Acute cardiovascular events myocardial infarction

Coexisting diseases precipitate DKA and DKA precipitates coexisting disease. Most often patients with DKA suffer from infectious disease and signs of infection should be vigorously sought for and treatment should be instituted on wide indications. Other prominent co-morbidities include cardiovascular events (myocardial infarction, stroke, thrombophlebitis, pulmonary embolism), acute gastrointestinal disorders and a variety of intoxications. 

Elevated levels of lipoprotein-associated cholesterol in the blood, particularly that associated with LDL but also that in the more triacylglycerol-rich lipoproteins, are associated with the formation of cholesterol-rich atheromatous plaque in the vessel wall, eventually leading to diffuse atherosclerotic vascular disease resulting in acute cardiovascular events, such as a myocardial infarction, a stroke, or symptomatic peripheral vascular insufficiency. High levels of HDL in the blood, therefore, are believed to be vasculoprotective, because these high levels increase the rate of reverse cholesterol transport away from the blood vessels and toward the liver ( out of harm s way ). 

Five patients (aged 23 to 58) treated for germ cell tumours died from unexpected acute life-threatening vascular events (myocardial infarction, rectal infarction, cerebrovascular accident) after treatment with VBP (vinblastine, bleomycin, cisplatin). A survey of the literature by the authors of this paper revealed 14 other cases of both acute and long-term cardiovascular problems (myocardial infarction, coronary heart disease, cerebrovascular accident) in patients given VBP. ... 

Cardiovascular In a matched cohort study 52229 patients who took tegaserod and 52229 patients with similar characteristics who did not were followed for up to 6 months looking for cardiovascular ischemic events (myocardial infarction, acute coronary syndrome, coronary revascularization, and stroke). Tegaserod was not associated with such events [21... 

NSAIDs, including ibuprofen, are contraindicated in patients with active bleeding, ulceration, or perforated viscous. NSAIDs are contraindicated in the setting of acute or chronic renal dysfunction. NSAIDs have been shown to increase the risk of cardiovascular thrombotic events, myocardial infarction, and stroke, especially in patients with known cardiovascular disease or with known risk factors for cardiovascular... 

Patients with acute coronary syndromes such as acute myocardial infarction and unstable angina remain at risk for recurrent myocardial ischemia despite therapy with antiplatelet agents and heparin. Although first clinical trials indicate a possible use of oral direct TIs for the prevention of cardiovascular events in patients after acute myocardial infarction, the presently available data are still limited and it has not... 

Bonaa KH, et al. Homocysteine lowering and cardiovascular events after acute myocardial infarction. N Engl J Med 2006. 

As cocaine use has become more widespread, the number of cocaine-related cardiovascular events has increased (39). Myocardial ischemia and infarction associated with cocaine are unrelated to the route of administration, the amount taken, and the frequency of use. The risk of acute myocardial infarction is increased after acute use of cocaine and it can occur in individuals with normal coronary arteries at angiography. The patients are typically young men and smokers and do not have other risk factors for atherosclerosis. 

Cocaine use may account for up to 25% of acute myocardial infarctions among patients aged 18-45 years. The safety of a 12-hour observation period in a chest pain unit followed by discharge in individuals with cocaine-associated chest discomfort who are at low risk of cardiovascular events has been evaluated in 302 consecutive patients aged 18 years or older (66% men, 70% black, 84% tobacco users) who developed chest pain within 1 week of cocaine use or who tested positive for cocaine (59). Cocaine use was self-reported by 247 of the 302 subjects and rest had urine positive for cocaine 203 had used crack cocaine, 51 reported snorting, and 10 had used it intravenously. Of the 247 who reported cocaine use, 237 (96%) said they had used it in the week before presentation and 169 (68%) within 24 hours before presentation. Follow-up information was obtained for 300 subjects. There were no deaths from cardiovascular causes. Four patients had a non-fatal myocardial infarction during the 30-day period all four had continued to use cocaine. Of the 42 who were directly admitted to hospital, 20 had acute coronary syndrome. The authors suggested that in... 

Tunstall-Pedoe H, Kuulasmaa K, Amouyel P et al. (1994). Myocardial infarction and coronary deaths in the World Health Organization MONICA Project. Registration procedures, event rates and case-fatality rates in 38 populations from 21 countries in four continents. Circulation 90 583-612 Wald NJ, Law MR (2003). A strategy to reduce cardiovascular disease by more than 80%. British Medical Journal 326 1419 White H, Boden-Albala B, Wang C et al. (2005). Ischemic stroke subtype incidence among whites, blacks and Hispanics the Northern Manhattan Study. Circulation 111 1327-1331 Wityk RJ, Pessin MS, Kaplan RF et al. (1994). Serial assessment of acute stroke using the NIH Stroke Scale. Stroke 25 362-365. 

Cardiovascular complications. Incidence of venous thromboembolism is increased in pill users. It is lowest in the 20-35 microgram pill and rises progressively with the 50 microgram and 100 microgram preparations it is not known if there is any difference between doses of 20-35 micrograms. The small increase in hypertension, cerebrovascular event and acute myocardial infarction is principally confined to smokers. 

