronary syndromes (ACS). Understand the differences between IHD and coronary artery disease, and learn about the symptoms such as angina pectoris. Test your knowledge on the factors contributing to these cardiovascular conditions.