Myocardial infarction coronary

Prior to myocardial infarction, coronary artery bypass graft (CABG), peripheral artery disease, cerebrovascular accident, or aspirin use... 

It is indicated in prophylaxis in cases of increased risk of blood clotting, myocardial infarction, coronary bypass, transluminal angioplasty, stroke, transient ischaemic attack and unstable angina. 

G. Other applications In patients with acute myocardial infarction, coronary stenting plus ReoPro leads to a greater degree of myocardial salvage and a better clinical outcome than does fibrinolysis with a tissue plasminogen activator. As compared with placebo, early administration of ReoPro in patients with acute myocardial infarction improves coronary patency before stenting, the success rate of the... 

A 73-year-old man with a history of breathlessness, cough, and weight loss had some ill-defined peripheral shadow in the upper zones of a chest X-ray. He had fiberoptic bronchoscopy with cocaine and lidocaine and 5 minutes later became distressed, with dyspnea, chest pain, and tachycardia. Electrocardiography showed an evolving anterior myocardial infarction. Coronary angiography showed a stenosis of less than 25% in the proximal left anterior descending artery with coronary artery spasm. He made an uneventful recovery. 

Endothelin has been implicated in myocardial infarction, coronary vasospasm and re-stenosis subsequent to percutaneous transluminal coronary angioplasty. The potent, prolonged coronary vasoconstrictor and mitogenic actions of endothelin are well-documented (see earlier section) and thus endothelin is certainly able to produce the biological effects seen in these disease states. Although a reduction in infarct size has been demonstrated in a rat model of myocardial infarction with an endothelin antibody [185], and with phosphoramidon [186], the argument for a role for endothelin in ischaemic heart disease has been based mainly on the finding of increased plasma endothelin levels in patients with myocardial infarction [187-190], coronary vasospasm [191, 192] and re-stenosis post-PTCA [193-195]. 

A 38-year-old white man with a history of coronary artery disease, myocardial infarction, coronary artery by-pass, alcoholism, and depression took a combined massive overdose of diltiazem and atenolol (24). He underwent cardiopulmonary resuscitation because of cardiac arrest bradycardia, hypotension, and oliguria followed and were resistant to intravenous pacing and multiple pharmacological interventions, including intravenous fluids, calcium, dopamine, dobutamine, adrenaline, prenalterol, and glucagon. Adequate mean arterial pressure and urine output were restored only after the addition of phenylephrine and transvenous pacing. He survived despite myocardial infarction and pneumonia. 

Trade names Abbokinase (Abbott) Ukidan Indications Acute myocardial infarction, coronary artery thrombosis, pulmonary embolism Category Fibrinolytic Plasminogen activator Half-life 10-20 minutes... 

As discussed in detail above, those exposed to smokes, aerosols or solutions of PCSI materials may have transient increases in SBP and DBP, often accompanied by a reflex bradycardia. This could be compounded with that caused by the emotional experience of being involved in a civil disturbance. Those who give a history of cardiovascular disease (notably myocardial infarction, coronary artery disease, cardiac arrhythmias, essential hypertension, aneurysm) may require admission and further investigation. 

Modern oral contraceptives can contribute to the incidence and severity of certain diseases if other risk factors are present. The following conditions are considered absolute contraindications for combination oral contraceptives the presence or history of thromboembolic disease, cerebrovascular disease, myocardial infarction, coronary artery disease, or congenital hyperlipidemia known or suspected carcinoma of the breast, carcinoma of the female reproductive tract, or other hormone-dependent/responsive neoplasias abnormal undiagnosed vaginal bleeding known or suspected pregnancy and past or present liver tumors or impaired liver function. The risk of serious cardiovascular side effects is particularly marked in women over 35 years of age who smoke heavily (e.g., >15 cigarettes/day) even low-dose oral contraceptives are contraindicated in such patients. 

Five patients (aged 23 to 58) treated for germ cell tumours died from unexpected acute life-threatening vascular events (myocardial infarction, rectal infarction, cerebrovascular accident) after treatment with VBP (vinblastine, bleomycin, cisplatin). A survey of the literature by the authors of this paper revealed 14 other cases of both acute and long-term cardiovascular problems (myocardial infarction, coronary heart disease, cerebrovascular accident) in patients given VBP. ... 

However, most pathological conditions, believed to involve derangements in the thromboxane biosynthesis - or in the thromboxane/prostacyclin balance - concern the cardiovascular system. A large number of diseases affecting this organ system have been studied in this respect, i.e. atherosclerosis, myocardial infarction, coronary artery disease with angina of various etiologies, thrombotic disorders, hemostatic defects, circulatory shock, ulcerative diseases, and so on. The possible roles of thromboxane and prostacyclin in the cardiovascular system have been discussed in several reviews, e.g. refs. 32, 33, 348-354. 

