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IHD - ISCHEMIC HEART DISEASE PHARMACOLOGY EXAM LATEST VERSION
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IHD - ISCHEMIC HEART DISEASE PHARMACOLOGY EXAM LATEST VERSION...
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IHD - ISCHEMIC HEART DISEASE PHARMACOLOGYEXAM LATEST VERSION
Ischemia describes a physiological state of - ANSWER disequilibria
between myocardial oxygen supply and demand that leads to tissue
damage
Chronic stable - ANSWER exertional ischemia
Unstable/Acute Coronary Syndrome - ANSWER rest ischemia
Determinants of O2 demand - ANSWER Heart rate
Stroke volume/contractility
Myocardial wall tension (LVEDP)
Determinants of O2 supply - ANSWER Coronary artery resistance to
blood flow
Demand for O2
Myocardial perfusion pressure (rate and volume of blood flow through
coronary vasculature)
Most common ischemia-precipitating event/condition is a - ANSWER
reduction in O2 supply due to atherosclerotic narrowing of one or more
major coronary arteries
Class I - ANSWER symptoms occur only with strenuous, rapid, or
prolonged exertion
Class II - ANSWER slight limitation on ordinary activity; symptoms
occur more often than not with moderate levels of activity and/or during
first two hours after awakening
Class III - ANSWER marked limitations on ordinary activities;
symptoms occur consistently with even minor exertion
Class IV - ANSWER inability to carry out any physical activity with
symptoms; symptoms may be present at rest
, Laboratory assessment - ANSWER Fasting lipid profile
Cardiac enzymes (R/O MI)
Radiology/cardiology assessments - ANSWER Electrocardiogram (low
sensitivity)
Exercise tolerance testing (staging)
Echocardiography (r/o valvular disease)
PCI/cardiac catheterization
Aggressive risk factor reduction - ANSWER Achieve BP goals if
hypertensive
Cholesterol reduction in most cases
Weight reduction in most cases
Goal of pharmacotherapy is to either / both: - ANSWER Reduce
myocardial O2 demand
Increase myocardial O2 supply
Initiate anti-platelet therapy - ANSWER Aspirin preferred
Clopidogrel if ASA contraindicated or not tolerated
Initiate anti-ischemic therapy (should use at least one) - ANSWER Beta
antagonist (>1 episode per day) (should use at least one as first line
therapy)
CCB if beta antagonist contraindicated (e.g. asthma, brittle diabetic) or
atypical presentation
Add oral/topical nitrate if symptoms of ischemia not well controlled with
above
Nitrates - ANSWER MOA is reduction of cardiac "preload" through
dilation of venous vasculature
Reduces LVEDP, cardiac workload, and O2 demand
Also moderately increases O2 supply via relaxation of coronary
vasculature (benefit in vasospastic IHD)
Nitrates
Rescue therapy - ANSWER SL NTG 0.4mg q5min up to three total
doses during acute episode- rescue dose during ischemic event****
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