Steps of CAD?
1. Fatty Streak caused by LDLs
2. Fibrous plack and endothelial damage (Calcium from smooth muscles)
3. LDLs and platelet growth factor causes the arterial wall to thicken
What is nocturnal angina?
occurs only at night but not necessarily when the person is in the recumbent position or during sleep
What is angina decubitus?
chest pain that occurs only while the person is lying down and is usually relieved by standing or sitting
What is silent ischemia?
refers to ischemia that occurs during the absence of any subjective symptoms
What is prinzmetal's angina?
Variant angina often occurs at rest usually in response to spasm of a major coronary artery.
What is a rare form of angina frequently seen in patients with a history of headaches and what?
Raynaud's phenomen
When a spasm in prinzmetal's angina what happens when the spasm occurs?
experiences angina and transient ST segment elevation
When does the pain occur in prinzmetal's angina?
during REM sleep when myocardial oxygen consumption occurs
Cyclic, short bursts of pain at a usual time each day may occur with what type of angina?
prinzmetal's angina
What is given to control prinzmetal's angina?
Calcium Channel Blockers and or nitrates
What is your first line defense therapy for Chronic Stable angina? (when you go to mow the lawn)
Short acting nitro
What do short acting nitro do?
increase flow by dilating
What happens when we dilate the arteries with short acting nitro?
Decrease resistance, preload, and decreases oxygen demand
What are examples of short acting nitrates?
Sublingual and Spray-- onset time is 1-3 minutes and last 30-40 minutes. One spray and one tab is one dose. Wait 5 minutes in-between and up to 3 times
How long does short acting nitro last?
6 months, if it tingles it is still good
Side effect of all nitrates?
dizziness, flushing, ortho hypotension, headache
What are long acting nitrates?
used prophylactically (patch and ointment)
What do you want to take with nitrates?
Tylenol
Patients must be scheduled 8 hours of off time for what med?
10-14 hours on for long acting nitrates
Topical nitrates are used for what problems?
Nocturnal angina
Transdermal controlled release patch?
therapeutic level achieved in 2 hours
lasts 24 hours
What are the two types of transdermal patches?
resevior- if popped it gets dose dumping- orthostatic hypotension
matrix- slow med delivery through polymere matrix
Nitro drug alert?
DON'T TAKE With erectile dysfunction drugs
What do you monitor in nitro?
heart rate below 60
systolic bp below 100
Side effects of beta blockers
dont stop abruptly
wheezing
asthma
broncho spasms
beta blockers mask what problem in diabetic pts?
tachycardia that is due to hypoglycemia
Calcium channel blockers do what?
substitute for beta blockers-- relax smooth muscles in the heart, by blocking calcium that would normally stiffen it
What do you use with prinzmetals angina?
calcium channel blockers
What is the risk with calcium channel blockers?
digoxin- s/s of toxicity is a irregular pulse (tachycardia)
VISION CHANGES!!!!!!!!
confusion
what are ACE inhibitors?
angiotension 1 to angiotension2
Where is angiotension located?
kidneys release renin-- angiot 1 goes to the lungs where ace is at to be changed to 2.
LUNGS-- dry hacking cough
Arbs dont let angiotension 2 bind to sites so when do I use this?
if interrelated to ace- due to dry cough
If we are decreasing blood volume and pressure, what do we look for?
orthostatic hypotension
What is the last resort medicine?
sodium current inhibitors
Chronic stable angina DX
Cardiac Catherization
Stent