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34 Cards in this Set

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what causes angina?

mismatch between coronary perfusion, oxygen supply and cardiac work, oxygen demand

Therapy of stable angina?

GTN


- Beta blockers


- vasodilators

What is the cause of unstable angina?

unstable atheromatous narrowing, plaque rupture and thrombosis and vasoconstriction

what is the treatment of unstable angina?

vasodilators, B-AR blockers, aspirin and herarin

main treatment for prinzmetal's angina

calcium entry blockers

Uses of B1- antagonists in angina

-reduce heart rate and force


- increase time in diastole



Uses of calcium entry blockers in angina?

-vasodilation hence reduce TPR/ afterload


- prevent coronary vasospasm

What are the uses of organic nitrates in angina?

-Venodilation / reduce preload


- improve perfusion of ischemic zones


- prevent vasospasm


- prevent platelet aggregation

What is abnormal automaticity?

- SAN overridden by pacemaker in the the myocardium

- ischaemia


- hypokalaemia


- catecholamine activity



What is triggered automaticity?

- extra depolarisation events during myocyte action potential


- End of phase 2/ start 3 =EAD


- Phase 4 =DAD

what causes triggered automaticity?

excessive calcium entry or accumulation

what are the degrees of heart block?

1- slow impulse


2- fraction of the impuse


3- no impulse

What phase do class 1 affect?

- Depress phase 0


- can interupt re-entry circuits and reduce both abnormal and triggered automaticity

- What phase doe class II agents affect?

- depress slope in phase 4 of nodal


- Extend phase 2 of non-nodal


- prevent sinus tachycardia + both automaticity

What phase doe class III agents affect?

- delay phase 3


- extend phase 2


- might reduce re-entry circuits

what phase do class IV agents affect?

- Depress phase 0 of nodal


- Shorten phase 2 in non-nodal


- reduces triggered automaticity

what is heart failure?

Inadequate cardiac output for tissue perfusion

What are the four types of heart failure?

- systolic dysfunction


- diastolic dysfunction


- excessive haemodynamic burden


- inrealistic peripheral demands for tissue perfusion

What is systolic dysfunction?and what causes it?

- failure of contractility

- cardiomyopathy (diabetes, infection, MI)


- drug toxicity


- arrthymias

What is diastolic dysfunction? and what causes it?

- failure to fill ventricles


- caused by stiffness (senile fibrosis, cardiac hypertrophy)

what is excessive haemodynamic burden? and what causes it?

relative failure of contractillity


- valvular disease


- cogenital heart defects


- ^ TPR (left heart failure)


- ^ pulmonary resistance (cor pulmonale) RHF

What causes unrealistic peripheral demand for cardiac output? and what is it

- Relative failure of contractillity


- decrease O2 capacity, severe anaemia


- excessive metabolic demand, thyrotoxicosis


- maintenace of blood pressure in sepsis, shock

What is the aim of Heart failure therapeutics?

- support cardiac output


- remove compensation


- reduce workload


- reduce oxygen demand


- +ve iontropy

what are the compensatory mechanisms in CHF?

- Venocontriction (raise preload)


- Vasoconstriction (raise afterload)


- increase heart rate and force of contraction

What is the sypathetic nervous system role is compensation of CHF?

- Vasoconstriction + venoconstriction (a AR)


- tachycardia and +ve inotropy (b AR)



What is the role of RAAS in CHF compensation?

- Vaso and Venoconstriction (AT1 and V1)


- salt and fluid retention (V2 and MC Type 1 receptors)

How is compensation removed in heart failure?

- RAAS inhibitors


- Diuretics


- Vasodilators

how is +ve ionotropy produced in heart failure?

- cardiac glycosides


- B1-AR agonists


- PDE III inhibitors

What is primary hypertension? and what causes it?

Chronic, progressive elevation in arterial pressure


- Neurogenic (sympathetic stimulation)


- renal salt balance (too much intake)

what can cause sustained ^ TPR?

- vasoconstriction (loss of NO, PGI2)


- arteriosclerosis (hypertrophy)


- rarefaction (loss of vessels)

What are the peripheral theraputics for hypertension?

- RAAS inhibitors


- Thiazide diuretics


- B1 AR antagonists


- calcium entry blockers


- vasodilators


- a1 AR antagonists

What are the centrally acting theraputics for hypertension?

- a2 AR agonists

- imidazoline

what is the use of calcium channel blockers in hypertension?

- reduce TPR


- amlodipine

what is the use of RAAS inhibition in hypertension?

Reduce cardiac output and total peripheral resistance