Ischemic Heart Disease and Anginal Drugs
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Questions and Answers

What is the primary cause of chronic stable angina?

  • Rupture of coronary artery plaque
  • Inflammation of the heart muscle
  • Formation of intraluminal thrombosis
  • Atheromatous narrowing of the coronary artery (correct)

    • Which symptom is most indicative of unstable angina?

  • Acceleration in frequency or severity of chest pain (correct)
  • Complete pain relief with medication
  • Pain that disappears with rest
  • Severe chest pain with high exertion

    • What usually follows the rupture of atherosclerotic plaque in the context of acute coronary syndromes?

  • Immediate relief of angina symptoms
  • Coronary vasodilation
  • Myocardial hypertrophy
  • Formation of intraluminal thrombosis (correct)

    • Which condition results in irreversible coagulativene necrosis of the heart muscle?

    <p>Myocardial infarction</p> Signup and view all the answers

    During an episode of chronic stable angina, when do symptoms typically arise?

    <p>During physical exertion</p> Signup and view all the answers

    What is a common characteristic of myocardial infarction compared to unstable angina?

    <p>It is associated with complete occlusion of the coronary artery</p> Signup and view all the answers

    What is the primary cause of Prinzmetal's angina?

    <p>Severe spasms from α1 receptor overactivity</p> Signup and view all the answers

    Which of the following symptoms is characteristic of stable angina?

    <p>Chest tightness precipitated by exercise</p> Signup and view all the answers

    What is the typical duration of pain in stable angina?

    <p>Up to 15 minutes</p> Signup and view all the answers

    Which factor is NOT a precipitating factor for stable angina?

    <p>Cold weather</p> Signup and view all the answers

    Which statement regarding Prinzmetal's angina is FALSE?

    <p>It is relieved by physical exertion.</p> Signup and view all the answers

    In chronic stable angina, what causes the imbalance leading to myocardial ischemia?

    <p>Increased heart work demand</p> Signup and view all the answers

    What is a common radiation area for pain experienced during stable angina?

    <p>Left shoulder and left arm</p> Signup and view all the answers

    Which of the following is NOT a characteristic of the pain associated with stable angina?

    <p>Dull ache that lasts over an hour</p> Signup and view all the answers

    Which drug class is considered the first-line therapy for chronic stable angina?

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

    What is the duration of action for glyceryl trinitrate when administered as a sublingual tablet?

    <p>10-20 minutes</p> Signup and view all the answers

    Which of the following is NOT classified as a long-acting nitrate?

    <p>Glyceryl trinitrate</p> Signup and view all the answers

    Which therapy is recommended as second-line for chronic stable angina?

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

    What is the onset of action for isosorbide dinitrate when administered sublingually?

    <p>3-5 minutes</p> Signup and view all the answers

    Which of the following medications would have extensive first-pass metabolism when administered orally?

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

    What is the typical duration of action for transdermal nitrate patches?

    <p>12-18 hours</p> Signup and view all the answers

    Which of the following is a newer antianginal drug?

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

    What is a characteristic finding on a resting 12-lead ECG that does not rule out ischemic heart disease?

    <p>Normal results</p> Signup and view all the answers

    During an attack of myocardial infarction, which ECG change is expected?

    <p>ST segment elevation</p> Signup and view all the answers

    Which of the following is a non-drug therapy approach to managing stable angina?

    <p>Lifestyle modification</p> Signup and view all the answers

    What is the primary purpose of performing an exercise ECG?

    <p>To record ischemic changes under controlled physical effort</p> Signup and view all the answers

    Which medication is recommended for immediate treatment of acute chest pain?

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

    Which imaging technique utilizes nuclear isotopes for assessing ischemic heart disease?

    <p>Nuclear stress testing</p> Signup and view all the answers

    What does ST segment depression indicate during an ECG?

    <p>Myocardial ischemia</p> Signup and view all the answers

    What is the effect of Glyceryl trinitrate administered during an acute chest pain episode?

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

    Chronic stable angina is primarily caused by a rupture of atheromatous plaque.

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

    Unstable angina is characterized by a consistent pattern of chest pain that does not change in frequency or severity.

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

    Myocardial infarction occurs when an intraluminal thrombus completely occludes a coronary artery due to plaque rupture.

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

    Pain from chronic stable angina typically worsens with rest.

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

    Acute coronary syndromes include conditions like chronic stable angina and myocardial infarction.

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

    Chronic stable angina typically presents with a gradual onset of pain that subdues within minutes.

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

    Prinzmetal's angina is associated with severe spasms of coronary arteries due to overactivity of α2 receptors.

