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18 Cards in this Set
- Front
- Back
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What factors inc cardiac o2 demand
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inc contractile force
inc ht rate inc vent wall tension (dilation) |
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What factors dec cardiac o2 supply
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Arterial [O2]
oxygen hemoglobin disassociation coronary blood flow restriction |
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Give a flow of exercise induced ischemia leading to angina
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O2 demand up -> coronary aa. can't keep up -> anaerobic met in ht -> LV failure -> inc LVEDP -> dialation -> inc wall tension -> inc O2 demand -> start over the cycle
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What is a major factor in stabilizing ath plaques
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Thick fibrous caps. Unstable plaques have thin caps
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What are the three effects of nitrates that lead to reduced angina
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Venous dilation - biggest effect
Coronary dilation Arteriole dilation |
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How does venous dilation lead to reduced angina
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decrease preload -> decrease LV volume -> LV wall tension -> O2 need
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How does coronary vessel dilation lead to dec angina
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inc O2 delivery to myocardium
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How does arterial dilation lead to reduced angina
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dec afterload -> dec BP -> decreased contractility -> O2 need
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When would you use nitrates
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CHF with ischemia
Orthopnea, paroxysmal noct dyspnea acute CHF with Pulm edema with hydralazine in ACE-i tolerance |
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How do nitrates relax BVs
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Through receptor mediated inc in cGMP
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How can you prevent tolerance to nitrates
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use low doses and give holidays for a few hours a day. Maybe n-acetylcysteine will help too
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When should you not use nitrates
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Hypersensitivity
hypotension acute MI with low filling pressure 1st trimester of pregnancy |
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How do beta blockers reduce angina
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dec afterload, dec ht rate, dec contractility
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What can be a side effect of beta blockers in an ischemic ht
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Dec preload. Can lead to hypotension?
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Physiologically, how do Ca channel blockers relieve angina?
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Reduce ht rate
dilate coronary aa. reduce afterload reduce contractility |
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How are beta blockers and nitrates complimentary
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beta prevent reflex tach from nitrate induce BP reduction
nitrates prevent vasospasm from betas nitrates prevent inc preload from neg inotropic beta both reduce O2 consumption both inc subendo blood flow |
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Of the Ca blockers, which has the best side effect profile
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Diltiazem
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Of the Ca blockers, which has the greater response in the ht?
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Verapamil
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