Podcast
Questions and Answers
What is the primary cause of chronic stable angina?
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?
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?
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?
Which condition results in irreversible coagulativene necrosis of the heart muscle?
During an episode of chronic stable angina, when do symptoms typically arise?
During an episode of chronic stable angina, when do symptoms typically arise?
What is a common characteristic of myocardial infarction compared to unstable angina?
What is a common characteristic of myocardial infarction compared to unstable angina?
What is the primary cause of Prinzmetal's angina?
What is the primary cause of Prinzmetal's angina?
Which of the following symptoms is characteristic of stable angina?
Which of the following symptoms is characteristic of stable angina?
What is the typical duration of pain in stable angina?
What is the typical duration of pain in stable angina?
Which factor is NOT a precipitating factor for stable angina?
Which factor is NOT a precipitating factor for stable angina?
Which statement regarding Prinzmetal's angina is FALSE?
Which statement regarding Prinzmetal's angina is FALSE?
In chronic stable angina, what causes the imbalance leading to myocardial ischemia?
In chronic stable angina, what causes the imbalance leading to myocardial ischemia?
What is a common radiation area for pain experienced during stable angina?
What is a common radiation area for pain experienced during stable angina?
Which of the following is NOT a characteristic of the pain associated with stable angina?
Which of the following is NOT a characteristic of the pain associated with stable angina?
Which drug class is considered the first-line therapy for chronic stable angina?
Which drug class is considered the first-line therapy for chronic stable angina?
What is the duration of action for glyceryl trinitrate when administered as a sublingual tablet?
What is the duration of action for glyceryl trinitrate when administered as a sublingual tablet?
Which of the following is NOT classified as a long-acting nitrate?
Which of the following is NOT classified as a long-acting nitrate?
Which therapy is recommended as second-line for chronic stable angina?
Which therapy is recommended as second-line for chronic stable angina?
What is the onset of action for isosorbide dinitrate when administered sublingually?
What is the onset of action for isosorbide dinitrate when administered sublingually?
Which of the following medications would have extensive first-pass metabolism when administered orally?
Which of the following medications would have extensive first-pass metabolism when administered orally?
What is the typical duration of action for transdermal nitrate patches?
What is the typical duration of action for transdermal nitrate patches?
Which of the following is a newer antianginal drug?
Which of the following is a newer antianginal drug?
What is a characteristic finding on a resting 12-lead ECG that does not rule out ischemic heart disease?
What is a characteristic finding on a resting 12-lead ECG that does not rule out ischemic heart disease?
During an attack of myocardial infarction, which ECG change is expected?
During an attack of myocardial infarction, which ECG change is expected?
Which of the following is a non-drug therapy approach to managing stable angina?
Which of the following is a non-drug therapy approach to managing stable angina?
What is the primary purpose of performing an exercise ECG?
What is the primary purpose of performing an exercise ECG?
Which medication is recommended for immediate treatment of acute chest pain?
Which medication is recommended for immediate treatment of acute chest pain?
Which imaging technique utilizes nuclear isotopes for assessing ischemic heart disease?
Which imaging technique utilizes nuclear isotopes for assessing ischemic heart disease?
What does ST segment depression indicate during an ECG?
What does ST segment depression indicate during an ECG?
What is the effect of Glyceryl trinitrate administered during an acute chest pain episode?
What is the effect of Glyceryl trinitrate administered during an acute chest pain episode?
Chronic stable angina is primarily caused by a rupture of atheromatous plaque.
Chronic stable angina is primarily caused by a rupture of atheromatous plaque.
Unstable angina is characterized by a consistent pattern of chest pain that does not change in frequency or severity.
Unstable angina is characterized by a consistent pattern of chest pain that does not change in frequency or severity.
Myocardial infarction occurs when an intraluminal thrombus completely occludes a coronary artery due to plaque rupture.
Myocardial infarction occurs when an intraluminal thrombus completely occludes a coronary artery due to plaque rupture.
Pain from chronic stable angina typically worsens with rest.
Pain from chronic stable angina typically worsens with rest.
Acute coronary syndromes include conditions like chronic stable angina and myocardial infarction.
Acute coronary syndromes include conditions like chronic stable angina and myocardial infarction.
Chronic stable angina typically presents with a gradual onset of pain that subdues within minutes.
Chronic stable angina typically presents with a gradual onset of pain that subdues within minutes.
Prinzmetal's angina is associated with severe spasms of coronary arteries due to overactivity of α2 receptors.
Prinzmetal's angina is associated with severe spasms of coronary arteries due to overactivity of α2 receptors.
Beta-blockers are considered second-line agents for chronic stable angina.
Beta-blockers are considered second-line agents for chronic stable angina.
Chronic stable angina typically presents with chest pain that lasts longer than 15 minutes.
