So let's dig deeper into the treatment
of the 3 types of chest pain.
Let's look at chronic stable angina.
Now, before we go on, on this part
of your notes, what I want you to do
is to draw what that vessel looks like.
Is there plaque or not?
Is the vessel completely open or not?
What does your picture look like?
Make sure you include those red cells,
and white cells, and your platelets.
Good. Now let's keep moving.
Okay. So, look at the vessel on your
screen. Is there plaque?
Yes. So you'll see that the vessel
is a smaller diameter.
You still have the endothelial cells,
the red blood cells, the white cells,
the platelets, they're all still there,
but definitely, the blood flow
has been compromised.
If I'm just hanging out and chilling,
I'm probably getting enough
oxygenated blood supply to my heart.
But if I do something that
causes a new demand and
exertion on my heart,
whether it's emotional excitement,
I ate a big, fat meal -- I don't want to
mention the name here, but there was
an actor in a very famous HBO series
about the mafia, that that's all they
reported when he passed away
is that the big meal that he
had before his death.
But the big meals require a lot
from our body to digest them,
so it's really an odd thing, but
that's something that can cause a
higher demand on your body.
But, you know, if you're going to go out,
going out with a lot of carbs
sounds good to me.
What about cold exposure? Oh, that stresses
out your body when you're cold,
and so that can bring on
chronic stable angina or exertional angina.
And just plain coronary artery disease,
right? As it progresses and it gets worse,
those are triggers for chronic
Okay, so we've looked at the
triggers for chronic stable.
Now let's look at the treatment goals.
Well, since its angina, and we want
to increase the oxygen supply,
so we're going to try and decrease the
demand and increase the supply.
So, definitely, if someone has exertional
angina, or chest pain,
we want them to rest, okay?
So we want to minimize
whatever that stressor was,
whatever that trigger was,
we want to eliminate it or minimize it,
and then we want to increase
the oxygen supply.
So, what do we do to treat it
with therapeutic agents?
We're looking for symptomatic relief, so
we're going to try use the organic nitrates.
We're going to try beta blockers.
We're going to try calcium channel blockers,
and we're going to try ranolazine.
Now, when I'm actively having chest pain,
nitrates are my friend. That's what
I'm going to reach for.
Beta blockers and calcium channel
blockers or ranolazine
are things that I take on a daily
basis to try to minimize
the opportunity to have chest pain.
But nitrates, I can take both
on a daily basis,
and I'm going to take it when I
have chest pain right now.
Okay, so let's look at non-drug therapy.
Now, this might not seem exciting to you,
but if you can be well-versed and
understand these concepts,
you can educate your patients and
make their lives much better.
So, it seems like common sense, but you
want to explain that to your patients
that they need to avoid the factors
that can precipitate angina.
So if you know that you have
chronic stable angina,
and you haven't been extremely active,
going out and shoveling the
driveway in the cold --
that's going to be a lot
of physical activity --
is not a good idea for a
patient with this status.
Encourage your patients to
decrease the risk factors.
You know the risk factors for coronary
artery disease. Now we're talking lifestyle.
So we'd want them to --
definitely, we'd want them to quit
smoking, if they smoke,
but at least limit the smoking. You have
to work with the patient to come to
a common agreement there. You want
them to maintain a healthy weight,
get adequate physical exercise,
eat lots of foods that are fresh,
healthy, greens and fiber,
and eat a healthier diet.
Now, if we can't manage this with drugs,
then we can consider some
procedures or surgeries.
PCI is an angioplasty or a stent.
So, go into cath lab, percutaneous
Angioplasty is we'll go in -- I'll talk about
that a little later, but they'll go in
with a balloon and try and open
up that blood vessel,
and they'll leave a stent behind
that will keep that vessel open.
Or a CABG, as we call it, which is
a coronary artery bypass graft.
So if we can't manage this with medication,
look at doing a procedure, a PCI, or
surgery, a coronary artery bypass graft.
So that's an overview of what we
do for chronic stable angina.
Now we talked about 4 different
things. We talked about
how the triggers, the treatment goals.
the therapeutic meds we use,
and the non-drug therapy.
Stop, for just a moment,
and see if you can recall,
what are the medications that we use
for chronic stable angina?
Okay, I hope you wrote this down
in the margin of your notes
because the more you can stop,
pause, think about something
that you're learning,
you're really increasing the efficiency
of encoding that into your memory,
so you'll be able to recall it later.
I call that studying as you go
and that's going to save
you time in the long run.