M. Quintana, P. Hjemdahl, A. Sollevi, T. Kalian, M. Edner, N. Rehnqvist, E. Swahn, A.C. Kjerr, and P. Nasman, Left ventricular function and cardiovascular events following adjuvant therapy with adenosine in acute myocardial infarction treated with thrombolysis, results of the ATTenuation by Adenosine of Cardiac Complications (ATTACC) study, EurJ Clin Pharmacol 59, 1-9 (2003). 

Aberrant thrombus formation and deposition on blood vessel walls imderlies the pathogenesis of acute cardiovascular disease states which remain the principal cause of morbidity and mortality in the industrialized world [1,2,3]. Plasma proteins, proteases and specific cellular receptors that participate in hemostasis have emerged as important risk considerations in thrombosis and thromboembolic disorders. The clinical manifestations of the above disease states include acute coronary artery and cerebrovascular syndromes, peripheral arterial occlusion, deep vein thrombosis and pulmonary/renal embolism [3]. The most dilabilitating acute events precipitated by these disorders are myocardial infarction and stroke. In addition, the interplay between hemostatic factors and hypertension (4) or atherosclerosis (5) dramatically enhances the manifestation of these pathologic states. 

As a prognostic test, ET is very popular after myocardial infarction and can be conducted within 3 days of an acute event. It can be used to determine functional capacity, assess the degree of rehabilitation, and identify patients at risk for further cardiovascular events. Immediately after myocardial infarction, a modified protocol is used the test is terminated when a heart rate of 70% to 75% of age- and gender-predicted maximum is reached (e.g., 140 beats per minute for those under age 40 and 130 for those older than age 40) or a MET level of 5 for patients older than 40 or 7 for those younger than 40. Tests usually are done prior to discharge or within 6 weeks of infarction. 

Macrovascular Complications. The connection between high insulin levels (hyperinsulinemia), insulin resistance, and cardiovascular events incorrectly leads some clinicians to believe that insulin therapy may cause macrovascular complications. The UKPDS and DCCT found no differences in macrovascular outcomes with intensive insulin therapy. One study, the Diabetes Mellitus, Insulin Glucose Infusion in Acute Myocardial Infarction study " reported reductions in mortality with insulin therapy. This group assessed the effect of an insulin-glucose infusion in type 2 DM patients who had experienced an acute myocardial infarction. Those randomized to insulin infusion followed by intensive insulin therapy lowered their absolute mortality risk by 11% over a mean follow-up period of approximately 3 years. This was most evident in subjects who were insulin-naive or had a low cardiovascular risk prior to the acute myocardial infarction. " ... 

A considerable body of evidence has accumulated about the benefits of antiplatelet therapy, in most cases aspirin, in patients with a previous cardiovascular event (previous myocardial infarction, acute... 

Of 55 patients with life-threatening anemia who were treated with HBOC-201, 23 survived and 32 did not p2 ]. There were adverse events in 12 patients, of whom six had preexisting cardiovascular or renal disease, although the events were not attributed directly to HBOC-201 by the treating physician. Myocardial infarction or stroke was reported in four of the non-survivors compared with none of survivors. There was acute renal insufficiency in eight non-survivors and two survivors. The most common non-serious adverse events related to HBOC-201 were increased blood pressure, increased liver enzymes, and methemoglobinemia. 

Cardiovascular Cardiac toxicity is rare. Acute myocardial infarction has been reported in patients with underlying cardiac disease [41" ]. Cardiac dysrhythmias are very rare [42" ]. In one case a 67-year-old woman with breast cancer and no cardiac history or risk factors developed a supraventricular tachycardia after an infusion of gemcitabine [43" ]. The dysrhythmia was eventually terminated with oral propranolol and no alternative precipitating cause of the event could be identified. There were no further episodes after withdrawal of the drug. 

Bonaa, K.H., Njolstad, I., Ueland, P.M., Schirmer, H., Tverdal, A., Steigen, T., Wang, H., Nordrehaug, J.E., Arnesen, E., and Rasmussen, K., 2006. Homocysteine lowering and cardiovascular events after acute myocardial infarction. New England Journal of Medicine. 354 1578-1588. 

In a case-control study using drug-dispensing and hospitalization data from more than 2 million residents in The Netherlands, subjects with a first hospitalization for acute myocardial infarction, cardiovascular and gastrointestinal events were identified [14 J. Use of coxibs and non-selective NSAIDs was classified into remote, recent, and current use. Compared with remote use, the risk of acute myocardial infarction was increased in current users of all coxibs (adjusted OR = 1.73 95% Cl = 1.37, 2.19) and all non-selective NSAIDs (adjusted OR = 1.41 95% Cl = 1.23, 1.61). Analysis by separate agents showed that the risk of acute myocardial infarction was increased with celecoxib (OR = 2.53 95% Cl = 1.53, 4.18), rofecoxib (OR = 1.60 95% Cl = 1.22, 2.10), ibuprofen (OR = 1.56 95% Cl — 1.19, 2.05), and diclofenac (OR = 1.51 95% Cl = 1.22, 1.87), but not with naproxen (OR = 1.21 95% Cl = 0.87,1.68). 

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