Chronic stable angina typically presents with chest pain that lasts longer than 15 minutes.
Pain from chronic stable angina is characterized by a sense of chest tightness, particularly during periods of exertion.
Pain from chronic stable angina is characterized by a sense of chest tightness, particularly during periods of exertion.
Amyl nitrite has a duration of action of 10-20 minutes when inhaled.
Amyl nitrite has a duration of action of 10-20 minutes when inhaled.
The radiation of pain from chronic stable angina can extend to the left arm and the right shoulder.
The radiation of pain from chronic stable angina can extend to the left arm and the right shoulder.
Isosorbide mononitrate acts within 30 minutes and its effects last for 6-10 hours.
Isosorbide mononitrate acts within 30 minutes and its effects last for 6-10 hours.
Chronic stable angina can be relieved by physical activity and nitrates.
Chronic stable angina can be relieved by physical activity and nitrates.
Ranolazine and nicorandil are classified as long-acting nitrates.
Ranolazine and nicorandil are classified as long-acting nitrates.
Prinzmetal's angina does not present with pain at rest.
Prinzmetal's angina does not present with pain at rest.
Extensive first-pass metabolism occurs when nitrates are administered orally.
Extensive first-pass metabolism occurs when nitrates are administered orally.
The imbalance in chronic stable angina arises from excessive coronary blood flow and insufficient heart workload.
The imbalance in chronic stable angina arises from excessive coronary blood flow and insufficient heart workload.
Transdermal nitrate patches have an onset of action of about 15 minutes.
Transdermal nitrate patches have an onset of action of about 15 minutes.
Intermediate-acting nitrates have a longer duration of action than short-acting nitrates.
Intermediate-acting nitrates have a longer duration of action than short-acting nitrates.
Chronic stable angina pain can result from emotional stress as one of its precipitating factors.
Chronic stable angina pain can result from emotional stress as one of its precipitating factors.
The primary purpose of statins is to prevent myocardial revascularization.
The primary purpose of statins is to prevent myocardial revascularization.
A resting 12-lead ECG can definitively exclude ischemic heart disease.
A resting 12-lead ECG can definitively exclude ischemic heart disease.
During a myocardial infarction, ST elevation and deep Q-wave formation are commonly observed.
During a myocardial infarction, ST elevation and deep Q-wave formation are commonly observed.
Nuclear isotopes imaging can be utilized for assessing ischemic changes in the heart.
Nuclear isotopes imaging can be utilized for assessing ischemic changes in the heart.
Glyceryl trinitrate is administered for chronic angina but has no effect during acute chest pain episodes.
Glyceryl trinitrate is administered for chronic angina but has no effect during acute chest pain episodes.
Exercise ECG recordings are performed without any physical effort.
Exercise ECG recordings are performed without any physical effort.
Coronary angiography is a method used for direct visualization of the coronary arteries.
Coronary angiography is a method used for direct visualization of the coronary arteries.
ST segment depression during an ECG suggests the presence of ischemia in the heart.
ST segment depression during an ECG suggests the presence of ischemia in the heart.
Aspirin is recommended as a loading dose of 300 mg to reduce the risk of progression to a myocardial infarction.
Aspirin is recommended as a loading dose of 300 mg to reduce the risk of progression to a myocardial infarction.
What type of angina is characterized by severe coronary artery spasms due to overactivity of α1 receptors?
What type of angina is characterized by severe coronary artery spasms due to overactivity of α1 receptors?
What are the common precipitating factors for chronic stable angina?
What are the common precipitating factors for chronic stable angina?
In chronic stable angina, how long does chest pain typically last?
In chronic stable angina, how long does chest pain typically last?
What is the typical character of pain experienced during an episode of chronic stable angina?
What is the typical character of pain experienced during an episode of chronic stable angina?
What is the difference in the onset of pain between chronic stable angina and Prinzmetal's angina?
What is the difference in the onset of pain between chronic stable angina and Prinzmetal's angina?
What symptom is indicative of unstable angina compared to chronic stable angina?
What symptom is indicative of unstable angina compared to chronic stable angina?
What might the presence of chest pain lasting longer than 15 minutes suggest in a patient with angina?
What might the presence of chest pain lasting longer than 15 minutes suggest in a patient with angina?
How is the radiation of pain typically described in a patient experiencing chronic stable angina?
How is the radiation of pain typically described in a patient experiencing chronic stable angina?
What differentiates chronic stable angina from acute coronary syndromes in terms of the nature of chest pain experienced?
What differentiates chronic stable angina from acute coronary syndromes in terms of the nature of chest pain experienced?
Explain the role of atheromatous plaque rupture in the development of unstable angina.
Explain the role of atheromatous plaque rupture in the development of unstable angina.
How does the pathophysiology of myocardial infarction relate to the process of thrombus formation?