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

    Beta-blockers are considered second-line agents for chronic stable angina.

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

    Chronic stable angina typically presents with chest pain that lasts longer than 15 minutes.

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

    Pain from chronic stable angina is characterized by a sense of chest tightness, particularly during periods of exertion.

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

    Amyl nitrite has a duration of action of 10-20 minutes when inhaled.

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

    The radiation of pain from chronic stable angina can extend to the left arm and the right shoulder.

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

    Isosorbide mononitrate acts within 30 minutes and its effects last for 6-10 hours.

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

    Chronic stable angina can be relieved by physical activity and nitrates.

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

    Ranolazine and nicorandil are classified as long-acting nitrates.

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

    Prinzmetal's angina does not present with pain at rest.

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

    Extensive first-pass metabolism occurs when nitrates are administered orally.

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

    The imbalance in chronic stable angina arises from excessive coronary blood flow and insufficient heart workload.

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

    Transdermal nitrate patches have an onset of action of about 15 minutes.

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

    Intermediate-acting nitrates have a longer duration of action than short-acting nitrates.

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

    Chronic stable angina pain can result from emotional stress as one of its precipitating factors.

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

    The primary purpose of statins is to prevent myocardial revascularization.

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

    A resting 12-lead ECG can definitively exclude ischemic heart disease.

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

    During a myocardial infarction, ST elevation and deep Q-wave formation are commonly observed.

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

    Nuclear isotopes imaging can be utilized for assessing ischemic changes in the heart.

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

    Glyceryl trinitrate is administered for chronic angina but has no effect during acute chest pain episodes.

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

    Exercise ECG recordings are performed without any physical effort.

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

    Coronary angiography is a method used for direct visualization of the coronary arteries.

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

    ST segment depression during an ECG suggests the presence of ischemia in the heart.

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

    Aspirin is recommended as a loading dose of 300 mg to reduce the risk of progression to a myocardial infarction.

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

    What type of angina is characterized by severe coronary artery spasms due to overactivity of α1 receptors?

    <p>Prinzmetal's angina.</p> Signup and view all the answers

    What are the common precipitating factors for chronic stable angina?

    <p>Exertion, emotion, and eating.</p> Signup and view all the answers

    In chronic stable angina, how long does chest pain typically last?

    <p>Usually less than 10-15 minutes.</p> Signup and view all the answers

    What is the typical character of pain experienced during an episode of chronic stable angina?

    <p>A sense of chest tightness.</p> Signup and view all the answers

    What is the difference in the onset of pain between chronic stable angina and Prinzmetal's angina?

    <p>Chronic stable angina pain usually occurs with exertion, while Prinzmetal's angina occurs at rest.</p> Signup and view all the answers

    What symptom is indicative of unstable angina compared to chronic stable angina?

    <p>Increased frequency or severity of chest pain.</p> Signup and view all the answers

    What might the presence of chest pain lasting longer than 15 minutes suggest in a patient with angina?

    <p>It could suggest acute coronary syndrome (ACS).</p> Signup and view all the answers

    How is the radiation of pain typically described in a patient experiencing chronic stable angina?

    <p>Radiating to the left shoulder and arm.</p> Signup and view all the answers

    What differentiates chronic stable angina from acute coronary syndromes in terms of the nature of chest pain experienced?

    <p>Chronic stable angina pain is predictable and occurs with exertion, while acute coronary syndromes involve sudden changes in frequency or severity of pain.</p> Signup and view all the answers

    Explain the role of atheromatous plaque rupture in the development of unstable angina.

    <p>Atheromatous plaque rupture leads to thrombus formation, which increases chest pain frequency or severity due to reduced blood flow.</p> Signup and view all the answers

    How does the pathophysiology of myocardial infarction relate to the process of thrombus formation?

    <p>Myocardial infarction occurs when an intraluminal thrombus completely occludes a coronary artery, causing irreversible tissue damage.</p> Signup and view all the answers

    Identify the major symptom of acute coronary syndromes and its implications for emergency response.

    <p>The major symptom is accelerated chest pain, which necessitates immediate medical attention to prevent myocardial damage.</p> Signup and view all the answers

    What physiological change typically triggers the onset of chronic stable angina during exertion?

    <p>The onset is triggered by an imbalance between increased myocardial oxygen demand and decreased supply due to narrowed coronary arteries.</p> Signup and view all the answers

    When comparing chronic stable angina and unstable angina, what is a key difference in how the pain's characteristics evolve?

    <p>Chronic stable angina has predictable pain patterns, while unstable angina shows unpredictable, escalating pain intensity or frequency.</p> Signup and view all the answers

    What does ST segment depression indicate during an exercise ECG?

