Ischemic heart disease treatment

Nuclear medicine studies may reveal information that is primarily anatomic in nature, or indicate the function of an organ on a regional basis (Table 1). These studies may be intended to identify new disease, confirm or deny suspected disease, or foUow the progress of treatment or the course of disease. The diseases may be relatively benign or extremely serious and can range from widespread medical problems such as ischemic heart disease to rarities such as Legge-Perthe s disease and malignant pheochromocytoma (7). 

About 4.5 million Americans have heart failure (HF). It is the most frequent cause of hospitalization for individuals older than 65 years. Some patients, with treatment, may lead nearly normal lives, whereas more than 50% of individuals with severe HF die each year. HF is a complex clinical syndrome that can result from any number of cardiac or metabolic disorders such as ischemic heart disease, hypertension, or hyperthyroidism. Any condition that impairs the ability of the ventricle to pump blood can lead to HF In HF, die heart... 

In general, treatment of the asthma underlying NSAlDs sensitivity should follow standard asthma guidelines. This type of asthma is often severe and frequently high doses of inhaled corticosteroids and daily doses of oral corticosteroids are necessary. A special treatment option is a chronic desensitization to aspirin [8]. Desensitization and aspirin maintenance is routinely used in some centers for treatment of chronic rhinusinusitis with nasal polyposis. It is the only available procedure which allows AIA patients with ischemic heart disease to use aspirin. During the state of desensitization to aspirin, not only aspirin but almost all strong NSAIDs are tolerated, so desensitization and NSAID maintenance could be used for treatment of rheumatic disease or chronic pain syndromes. 

Serious adverse effects of epinephrine potentially occur when it is given in an excessive dose, or too rapidly, for example, as an intravenous bolus or a rapid intravenous infusion. These include ventricular dysrhythmias, angina, myocardial infarction, pulmonary edema, sudden sharp increase in blood pressure, and cerebral hemorrhage. The risk of epinephrine adverse effects is also potentially increased in patients with hypertension or ischemic heart disease, and in those using (3-blockers (due to unopposed epinephrine action on vascular Ui-adrenergic receptors), monoamine oxidase inhibitors, tricyclic antidepressants, or cocaine. Even in these patients, there is no absolute contraindication for the use of epinephrine in the treatment of anaphylaxis [1,5,6]. 

The a-tocopherol, P-carotene (ATBC) Cancer Prevention study was a randomised-controlled trial that tested the effects of daily doses of either 50 mg (50 lU) vitamin E (all-racemic a-tocopherol acetate), or 20 mg of P-carotene, or both with that of a placebo, in a population of more than 29,000 male smokers for 5-8 years. No reduction in lung cancer or major coronary events was observed with any of the treatments. What was more startling was the unexpected increases in risk of death from lung cancer and ischemic heart disease with P-carotene supplementation (ATBC Cancer Prevention Study Group, 1994). Increases in the risk of both lung cancer and cardiovascular disease mortality were also observed in the P-carotene and Retinol Efficacy Trial (CARET), which tested the effects of combined treatment with 30 mg/d P-carotene and retinyl pahnitate (25,000 lU/d) in 18,000 men and women with a history of cigarette smoking or occupational exposure to asbestos (Hennekens et al, 1996). 

Identify the treatment goals of ischemic heart disease and appropriate lifestyle modifications and pharmacologic therapy to address each goal. 

The major goals for the treatment of ischemic heart disease are to prevent acute coronary syndromes and death, alleviate acute symptoms of myocardial ischemia, prevent recurrent symptoms of myocardial ischemia, and avoid or minimize adverse treatment effects. 

FIGURE 4-5. The treatment algorithm for ischemic heart disease. 

The [ -adrenoreceptors antagonists (also called [)-blockers) comprise a group of chiral drugs that are mostly used in the treatment of cardiovascular disorders such as hypertension, cardiac arrhythmia, or ischemic heart disease. Teicoplanin is the chiral selector most exploited for the enantioseparation of this class of compounds, followed by vancomycin. Several P-blockers have been analyzed, particularly in the... 

R. Delgado, H.S. Arora (eds.), Interventional Treatment of Advanced Ischemic Heart Disease, DOI 10.1007/978-l-84800-395-8 l, Springer-Verlag London Limited 2009... 

Myocardial ischemia and infarction cause abnorma myocardial metabolism, decreased left ventricular (LV) systolic function, diastolic dysfunction, congestive heart failure, and decreased survival. Consequently, revascularization techniques, either surgical or catheter based, have become integral to treatment of severe ischemic heart disease. 

The Future of Treatment of Advanced Ischemic Heart Disease... 

Future treatments for advanced ischemic heart disease may include techniques and technologies which can... 

Part of the futuristic approach to treating advanced ischemic heart disease will encompass a better understanding of and better utilization of existing technologies that previously were not considered to be beneficial. We can and should explore simple technologies and techniques used for other disease states to augment the treatment of this disease. Much effort has been placed in the research of... 

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