Medical Treatment for Hypertension and Diabetes
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Questions and Answers

What is the primary mechanism contributing to cardiac ischemia?

  • Atherosclerosis
  • Imbalance between coronary flow and cardiac work (correct)
  • Increased cardiac work
  • Excessive oxygen supply

    • Which of the following is a fixed risk factor for coronary artery disease?

  • Obesity
  • Cigarette smoking
  • Hypertension
  • Age (correct)

    • What is the male to female ratio for coronary artery disease in all age groups according to studies?

  • 2:1 (correct)
  • 8:1
  • 5:1
  • 1:1

    • At what age range does the peak incidence of symptomatic ischemic heart disease occur for men?

    <p>50-60</p> Signup and view all the answers

    Which is NOT a potentially changeable risk factor for coronary artery disease?

    <p>Positive family history</p> Signup and view all the answers

    Which of the following best describes atherosclerosis?

    <p>A process that can affect many blood vessels</p> Signup and view all the answers

    Which is an important consideration when selecting investigations for acute coronary syndrome?

    <p>Duration of chest pain</p> Signup and view all the answers

    Which of the following elements is part of effective long-term risk factor management for coronary artery disease?

    <p>Balanced diet and exercise regimen</p> Signup and view all the answers

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

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

    Which therapy is NOT commonly used for symptomatic treatment in angina?

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

    What is a potential adverse effect when abruptly stopping nitrate therapy?

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

    What additional effect does glyceryl trinitrate (GTN) provide in angina treatment?

    <p>Decreases blood pressure and ventricular volume</p> Signup and view all the answers

    How does Nicorandil function as an anti-anginal drug?

    <p>Acts as a vasodilator with nitrate-like effects</p> Signup and view all the answers

    Which class of drugs decreases cardiac work and oxygen consumption?

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

    What is the mechanism of action of Ranolazine in angina treatment?

    <p>Interacts with sodium channels to improve exercise tolerance</p> Signup and view all the answers

    What should patients on long-acting nitrates do to avoid tolerance?

    <p>Have a nitrate-free period of 8-10 hours</p> Signup and view all the answers

    What does acute coronary syndrome (ACS) encompass?

    <p>Unstable angina, NSTEMI, and STEMI</p> Signup and view all the answers

    Which of the following symptoms is not typically associated with myocardial infarction?

    <p>Sudden headaches</p> Signup and view all the answers

    What characterizes NSTEMI?

    <p>Myocardial infarction without ST elevation</p> Signup and view all the answers

    Which of the following is a common clinical presentation of unstable angina?

    <p>Accelerating pattern of pain</p> Signup and view all the answers

    What is defined as myocardial necrosis?

    <p>Myocardial loss of viability or wall motion abnormality</p> Signup and view all the answers

    Which ECG finding is indicative of STEMI?

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

    Which of the following best describes the pulse findings in a patient experiencing myocardial infarction?

    <p>Thready with significant hypotension</p> Signup and view all the answers

    What type of pain pattern indicates new-onset angina?

    <p>Pain starting suddenly without previous episodes</p> Signup and view all the answers

    What is the primary indication for the use of ivabradine?

    <p>Symptomatic treatment of chronic stable angina pectoris in patients with normal sinus rhythm</p> Signup and view all the answers

    Which of the following is NOT an indication for coronary artery bypass grafting (CABG)?

    <p>Non-reversible myocardial ischemia due to coronary vasospasm</p> Signup and view all the answers

    What is a common treatment modality for microvascular angina?

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

    What does the term 'refractory angina' refer to?

    <p>Angina that cannot be controlled by medical therapy and revascularization is not possible</p> Signup and view all the answers

    Which statement about percutaneous coronary intervention (PCI) is true?

    <p>PCI uses an inflatable balloon and stent to dilate coronary artery stenosis.</p> Signup and view all the answers

    What is the main function of anti-platelet drugs like aspirin in the management of coronary artery disease?

    <p>Prevent platelet aggregation</p> Signup and view all the answers

    Which of the following statements regarding beta-blockers in angina treatment is correct?

    <p>Beta-blockers are contraindicated in patients with variant angina.</p> Signup and view all the answers

    What is a hallmark ECG finding in patients with variant angina?