    <p>It suggests the presence of ischemic changes in the heart.</p> Signup and view all the answers

    What is the role of glyceryl trinitrate in the management of acute chest pain?

    <p>Glyceryl trinitrate acts as a vasodilator to relieve chest pain.</p> Signup and view all the answers

    What is a significant ECG finding during a myocardial infarction?

    <p>The presence of ST elevation and deep Q waves.</p> Signup and view all the answers

    Which imaging technique utilizes nuclear isotopes to assess ischemic heart disease?

    <p>Nuclear isotopes imaging.</p> Signup and view all the answers

    What is often the first step in the management of stable angina?

    <p>Lifestyle modification is the initial approach.</p> Signup and view all the answers

    During which circumstance might a resting 12-lead ECG appear normal despite underlying conditions?

    <p>It may be normal in cases of ischemic heart disease at rest.</p> Signup and view all the answers

    What is a recommended immediate treatment for chest pain, according to the management guidelines?

    <p>Administer aspirin at a 300 mg loading dose.</p> Signup and view all the answers

    What is the main goal of performing an exercise ECG?

    <p>To record ischemic changes under controlled physical exertion.</p> Signup and view all the answers

    What is the mechanism that leads to extensive first-pass metabolism of nitrates when taken orally?

    <p>Nitrates undergo extensive first-pass metabolism primarily in the liver.</p> Signup and view all the answers

    Which class of medications is primarily used as first-line agents for managing chronic stable angina?

    <p>Beta-blockers are the first-line agents for chronic stable angina.</p> Signup and view all the answers

    What is the typical duration of action for glyceryl trinitrate when administered sublingually?

    <p>The duration of action for glyceryl trinitrate sublingually is 10-20 minutes.</p> Signup and view all the answers

    Identify the secondary agent class recommended for chronic stable angina after beta-blockers.

    <p>Calcium channel blockers (CCBs) are the second-line agents for chronic stable angina.</p> Signup and view all the answers

    For how long do transdermal nitrate patches typically exert their effects?

    <p>Transdermal nitrate patches have an effect duration of 12-18 hours.</p> Signup and view all the answers

    What role do lipid-lowering drugs, such as statins, play in the management of chronic stable angina?

    <p>Statins are used to lower cholesterol levels and can help prevent further atherosclerosis.</p> Signup and view all the answers

    Which newer antianginal drugs are considered when standard treatments are insufficient?

    <p>Ranolazine and nicorandil are classified as newer antianginal drugs.</p> Signup and view all the answers

    What effect does the administration of nitroglycerin generally have during an acute chest pain episode?

    <p>Nitroglycerin dilates coronary arteries, relieving chest pain by improving blood flow.</p> Signup and view all the answers

    Chronic stable angina is due to atheromatous narrowing of the coronary ______.

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

    Unstable angina is characterized by the rupture of atheromatous ______.

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

    Myocardial infarction occurs when an intraluminal thrombosis completely occludes the epicardial coronary ______.

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

    Pain from chronic stable angina is induced by ______ and disappears with rest.

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

    Acute coronary syndromes include conditions such as unstable angina and myocardial ______.

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

    Ranolazine and nicorandil are classified as long-acting ______.

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

    Prinzmetal's angina is characterized by severe spasms of the coronary arteries due to overactivity of ______ receptors.

    <p>α1</p> Signup and view all the answers

    The classic symptom of stable angina is ______ pain.

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

    Stable angina can be precipitated by exertion, emotion, eating, and relieved by ______.

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

    In chronic stable angina, the imbalance arises from the demand of heart work and ______ blood flow.

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

    Chest pain that lasts longer than ______ minutes may suggest acute coronary syndrome (ACS).

    <p>15</p> Signup and view all the answers

    The pain experienced during stable angina may radiate to the left shoulder and the ______.

    <p>left arm</p> Signup and view all the answers

    In stable angina, the character of pain is often described as a sense of chest ______.

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

    Prinzmetal's angina often occurs at ______.

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

    During an attack, there is ST segment ______ and T-wave inversion.

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

    Glyceryl trinitrate (GTN) is often administered sublingually or as a ______.

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

    The same lifestyle modifications for managing stable angina are also recommended for ______.

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

    Exercise ECG records ischemic changes during controlled physical ______.

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

    In myocardial infarction, there may be ST ______ and deep Q-wave.

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

    Aspirin 300 mg loading dose should be given as soon as ______.

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

    Resting 12-lead ECG is often ______ and does not exclude ischemic heart disease.

