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

• less O2 demand

• 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

Prinzmetal

• 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)