Cardiac events

Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study European Trial on Reduction of Cardiac Events with Perindopril in Stable Coronary Artery Disease Trial... 

To control risk factors and prevent major adverse cardiac events, statin therapy should be considered in all patients with ischemic heart disease, particularly in those with elevated low-density lipoprotein cholesterol. In the absence of contraindications, angiotensin-converting enzyme inhibitors should be considered in ischemic heart disease patients who also have diabetes melli-tus, left ventricular dysfunction, history of myocardial infarction, or any combination of these. Angiotensin receptor blockers... 

When drug therapy fails or if extensive coronary atherosclerosis is present, PCI is often performed to restore coronary blood flow, relieve symptoms, and prevent major adverse cardiac events. Patients with one or more critical coronary stenoses (i.e., greater than 70% occlusion of the coronary lumen) detected during coronary angiography may be candidates for PCI. Several catheter-based interventions maybe used during PCI, including ... 

Over the last decade, several studies in tens of thousands of patients have revealed that lowering cholesterol, specifically lowering LDL cholesterol with statins, is effective for both primary and secondary prevention of IHD-related events. Statins shown to decrease morbidity and mortality associated with IHD include lovastatin, simvastatin, pravastatin, and atorvas-tatin.22,23 A recent meta-analysis showed that the risk of major adverse cardiac events is reduced by 21% with the use of statins in patients at high risk for IHD-related events.23... 

Because lipoprotein metabolism and the pathophysiology of atherosclerosis are closely linked, treatment of dyslipidemias is critical for both primary and secondary prevention of IHD-related cardiac events. In 2001, the Adult Treatment Panel III of the National Cholesterol Education Program... 

Like dyslipidemia, hypertension is a major, modifiable risk factor for the development of IHD and related complications. Unfortunately, awareness, treatment, and control of blood pressure are not nearly enough.30 Aggressive identification and control of hypertension is warranted in patients with IHD to minimize the risk of major adverse cardiac events. Goal blood pressure in patients with IHD is less than 140/90 mm Hg or less than 130/80 mm Hg in patients with diabetes. Because of their cardioprotective benefits, 3-blockers and ACE inhibitors (or ARBs in ACE-inhibitor-intolerant patients), either alone or in combination, are appropriate for most patients with both hypertension and IHD. 

Elevated homocysteine concentrations have been associated with an increased risk for cardiovascular disease in both epidemiologic and clinical studies.43 Several studies have evaluated the benefit of lowering homocysteine levels with folic acid supplementation. One study reported a reduction in major cardiac events with the combination of folic acid, vitamin B12, and vitamin B6 following PCI.44 However, a more recent study found an increased risk of instent restenosis and the need for target-vessel revascularization with folate supplementation following coronary stent placement.45 The role of folate in the management of IHD is currently unclear. 

Treiman (1998)46 Seizure control Resp/cardiac events Patients with subtle GCSE... 

Alldredge (2001 )47 Seizure control Resp/cardiac events Higher doses used in... 

Misra (2006)48 Seizure control Resp/cardiac events As second line agent,... 

Common precipitating factors that may cause a previously compensated patient to decompensate include noncompliance with diet or drug therapy, coronary ischemia, inappropriate medication use, cardiac events (e.g., MI, atrial fibrillation), pulmonary infections, and anemia. 

Use 5-HTi agonists only where a clear diagnosis of migraine has been established. Risk of myocardial ischemia or infarction and other adverse cardiac events Because of the potential of this class of compounds to cause coronary vasospasm, do not give these agents to patients with documented ischemic or vasospastic coronary artery disease (CAD). 

Cardiac events and fatalities associated with 5-HT-f agonists Serious adverse... 

CYP3A4 inhibitors (eg, macrolide antibiotics, protease inhibitors) There have been rare reports of serious adverse events in connection with the coadministration. Fibrotic complications There have been reports of pleural and retroperitoneal fibrosis in patients following prolonged daily use of injectable dihydroergotamine. Risk of myocardial Ischemia and/or Ml and other adverse cardiac events Do not use dihydroergotamine in patients with documented ischemic or vasospastic coronary artery disease. 

Cardiac events and fatalities Serious adverse cardiac events, including acute Ml, life-threatening disturbances of cardiac rhythm, and death have been reported following the administration of dihydroergotamine. 