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

    Nuclear isotopes imaging helps assess ______ heart disease.

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

    Beta-blockers are the first-line agents for chronic stable ______.

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

    Long and intermediate acting ______ are used in the treatment of chronic stable angina.

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

    Ranolazine and ______ are classified as newer antianginal drugs.

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

    Glyceryl trinitrate has a duration of action of ______ when administered as a sublingual tablet.

    <p>10-20 minutes</p> Signup and view all the answers

    Isosorbide mononitrate can be taken orally and usually acts within ______.

    <p>30 minutes</p> Signup and view all the answers

    The duration of action for transdermal nitrate patches can last up to ______ hours.

    <p>18</p> Signup and view all the answers

    Short-acting nitrates like Amyl nitrite are rapidly absorbed and have a short ______.

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

    Extensive first-pass metabolism occurs when ______ are administered orally.

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

    Match the condition with its primary characteristic:

    <p>Chronic Stable Angina = Pain induced by effort, disappears with rest Unstable Angina = Acceleration in frequency or severity of chest pain Myocardial Infarction = Intraluminal thrombosis completely occluding a coronary artery Acute Coronary Syndromes = Includes unstable angina and myocardial infarction</p> Signup and view all the answers

    Match the type of angina with its description:

    <p>Chronic Stable Angina = Classic or exertional angina Unstable Angina = New-onset angina pain Prinzmetal's Angina = Severe spasms of coronary arteries Acute Coronary Syndromes = Associated with sudden cardiac events</p> Signup and view all the answers

    Match the term with its definition:

    <p>Atheromatous Narrowing = Causes chronic stable angina Thrombus = Formed during plaque rupture in unstable angina Ischemia = Imbalance of coronary blood flow and heart workload Necrosis = Irreversible damage due to myocardial infarction</p> Signup and view all the answers

    Match the angina type to its triggering factor:

    <p>Chronic Stable Angina = Triggered by physical exertion Unstable Angina = Occurs at rest or with minimal exertion Myocardial Infarction = Associated with complete arterial occlusion Prinzmetal's Angina = Linked to coronary artery spasms</p> Signup and view all the answers

    Match the angina feature with its correct description:

    <p>Chronic Stable Angina = Pain lasts shorter than 15 minutes Unstable Angina = Chest pain increases in frequency over time Myocardial Infarction = Necrosis develops immediately after occlusion Acute Coronary Syndromes = A continuum of unstable angina to myocardial infarction</p> Signup and view all the answers

    Match the angina category with its relevant treatment approach:

    <p>Chronic Stable Angina = Managed with nitrates and beta-blockers Unstable Angina = Requires immediate hospitalization Myocardial Infarction = Treated with thrombolytics or angioplasty Prinzmetal's Angina = Responsive to calcium channel blockers</p> Signup and view all the answers

    Match the type of angina with their defining characteristics:

    <p>Prinzmetal's angina = Pain at rest due to severe coronary artery spasms Chronic stable angina = Chest pain triggered by exertion and relieved by rest Unstable angina = Pain that occurs with increased frequency or severity Variant angina = Angina episodes tend to occur at specific times, often at night</p> Signup and view all the answers

    Match the symptom of angina with its description:

    <p>Central chest pain = Retrosternal pain radiating to the left shoulder Chest tightness = Usually described as a sense of pressure or squeezing Duration of pain = Typically lasts less than 10-15 minutes Precipitating factors = Includes exertion, emotion, and eating</p> Signup and view all the answers

    Match the type of angina with their typical treatment methods:

    <p>Chronic stable angina = Nitrates and beta-blockers Prinzmetal's angina = Calcium channel blockers Unstable angina = Antiplatelet therapy Variant angina = Long-acting nitrates</p> Signup and view all the answers

    Match the condition with its cause:

    <p>Chronic stable angina = Imbalance between oxygen supply and demand Prinzmetal's angina = Overactivity of α1 receptors leading to spasms Myocardial infarction = Complete occlusion of coronary artery Unstable angina = Rupture of atherosclerotic plaque</p> Signup and view all the answers

    Match the type of angina with their notable occurrence patterns:

    <p>Chronic stable angina = Symptoms typically triggered by stress or physical exertion Prinzmetal's angina = Symptoms often arise during sleep or rest Unstable angina = Symptoms may occur at rest and are unpredictable Variant angina = Symptoms occur intermittently and often at night</p> Signup and view all the answers

    Match the clinical feature with its associated angina type:

    <p>Chest pain lasting &gt; 15 minutes = Suspicious for acute coronary syndrome Pain relieved by nitrates = Common in chronic stable angina Chest pain coinciding with emotional stress = Typical of chronic stable angina Pain occurring unpredictably = Characteristic of unstable angina</p> Signup and view all the answers

