PCOL 2 - 2: Drugs for Angina and Heart Failure

Myocardial Ischemia

It is the condition in which myocardial oxygen supply is insufficient to meet the oxygen demand of the heart.

Stable Angina

This type of angina is usually triggered by physical exertion or emotional stress and is relieved by rest or nitroglycerin

Prinzmetal Angina

This type of angina is mainly caused by a temporary spasm of a coronary artery and commonly occurs at rest

Unstable Angina

This type of angina is associated with disruption of an atherosclerotic plaque and thrombus formation and may occur even at rest

Nitrates

Which type of drug reduces venous return to the heart and therefore decreases preload?

Myosin light-chain phosphate

What is the main enzyme by nitrates indirectly through the nitric oxide-cGMP pathway?

Beta-blockers

What class of drugs decreases myocardial oxygen demand primarily by reducing heart rate and contractility?

Sublingual Nitroglycerin

What type of drug is commonly used to relieve acute attacks of angina because of its rapid onset?

Preload

In heart failure, which term refers to the amount of blood filling the ventricle at the end of diastole?

Afterload

What term refers to the resistance that the ventricle must overcome to eject blood?

Contractility

What term describes the force of contraction of the cardiac muscle?

Frank-Sterling Mechanism

Which principle states that increased ventricular filling, within physiological limits, results in a stronger contraction?

Class IV

Which NYHA functional class describes patients who have symptoms even at rest?

Diuretics

Which class of anti-heart-failure drugs increases urine production and decreases fluid overload?

Digoxin

Which cardiac glycoside has a positive inotropic effect and can increase the force of cardiac contraction?

Imbalance between myocardial oxygen supply and demand

Cause of angina pectoris

Stable Angina

A patient develops chest pain after walking quickly and the pain disappears after resting. Which type of angina is most likely?

Reduction of preload through venodilation

Which mechanism is most directly responsible for the therapeutic effect of nitrates in angina?

It decreases ventricular filling and myocardial oxygen demand

Why does reducing preload help a patient with angina?

Increased heart rate

What would most directly increase myocardial oxygen demand?

Sublingual Nitroglycerin

Which drug is most appropriate for rapid relief of an acute episode of angina?

Decreased heart rate and contractility

A patient with angina is given a beta-blocker. Which effect contributes most to its antianginal action?

Makes ventricular ejection easier

What is the main effect of reducing afterload in heart failure?

Diuretics

A patient with heart failure has significant fluid retention and edema. Which drug class would be most useful for reducing excess fluid?

Frank-Sterling Mechanism

Increased ventricular filling can increase the force of contraction within physiological limits

Class II

Which NYHA class corresponds to a slight limitation of physical activity, with the patient comfortable at rest?

Class III

Which NYHA class describes a patient with a marked limitation of physical activity, although the patient is comfortable at rest?

Digoxin

Which drug has a positive inotropic effect and increases the force of cardiac contraction?

Reduced afterload

Which would decrease cardiac workload in a patient with heart failure?

Reduced ventricular workload and improved cardiac performance

What combination describes the effect of reducing preload and afterload?

TRUE

TRUE or FALSE

Stable angina usually occurs when myocardial oxygen demand increases, such as during exercise.

TRUE

TRUE or FALSE

Variant angina is mainly caused by a temporary coronary artery spasm.

FALSE

TRUE or FALSE

Unstable angina is generally predictable and occurs only during strenuous exercise.

TRUE

TRUE or FALSE

Nitrates primarily reduce myocardial oxygen demand by decreasing preload.

FALSE

TRUE or FALSE

Increasing heart rate generally decreases myocardial oxygen demand.

TRUE

TRUE or FALSE

Increased contractility increases the oxygen requirement of the myocardium.

FALSE

TRUE or FALSE

Preload refers to the resistance the ventricle must overcome during systolic ejection.

TRUE

TRUE or FALSE

Reducing afterload can make it easier for the failing heart to eject blood.

TRUE

TRUE or FALSE

The Frank-Sterling mechanism states that increased ventricular filling can increase fore of contraction within physiological limits.

TRUE

TRUE or FALSE

Excessive ventricular filling can eventually become harmful in heart failure because it can contribute to increased filling pressures and congestion.

FALSE

TRUE or FALSE

NYHA Class I patients have marked limitation of physical activity.

TRUE

TRUE or FALSE

NYHA Class IV patients may experience symptoms even while at rest.

TRUE

TRUE or FALSE

Diuretics can help patients with heart failure by reducing fluid volume.

FALSE

TRUE or FALSE

Digoxin is a negative inotropic drug that decreases the force of cardiac contraction.

TRUE

TRUE or FALSE

Beta-blockers can decrease myocardial oxygen demand by reducing heart rate and contractility.