Agents and MAO of CAD - Karimi

Treatment for atherosclerotic angina

nitrates for immediate relief and BB for prophylaxis

Treatment for microvascular angina

BB 1st line, non-DHP CCB 2nd line, nitrates

Treatment of Vasospastic angina

non-DHP CCB first line, long acting nitrate 2nd line

• effective in the prophylaxis and atherosclerotic angina attacks (particularly for ongoing angina and have no value in acute attack)

• 1st line for atherosclerotic angina (not useful in vasospastic angina)

• reduce cardiac work and oxygen demand

  • Decrease BP (decrease renin release) and decrease HR (decrease chronotropy)

  • Decrease contractility (decrease inotropy)

• ______: 1st line BB but be careful with

BB; metoprolol succinate

abrupt D/C → exacerbations of angina pectoris and possibly MI

BB

• Aldehyde dehydrogenase-2 (ALDH2) catalyzes nitroglycerin to nitric oxide (NO) which in turn activates the soluble guanylyl cyclase to convert GTP to cGMP

• cGMP dephosphorylates myosin light chains which leads to the relaxation of vascular smooth muscle cells 

Nitrates

• ncourage a high degree of venodilation (primarily effect to reduce O2 demand)

  • They reduce venous tone

• They also dilate arteries at higher doses (secondary effect)

  • Moderately decrease afterload and helps coronaries deliver O2

  • Predominantly dilates the epicardial coronary arteries

  • As opposed to the small coronary arterioles 

nitrates

• tachycardia, orthostatic hypotension, dizziness, and throbbing headache

•  Nitrates promote synthesis of cGMP in the vascular smooth muscle cells (leading to smooth muscle relaxation)

Nitrates

The L-type calcium channel is the dominant type of calcium channel in cardiac and smooth muscle. A few calcium channels blockers:

CCB

can cause constipation, peripheral edema, nausea, flushing, and dizziness

CCBs

• selective inhibitor of late Na+ influx into cardiomyocytes. By blocking the lat sodium current, it is though to reduce calcium overload, increasing relaxing of the heart muscle (decrease O2 demand)

• While it can be used in combo with other 3 classes, often used with patients cannot tolerate beta blockers, CCBs, or long acting nitrates (transdermal

Ranolazine