    Match the type of angina with their common presentation:

    <p>Chronic stable angina = Retrosternal pain that may radiate to the left arm Prinzmetal's angina = Severe spasms of the coronary arteries Unstable angina = Increasing frequency and severity of pain Variant angina = Episodes occurring at similar times each day</p> Signup and view all the answers

    Match the precipitating factor with its effect on angina:

    <p>Exertion = Increases cardiac workload and oxygen demand Emotion = Can trigger episodes due to stress response Eating = May provoke angina due to postprandial oxygen demand Cold weather = Can lead to coronary vasoconstriction and symptoms</p> Signup and view all the answers

    Match the following types of ECG findings with their significance:

    <p>Resting 12-lead ECG = Often normal, does not exclude ischemic heart disease Exercise ECG = Records ischemic changes under physical effort ST segment depression = Indicates myocardial ischemia during an attack Deep Q-wave = Characteristic of myocardial infarction</p> Signup and view all the answers

    Match the following therapies with their descriptions:

    <p>Glyceryl trinitrate (GTN) = Immediate treatment for acute chest pain Aspirin loading dose = 300 mg to reduce MI progression risk Lifestyle modification = Non-drug therapy to manage stable angina Coronary angiography = Invasive imaging technique to assess coronary arteries</p> Signup and view all the answers

    Match the following imaging techniques with their purpose:

    <p>Nuclear isotopes imaging = Assesses ischemic heart disease Exercise ECG = Records cardiac function during exertion Coronary angiography = Visualizes coronary artery blockages ECG during an attack = Detects ST elevation indicative of myocardial infarction</p> Signup and view all the answers

    Match the following statements regarding angina management:

    <p>Non-drug therapy = Includes lifestyle modifications similar to hypertension Pharmacological therapy = Immediate treatment focuses on acute chest pain Stable angina management = Combines drug therapy with lifestyle changes Exercise ECG = Evaluates ischemic changes after controlled physical effort</p> Signup and view all the answers

    Match the following descriptors to the type of chest pain:

    <p>Stable angina = Chest pain that typically worsens with exertion Unstable angina = Chest pain that may occur unpredictably Myocardial infarction = Chest pain often associated with lasting symptoms Prinzmetal's angina = Chest pain related to vasospasm</p> Signup and view all the answers

    Match the following medications with their respective functions:

    <p>Glyceryl trinitrate = Sublingual treatment for acute episodes Aspirin = Prevents progression to myocardial infarction Isosorbide dinitrate = Long-acting nitrate for angina management Amyl nitrite = Short-acting nitrate with rapid onset</p> Signup and view all the answers

    Match the following ECG changes with their associated conditions:

    <p>ST segment elevation = Characteristic of myocardial infarction ST segment depression = Indicates ischemia during stable angina attack T-wave inversion = Common during ischemic episodes Deep Q-wave = Represents previous myocardial infarction</p> Signup and view all the answers

    Match the following types of therapy with their classifications:

    <p>Beta-blockers = Second-line agents for angina management Lifestyle changes = Non-drug approach to stable angina Nitrates = Classified based on duration of action Calcium channel blockers = Alternative therapy for chronic stable angina</p> Signup and view all the answers

    Match the following nitrate types with their characteristics:

    <p>Short-acting nitrates = Onset 1-5 min, Duration 5-10 min Intermediate-acting nitrates = Onset 15 min, Duration 3-6 hrs Long-acting nitrates = Onset 30 min, Duration 12-18 hrs Transdermal patches = Onset 30 min, Duration 6-10 hrs</p> Signup and view all the answers

    Match the following antianginal drugs with their classes:

    <p>Ranolazine = Newer antianginal drugs Trimetazidine = pFOX inhibitors Beta-blockers = First-line agents CCBs = Second-line agents</p> Signup and view all the answers

    Match the following short-acting nitrates with their dosage forms:

    <p>Amyl nitrite = Crushable ampoules Glyceryl trinitrate = Sublingual tablets or spray Isosorbide dinitrate = Sublingual administration Glyceryl trinitrate (Tridil®) = Intravenous infusion</p> Signup and view all the answers

    Match the following statements with their corresponding pharmacokinetic properties:

    <p>Nitrates are rapidly absorbed = Absorption from all administration sites Oral bioavailability is affected = Extensive first-pass metabolism Short-acting nitrates = Quick onset of action Long-acting nitrates = Extended duration of action</p> Signup and view all the answers

    Match the following drug types with their respective therapeutic roles:

