Myocardial infarction phosphodiesterase inhibitors

High risk Has unstable or symptomatic angina, despite treatment Has poorly controlled hypertension Has severe congestive heart failure (NYHA Class III or IV) Had a recent myocardial infarction or stroke within the past 2 weeks Has moderate or severe valvular heart disease Phosphodiesterase inhibitor is contraindicated... 

Low risk Has asymptomatic cardiovascular disease with <3 risk factors for cardiovascular disease Has well-controlled hypertension Has mild, stable angina Has mild congestive heart failure (NYHA class 1) Has mild valvular heart disease Had a myocardial infarction >6 weeks ago Patient can be started on phosphodiesterase inhibitor... 

Nomura, Y., Horimoto, H., Mieno, S., Nakahara, K., Okawa, H., Yoshida, M., and Shinjiro, S. 2003. Repetitive preischemic infusion of phosphodiesterase III inhibitor olprinone elicits cardioprotective effects in the failing heart after myocardial infarction. Mol. Cell. Biochem. 248 179-184. 

PHOSPHODIESTERASE TYPE 5 INHIBITORS NITRATES Risk of severe 1 BP and precipitation of myocardial infarction Additive effect Avoid co-administration... 

CANNABIS PHOSPHODIESTERASE TYPE S INHIBITORS-SILDENAFIL Report of myocardial infarction Both drugs have been independently linked to myocardial infarction. However, the exact mechanism is uncertain Be aware... 

The interaction between phosphodiesterase type-5 inhibitors and nitrates is established, clinically important, potentially serious and even possibly fatal. Sildenafil and organic nitrates of any form are contraindicated both for erectile dysfunction (within 24 hours of each other ) and for pulmonary hypertension because of the risk of precipitating serious hypotension, or even myocardial infarction. The ACC/AHA Expert consensus document provides a useful list of many of the organic nitrates available, whieh inelude glyeeryl trinitrate (nitroglycerin), isosorbide mononitrate, isosorbide dinitrate and illicit substances such as amyl nitrite. ... 

PKG and cyclic nucleotide phosphodiesterases (PDEs) (reviewed by Baxter37). A rapid release of natriuretic peptides and induction of their de novo synthesis occurs in myocardial ischemia. Natriuretic peptides may have a cardioprotective role. BNP-32 administration in perfused rat hearts prior to left main coronary artery occlusion and until 30 min of reperfusion resulted in limitation of infarct size in a concentration dependent manner. Furthermore, this effect was abolished by 5-hydroxydecanoate (presumed to be a selective blocker of mitochondrial KATp channels), L-NAME, an inhibitor of NOS and ODQ, a specific soluble guanyl cyclase inhibitor.38 Similarly, human recombinant ANP limited infarct size and reperfusion arrhythmias in a canine model of coronary occlusion and reperfusion.39... 

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