Cardio

Cardiovascular Overview

• Heart Problems Types:

  • Electrical (conduction issues)

  • Plumbing (artery blockage, spasm, valve issues)

  • Pump (heart muscle issues)

Objectives for Cardiovascular Study

• Understand:

  • Causes of coronary artery disease and its pathophysiology.

  • Difference between stable and unstable angina.

  • Pharmacotherapy for angina.

Ischemic Heart Disease

• Occurs due to reduced blood supply.

Coronary Artery Disease (CAD)

• Blood supply from coronary arteries, branching from the aorta.

• Right and left coronary arteries fill primarily during diastole.

Coronary Artery Perfusion

• Factors affecting perfusion:

  • Oxygen consumption, heart rate, and coronary perfusion dynamics.

  • Atherosclerosis affects plaque stability and can lead to infarction.

Risk Factors for CAD

• Non-modifiable:

  • Age, family history, gender, ethnicity.

• Modifiable:

  • Hypertension, tobacco use, diabetes, obesity, inactivity, diet, hyperlipidemia, depression/stress.

Endothelial Dysfunction Causes

• Uncontrolled diabetes, hypertension, hypercholesterolemia, smoking.

Supply and Demand Mechanism

• Increased Demand: Elevated heart rate, blood pressure, myocardial contractility, and left ventricular hypertrophy.

• Decreased Supply: Duration of systole and coronary artery pressure (CAPP).

Angina Types

• Stable Angina: Predictable chest pain during exertion or stress, lasts 2-15 minutes.

• Unstable Angina: Unexpected chest pain, may occur at rest, signifies a risk of myocardial infarction (MI).

Pharmacotherapy for Stable Angina

• Goals:

  • Relieve pain (Nitrates, Beta Blockers, Calcium Channel Blockers, Ranolazine).

  • Reduce risk factors (lipid-lowering agents, aspirin/clopidogrel).

  • Improve morbidity/mortality (ACE Inhibitors, ARBs).

• Drug Mechanisms:

  • Nitrates: Dilate veins; reduce preload.

  • Beta Blockers: Decrease heart rate and contractility.

  • Calcium Channel Blockers: Reduce afterload; relax vasospasm.

  • Ranolazine: Improves myocardial energy efficiency.

Nitroglycerin Use

• First-line anti-anginal agent; side effects include headaches, hypotension, and tolerance.

• Routes: Sublingual, translingual, intravenous, topical, and oral formulations.

Ranolazine (Ranexa)

• Newest anti-anginal; potentially improves energy efficiency.

• Warnings: Prolonged QT interval, acute renal failure risks.

Important Guidelines for Nitro Use

• If chest pain worsens or does not improve after first dose within 5 minutes, seek medical attention.