Coronary artery disease CAD

O The most common causes of heart failure are coronary artery disease (CAD), hypertension, and dilated cardiomyopathy. 

Endothelial dysfunction, inflammation, and the formation of fatty streaks contribute to the formation of atherosclerotic coronary artery plaques, the underlying cause of coronary artery disease (CAD). The predominant cause of ACS, in more than 90% of patients, is atheromatous plaque rupture, Assuring, or erosion of an unstable atherosclerotic plaque that occludes less than 50% of the coronary lumen prior to the event, rather than a more stable 70% to 90% stenosis of the coronary artery.3 Stable stenoses are characteristic of stable angina. 

The formation of atherosclerotic plaques is the underlying cause of coronary artery disease (CAD) and ACS in most patients. Endothelial dysfunction leads to the formation of fatty streaks in the coronary arteries and eventually to atherosclerotic plaques. Factors responsible for development of atherosclerosis include hypertension, age, male gender, tobacco use, diabetes mellitus, obesity, and dyslipidemia. 

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). 

Abstract Two thirds of the nearly half a million deaths per year in the United States due to sudden cardiac death (SCD) is attributed to coronary artery disease (CAD) and most commonly results from untreated ventricular tachyarrhythmias. Patients with ischemic cardiomyopathy and left ventricular dysfunction are at highest risk for SCD, but this still defines only a small subset of patients who will suffer SCD. Multiple lines of evidence now support the superiority of implantable cardioverter defibrillator (ICD) therapy over antiarrhythmic therapy for both primary and secondary prevention of SCD in advanced ischemic heart disease. Optimization of ICD therapy in advanced ischemic cardiomyopathy includes preventing right ventricular pacing as well as the use of highly effective anti-tachycardia pacing to reduce the number of shocks. While expensive, ICD therapy has been shown to compare favorably to the accepted standard of hemodialysis in cost effectiveness analyses. 

Lowering LDL cholesterol is highly effective if LDL is higher than 130 mg/dl and in suspected coronary artery disease (CAD) patients. A 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitor (statin) will be the first choice, and target LDL will be less than 100 mg/dl. LDL levels between 100-129 mg/dl will also be advantageous to be treated. Other than statins, cholestylamine, forate or other types will also be used. 

Unlabeled Uses To increase survival rate in diabetic patients with coronary artery disease (CAD) treatment orprevention of anxiety cardiacarrhythmias hypertrophiccar-diomyopathy mitral valve prolapse syndrome pheochromocytoma tremors thyrotoxicosis vascular headache... 

Some patients will be seen for multiple reasons therefore, the pharmacist may need to record more than one ICD-9-CM code to fully describe the patient visit. For example, if a client with coronary artery disease (CAD) is referred to a pharmacist, it may not be uncommon that the physician requests education on lowering cholesterol through both diet and medications and education on weight loss and smoking cessation. All three conditions (CAD, obesity, and tobacco use) can be coded to represent the health conditions discussed. Example ICD-9 codes for these conditions include 414.01 (native-vessel disease), 272.2 (mixed hyperlipidemia), and 305.1 (tobacco-use disorder) (Buck and Lockyear, 2007). The specific ICD-9 code used on the claim form should be the same code used by the physician to decrease the risk of claim rejection owing to mismatched codes. Therefore, the ICD-9 code should be requested on the referral form from the physician (Snella et ah, 2004). 

Many studies published during the last few decades have suggested that hyperhomocysteinemia is a risk factor for coronary artery disease (CAD), stroke, and thromboembolic disease. The Homocysteine Studies Collaboration metaanalysis of 30 studies concluded that elevated tHcy is a moderate risk factor for ischemic heart disease a level 3 xmol/L lower reduces the risk with an odds ratio of 0.89 (95% Cl = 0.83-0.96). The same was true for homocysteine as a risk factor for stroke (odds ratio = 0.81 95%5CI = 0.69-0.95) (6). A meta-analysis of 40 studies of the MTHFR 677 C > T polymorphism demonstrated a mildly increased risk of coronary heart disease with an odds ratio of 1. 16 (95% Cl = 1.05-1.28) (25). 

Clinical effects A large number of randomized, doubleblind, placebo-controlled trials have shown that the longterm use of (3 blockers improves the clinical status in patients with HF (22-32) (Table 2) and the ACC/AHA guidelines (II) recommend that (3 blockers should be routinely prescribed to all patients with asymptomatic LV dysfunction or stable HF caused by LV systolic dysfunction (unless they have a contraindication or have been shown to be intolerant to treatment with these drugs). (3 blockers should also be used in patients with HF and preserved LV systolic function, particularly when those patients have hypertension, coronary artery disease (CAD) and/or atrial fibrillation. 

Diabetes is extremely prevalent within the United States, with more than 16 million confirmed cases and an additional 20 million cases of glucose intolerance, As the incidence of diabetes in this country is thought to be on the rise (I), coronary artery disease (CAD) in this group, which is the principal cause of death in this population, is expected to rise concomitantly (2), Clearly reflecting these trends, in over a 20-year period, the mortality rate in the United States from diabetes has risen more than 30% (3). 

Almost 40% of hypertensive patients have LVH which, after age, is the strongest predictor of cardiovascular disease, such as congestive heart failure (CHF), stroke, and coronary artery disease (CAD). Cardiovascular events occur in relation to left ventricular mass. Blood pressure reduction causes LVH regression, and therefore decreases the risk of all-cause, cardiovascular, and CAD mortality. ARBs have been shown to reduce LVH in a number of trials, including losartan in the LIFE [8] and irbesartan in the SILVHIA study [9]. 

---