Myocardial infarction and coronary artery disease

WlNKELMANN BR, NAUCK M, KlEIN B, Russ AP, Bohm BO, Siekmeier R, Ihn-ken K, Verho M, Gross W, Marz W. Deletion polymorphism of the angiotensin I-converting enzyme gene Is associated with increased plasma angiotensin-con-verting enzyme activity but not with increased risk for myocardial infarction and coronary artery disease. Ann Intern Med 1996 125 19-25. 

The above findings confirm that exposure to PSCI RCAs by airborne dispersion or by contamination in solution produce abrupt and marked increases in SBP and DBP, with resolution within about 0.5 h of the start of exposure. The magnitude and duration of the changes can be tolerated without significant medical hazards in healthy individuals. However, as with other stressful situations, some susceptible individuals may be at increased risk from the induced transient hypertensive episode this will include those with essential hypertension, established myocardial infarction and coronary artery disease, cardiac arrhythmias and arterial aneurysms (Ballantyne, 1977a, 1987 Ballantyne and Salem, 2004). 

Da Silva B, Tschampa J, Beron J, Fredrick L, Patwardhan M, Zachry W, et al. Evaluation of myocardial infarction and coronary artery disease in subjects taking lopinavir/ritonavir a study using clinical trial and pharmacovigilance databases. Int J Clin Pharmacol Ther 2012 50(6) 391-402. 

BRADYKININ AND THE EEFECTS OE ACE INHIBITORS ACE inhibitors are used widely in the treatment of hypertension, and they reduce mortality in patients with diabetic nephropathy, left ventricular dysfunction, previous myocardial infarction, or coronary artery disease. ACE inhibitors block the conversion of Angl to Angll, a potent vasoconstrictor and growth promoter (Figure 24-2) (see Chapter 30). Studies using the specific bradykinin B antagonist HOE-140 demonstrate that bradykinin also contributes to many of the protective effects of ACE inhibitors. The contribution of bradykinin to the effects of ACE inhibitors may result not only from decreased degradation of bradykinin but also from induction of enhanced receptor sensitivity. 

Another example is the use of Tc-sestamibi, approved for use in the evaluation of coronary artery disease and myocardial infarction, in patients with breast cancer. Use in breast cancer is under investigation by a number of physicians. The data are not yet sufficient to determine the efficacy of this agent in this setting. Its safety, of course, has already been demonstrated as part of its initial evaluation for heart disease. 

There can be a number of underlying causes of CHE. The most prevalent is the lack of oxygenated blood reaching the heart muscle itself because of coronary artery disease with myocardial infarction (111). Hypertension and valvular disease can contribute to CHE as well, but to a lesser extent in terms of principal causes for the disease. 

Carotenoids and cardiovascular diseases — Numerous epidemiological studies aimed to study the relationship of carotenoids and cardiovascular diseases (CVDs) including coronary accident risk and stroke. It appeared then that observational studies, namely prospective and case-control studies, pointed to a protective effect of carotenoids on myocardial infarct and stroke, but also on some atherosclerosis markers such as intima media thickness (IMT) of the common carotid artery (CCA) and atheromatous plaque formation. 

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... 

Father with coronary artery disease, had a myocardial infarction at age 50 years Mother alive and well... 

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... 

Contraindications to these agents include hypertension, tachyarrhythmias, coronary artery disease, myocardial infarction, cor pulmonale, hyperthyroidism, renal failure, and narrow-angle glaucoma. 

Use 5-HTi agonists only where a clear diagnosis of migraine has been established. Risk of myocardial ischemia or infarction and other adverse cardiac events Because of the potential of this class of compounds to cause coronary vasospasm, do not give these agents to patients with documented ischemic or vasospastic coronary artery disease (CAD). 

Perin EC, Silva GV, Sarmento-Leite R, Sousa AL, Howell M, Muthupillai R, Lambert B, Vaughn WK, Flamm SD. Assessing myocardial viability and infarct transmurality with left ventricular electromechanical mapping in patients with stable coronary artery disease validation by delayed-enhancement magnetic resonance imaging. Circulation 2002 106 957-961. 

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. 

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