Ischemic heart disease assessment

Formulate a monitoring plan to assess effectiveness and adverse effects of an ischemic heart disease drug regimen. 

Patients with chest pressure or heaviness that is provoked by activity and relieved with rest should be assessed for ischemic heart disease. Sharp pain is not a typical symptom of ischemic heart disease. Some patients may experience discomfort in the neck, jaw, shoulder, or arm rather than, or in addition to, the chest. Pain may be accompanied by nausea, vomiting, or diaphoresis. 

Randomized trials have been completed assessing the role of antiplatelet therapy with aspirin for primary stroke prevention. The use of aspirin in patients with no history of stroke or ischemic heart disease reduced the incidence of non-fatal myocardial infarction (MI) but not of stroke. A meta-analysis of eight trials found that the risk of stroke was slightly increased with aspirin use, especially hemorrhagic stroke. Major bleeding risk was also increased with aspirin use.4 Aspirin is beneficial in the primary prevention of MI, but not for primary stroke prevention. 

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). 

The pharmacists of Care-Rite Pharmacy also developed patient educational tools to be used during the patient assessment and patient education components of the Pharmacy Check-up Service. Because many of the targeted patients have similar medical conditions, education materials were developed for specific disease states, including hypertension, ischemic heart disease, diabetes, asthma, chronic obstructive pulmonary disease (COPD), etc. Also, educational materials were developed for certain therapeutic classes of medications. The Care-Rite pharmacists also determined that many patients needed individualized education materials, so they implemented a drug information/educational service as part of the MTM service. With this service, patients can ask questions regarding their medical conditions and/or drug therapies. The pharmacists will research and provide an individualized written response for each patient. 

Richards M, Nicholls MG, Espiner EA, etal. Comparison of B-type natriuretic peptides for assessment of cardiac function and prognosis in stable ischemic heart disease. J Am Coll Cardiol 2006 47 52-60. 

In epidemiologic studies, the ECG is used to assess physical fitness, document the prevalence of ischemic heart disease (IHD),... 

In addition, an epidemiological study of 1931 selected men in Finland has indicated that increases in stored iron levels, as assessed by serum ferritin concentration, is a risk factor for coronary heart disease [60]. Iron mobilized from ferritin generates reactive oxygen radicals that presumably oxidatively modify low-density lipoproteins, thereby enhancing the risk of ischemic heart disease. 

To assess the relationship of Hey concentrations with vascular disease risk, a meta-analysis of observational studies was carried out, showing that elevated Hey is at most a modest independent predictor of ischemic heart disease and stroke risk in healthy populations. Studies of the impact on disease risk of genetic variants that affect blood Hey concentrations will help determine whether Hey is causally related to vascular disease, as may large randomized trials of the effects on ischemic heart disease and stroke of vitamin supplementation to lower blood Hey concentrations (Homocysteine Studies Collaboration 2002). 

Stem cells from a number of sources have been explored for regenerating the myocardium. Both multi-potent adult stem cells and pluripotent embryonic stem (ES) cells have been used to generate vascular cells and cardiac myocytes for therapy (Figure 34.3). A number of clinical studies have explored adult stem cells for their therapeutic potential in treating ischemic heart disease. While ES cells have only been investigated to date in preclinical models, a new clinical study is expected to assess safety of ES cell transplantation (Alper, 2009). In addition to stem cells, adult skeletal muscle cells have also been explored for clinical cardiac cell therapy. Each cell type is briefly reviewed in the context of myocardium regeneration. 

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