Myocardial infarction anxiety with

While epinephrine is usually well tolerated in young and healthy individuals, there may be problems in elderly patients with cardiac arrhythmia or previous myocardial infarction episodes [31-33]. Pharmacological effects of epinephrine include rapid rise in blood pressure, pallor, anxiety, tachycardia, headache and tremor as well as vertigo. Most commonly these effects occur after intravenous injection or after overdosing epinephrine. Cardiac arrhythmia or pulmonary edema may develop in serious cases [33, 34]. 

Anxiety is common among the elderly but the literature regarding the assessment, diagnosis, and treatment of these illnesses in older individuals is sparse (Blazer 1997). Most often anxiety does not present for the first time in late life. If that is the case one should suspect an underlying condition or other external cause. These causes could be medications such as digitalis, antipsychotics but also conditions as anaemia, chronic obstructive lung disease with hypoxia or myocardial infarction. 

Therapeutic indications for benzodiazepines include anxiety states associated with neurotic, phobic, and depressive disorders, or myocardial infarction (decrease in cardiac stimulation due to anxiety) insomnia preanesthetic (preoperative) medication epileptic seizures and hypertonia of skeletal musculature (spasticity, rigidity). 

Anxiety is characterized by fear and apprehension that may or may not be associated with a cieariy identifiabie stimuius. Anxiety is a common reaction to significant life stress, is seen in conjunction with almost every psychiatric disorder, and is a common component of numerous organic disorders as well (e.g., hyperthyroidism, hypoglycemia, pheochromocytoma, complex partial seizures, pulmonary disorders, acute myocardial infarction, caffeine intoxication, various substances of abuse). Anxiety is almost invariably accompanied by physical symptoms such as the following ... 

Central nervous system toxicity is rarely observed with catecholamines or drugs such as phenylephrine. In moderate doses, amphetamines commonly cause restlessness, tremor, insomnia, and anxiety in high doses, a paranoid state may be induced. Cocaine may precipitate convulsions, cerebral hemorrhage, arrhythmias, or myocardial infarction. Therapy is discussed in Chapter 59 Management of the Poisoned Patient. 

Benzodiazepines have been used to treat anxiety associated with acute myocardial infarction... 

Chronic renal failure is also frequently associated with diminished erectile function, impaired libido, and infertility. The mechanism is probably multifactorial low serum testosterone concentrations, diabetes mellitus, vascular insufficiency, multiple medications, autonomic and somatic neuropathy, and psychological stress. Men with angina, myocardial infarction, or heart failure may have erectile dysfunction from anxiety, depression, or concomitant penile arterial insufficiency. 

Observational studies In a multicenter, observational retrospective review of 127 patients (80 male, mean age 51.7years) who had undergone at least ISmonths of treatment with alpha-l-antitrypsin therapy (Trypsone or Pro-lastin ), there were four serious adverse events that occurred during the treatment period one massive pulmonary thromboembolism, one myeloid leukaemia, one acute myocardial infarction and one haemorrhagic infarcHon but were judged not to be related to treatment. Seven of 11 nonserious adverse events were considered related to treatment including mild to moderate cutaneous symptoms (facial erythema, oedema/pruritus, rash), chills, fever and anxiety [31 ]. 

Some NOS inhibitors have been used in research in humans. The nonselective inhibitor NMMA has been used in normals and in trials for septic shock (Bakker et al. 2004) and for migraine headache (Tepper et al. 2001). A phase 11 randomized, double-blind trial of NMMA to treat patients with shock associated with acute myocardial infarction revealed no beneficial or possibly deleterious effects (Alexander et al. 2(X)7). In a different trial, a pro-drug for the NOS2-specific inhibitor L-NIL was administered orally to normal individuals and to those with asthma. The drug reduced exhaled NO and had no effects on blood pressure, pulse, and respiratory function (Hansel et al. 2003). There have been numerous preclinical studies in non-human animals of a variety of nonselective and selective inhibitors. Several NOS 1-specific inhibitors have been studied in animal models of amyotrophic lateral sclerosis, Parkinson s disease, Huntington s disease, Alzheimer s disease, depression, and anxiety (Chabrier et al. 1999). 

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