IHD- Young

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?

1. HR

2. Contractility

3. 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