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Cardiovascular Drugs during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Antianginal agents are potent vasodilators with organic nitrites are the most commonly used agents (Box 3.2). Nitroglycerin is the prototype organic nitrite agent. No human studies of organic nitrites in pregnant women are published. These agents were not associated with an increased frequency of birth defects in rats and rabbit studies when exposure occurred during organogenesis.
Coronary Artery Disease
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
CABG is preferred over PCI if the patient has left main or left main equivalent angina, left ventricular dysfunction, or diabetes mellitus that is being treated. Lesions that are long or close to bifurcation points are often not successfully treated with PCI. All unstable angina patients are given anticoagulants, antiplatelet drugs, and when chest pain is present, antianginal drugs. The drug regimen is based on reperfusion strategy. Unless contraindicated, the drugs for unstable angina include unfractionated or low molecular weight heparin (or bivalirudin); aspirin, clopidogrel, or both, with alternatives to clopidogrel being prasugrel or ticagrelor; nitroglycerin or another antianginal drug; beta-blockers; ACE inhibitors; statins; and if PCI is done, a glycoprotein IIb/IIIa inhibitor may be required. Aspirin is not of the enteric-coated type. Chewing the first dose before it is swallowed will speed up absorption, and reduce short- and long-term risks of death. For patients having PCI, a loading dose of clopidogrel, prasugrel, or ticagrelor will improve results, especially when given 24 hours before the procedure. If the patient requires urgent PCI, prasugrel and ticagrelor work more quickly than clopidogrel, so they are often preferred.
Atherosclerosis
Published in Nicholas Green, Steven Gaydos, Hutchison Ewan, Edward Nicol, Handbook of Aviation and Space Medicine, 2019
Nicholas Green, Steven Gaydos, Hutchison Ewan, Edward Nicol
Evaluation following ACS and/or revascularisation should include assessment of: Ventricular function, including consideration of presence of myocardial scar.Symptoms (off anti-anginal medication).Ischaemia.Arrhythmia.Risk factor modification.
Adipokine gene expression in adipocytes isolated from different fat depots of coronary artery disease patients
Published in Archives of Physiology and Biochemistry, 2022
Maxim Yu. Sinitsky, Yulia A. Dyleva, Evgenya G. Uchasova, Ekaterina V. Belik, Arseniy E. Yuzhalin, Olga V. Gruzdeva, Vera G. Matveeva, Anastasia V. Ponasenko
Grades I–II stable angina and arterial hypertension was diagnosed in all patients included in the study and direct myocardial revascularization by coronary artery bypass surgery was performed. All patients received standard antianginal and antiagregatory treatment (β-blockers, aspirin, statins and angiotensin-converting enzyme inhibitors). The majority (56%) of patients were overweight (BMI = 25.10–29.76), 24% suffered from obesity (BMI = 30.35–34.38) and 20% had a normal weight (BMI = 20.42–22.86). Glucose concentration measured in plasma of CAD patients was increased relative to reference values both in males and females; moreover, females were characterised by a more pronounced increase in glucose level compared with males. Average total cholesterol plasma level was within the normal range both in males and females and only six patients were characterised by an increase of this indicator (5.7 mmol/L–8.8 mmol/L). In one patient, this increase was due to an excess of LDL cholesterol, in the rest of the patients – due to excess of VLDL cholesterol. 5% of males and 33% of females were characterised by an increased level of triglycerides compared to the reference value range. At the same time we identified no significant differences in studied indicators between males and females. The full list of clinico-pathological characteristics of patients included in this study is presented in Table 2.
Incidence and risk markers of 5-fluorouracil and capecitabine cardiotoxicity in patients with colorectal cancer
Published in Acta Oncologica, 2020
Anne Dyhl-Polk, Merete Vaage-Nilsen, Morten Schou, Kirsten Kjeldgaard Vistisen, Cecilia Margareta Lund, Thomas Kümler, Jon Michael Appel, Dorte Lisbet Nielsen
The effect of dose reduction and/or antianginal therapy on cardiac symptoms during retreatment was modest to poor in this study. Previous studies have reported slightly better outcomes [16,17], but the evidence is limited to case series. The impact of dose reductions on cancer recurrence or progression is not well documented. A retrospective study of adjuvant chemotherapy for stage III colon cancer reported no association between relative dose intensity and recurrence-free or overall survival [34], while another study found better 5-year overall survival for relative dose intensities >70% compared to relative dose intensities <70% [35]. In the metastatic setting, two retrospective studies found no effect of dose reduction or low dose intensities on overall survival and time to treatment failure [36,37]. Thus, the scientific evidence to guide the clinical decision regarding whether or not to retreat with these drugs is sparse, but the minor risk of severe cardiotoxicity should be weighed against the expected treatment benefit.
The coronary sinus Reducer device for refractory chronic angina: rationale, clinical evidence and future perspectives
Published in Expert Review of Medical Devices, 2018
Rocco A. Montone, Michele Russo, Francesco Giannini, Giampaolo Niccoli
The hypothesis that an increased coronary sinus pressure could have antianginal effects was proposed by Claude Schaeffer Beck, a pioneer American cardiac surgeon, that in 1950’s and 1960’s obtained a significant relief of angina symptoms in patients suffering from severe disabling angina, by performing a 60–70% narrowing of coronary sinus [6]. Other surgeons confirmed his results in the next years stimulating the research on devices able to update Beck’s hypothesis on new technologies. The physiological mechanism behind the antianginal effect of coronary sinus intervention is that coronary sinus increasing pressure provides a direct retrograde access route to ischemic myocardium for blood flow. Indeed, in patients with epicardial coronary disease there is a dysfunction in normal physiological compensatory mechanism of blood redistribution from subepicardial layers to subendocardial ones during stress. In this condition the normal ratio between subendocardial and subepicardial blood flow is altered, in favor of second one, so that subendocardium perfusion is compromised during stress, causing angina symptoms [7]. It has been supposed that an increased pression in the coronary venous system could determine a vasodilatation of the arterioles, reducing resistances in the subendocardium vessels and favoring a blood redistribution from subepicardial layers to subendocardium, with a reduction of subendocardium ischemia and, consequently, angina symptoms [7,8].