Tabs SE Dizziness, somnolence, N, asthenia, xerostomia, paresthesias pain, pressure, or tightness in chest, jaw or neck serious cardiac events Interactions T Risk of serotonin synd W/ SSRIs T risks of prolonged vasospasms W/ ergot-containing medications EMS Acute Mis and arrhythmias have occurred after taking a 5-HTi agonist long-term use can cause adverse ophthalmic effects OD May cause severe CV effects symptomatic and supportive... 

Ephedra (Ephedra sinica)/Ma Huang Uses Stimulant, aid in wt loss, bronchial dilation Dose Not OK d/t reported deaths (>100 mg/d can be life-threatening). US sales banned by FDA in 2004 bitter orange w/ similar properties has replaced this compound in most wt loss supplements Caution Advise cardiac events, strokes, death SE Nervousness, HA, insomnia, palpitations, V, hypoglycemia Interactions Digoxin, antihypertensives, antidepressants, diabetic medications EMS Tinctures extracts contain EtOH may X glucose linked to several deaths behavioral mood changes... 

Uses CAD, hypercholest olemia, hypertriglyceridemia, type 2 DM, arthritis Efficacy No definitive data on X cardiac risk in general population may X lipids and help w/ secondary MI prevention Dose One FDA approved (Lovaza) OTC 1500-3000 mg/d Ammcan Heart Association recommends 1 g/d Caution Mct-cury contamination possible, some studies suggest t cardiac events SE t Bleed risk, dyspqjsia, belching, aftertaste Interactions Anticoagulants EMS t Effects of anticoagulants... 

Brown KA, Heller GV, Landin RS, Shaw LJ, Beller GA, Pasquale MJ et al. Early dipyridamole (99m)Tc-sestamibi single photon emission computed tomographic imaging 2 to 4 days after acute myocardial infarction predicts in-hospital and postdischarge cardiac events comparison with submaximal exercise imaging. Circulation 1999 100 2060-2066... 

Rohatgi R, Epstein S, Henriquez J, Ababneh AA, Hickey KT, Pinsky D et al. Utility of positron emission tomography in predicting cardiac events and survival in patients with coronary artery disease and severe left ventricular dysfunction. Am J Cardiol 2001 87 1096-1099, A6... 

One of the significant factors promoting late stent thrombosis has been found to be premature discontinuation of dual antiplatelet therapy (aspirin and clopidrogel). In an analysis of 4,666 of patients undergoing initial PCI with BMS or DES, researchers from the Duke Heart center reported that longterm risk for death and major cardiac events was significantly increased among patients in the DES... 

The prevention of cardiac events is the first priority. When there is a choice between two methods for effectively relieving the patient s symptoms, you have to choose the one for which there is proof or at least a high possibility for these events to be prevented. Because MI can be critical, non-pharmacological therapy might have a higher priority but the above mentioned principles for therapy selection is also effective for the choice of drugs. There is a need to keep updated with respect to treatment guidelines and the latest clinical studies. 

Eptifibatide, tirofiban, and abciximab can all decrease the incidence of cardiac events associated with acute coronary syndromes direct comparisons are needed to establish which, if any, issuperior for angioplasty, until more data become available, abciximab appears to be the drug of choice... 

Substantial tachycardia may lead to ischemic cardiac events orworsened heart failure. 

Depression is common, is frequently unrecognized or underestimated, and may be deadly. For example, 50% of completed suicides are associated with a major depressive episode. Furthermore, depression can adversely affect life activities in a variety of ways. Medical disorders such as cardiovascular disease are also affected by depression, often predicting future cardiac events and hastening death, which is unfortunate, given that there is a very specific set of diagnostic criteria and that there is a variety of effective pharmacologic and somatic therapies (see Chapter 7.) (8). 

Anesthetic techniques that have minimized adverse effects include the use of muscle relaxants and, more recently, nerve stimulators to assess adequacy of relaxation, the introduction of very rapid acting, short-duration barbiturates, and the use of atropinic agents to minimize the cardiovascular response to a combination of a seizure and anesthesia (93). In addition, 100% oxygenation (adequacy monitored by a pulse oximeter) with positive-pressure ventilation can minimize related cardiac events and memory disruption. 

Retrospective case-control studies reported that immediate-acting nifedipine increased the risk of myocardial infarction in patients with hypertension. Slow-release and long-acting vasoselective calcium channel blockers are usually well tolerated. Flowever, dihydropyridines, compared with angiotensin-converting enzyme (ACE) inhibitors, have been reported to increase the risk of adverse cardiac events in... 

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