Coronary artery disease heart failure

Hypertension is the most common cardiovascular disease and is the major risk factor for coronary artery disease, heart failure, stroke, and renal failure. Approximately 50 million Americans have a systolic or diastolic blood pressure above 140/90 mm Hg. The onset of hypertension is defined as having a blood pressure of 140/90 mm Hg or greater and most commonly appears during the fourth, fifth, and sixth decades of life (1). 

Heart (angina, coronary artery disease, myocardial infarction, or heart failure)... 

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... 

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

Hypertension x 15 years Coronary artery disease x 10 years Myocardial infarction 1998 Heart failure x 3 years... 

Coronary artery disease Myocardial infarction Heart failure... 

Prolonged exposure to elevated GH and IGP-Is can lead to serious complications in patients with acromegaly. Aggressively manage comorbid conditions such as hypertension, diabetes, arrhythmias, coronary artery disease and heart failure to prevent vascular and neuropathic complications. It is critical to monitor patients indefinitely for management of the comorbidities associated with acromegaly8 (Table 43-4). 

Moderate risk Has three or more risk factors for coronary artery disease Has moderate, stable angina Had a recent myocardial infarction or stroke within the past 6 weeks Has moderate congestive heart failure (NYHA Class 2) Fbtient should undergo a complete cardiovascular work-up and treadmill stress testing to determine tolerance to increased myocardial energy consumption associated with increased sexual activity... 

Hypertension, or a chronic elevation in blood pressure, is a major risk factor for coronary artery disease congestive heart failure stroke kidney failure and retinopathy. An important cause of hypertension is excessive vascular smooth muscle tone or vasoconstriction. Prazosin, an aradrenergic receptor antagonist, is very effective in management of hypertension. Because oq-receptor stimulation causes vasoconstriction, drugs that block these receptors result in vasodilation and a decrease in blood pressure. 

Although the risk of GI complications is relatively small with short-term therapy, coadministration with a proton pump inhibitor should be considered in elderly patients and others at increased GI risk. NSAIDs should be used with caution in individuals with a history of peptic ulcer disease, heart failure, uncontrolled hypertension, renal insufficiency, coronary artery disease, or if they are receiving anticoagulants concurrently. 

Sibutramine is more effective than placebo with the most significant weight loss during the first 6 months of use. Dry mouth, anorexia, insomnia, constipation, increased appetite, dizziness, and nausea occur two to three times more often than with placebo. Sibutramine should not be used in patients with coronary artery disease, stroke, congestive heart failure, arrhythmias, or monoamine oxidase inhibitor use. 

The pharmacological mechanisms of action of NO donors that contribute to their benefit in coronary artery disease, congestive heart failure, and hypertension are listed in Table 11.1. These actions can be grouped into five categories vasodilation, decrease in myocardial oxygen consumption, improvement in hemodynamic performance,... 

Many disorders benefit from exercise (Pederson Saltin, 2005). These include asthma, cancer, chronic heart failure, coronary artery disease, chronic obstructive pulmonary disease (COPD), depression, type 1 diabetes melUtus, type 2 diabetes melUtus, hypertension, intermittent claudication, osteoarthritis, osteoporosis, rheumatoid arthritis and obesity. 

As the prevalence of obesity increases worldwide, so does the prevalence of associated co-morbidities type-2 diabetes, chronic obstructive sleep apnoea, cardiovascular disease (hyper-tension, coronary artery disease and congestive heart failure, stroke and peripheral vascular disease), fatty liver disease, various malignancies (Table 7.2), gallstones, subfertility, musculo-skeletal problems and depression. 

Auricchio A, Sommariva L, Salo RW, Scafuri A, Chiariello L. Improvement of cardiac function in patients with severe congestive heart failure and coronary artery disease by dual chamber pacing with shortened AV delay, [see comment]. Pacing Clin. Electrophysiol. 1993 16 2034 3. 

Highly recommended are jS-blockers for those who have a prior MI event. They showed a significant effect on death. Recent studies suggest that patients who have coronary artery disease without acute myocardial infarction and/or congestive heart failure have approximately the same protective benefit against death. 

Bnnch TJ, Mnhlestein JB, Bair TL, Renlnnd DG, Lappe DL, Jensen KR et al. Effect of beta-blocker therapy on mortality rates and future myocardial infarction rates in patients with coronary artery disease but no history of myocardial infarction or congestive heart failure. Am J Cardiol 2005 95(7) 827-31. 

Low doses (100-200 mg/d) of amiodarone are effective in maintaining normal sinus rhythm in patients with atrial fibrillation. The drug is effective in the prevention of recurrent ventricular tachycardia. It is not associated with an increase in mortality in patients with coronary artery disease or heart failure. In many centers, the implanted cardioverter-defibrillator (ICD) has succeeded drug therapy as the primary treatment modality for ventricular tachycardia, but amiodarone may be used for ventricular tachycardia as adjuvant therapy to decrease the frequency of uncomfortable cardioverter-defibrillator discharges. The drug increases the pacing and defibrillation threshold and these devices require retesting after a maintenance dose has been achieved. 

Most clinical trials have been carried out in patients with systolic dysfunction, so the evidence regarding the superiority or inferiority of drugs in heart failure with preserved ejection fraction is meager. Most authorities support the use of the drug groups described above. Control of hypertension is particularly important, and revascularization should be considered if coronary artery disease is present. Tachycardia limits filling time therefore bradycardic drugs may be particularly useful, at least in theory. 

Increased production of ET-1 has been implicated in a variety of cardiovascular diseases, including hypertension, cardiac hypertrophy, heart failure, atherosclerosis, coronary artery disease, and myocardial infarction. ET-1 also participates in pulmonary diseases, including asthma and pulmonary hypertension, as well as in several renal diseases. 

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