    <p>Statins = Lipid lowering drugs Aspirin = Antiplatelet drugs Beta-blockers = Management of chronic stable angina Ranolazine = Treatment of myocardial ischemia</p> Signup and view all the answers

    Match the following formulations with their respective dosage information:

    <p>Isosorbide dinitrate 5 mg = Sublingual, Duration 60 min Glyceryl trinitrate 0.5 mg = Sublingual, Onset 1-5 min Transdermal patch = Onset 30 min, Duration 12-18 hrs Isosorbide mononitrate 20 mg = Oral, Duration 6-8 hrs</p> Signup and view all the answers

    Match the following surgeries with their associated treatment:

    <p>Myocardial revascularization = Surgical treatment Drug therapy = First-line management Nitrates = Acute symptomatic relief Antiplatelet drugs = Prevention of thrombosis</p> Signup and view all the answers

    Match the following types of angina with their properties:

    <p>Chronic stable angina = Pain typically occurs during exertion Unstable angina = Pain may occur at rest Prinzmetal's angina = Characterized by severe coronary spasms Microvascular angina = Associated with pain during everyday activities</p> Signup and view all the answers

    Study Notes

    Ischemic Heart Disease

    • Includes chronic stable angina, acute coronary syndromes (ACS), and Prinzmetal's angina.

    Chronic Stable Angina

    • Characterized by retrosternal pain due to myocardial ischemia.
    • Pain is triggered by exertion, emotional stress, or eating and relieved by rest or nitrates.
    • Symptoms last typically less than 10-15 minutes. If pain exceeds 15 minutes, ACS is suspected.
    • Radiates to the left shoulder and arm; described as a tightness.

    Diagnosis

    • Resting ECG often normal; may show ST segment depression and T-wave inversion during an attack.
    • Myocardial infarction indicated by ST elevation and deep Q waves.
    • Exercise ECG identifies ischemic changes during controlled physical activity.
    • Nuclear imaging and coronary angiography used for further evaluation.

    Management of Stable Angina

    • Non-drug therapy focuses on lifestyle modifications, akin to those for hypertension.

    Pharmacological Therapy

    • Immediate treatment for chest pain includes:

      • Glyceryl trinitrate (GTN) for rapid relief.
      • Aspirin (300 mg loading dose) to prevent myocardial infarction progression.

    • Long-term treatment options include:

      • Beta-blockers: First-line for chronic stable angina.
      • Calcium channel blockers (CCBs): Second-line option.
      • Long-acting nitrates and pFOX inhibitors (e.g., trimetazidine).
      • Newer antianginal agents: ranolazine and nicorandil.
      • Statins for lipid management.
      • Antiplatelet drugs such as aspirin and clopidogrel.

    Nitrates Classification

    • Short-acting nitrates:

      • Amyl nitrite: 0.3 ml inhalation; onset 1-2 min, duration 5-10 min.
      • Glyceryl trinitrate tablets/spray: 0.5 mg SL; onset 1-5 min, duration 10-20 min.
      • Isosorbide dinitrate: 5 mg SL; onset 3-5 min, duration 60 min.

    • Intermediate-acting nitrates:

      • Isosorbide dinitrate: 10 mg oral; onset 15 min, duration 3-6 hrs.

    • Long-acting nitrates:

      • Isosorbide mononitrate: 20 mg oral; onset 30 min, duration 6-8 hrs.
      • Transdermal patches: onset 30 min, duration 12-18 hrs.

    Pharmacokinetics of Nitrates

    • Nitrates are rapidly absorbed from all administration sites.
    • First-pass metabolism occurs extensively in the liver for orally administered nitrates.

    Ischemic Heart Disease

    • Includes chronic stable angina, acute coronary syndromes (ACS), and Prinzmetal's angina.

    Chronic Stable Angina

    • Characterized by retrosternal pain due to myocardial ischemia.
    • Pain is triggered by exertion, emotional stress, or eating and relieved by rest or nitrates.
    • Symptoms last typically less than 10-15 minutes. If pain exceeds 15 minutes, ACS is suspected.
    • Radiates to the left shoulder and arm; described as a tightness.

    Diagnosis

    • Resting ECG often normal; may show ST segment depression and T-wave inversion during an attack.
    • Myocardial infarction indicated by ST elevation and deep Q waves.
    • Exercise ECG identifies ischemic changes during controlled physical activity.
    • Nuclear imaging and coronary angiography used for further evaluation.

    Management of Stable Angina

    • Non-drug therapy focuses on lifestyle modifications, akin to those for hypertension.

