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Cardiovascular Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Cardiac surgery is an effective treatment for ischaemic heart disease and valve disease, relieving symptomatic angina and prolonging survival in selected patient groups. Standard indications for coronary artery bypass surgery include left main stem or triple vessel coronary artery disease, particularly in patients with diabetes and/or LV dysfunction where there is prognostic benefit. Surgery is offered for severe heart valve disease providing specific criteria are met, with either repair or replacement with bioprosthetic or mechanical valves. Surgical treatments for severe HF include cardiac transplantation or LV assist device implantation for eligible patients. Patients with complex congenital heart disease frequently require surgical correction.
The cardiovascular system
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Mary N Sheppard, C. Simon Herrington
The incidence of ischaemic heart disease is an indicator of the extent of atherosclerosis in a community. Epidemiological studies have identified many risk factors associated with an increased or decreased risk of developing ischaemic heart disease but only the major factors are discussed here. Age, sex, and heredity are all important, but hyperlipidaemia, hypertension, cigarette smoking, and diabetes are the most important because they are modifiable (Table 7.4).
Answers
Published in Andrew Schofield, Paul Schofield, The Complete SAQ Study Guide, 2019
Andrew Schofield, Paul Schofield
The major risk factors for ischaemic heart disease are smoking, hypertension, diabetes and hypercholesterolaemia. For the diagnosis of myocardial infarction, two of the following are required: cardiac-sounding chest pain, positive ECG changes and raised biochemical markers. If the ECG shows ST elevation, the diagnosis is an ST-segment elevation myocardial infarction (STEMI). If the cardiac enzymes are raised and the chest pain sounds cardiac, the diagnosis is a non-ST-segment elevation myocardial infarction (NSTEMI). Both are encompassed by the term acute coronary syndrome (ACS), as is unstable angina. This is angina of new onset, angina that is increasing in severity or frequency or angina that comes on with minimal exertion or at rest. Cardiac chest pain is often described as a crushing or heavy central pain and may radiate to the neck/jaw or arms. Many centres now offer 24-hour PCI, and this is the treatment of choice for the majority of patients. Following a myocardial infarction, patients should be taking aspirin, an ACE inhibitor, a β-blocker and a statin as long as there are no contraindications. In addition to these, clopidogrel should be taken for 1 year if PCI has been performed. Nonpharmacological measures also play a significant role, including cardiac rehabilitation programmes, smoking cessation, encouraging weight loss and dietary changes.
Understanding the role of alternative macrophage phenotypes in human atherosclerosis
Published in Expert Review of Cardiovascular Therapy, 2022
Kenji Kawai, Aimee E. Vozenilek, Rika Kawakami, Yu Sato, Saikat Kumar B Ghosh, Renu Virmani, Aloke V. Finn
Atherosclerotic lesions develop over time and hamper blood flow to vital organs. Narrowing of coronary and peripheral vessels due to atherosclerosis causes clinical symptoms (i.e. chest pain/angina pectoris for coronary arterial disease and claudication for peripheral arterial disease). A sudden rupture of an otherwise non-flow limiting coronary atherosclerotic plaque can cause thrombosis, which itself can lead to ischemia [1]. Rupture of coronary plaque is the leading cause of myocardial infarction, a major cause of death [2]. In 2019, as reported by the World Health Organization (WHO), ischemic heart disease was the leading cause of death and accounted for 16% of all deaths. The incidence of ischemic heart disease is expected to continue increasing in coming years, due to increasing prevalence of co-morbidities such as obesity, diabetes, and metabolic syndrome [3].
The prognostic role of intra-aortic pulse pressure measured before percutaneous coronary intervention in patients with chronic coronary syndrome: a single-center, retrospective, observational cohort study
Published in Clinical and Experimental Hypertension, 2022
Despite recent advances in diagnosis and treatment, patients with ischemic heart disease are at high-risk of adverse cardiac events. Therefore, the identification of potential prognostic factors is crucial for classifying high-risk patients. PP is a simple and beneficial BP variable reflecting stiffness and pulse wave velocity of the aorta and large arteries (3). Numerous studies on the general population, in hypertensives and, in high-risk patients have supported aortic stiffness as a robust and independent predictor of cardiovascular outcomes (10–12). The IAPP has been thought to be mainly determined by the stiffness of the aorta and is closely associated with adverse cardiac events (13). Although IAPP is influenced by both LV ejection dynamics and pressure wave reflection, the main determinant of PP is considered to LV ejection dynamics (14). Thus, PP is closely related to cardiac performance and stroke volume.
What is the current value of beta-adrenoreceptor antagonists for angina?
Published in Expert Opinion on Pharmacotherapy, 2022
Jayakumar Sreenivasan, Urvashi Hooda, Wilbert S. Aronow
Ischemic heart disease is one of the leading causes of mortality worldwide [1]. Management of patients with stable ischemic heart disease involves risk modification, anti-platelet therapy, anti-anginal pharmacotherapy, and selective coronary revascularization for refractory angina despite maximal medical therapy. Clinical trials comparing revascularization and medical therapy showed that revascularization does not provide a survival benefit or improve exercise tolerance in patients with stable angina. Guidelines recommend beta-blockers, calcium channel blockers, and nitrates as the first-line anti-anginal agents. Ranolazine is used as a second-line agent in patients unable to tolerate first-line anti-anginal agents due to side effects or as a combination therapy with first-line agents in patients with residual angina. Ivabradine, nicorandil, and trimetazidine are other newer drugs that are being studied for angina. Although current guidelines recommend a hierarchical approach to the treatment of angina, there is no evidence for the superiority of one anti-anginal agent over the others. Beta-adrenoreceptor blockers have been used for chronic coronary artery disease since the 1960s. Beta-blockers significantly reduce mortality in patients with recent myocardial infarction and left ventricular dysfunction, while there is limited evidence to support such a mortality benefit in stable ischemic heart disease with normal ejection fraction. This editorial inspects the evidence behind the current use and future of beta-blockers for the treatment of angina.