Coronary insufficiency

Patients having high plasma renin activity (PRA) (>8 ng/(mLh)) respond best to an ACE inhibitor or a -adrenoceptor blocker those having low PRA (<1 ng/(mLh)) usually elderly and black, respond best to a calcium channel blocker or a diuretic (184). -Adrenoceptor blockers should not be used in patients who have diabetes, asthma, bradycardia, or peripheral vascular diseases. The thiazide-type diuretics (qv) should be used with caution in patients having diabetes. Likewise, -adrenoceptor blockers should not be combined with verapamil or diltiazem because these dmgs slow the atrioventricular nodal conduction in the heart. Calcium channel blockers are preferred in patients having coronary insufficiency diseases because of the cardioprotective effects of these dmgs. 

Although sudden deaths due to circulatory failure have been reported among workers exposed chronically to nitrated esters such as nitroglycerin and ethylene glycol dinitrate (Carmichael and Lieben 1963), no deaths attributable to cardiovascular effects were reported for U.S. Navy personnel involved in torpedo maintenance work (Horvath et al. 1981 Forman et al. 1987). The sudden deaths for workers in the explosives industry were attributed to a compensatory vasospasm that may produce coronary insufficiency upon withdrawal from nitrate ester exposure. 

It is used for chronic coronary insufficiency, as well as for preventing and treating thrombosis. Synonyms of this drag are anginal, cnrantyl, stenocor, thrompresantin, and many others. 

Use with caution in patients with severe coronary insufficiency, recent Ml, cerebrovascular disease, or chronic renal failure. 

Coronary insufficiency Discontinue alfuzosin if symptoms of angina pectoris should newly appear or worsen. 

Cardiovascular effects Use with caution in patients with cardiovascular disorders including coronary insufficiency, ischemic heart disease, history of stroke, coronary artery disease, cardiac arrhythmias, CHF, and hypertension. 

Ephedrine may cause hypertension resulting in intracranial hemorrhage. It may induce anginal pain in patients with coronary insufficiency or ischemic heart disease. Large doses of inhaled or oral salmeterol (12 to 20 times the recommended dose) have been associated with clinically significant prolongation of the QTc interval, which has the potential for producing ventricular arrhythmias. 

Cardiovascular effects Limit use of levorphanol in acute Ml or in cardiac patients with myocardial dysfunction or coronary insufficiency because the effects of levorphanol on the heart are unknown. 

Use with caution Use with caution in patients with depression, cerebral or coronary insufficiency, Raynaud phenomenon, orthostatic hypotension, or thromboangiitis obliterans. 

The greatest hazards of accidental overdosage with epinephrine and norepinephrine are cardiac arrhythmias, excessive hypertension, and acute pulmonary edema. Large doses of isoproterenol can produce such excessive cardiac stimulation, combined with a decrease in diastolic blood pressure, that coronary insufficiency may result. It also may cause arrhythmias and ventricular fibrillation. Tissue sloughing and necrosis due to severe local ischemia may follow extravasation of norepinephrine at its injection site. 

In patients with coronary insufficiency, a -blocker can be given in conjunction with diazoxide to decrease the cardiac work associated with reflex increases in sympathetic stimulation of the heart. However, 3-blockers potentiate the hypotensive effect of diazoxide, and therefore, the dose of the vasodilator should be lowered. The dose of diazoxide should also be lowered if the patient has recently been treated with guanethidine or another drug that depresses the action of the sympathetic nervous system. Such drugs permit a greater hypotensive effect because they reduce the increase in cardiac output that normally partially counteracts the fall in pressure. 

The fact that the microbubbles are restricted to the vascular space makes them ideal for contrast echocardiography and vascular imaging. Echocardiography is used extensively to assess ischemic heart disease. Contrast-enhanced echocardiography improves visualization of the cavities of the heart, the lumen of arteries and veins, and small vessels within solid organs and perfused tissues. Effective endocardial border delineation allows assessment of global heart function and the detection of coronary insufficiency (Fig. 12). 

Contraindications Coronary insufficiency, pyloric stenosis, glaucoma, uremia, recent myocardial infarction, unreliable patients... 

It is indicated in acute attacks (sublingually) and chronic prophylaxis (orally) of angina pectoris and coronary insufficiency. In acute myocardial infarction, CHF and acute LVF. 

This report highlights the risk of cardiovascular adverse effects with short courses of glucocorticoid therapy in elderly patients with inflammatory bowel disease, even with rather low-dosage regimens. Acute myocardial infarction occurred in an old man with coronary insufficiency and giant cell arteritis after treatment with prednisolone (SEDA-10, 343) but could well have been coincidental. 