    Pharmacological Therapy

    • Immediate treatment for chest pain includes:

      • Glyceryl trinitrate (GTN) for rapid relief.
      • Aspirin (300 mg loading dose) to prevent myocardial infarction progression.

    • Long-term treatment options include:

      • Beta-blockers: First-line for chronic stable angina.
      • Calcium channel blockers (CCBs): Second-line option.
      • Long-acting nitrates and pFOX inhibitors (e.g., trimetazidine).
      • Newer antianginal agents: ranolazine and nicorandil.
      • Statins for lipid management.
      • Antiplatelet drugs such as aspirin and clopidogrel.

    Nitrates Classification

    • Short-acting nitrates:

      • Amyl nitrite: 0.3 ml inhalation; onset 1-2 min, duration 5-10 min.
      • Glyceryl trinitrate tablets/spray: 0.5 mg SL; onset 1-5 min, duration 10-20 min.
      • Isosorbide dinitrate: 5 mg SL; onset 3-5 min, duration 60 min.

    • Intermediate-acting nitrates:

      • Isosorbide dinitrate: 10 mg oral; onset 15 min, duration 3-6 hrs.

    • Long-acting nitrates:

      • Isosorbide mononitrate: 20 mg oral; onset 30 min, duration 6-8 hrs.
      • Transdermal patches: onset 30 min, duration 12-18 hrs.

    Pharmacokinetics of Nitrates

    • Nitrates are rapidly absorbed from all administration sites.
    • First-pass metabolism occurs extensively in the liver for orally administered nitrates.

    Ischemic Heart Disease

    • Includes chronic stable angina, acute coronary syndromes (ACS), and Prinzmetal's angina.

    Chronic Stable Angina

    • Characterized by retrosternal pain due to myocardial ischemia.
    • Pain is triggered by exertion, emotional stress, or eating and relieved by rest or nitrates.
    • Symptoms last typically less than 10-15 minutes. If pain exceeds 15 minutes, ACS is suspected.
    • Radiates to the left shoulder and arm; described as a tightness.

    Diagnosis

    • Resting ECG often normal; may show ST segment depression and T-wave inversion during an attack.
    • Myocardial infarction indicated by ST elevation and deep Q waves.
    • Exercise ECG identifies ischemic changes during controlled physical activity.
    • Nuclear imaging and coronary angiography used for further evaluation.

    Management of Stable Angina

    • Non-drug therapy focuses on lifestyle modifications, akin to those for hypertension.

    Pharmacological Therapy

    • Immediate treatment for chest pain includes:

      • Glyceryl trinitrate (GTN) for rapid relief.
      • Aspirin (300 mg loading dose) to prevent myocardial infarction progression.

    • Long-term treatment options include:

      • Beta-blockers: First-line for chronic stable angina.
      • Calcium channel blockers (CCBs): Second-line option.
      • Long-acting nitrates and pFOX inhibitors (e.g., trimetazidine).
      • Newer antianginal agents: ranolazine and nicorandil.
      • Statins for lipid management.
      • Antiplatelet drugs such as aspirin and clopidogrel.

    Nitrates Classification

    • Short-acting nitrates:

      • Amyl nitrite: 0.3 ml inhalation; onset 1-2 min, duration 5-10 min.
      • Glyceryl trinitrate tablets/spray: 0.5 mg SL; onset 1-5 min, duration 10-20 min.
      • Isosorbide dinitrate: 5 mg SL; onset 3-5 min, duration 60 min.

    • Intermediate-acting nitrates:

      • Isosorbide dinitrate: 10 mg oral; onset 15 min, duration 3-6 hrs.

    • Long-acting nitrates:

      • Isosorbide mononitrate: 20 mg oral; onset 30 min, duration 6-8 hrs.
      • Transdermal patches: onset 30 min, duration 12-18 hrs.

    Pharmacokinetics of Nitrates

    • Nitrates are rapidly absorbed from all administration sites.
    • First-pass metabolism occurs extensively in the liver for orally administered nitrates.

    Ischemic Heart Disease

    • Includes chronic stable angina, acute coronary syndromes (ACS), and Prinzmetal's angina.

    Chronic Stable Angina

    • Characterized by retrosternal pain due to myocardial ischemia.
    • Pain is triggered by exertion, emotional stress, or eating and relieved by rest or nitrates.
    • Symptoms last typically less than 10-15 minutes. If pain exceeds 15 minutes, ACS is suspected.
    • Radiates to the left shoulder and arm; described as a tightness.

