Vasospastic angina. Let's continue. The ST segments are
transiently elevated resolves
of the pain. Now remember, it can come as clusters. Key
point, the cardiac enzymes are negative.
It rules out what please? Myocardial infarction.
What are the two types that you should know?
Once again, if it is transmural, you tell me
what kind of blood vessel? Artery, arteriole?
And I am hearing? Artery. Excellent. So, that
will be transmural there will be an ST elevation.
Whereas if it was arteriole, then it will be a
subendocardial MI and it will be a non-STEMI.
Maybe perhaps you will find a ST depression
but the cardiac enzymes there wold be positive,
here typically negative as they would be in
almost all types of angina. Let's continue.
What do we say about the narrowing? Would
you find narrowing if the coronary arteries have
undergone a type of blundering effect? No. The
catherization in angiography would find normal
caliber of your coronary arteries.
The definitive diagnosis, what do you do?
Induction of vasospasm during the angiographies
at least keep that concept in mind because
you are not going to find actual blockage.
Important here, be careful. So, what exactly
are you trying to control? You are trying
to control that vasospasm, aren't you? And let
us make sure that we go back to our biochemistry
and physio here to make sure that we can lead
up into why calcium channel blockers are so
important? Remember please. When we're doing our medicine here,
it's the fact that our foundation has to be strong
and you could get questions on the foundation,
meaning phsio and biochem and then, of course,
dealing with pharm or pathology. Here if you
are thinking about calcium, what kind of muscle
is blood vessel? Smooth muscle. Involuntary
or voluntary? Obviously involuntary. You don't
have to tell your blood vessels, please contract.
That doesn't make any sense.
Next. You are talking about calcium calmodulin, aren't
you? You should be thinking about alpha-1, aren't you?
And when you do so, the calcium then brings about what
kind of effect on your blood vessel, on smoth
muscle? Contraction. Blood vessels cause vasoconstriction
so therefore what do we try to do here with vasospastic?
It is already in spasm, let us try to relax
it. If you are trying to relax it, what might
you want to do with your calcium? We are
now trying to block effects of calcium. And by
doing so you are relaxing the blood vessels. Ditiazem.
Be careful, you do not want to use beta blockers.
Is that clear? Once again, beta blockers will
be contraindicated in vasospastic disease.
Be careful. Now in addition, you also want to
bring about relaxation. That is the bottom
line, isosorbide mononitrate and that is a
long-acting type of what? Take a look at the
name here. The operative word, nitrate. What does that mean to
you? Relaxation of your blood vessels.
Management. Well, there is another one.
It is called Fasudil.
Rho-kinase inhibitor to prevent the release
of acetocholine induced vasospasm. Once again,
the objective with vasospastic is to do what? So make sure
that you try to induce relaxation as much as possible.