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

    Which therapy is the only MONA therapy that improves mortality?

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

    What is the recommended loading dose of clopidogrel for ACS treatment?

    <p>300mg</p> Signup and view all the answers

    What additional therapy should be administered alongside dual antiplatelet therapy for patients with ACS?

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

    Which agent is not a glycoprotein IIb/IIIa receptor antagonist?

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

    Which condition is generally a contraindication for using beta-blockers?

    <p>Acute pulmonary edema</p> Signup and view all the answers

    Which of the following drugs is used for plaque stabilization in ACS?

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

    What is the desired resting heart rate when titrating beta-blocker dosage?

    <p>50-60 beats per minute</p> Signup and view all the answers

    What is a common concern when using unfractionated heparin (UFH)?

    <p>Frequent monitoring is required.</p> Signup and view all the answers

    Study Notes

    Coronary Artery Disease (CAD) Overview

    • CAD results from an imbalance between coronary flow (O2 supply) and cardiac work (O2 needs).
    • It is the most prevalent cause of cardiovascular morbidity and mortality globally.
    • Peak incidence occurs in men aged 50-60 and women aged 60-70.
    • Risk factors include both fixed (age, male sex, family history) and changeable (hyperlipidemia, smoking, hypertension, diabetes, etc.).

    Pathophysiology and Risk Factors

    • Atherosclerosis and thrombosis are key mechanisms in CAD development.
    • Fixed risk factors: Age, male sex, positive family history.
    • Changeable risk factors: Hyperlipidemia, hypertension, diabetes, lack of exercise, obesity, etc.

    Medical Treatment Goals

    • Prognostic therapies include aspirin for reducing coronary events, particularly in angina patients.
    • Lipid-lowering medications are vital for patients with elevated cholesterol levels.
    • Symptomatic relief can be achieved with glyceryl trinitrate (GTN).
    • Drug treatments should be individualized; options include beta-blockers, nitrates, and calcium channel blockers.

    Anti-Anginal Pharmacology

    • Nitrates decrease oxygen requirements by lowering blood pressure and diastolic pressure.
    • Beta-blockers reduce cardiac work and oxygen demand.
    • Calcium channel blockers act as vasodilators to improve coronary blood flow.
    • Nicorandil offers unique vasodilatory properties; it does not develop tolerance unlike nitrates.
    • Ranolazine assists in managing angina, particularly in patients unresponsive to other therapies.

    Invasive Procedures

    • Percutaneous coronary intervention (PCI) involves balloon dilation and stenting for coronary stenosis treatment.
    • Coronary artery bypass grafting (CABG) is indicated in severe cases, such as three-vessel disease or significant left main coronary obstruction.

    Acute Coronary Syndrome (ACS)

    • ACS encompasses unstable angina (UA), NSTEMI, and STEMI, guiding therapeutic interventions.
    • Clinical signs include prolonged chest pain, changes in vital signs, and potentially atypical presentations in elderly or diabetic patients.

    Myocardial Infarction (MI)

    • MI is characterized by myocardial necrosis, identified via serum markers and clinical symptoms.
    • Two types:
      • NSTEMI: No ST elevation on ECG, meets necrosis criteria.
      • STEMI: ST elevation or new bundle branch block on ECG, more critical.

    Management of Unstable Angina and NSTEMI

    • Dual antiplatelet therapy is crucial for ACS treatment (aspirin plus ADP-receptor antagonist).
    • Antithrombin agents (e.g., unfractionated heparin, low-molecular-weight heparin) reduce thrombotic events.
    • Glycoprotein IIb/IIIa receptor blockers are utilized in certain ACS cases for platelet aggregation inhibition.

    Post-Coronary Intervention Outcomes

    • Most patients show improvement within 1 to 2 days with appropriate medical management.
    • The choice between early invasive strategies or conservative management remains a topic of discussion among clinicians.

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    Description

    This quiz covers essential medical treatments for hypertension, diabetes mellitus, and hypercholesterolemia. It includes insights into prognostic therapies like aspirin for coronary artery disease and the role of lipid-lowering therapies. Test your knowledge about these critical health interventions.

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