Stable and Unstable Angina Quiz

A common heart condition caused by narrowing of the coronary arteries, leading to reduced blood flow to the heart.

A type of angina that occurs during exertion or stress, causing chest pain or discomfort.

A type of angina that occurs at rest or with minimal activity, often caused by spasms in the coronary arteries.

A condition where the heart muscle doesn't receive enough oxygen, leading to chest pain or discomfort.

The reduction of blood flow through the coronary arteries, supplying oxygen to the heart.

A sudden, intense pain in the chest, often described as a squeezing or crushing sensation.

A serious condition where the heart muscle is damaged due to a lack of blood flow.

A type of angina that is unpredictable and can occur at any time, even at rest.

Angina that occurs at rest and is caused by spasms in the coronary arteries, typically unrelated to physical activity, heart rate, or blood pressure.

A group of conditions characterized by a sudden interruption of blood flow to the heart, often caused by a ruptured atherosclerotic plaque. Can manifest as ST-segment elevation myocardial infarction, non-ST-segment elevation myocardial infarction, or unstable angina.

Any situation where the heart's demand for oxygen surpasses the supply causing chest pain. This can be caused by factors such as exertion, stress, or underlying heart conditions.

A group of medications used to manage stable angina, such as beta-blockers, calcium channel blockers, organic nitrates, and ranolazine. They help to balance the heart's oxygen supply and demand.

A substance released from damaged heart muscle cells that can be detected in blood tests. It is used to diagnose heart attacks.

Beta-blockers are drugs that decrease the demand for oxygen by the heart muscle by blocking beta-1 receptors, leading to a decrease in heart rate, contraction strength, blood output, and blood pressure. This can reduce the frequency and severity of angina attacks.

Beta-blockers can help prolong exercise in people with angina because they reduce the oxygen demands of the heart muscle, allowing them to exert themselves more before experiencing chest pain.

Beta-blockers are often the first choice for treating angina unless there are specific contraindications, such as vasospastic angina, where they can worsen symptoms.

Beta-blockers can reduce the risk of heart attack and death in individuals who have previously experienced a heart attack, and they also help improve survival chances in patients with heart failure.

Beta-blockers with intrinsic sympathomimetic activity (ISA), like pindolol, should be avoided in patients with angina and those who have had a heart attack.

Calcium is crucial for muscle contractions, and increased calcium influx can damage heart cells during ischemia. Calcium channel blockers prevent this damage by blocking calcium entry into heart and blood vessel muscle cells, acting as vasodilators.

Calcium channel blockers are vasodilators, meaning they widen blood vessels by relaxing smooth muscle, reducing resistance to blood flow.

Calcium channel blockers act by blocking the entry of calcium into smooth muscle cells, which relaxes the blood vessels and decreases resistance to blood flow, leading to lower blood pressure.

Nitrates, like nitroglycerin, dilate large veins, reducing preload (blood returning to the heart). This decreases the workload for the heart and increases the oxygen supply to the heart muscle.

Nitrates dilate coronary arteries, improving the blood supply to the heart muscle. This ensures that the heart receives enough oxygen.

Sublingual nitroglycerin is preferred for immediate relief of angina attacks triggered by exercise or stress. It acts quickly and can be easily administered.

First-pass metabolism in the liver significantly reduces the effectiveness of nitroglycerin when taken orally. To bypass this, it's often administered sublingually or transdermally.

Isosorbide mononitrate has a longer duration of action due to its resistance to hepatic breakdown. This means it stays active longer in the body.

Tolerance to nitrates develops quickly as blood vessels become less responsive to dilation. This can be overcome by providing a 'nitrate-free interval' to reset the sensitivity.

A nitrate-free interval is crucial to prevent tolerance and maintain the effectiveness of nitrates. This typically involves skipping nitrates for 10-12 hours, often at night.

In patients with variant angina, the nitrate-free interval should occur in the late afternoon due to increased vulnerability in the early morning hours.

Calcium channel blockers primarily affect the resistance of peripheral and coronary arteriolar smooth muscle, leading to a decrease in myocardial oxygen consumption and afterload, thus relieving angina symptoms.

Amlodipine, a dihydropyridine calcium channel blocker, primarily acts as an arteriolar vasodilator, with minimal impact on cardiac conduction. This effect makes it beneficial in treating variant angina (coronary spasm).

Short-acting dihydropyridines should be avoided in patients with coronary artery disease (CAD). They have been linked to increased mortality after a heart attack (MI) and an increase in acute MI in hypertensive patients.

Verapamil, a non-dihydropyridine calcium channel blocker, slows AV conduction, reduces heart rate and contractility, lowers blood pressure, and decreases oxygen demand. However, it has a greater negative inotropic effect than amlodipine and is a weaker vasodilator.

Non-dihydropyridine calcium channel blockers (like verapamil and diltiazem) can worsen heart failure due to their negative inotropic effect, which reduces the heart's ability to pump effectively. Their use should be avoided in patients with heart failure.

Organic nitrates, used for angina relief, work by relaxing vascular smooth muscle through the intracellular conversion to nitrite ions and nitric oxide. This process activates guanylate cyclase, increasing cyclic GMP (cGMP) synthesis.

Diltiazem, a non-dihydropyridine calcium channel blocker, similarly to verapamil, slows AV conduction, reduces heart rate, and acts as a coronary artery vasodilator. It is effective in relieving coronary artery spasm, especially in variant angina.

Organic nitrates are effective in treating stable, unstable, and variant angina. They reduce myocardial oxygen demand, leading to symptom relief.