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What are the symptoms of angina?
SOB
chest pain
tachycardia
diaphoresis (excessive sweating)
nausea
What are the characteristics of chest pain?
Mnemonic: “PQRST”
P- precipitating factors
Q- quality of pain
R- region/radiation of pain
S- severity of pain
T- timing/ temporal pattern
What are the MODIFIABLE risk factors for Ischemic Heart disease?
Inactivity
Obesity
HTN
diabetes
dyslipidemia
smoking
What are the NON-MODIFIABLE risk factors for Ischemic Heart disease?
Age
Gender
in males more common
family history
How do nitrates effect myocardial oxygen supply and demand?
Supply- increase
demand- decrease
How do beta-blockers effect myocardial oxygen supply and demand?
supply- no effect
demand- decrease
How do Non-DHP CCBs effect myocardial oxygen supply and demand?
Supply- increase
demand- decrease
How do DHP CCBs effect myocardial oxygen supply and demand?
Supply- increase
demand- decrease
What are the 3 determinants of oxygen demand?
HR
Contractility
ventricular wall pressure
What layer of the coronary artery allows for relaxation and prevention of blood clots and plaque build up?
endothelial layer
How does a Heart attack present in women versus men?
Women- atypical, epigastric
Men- typical
sub-sternal, left side, radiates down left arm
What type of diagnostic test for CAD is invasive and involves injecting dyes into the coronary vessels to identify the extent/location of the disease?
coronary angiography
What are the general ways we can treat angina?
lifestyle
pharm therapy
Revascularization
Revascularization is for ____________ CAD. What are some of the different revascularization techniques?
Revascularization is for obstructive CAD
different techniques:
PCI (percutaneous coronary intervention)
PTCA (percutaneous transluminal coronary angiography)
CABG (coronary artery bypass graft)
What is the dosing for sublingual nitroglycerin?
0.3 or 0.4 mg SL x 1 dose
What is the brand name for:
isosorbide mononitrate ER
isosorbide dinitrate
isosorbide mononitrate ER- Imdur
isosorbide dinitrate- Isordil
What is the starting and max dose of Imdur?
Starting: 30-60 mg PO daily
Max: 240 mg
What is the starting and maintenance dose of Isordil?
Starting: 5-20 mg q6 hrs
Maintenance: 40-80 mg
Nitrates are contraindicated with what class of drugs?
PDE5 Inhibitors (-afil)
What are the ADRs of nitrates?
flushing
orthostatic hypotension
reflex tachycardia
dizzy
HA
To avoid tolerance, you MUST have a nitrate free period of ___-___ hours.
8-14 hours
Beta-blockers are used in ALL patients with what?
Left Ventricular dysfunction (LVEF <40%) and prior MI
What are the contraindications of non-DHPs?
HF
bradycardia
SA node dysfunction
AV block
hypotension
What are the contraindications of DHPs?
hypotension
When is Ranolazine used in treatment for angina?
CHRONIC angina
used last line if other meds don’t work
What is a benefit of Ranolazine?
Doesn’t effect HR or BP
What is the initiation and titrated dose of Ranolazine?
Iniital: 500 mg PO BID
Titrate: to 1000mg PO BID
All patients with CAD should continue ________________ indefinitely.
aspirin
What is the dosing of aspirin?
81 mg PO daily
What is the dosing of clopidogrel?
75 mg PO daily
Clopidogrel is only used if…
aspirin is contraindicated
For Prinzmetal or variant angina, what is our drug of choice in acute settings?
sublingual Nitroglycerin
For Prinzmetal or variant angina, what is our drug of choice for prevention?
CCBs
AVOID BB
What is our BP goal to reduce CV events?
<130/80
To manage lipids to reduce CV events, what drugs can we use?
1st line- high intensity statin
2nd- add Ezetimibe
3rd- add PSCK9 inhibitor
4th- consider icosapent ethyl
What is our A1c goal in pts. with Diabetes mellitus to reduce CV events?
< 7%
In diabetics, what 2 medication classes can be considered for reduction in MACE?
GLP-1 receptor agonists or SGLT2 inhibitors
What is the recommended alcohol intake per day to reduce cardiovascular and all-cause death?
Women: ≤1
Men: ≤2
What are the exercise recommendations to reduce CV mortality?
Exercise ≥ 150 minutes / week of moderate-intensity aerobic activities
or
75 minutes/week of higher-intensity aerobic activities
In general, should nonpresciption or dietary supplements be used to reduce CV risk?
no