Pharma 27: Ischaemic Heart Disease - Matching Supply to Demand

This episode frames ischaemic heart disease as a problem of mismatch: myocardial oxygen demand exceeding supply. Rather than focusing on individual drugs, we build a physiological map of coronary flow, preload, afterload, heart rate, and contractility—and then show how anti-anginal therapies act by reshaping these variables. When understood this way, nitrates, beta-blockers, and calcium channel blockers become logical tools rather than memorised categories.Key takeaways you’ll build and reuse throughout the series:* Ischaemia as imbalance: demand (rate, pressure, contractility) versus supply (coronary flow, perfusion time).* Coronary physiology in context: why diastole matters more than systole for myocardial perfusion.* Drug strategies explained physiologically: reducing demand, increasing supply, or both.* Predictable adverse effects: headache, hypotension, bradycardia, and reflex responses as extensions of mechanism.* Clinical reasoning: tailoring therapy to symptom pattern, comorbidity, and haemodynamic profile. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit drmanaankarray.substack.com/subscribe