11 Stable Angina

  • stable, no thrombus, not ruptured
  • exercise: more O2 demand, not enough supply

  • coronary arteries supplied in diastole

Angina Physiology

  • faster HR, more O2 demand, less O2 delivered

Treatment

  • less O2 demand

  • partial: can worsen angina symptoms

  • Agonizing plastic bugle: acebutolol (a selective beta-1 antagonist with partial agonist activity)
  • Agonizing pin: pindolol (a nonselective beta blocker with partial agonist activity)
  • Popping failing heart: beta blockers with partial agonist activity (e.g. pindolol, acebutolol) should be avoided in patients with heart failure or a history of MI

  • negative ionotropic effects can cause systolic dysfunction: acute HF

  • Calci yum: CCB
  • L-shaped handle: calcium channel blockers target voltage gated L-type calcium channels
  • Dairy: dihydropyridines
  • Non-dairy: nondihydropyridines
  • Smooth muscle tile: dihydropyridines block L-type calcium channels in smooth muscle
  • Cardiac muscle tile: non-dihydropyridines block L-type calcium channels in cardiac muscle
  • Dippin' station: -dipine suffix of dihydropyridines (e.g. nifedipine, amlodipine, nicardipine)
  • Dilated dairy nozzle: dihydropyridines cause vasodilation
  • Dilated coronary crown: dihydropyridines (e.g. amlodipine, felodipine) dilate coronary arteries
  • Reduced load: dihydropyridines reduce afterload
  • Weak kid at the non-dairy: non-dihydropyridines decrease cardiac contractility
  • Music notes: non-dihydropyridines decrease activity at the SA and AV nodes
  • Low dangling heart watch: inhibition of the SA node by non-dihydropyridines causes bradycardia
  • Discarded oxygen: non-dihydropyridines decrease myocardial oxygen demand
  • Knife cutting heart: nifedipine can exacerbate myocardial ischemia due to reflex tachycardia - avoid in patients with unstable angina or MI (shorter acting, higher SE)
  • Failing heart balloon locked out of store: CCBs can worsen heart failure (increased sympathetic activity and decreased contractility)

  • coronary arteries supplied in diastole

Prinzmetal

  • ergonovine: alpha agonist

Coronary Steal

  • pts on stress tests: give vasodilators that preferentially dilate healthy territories > coronary steal > can be picked up on tracers (usually won't precipitate EKG/symptoms changes)

  • Don’t phoster disinterest: phosphodiesterase inhibitors (e.g. dipyridamole, cilostazol)
  • Phosphodiesterase inhibitors increase cAMP, impairing platelet function
  • Two pyramids: dipyridamole (an antiplatelet phosphodiesterase inhibitor)