Ischaemic heart disease severe

Familial hypercholesterolaemia is characterized by a significant elevation in plasma LDL concentration. The basic metabolic defect appears to be abnormal LDL receptor function, arising from mutations in the LDL receptor gene. Several receptor mutations have been identified and hypercholesterolaemia severity as well as the age of onset of ischaemic heart disease has recently been demonstrated to vary according to the type of LDL receptor gene defect (Moorjani et al., 1993). 

Green CR, Severs J Robert Feulgen Prize Lecture. Distribution and role of gap junctions in normal myocardium and human ischaemic heart disease. Histochemistry 1993 99 105-120. 

NS AID, moderate or severe heart failure, patients with active peptic ulceration, ischaemic heart disease, cerebrovascular disease, peripheral arterial disease, inflammatory bowel disease, uncontrolled hypertension, pregnancy, breastfeeding... 

Avoid respiratory stimulants in patients with epilepsy (risk of convulsions). Other relative contraindications include ischaemic heart disease, acute severe asthma ( status asthmaticus ), severe hypertension and thyrotoxicosis. 

Barankay A. Circulatory effects of pipecurium bromide during anaesthesia of patients with severe valvular and ischaemic heart diseases. Arzneimittelforschung 1980 30(2a) 386-9. 

Statins are now amongst the most widely used drugs worldwide. They are highly effective in lowering cholesterol levels, and have been shown to be effective in the primary and secondary prevention of ischaemic heart disease. Statins, however, can cause muscle toxicity, which most commonly manifests as an asymptomatic rise in CPK, and in the most severe cases, can cause rhabdomyolysis and death (Fig. 3) (Laaksonen 2006). Cerivastatin was withdrawn in 2001 because of its propensity to... 

Several computer-based risk scoring programs are available. One of them is the UKPDS Risk Engine (www.dtu.ox.ac.uk), which has been developed at Oxford University. It can be used to estimate the future risk of the type 2 diabetic patient to develop ischaemic heart disease or stroke. A CVD risk profile at annual intervals may be a useful tool for the repetitive motivating dialogues and prioritization of risk marker interventions. 

Established interactions. The CSM in the UK advises that, as potentially serious hypokalaemia may result from beta2 agonist therapy, particular caution is required in severe asthma, as this effect may be potentiated by theophylline and its derivatives, corticosteroids, diuretics, and by hypoxia. Hypokalaemia with concurrent use of thiazide and loop diuretics may be reduced or even abolished by the addition of spironolactone or high-dose triamterene. Plasma potassium levels should therefore be monitored in patients with severe asthma. Hypokalaemia may result in cardiac arrhythmias in patients with ischaemic heart disease and may also affect the response of patients to drugs such as the digitalis glycosides and an-tiarrhythmics. 

Ripa, R. S., Wang, Y, Jorgensen, E., Johnsen, H. E., Hesse, B., and Kastrup, J. 2006. Intramyocardial injection of vascular endothelial growth factor-A(165) plasmid followed by granulocyte-colony stimulating factor to induce angiogenesis in patients with severe chronic ischaemic heart disease. European Heart Journal, 27,1785-1792. 

The classification of hyperUpidaemias is confusing as there are two means of classification - the Fredrickson based on the pattern of plasma lipoproteins in each condition, and the Goldstein based on the underlying enzyme defects. Type I hyperlipidaemia (Fredrickson) is a lipoprotein lipase or apolipoprotein-C2 deficiency. It leads to massive Hpid deposition and presents in childhood. Type Da hyperlipidaemia (familial hypercholesterolaemia) is a severe illness, not to be confused with common hypercholesterolaemia. Familial hypercholesterolaemia presents in childhood with deposits of cholesterol in the skin and ischaemic heart disease in adolescence. 

An inherited lack of, or deficiency in, cell surface receptors for low density lipoproteins results in a condition, familial hypercholesterolaemia, in which blood cholesterol concentrations are rather high. This condition, if untreated, leads to severe vascular disease and death from ischaemic heart disease. Lipids are involved in several ways. First, one of the characteristics of developing atherosclerotic plaques is an accumulation of lipids, particularly cholesteryl esters, which are derived from plasma lipoproteins secondly, lipids are involved (because of their role as precursors of eicosanoids) in the formation of thrombi which may block arteries and cause ischaemia. Another risk factor for ischaemic heart disease that involves lipid metabolism is obesity, characterized by an excessive accumulation of adipose tissue. In particular, upper body obesity is also associated with Type II diabetes and hyperinsulinaemia. Hyperlipoproteinaemia is secondary to obesity and diabetes mellitus and if these conditions are treated, blood lipid concentrations return to normal. 

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