How does the pathophysiology of myocardial infarction relate to the process of thrombus formation?
Identify the major symptom of acute coronary syndromes and its implications for emergency response.
Identify the major symptom of acute coronary syndromes and its implications for emergency response.
What physiological change typically triggers the onset of chronic stable angina during exertion?
What physiological change typically triggers the onset of chronic stable angina during exertion?
When comparing chronic stable angina and unstable angina, what is a key difference in how the pain's characteristics evolve?
When comparing chronic stable angina and unstable angina, what is a key difference in how the pain's characteristics evolve?
What does ST segment depression indicate during an exercise ECG?
What does ST segment depression indicate during an exercise ECG?
What is the role of glyceryl trinitrate in the management of acute chest pain?
What is the role of glyceryl trinitrate in the management of acute chest pain?
What is a significant ECG finding during a myocardial infarction?
What is a significant ECG finding during a myocardial infarction?
Which imaging technique utilizes nuclear isotopes to assess ischemic heart disease?
Which imaging technique utilizes nuclear isotopes to assess ischemic heart disease?
What is often the first step in the management of stable angina?
What is often the first step in the management of stable angina?
During which circumstance might a resting 12-lead ECG appear normal despite underlying conditions?
During which circumstance might a resting 12-lead ECG appear normal despite underlying conditions?
What is a recommended immediate treatment for chest pain, according to the management guidelines?
What is a recommended immediate treatment for chest pain, according to the management guidelines?
What is the main goal of performing an exercise ECG?
What is the main goal of performing an exercise ECG?
What is the mechanism that leads to extensive first-pass metabolism of nitrates when taken orally?
What is the mechanism that leads to extensive first-pass metabolism of nitrates when taken orally?
Which class of medications is primarily used as first-line agents for managing chronic stable angina?
Which class of medications is primarily used as first-line agents for managing chronic stable angina?
What is the typical duration of action for glyceryl trinitrate when administered sublingually?
What is the typical duration of action for glyceryl trinitrate when administered sublingually?
Identify the secondary agent class recommended for chronic stable angina after beta-blockers.
Identify the secondary agent class recommended for chronic stable angina after beta-blockers.
For how long do transdermal nitrate patches typically exert their effects?
For how long do transdermal nitrate patches typically exert their effects?
What role do lipid-lowering drugs, such as statins, play in the management of chronic stable angina?
What role do lipid-lowering drugs, such as statins, play in the management of chronic stable angina?
Which newer antianginal drugs are considered when standard treatments are insufficient?
Which newer antianginal drugs are considered when standard treatments are insufficient?
What effect does the administration of nitroglycerin generally have during an acute chest pain episode?
What effect does the administration of nitroglycerin generally have during an acute chest pain episode?
Chronic stable angina is due to atheromatous narrowing of the coronary ______.
Chronic stable angina is due to atheromatous narrowing of the coronary ______.
Unstable angina is characterized by the rupture of atheromatous ______.
Unstable angina is characterized by the rupture of atheromatous ______.
Myocardial infarction occurs when an intraluminal thrombosis completely occludes the epicardial coronary ______.
Myocardial infarction occurs when an intraluminal thrombosis completely occludes the epicardial coronary ______.
Pain from chronic stable angina is induced by ______ and disappears with rest.
Pain from chronic stable angina is induced by ______ and disappears with rest.
Acute coronary syndromes include conditions such as unstable angina and myocardial ______.
Acute coronary syndromes include conditions such as unstable angina and myocardial ______.
Ranolazine and nicorandil are classified as long-acting ______.
Ranolazine and nicorandil are classified as long-acting ______.
Prinzmetal's angina is characterized by severe spasms of the coronary arteries due to overactivity of ______ receptors.
Prinzmetal's angina is characterized by severe spasms of the coronary arteries due to overactivity of ______ receptors.
The classic symptom of stable angina is ______ pain.
The classic symptom of stable angina is ______ pain.
Stable angina can be precipitated by exertion, emotion, eating, and relieved by ______.
Stable angina can be precipitated by exertion, emotion, eating, and relieved by ______.
In chronic stable angina, the imbalance arises from the demand of heart work and ______ blood flow.
In chronic stable angina, the imbalance arises from the demand of heart work and ______ blood flow.
Chest pain that lasts longer than ______ minutes may suggest acute coronary syndrome (ACS).
Chest pain that lasts longer than ______ minutes may suggest acute coronary syndrome (ACS).
The pain experienced during stable angina may radiate to the left shoulder and the ______.
The pain experienced during stable angina may radiate to the left shoulder and the ______.
In stable angina, the character of pain is often described as a sense of chest ______.
In stable angina, the character of pain is often described as a sense of chest ______.
Prinzmetal's angina often occurs at ______.
