Patho & Pharmo 2 Cardiac Ishemia Wk 2
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What does Ischemia mean?
In adequate blood supply to tissues
What does CAD stand for?
Coronary Artery Disease
What does CHD stand for?
Coronary heart Disease - is normally responsible for heart failure, Angina or myocardial infarction.
What does Infarction mean?
Tissue is dying off
Name some consequences of CHD and Ischemia?
Hypoxia pain in the myocardial muscle, causing Angina. The O2 deficit if <20 mins ischemic episode if >20 mins myocardial infarction.
Angina Pectoris is what?
- Myocardial ischemia due to inadequate oxygen supply for supply the metabolic demands of the heart.
- Build up of latic acid (anaerobic respiration) & waste in the cells.
- Makes the cells swell resulting in Angina pain
If a patient describes a crushing pain in their chest what would that suggest?
What is the difference between stable and unstable angina?
- Stable angina - a small AS plaque has formed but Ischemic pain would only occur if heart is excerted ie running for a bus.
- Unstable angina - once a thrombus has formed a MI is likely Antithrombus medication will be needed and soon.
What does Nitro glycerin do?
It is a vasodilator and operates on the veins. Beware that it will reduce the load going back to the heart so may cause Orthostatic Hypotension.
I am often severe and prolonged and frequent pain. I can occur during rest. I am associated with AS plaque disruption, platlet aggregation and possibly vasoconstriction. I am a transition period prior to a MI. What am I?
Not all people experience me when they are having a attack. I have been linked to diabetes and the elderly. I am result of the Autonomic neuropathy in diabetics lacking in pain. What am I?
How do you deal with angina?
- 1st Episode - Assume MI = Hospital: Antithrombolytic therapy increases the chances of MI if applied quickly.
- Previously diagnosed - rest - cease activity, take medication, monitor vital signs and pain resolution.
What commonly results in MI?
- Thrombus formation in the coronary arteries
- Embolisation of a coronary thrombus
- Severe vaso-spasm
What does STEMI mean?
STEMI is when there is a transmural infartion of the myocardium - which just means that the entire thickness of the myocardium has undergone necrosis - resulting in ST elevation. Usually due to a complete block of a coronary artery (occlusive thrombus). This requires the use of thrombolytics like Streptokinase to lyse the thrombus. Evidence has proven that it is very effective but risky.
What does non-STEMI stand for?
UA or NSTEMI is when there is a partial dynamic block to coronary arteries (non-occlusive thrombus). There will be no ST elevation or Q waves on ECG, as transmural infarction is not seen. The main difference between NSTEMI and unstable angina is that in NSTEMI the severity of ischemia is sufficient to cause cardiac enzyme elevation.
What is the main focus of Drug therapy in Angina?
Restoring the balance between myocardial oxygen supply and demand.
Name some drug catagories applicable?
- Peripheral vasodilators - Both arterial and venous vasculture reducing the workload of the heart
- Selective Coronary vasodilators - A prophylactic agent
- Beta adrenergic antagonists - B1 blockers reduce HR and force of contraction
- Calcium Channel blockers - This will reduce the contractiability of the heart muscles.
- Combined A & B antagonists - Reduces heart workload and indirectly by peripheral vasodilation as a result of A receptor blockade.
- Potassium channel openers - Opening potassium channels in the muscle membrane blocking calcium therefore inhibiting muscle contraction producing arterial vasodilation.
Name the most important groups of peripheral vasodialators?
- Glyceryl Trinitrate
- Isosorbide Dinitrate
- Isosorbide Moninitrate
- These are all organic nitrates, the nitrates are NO (Nitric Oxide) donors which at a intracellular level alters availibilty of Calium ions. Hindering the activity of contractile protein.
Name some common side effects of peripheral vasodilators?
- Excessive vasodilation
- Reflex tachycardia - Because this tachycardia occurs reflexly in response a hemodynamic situation
- Facial Flushing
- Syncope - Loss of consciousness (Fainting)
- Migraine like headache - Due to cerebal vasodilation
Name a medication that causes cornary vasodilation?
Dipyridamole - Inhibits phosphodiesterase elvating cAMP which is a selective vasodilator promoting BF and O2 delivery to the myocardium.
Name some common adverse effect of B Blockers?
- GI distress
- Atrioventricular block
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