    Diagnosis

    • Resting ECG often normal; may show ST segment depression and T-wave inversion during an attack.
    • Myocardial infarction indicated by ST elevation and deep Q waves.
    • Exercise ECG identifies ischemic changes during controlled physical activity.
    • Nuclear imaging and coronary angiography used for further evaluation.

    Management of Stable Angina

    • Non-drug therapy focuses on lifestyle modifications, akin to those for hypertension.

    Pharmacological Therapy

    • Immediate treatment for chest pain includes:

      • Glyceryl trinitrate (GTN) for rapid relief.
      • Aspirin (300 mg loading dose) to prevent myocardial infarction progression.

    • Long-term treatment options include:

      • Beta-blockers: First-line for chronic stable angina.
      • Calcium channel blockers (CCBs): Second-line option.
      • Long-acting nitrates and pFOX inhibitors (e.g., trimetazidine).
      • Newer antianginal agents: ranolazine and nicorandil.
      • Statins for lipid management.
      • Antiplatelet drugs such as aspirin and clopidogrel.

    Nitrates Classification

    • Short-acting nitrates:

      • Amyl nitrite: 0.3 ml inhalation; onset 1-2 min, duration 5-10 min.
      • Glyceryl trinitrate tablets/spray: 0.5 mg SL; onset 1-5 min, duration 10-20 min.
      • Isosorbide dinitrate: 5 mg SL; onset 3-5 min, duration 60 min.

    • Intermediate-acting nitrates:

      • Isosorbide dinitrate: 10 mg oral; onset 15 min, duration 3-6 hrs.

    • Long-acting nitrates:

      • Isosorbide mononitrate: 20 mg oral; onset 30 min, duration 6-8 hrs.
      • Transdermal patches: onset 30 min, duration 12-18 hrs.

    Pharmacokinetics of Nitrates

    • Nitrates are rapidly absorbed from all administration sites.
    • First-pass metabolism occurs extensively in the liver for orally administered nitrates.

    Ischemic Heart Disease

    • Includes chronic stable angina, acute coronary syndromes (ACS), and Prinzmetal's angina.

    Chronic Stable Angina

    • Characterized by retrosternal pain due to myocardial ischemia.
    • Pain is triggered by exertion, emotional stress, or eating and relieved by rest or nitrates.
    • Symptoms last typically less than 10-15 minutes. If pain exceeds 15 minutes, ACS is suspected.
    • Radiates to the left shoulder and arm; described as a tightness.

    Diagnosis

    • Resting ECG often normal; may show ST segment depression and T-wave inversion during an attack.
    • Myocardial infarction indicated by ST elevation and deep Q waves.
    • Exercise ECG identifies ischemic changes during controlled physical activity.
    • Nuclear imaging and coronary angiography used for further evaluation.

    Management of Stable Angina

    • Non-drug therapy focuses on lifestyle modifications, akin to those for hypertension.

    Pharmacological Therapy

    • Immediate treatment for chest pain includes:

      • Glyceryl trinitrate (GTN) for rapid relief.
      • Aspirin (300 mg loading dose) to prevent myocardial infarction progression.

    • Long-term treatment options include:

      • Beta-blockers: First-line for chronic stable angina.
      • Calcium channel blockers (CCBs): Second-line option.
      • Long-acting nitrates and pFOX inhibitors (e.g., trimetazidine).
      • Newer antianginal agents: ranolazine and nicorandil.
      • Statins for lipid management.
      • Antiplatelet drugs such as aspirin and clopidogrel.

    Nitrates Classification

    • Short-acting nitrates:

      • Amyl nitrite: 0.3 ml inhalation; onset 1-2 min, duration 5-10 min.
      • Glyceryl trinitrate tablets/spray: 0.5 mg SL; onset 1-5 min, duration 10-20 min.
      • Isosorbide dinitrate: 5 mg SL; onset 3-5 min, duration 60 min.

    • Intermediate-acting nitrates:

      • Isosorbide dinitrate: 10 mg oral; onset 15 min, duration 3-6 hrs.

    • Long-acting nitrates:

      • Isosorbide mononitrate: 20 mg oral; onset 30 min, duration 6-8 hrs.
      • Transdermal patches: onset 30 min, duration 12-18 hrs.

    Pharmacokinetics of Nitrates

    • Nitrates are rapidly absorbed from all administration sites.
    • First-pass metabolism occurs extensively in the liver for orally administered nitrates.

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    Ischemic Heart Disease & Antianginal Drugs PDF

    Description

    This quiz covers essential information about ischemic heart disease, focusing on chronic stable angina. You will learn about the causes, symptoms, and treatments of angina, along with the role of antianginal drugs. Test your knowledge on these critical cardiovascular concepts.

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