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The AC syndrome is ischemia of the heart muscle expressing itself
this ischemia is due to increased demands with less suuply so all drugs used play on this axis :
1) BB --> inhibit all cardiac properties --> saving of fuel --- > ttt the increaded demand
2)Nitrates ---> potent venodilator---> decrease the preload ---> decresed
demand + also it is coronary dilator-- > increased supply
3)ACEI : arteriodilator (without reflex tachycardia )---> decreased afterload --> decreased demand
4)CCB ---> act like BB by inhibition of all cardiac proprties and coronary dilator + ?
peripheral VD which differ according to subgroups e.g : short acting dihydropyridines e.g short acting nifedipine is potent peripheral VD-- > + of baroreceptors --> reflex Sypmathetic stimulation --> overcome the inhibition on heart--> reflex tachcardia ---> increased demand ---> preciptate and worsen ischemia
this can be avoided by use of additon of BB or using long actind nifedipine or other new generations in dihydropyridines or use other CCB groups:)
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