11 Stable Angina
- stable, no thrombus, not ruptured
- exercise: more O2 demand, not enough supply
- coronary arteries supplied in diastole
Angina Physiology
- faster HR, more O2 demand, less O2 delivered
Treatment
- partial: can worsen angina symptoms
- Agonizing plastic bugle: acebutolol (a selective beta-1 antagonist with partial agonist activity)
- Agonizing pin: pindolol (a nonselective beta blocker with partial agonist activity)
- Popping failing heart: beta blockers with partial agonist activity (e.g. pindolol, acebutolol) should be avoided in patients with heart failure or a history of MI
- negative ionotropic effects can cause systolic dysfunction: acute HF
- Calci yum: CCB
- L-shaped handle: calcium channel blockers target voltage gated L-type calcium channels
- Dairy: dihydropyridines
- Non-dairy: nondihydropyridines
- Smooth muscle tile: dihydropyridines block L-type calcium channels in smooth muscle
- Cardiac muscle tile: non-dihydropyridines block L-type calcium channels in cardiac muscle
- Dippin' station: -dipine suffix of dihydropyridines (e.g. nifedipine, amlodipine, nicardipine)
- Dilated dairy nozzle: dihydropyridines cause vasodilation
- Dilated coronary crown: dihydropyridines (e.g. amlodipine, felodipine) dilate coronary arteries
- Reduced load: dihydropyridines reduce afterload
- Weak kid at the non-dairy: non-dihydropyridines decrease cardiac contractility
- Music notes: non-dihydropyridines decrease activity at the SA and AV nodes
- Low dangling heart watch: inhibition of the SA node by non-dihydropyridines causes bradycardia
- Discarded oxygen: non-dihydropyridines decrease myocardial oxygen demand
- Knife cutting heart: nifedipine can exacerbate myocardial ischemia due to reflex tachycardia - avoid in patients with unstable angina or MI (shorter acting, higher SE)
- Failing heart balloon locked out of store: CCBs can worsen heart failure (increased sympathetic activity and decreased contractility)
- coronary arteries supplied in diastole
- ergonovine: alpha agonist
Coronary Steal
- pts on stress tests: give vasodilators that preferentially dilate healthy territories > coronary steal > can be picked up on tracers (usually won't precipitate EKG/symptoms changes)
- Don’t phoster disinterest: phosphodiesterase inhibitors (e.g. dipyridamole, cilostazol)
- Phosphodiesterase inhibitors increase cAMP, impairing platelet function
- Two pyramids: dipyridamole (an antiplatelet phosphodiesterase inhibitor)
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