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18 Cards in this Set

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