Prinzmetal's angina often occurs at ______.
During an attack, there is ST segment ______ and T-wave inversion.
During an attack, there is ST segment ______ and T-wave inversion.
Glyceryl trinitrate (GTN) is often administered sublingually or as a ______.
Glyceryl trinitrate (GTN) is often administered sublingually or as a ______.
The same lifestyle modifications for managing stable angina are also recommended for ______.
The same lifestyle modifications for managing stable angina are also recommended for ______.
Exercise ECG records ischemic changes during controlled physical ______.
Exercise ECG records ischemic changes during controlled physical ______.
In myocardial infarction, there may be ST ______ and deep Q-wave.
In myocardial infarction, there may be ST ______ and deep Q-wave.
Aspirin 300 mg loading dose should be given as soon as ______.
Aspirin 300 mg loading dose should be given as soon as ______.
Resting 12-lead ECG is often ______ and does not exclude ischemic heart disease.
Resting 12-lead ECG is often ______ and does not exclude ischemic heart disease.
Nuclear isotopes imaging helps assess ______ heart disease.
Nuclear isotopes imaging helps assess ______ heart disease.
Beta-blockers are the first-line agents for chronic stable ______.
Beta-blockers are the first-line agents for chronic stable ______.
Long and intermediate acting ______ are used in the treatment of chronic stable angina.
Long and intermediate acting ______ are used in the treatment of chronic stable angina.
Ranolazine and ______ are classified as newer antianginal drugs.
Ranolazine and ______ are classified as newer antianginal drugs.
Glyceryl trinitrate has a duration of action of ______ when administered as a sublingual tablet.
Glyceryl trinitrate has a duration of action of ______ when administered as a sublingual tablet.
Isosorbide mononitrate can be taken orally and usually acts within ______.
Isosorbide mononitrate can be taken orally and usually acts within ______.
The duration of action for transdermal nitrate patches can last up to ______ hours.
The duration of action for transdermal nitrate patches can last up to ______ hours.
Short-acting nitrates like Amyl nitrite are rapidly absorbed and have a short ______.
Short-acting nitrates like Amyl nitrite are rapidly absorbed and have a short ______.
Extensive first-pass metabolism occurs when ______ are administered orally.
Extensive first-pass metabolism occurs when ______ are administered orally.
Match the condition with its primary characteristic:
Match the condition with its primary characteristic:
Match the type of angina with its description:
Match the type of angina with its description:
Match the term with its definition:
Match the term with its definition:
Match the angina type to its triggering factor:
Match the angina type to its triggering factor:
Match the angina feature with its correct description:
Match the angina feature with its correct description:
Match the angina category with its relevant treatment approach:
Match the angina category with its relevant treatment approach:
Match the type of angina with their defining characteristics:
Match the type of angina with their defining characteristics:
Match the symptom of angina with its description:
Match the symptom of angina with its description:
Match the type of angina with their typical treatment methods:
Match the type of angina with their typical treatment methods:
Match the condition with its cause:
Match the condition with its cause:
Match the type of angina with their notable occurrence patterns:
Match the type of angina with their notable occurrence patterns:
Match the clinical feature with its associated angina type:
Match the clinical feature with its associated angina type:
Match the type of angina with their common presentation:
Match the type of angina with their common presentation:
Match the precipitating factor with its effect on angina:
Match the precipitating factor with its effect on angina:
Match the following types of ECG findings with their significance:
Match the following types of ECG findings with their significance:
Match the following therapies with their descriptions:
Match the following therapies with their descriptions:
Match the following imaging techniques with their purpose:
Match the following imaging techniques with their purpose:
Match the following statements regarding angina management:
Match the following statements regarding angina management:
Match the following descriptors to the type of chest pain:
Match the following descriptors to the type of chest pain:
Match the following medications with their respective functions:
Match the following medications with their respective functions:
Match the following ECG changes with their associated conditions:
Match the following ECG changes with their associated conditions:
Match the following types of therapy with their classifications:
Match the following types of therapy with their classifications:
Match the following nitrate types with their characteristics:
Match the following nitrate types with their characteristics:
Match the following antianginal drugs with their classes:
Match the following antianginal drugs with their classes:
Match the following short-acting nitrates with their dosage forms:
Match the following short-acting nitrates with their dosage forms:
Match the following statements with their corresponding pharmacokinetic properties:
Match the following statements with their corresponding pharmacokinetic properties:
Match the following drug types with their respective therapeutic roles:
Match the following drug types with their respective therapeutic roles:
Match the following formulations with their respective dosage information:
Match the following formulations with their respective dosage information:
Match the following surgeries with their associated treatment:
Match the following surgeries with their associated treatment:
Match the following types of angina with their properties:
Match the following types of angina with their properties:
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.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Related Documents
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.