The heart attack occurs when one or more of the coronary arteries, which are responsible for supplying blood to the heart muscle, becomes blocked. The part of the heart that is consequentially robbed of oxygen and nutrients and therefore damaged is called an infarct. From this, the terms of myocardial infarct, coronary occlusion and coronary thrombosis (blood clot) all refer, either more or less precisely, to what is called a heart attack . 

Administration of nicotinic add for five years at dose of 3 g/day as monotherapy in the Coronary Drug Projed study led to marked secondary prevention of myocardial infarction (Coronary Drug Project 1975). Importantly, niacin is also being shown to have long-term benefit in decreasing mortality after discontinuation of treatment a follow-up for 15 years of Coronary Drug Project revealed that niacin decreased mortality in patients treated with niacin (Canner et al. 1986). 

The health risks and benefits from vitamin D and calcium supplementation have been evaluated from a clinical trial and cohort study including 36,282 postmenopausal women who were given 1000 mg elemental calcium carbonate plus 400 lU of vitamin D3 daily or placebo over a 7-year period [42 ]. There was no significant effect on myocardial infarction, coronary heart disease, total heart disease, stroke, overall cardiovascular disease, colorectal cancer or overall mortality. 

Right bundle-branch block occurs with such conditions as anterior-wall myocardial infarction, coronary artery disease, and pulmonary embolism. However, it also may occur without cardiac disease. If it develops as the patient s heart rate increases, it s known as rate-related right bundle-branch block. 

There is a close correlation between myocardial infarctions and tachyarrhythmias, illustrated by the presence of complex ventricular arrhythmias among heart attack victims which are estimated to affect one-third of the survivors each year. Frequendy, the immediate cause of sudden death is ventricular fibrillation, an extreme arrhythmia that is difficult to detect or treat. In the majority of cases, victims have no prior indication of coronary heart disease. 

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. 

A third study (85) enrolled 7825 hypertensive patients (55% males and 45% females) having diastoHc blood pressures (DBP) of 99—104 mm Hg (13—14 Pa) there were no placebo controls. Forty-six percent of the patients were assigned to SC antihypertensive dmg therapy, ie, step 1, chlorthaUdone step 2, reserpine [50-55-5] or methyldopa [555-30-6], and step 3, hydralazine [86-54-4]. Fifty-four percent of the patients were assigned to the usual care (UC) sources in the community. Significant reductions in DBP and in cardiovascular and noncardiovascular deaths were noted in both groups. In the SC group, deaths from ischemic heart disease increased 9%, and deaths from coronary heart disease (CHD) and acute myocardial infarctions were reduced 20 and 46%, respectively. 

Indications for treatment with streptokinase include acute occlusion of arteries, deep vein thrombosis, and pulmonary embolism. Streptokinase therapy in coronary thrombosis, which is the usual cause of myocardial infarction (54,71,72), has proved to be valuable. In this frequently fatal condition, the enzyme is adrninistered intravenously at a dose of 1.5 million units over 60 min, or given by intracoronary infusion at a 20,000- to 50,000-unit bolus dose followed by 2000 to 4000 units/min for 60 min therapy must be instituted as soon as practicable after the diagnosis of heart attack is made. For deep vein thrombosis, pulmonary embolism, or arterial occlusion, streptokinase is infused at a loading dose of 250,000 units given over 30 min, followed by a maintenance dose of 100,000 units over a 60-min period. 

Meticulous care needs to be used in the application of this tissue adhesive. Only a very thin layer of adhesive should be used to assist with reapproximation of the intima and adventitia. It is important to remember that the material should not be allowed to drip into or onto critical areas such as the ostium of the coronary arteries. Inadvertent placement of this agent in such areas can result in blockage of a critical artery and a potentially fatal myocardial infarction. In addition. 

Fondaparinux, the factor Xa-binding pentasaccharide (Arixtra, MW 1,728 Da), is prepared synthetically, unlike UFH, LMWH and danaparoid, which are obtained from animal sources. Despite only inactivating free factor Xa, clinical trials indicate that fondaparinux is an effective antithrombotic agent, both for venous thromboembolism prophylaxis and treatment, as well as for acute coronary syndrome and ST elevation myocardial infarction [4]. 

GPIIb/IIIa antagonists have to be administered parenterally. They are currently used prophylactically during intracoronary interventions such as percutaneous transluminal revascularization with balloon angioplasty or intracoronary stenting, as well as to treat acute coronary syndromes like unstable angina and acute myocardial infarction. The main complications... 

Acute coronary syndromes most often result from a physical disruption of the fibrous cap, either frank cap fracture or superficial endothelial erosion, allowing the blood to make contact with the thrombogenic material in the lipid core or the subendothelial region of the intima. This contact initiates the formation of a thrombus, which can lead to a sudden and dramatic blockade of blood flow through the affected artery. If the thrombus is nonocclusive or transient, it may either be clinically silent or manifest as symptoms characteristic of unstable angina. Importantly, if collateral vessels have previously formed, for example, due to chronic ischemia produced by multi vessel disease, even total occlusion of one coronary artery may not lead to an acute myocardial infarction. 

---