I 5 Neri Serneri GG, Gensini Gp Abbate R, et al, Is raised plasma fibrinopeptide A a marker of acute coronary insufficiency Lancet 1980 11 982. 

Diazoxide [dye az OX ide] is a direct-acting arteriolar vasodilator. It has vascular effects like those of hydralazine. For patients with coronary insufficiency, diazoxide is administered intravenously with a p-blocker, which diminishes reflex activation of the heart. Diazoxide is useful in the treatment of hypertensive emergencies, hypertensive encephalopathy, and eclampsia. Excessive hypotension is the most serious toxicity. 

Tachycardia and vasoconstriction from cocaine can exacerbate coronary insufficiency, complicated by dysrhythmias and hypertensive and vascular hemorrhage (1). Sudden deaths have been reported in patients with angina (40). Chronic dosing includes cardiomyopathy and cardiomegaly other chronic conditions include endocarditis and thrombophlebitis. Crack smoking has led to pneumopericardium (41). 

Attention must be paid to severe clotting disorders, cardiac and coronary insufficiency, severe cardiac arrhythmia, serious hypertension, respiratory insufficiency and purulent peritonitis as possible contraindications. The same is true of Bekhterev s disease and cerebral insufficiency (depending on the respective severity). Despite a wide range of indications, the list of contraindications (with the exception of hepatogenic clotting disorders) only covers severe extrahepatic diseases. In these cases, it is the treatment of the serious condition which is of paramount importance and not the diagnostic clarification of abdominal or hepatobiliary diseases. (228, 244, 254, 266, 275) (s. tab. 7.13)... 

Cardiac and coronary insufficiency, severe cardiac arrhythmia... 

Rapid peripheral intravenous injection of concentrated ionic contrast media produces a brief rise in systemic arterial pressure followed by a prolonged fall the diastolic pressure decreases more than the systolic pressure and the heart slows the pulse contour changes, and the venous pressure rises the arterial hypotension is more marked if injection is rapid. The electrocardiogram can show flattening, splitting, or T-wave inversion tachycardia is probably compensatory, as are the concomitant increases in venous pressure and pulmonary arterial pressure. Hypotension associated with a vasovagal reaction probably explained four deaths from acute coronary insufficiency (two each with iodoalphionic acid and iopa-noic acid) in patients with ischemic heart disease. 

Adrenal tumor Alcoholism Angina pectoris Cardiac arrhythmia CNS degenerative disease Cushing s disease Coronary insufficiency Delirium ... 

Adrenaline is contraindicated in cases of diabetes, hyperthyroidism, serious heart arrhythmias and coronary insufficiency or in combination with beta-blockers or monoamine oxidase (MAO) inhibitors. Lidocaine with adrenaline has a very rapid onset of action. Its duration of action is longer than that of lidocaine without adrenaline. However, inadvertent injection of a lidocaine-adrenaline solution into the vessels located near the nerve trunks increases the heart rate (immediate sinus tachycardia at over 130 beats per minute, spontaneously reversible in around 15 minutes) and increases ventricular excitability (risk of fibrillation). It can trigger angina attacks that may lead to a heart attack. It is therefore preferable not to use adrenaline before a full-face phenol peel. 

Children s Cancer Group cyanotic congenital heart disease chronic coronary insufficiency clean catch midstream urine cell cycle nonspecific cervical collar... 

Albuterol is used to relieve and prevent bronchospasm in patients with reversible obstructive airway disease and in individuals with exercise-induced bronchospasm. The onset of action of albuterol is 5 to 15 minutes, peak of action is 0.5 to 2 hours, and duration of action is 3 to 6 hours. Albuterol does not cross the blood-brain barrier. It must be used cautiously in patients with hyperthyroidism, diabetes mellitus, coronary insufficiency, and hypertension. The concomitant use of albuterol with monoamine oxidase inhibitors or tricyclic antidepressants should be discouraged. Glucocorticoids (beclomethasone, dexametha-sone, flunisolide, or triamcinolone) may be used 15 minutes after inhalational albuterol. 

Use with tricyclic antidepressants or sympathomimet-ics may increase the effects of these medications or of thyroid USP, possibly leading to coronary insufficiency or cardiac arrhythmias. Use with oral antidiabetic agents or insulin may affect dosage requirements of these agents. Estrogens, which increase serum thyroxine-binding globulin levels, raise thyroid USP requirements. 

Therap cat Anti-anginal. Treatment of coronary insufficiency-... 

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