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Coronary Artery Disease
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Sublingual nitroglycerin is usually able to quickly relieve variant angina. Symptoms can be prevented by using calcium channel blockers. The most commonly used drugs in this class include sustained-release diltiazem, sustained-release verapamil (though doses must be reduced if there is kidney or liver dysfunction), and amlodipine (though doses must be reduced with liver dysfunction or in elderly patients). These drugs do not appear to change the prognosis, however. Though not proven clinically, it is theorized that beta-blockers can worsen spasms by allowing alpha-adrenergic vasoconstriction to occur. For diabetic patients, bisoprolol must be used carefully since it can mask symptoms of hypoglycemia. However, this is not an issue in nondiabetic patients with variant angina.
Cardiac diseases in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Saravanan Kuppuswamy, Sudarshan Balla
In asymptomatic patients, management involves avoiding situations that increase the outflow tract obstruction such as hypovolemia, vasodilatation, and medications like digoxin, inotropes, and diuretics (Table 8). For symptomatic pregnant patients, treatment should be aimed at alleviating symptoms with beta blockers or non-dihydropyridine calcium channel blockers. Arrhythmias, both atrial and ventricular, occur frequently in patients with hypertrophic cardiomyopathy. General measures during labor and delivery in these patients include laboring in the left lateral decubitus position to maximize venous return to the heart, avoidance of hypovolemia, and a shortened second stage of labor. Prostaglandins, such as PGE2 (because of their vasodilatory effect), and beta-adrenergic stimulants should be avoided in these patients.
Anesthetic Management for Surgical Myectomy in Hypertrophic Cardiomyopathy
Published in Srilakshmi M. Adhyapak, V. Rao Parachuri, Hypertrophic Cardiomyopathy, 2020
Heather K. Hayanga, Jeremiah W. Hayanga, Joseph McGuire, Vinay Badhwar
The diagnosis may be made from a combination of history, physical examination, and echocardiographic and/or conventional imaging that highlights the obstructive pathology showing LVH is not attributable to another disease process. In patients who already have a diagnosis of HCM, a standard preoperative history and physical will be necessary. The history should provide answers to the specific questions pertaining to clinical presentation that led to the diagnosis as well as a history of arrhythmias. Symptoms may include impaired exercise capacity, dyspnea on exertion, angina, lightheadedness, or prior syncopal episodes [14]. Medications including chronic beta blockers or calcium channel blockers should be continued [15]. On physical examination, a characteristic harsh crescendo-decrescendo systolic murmur may be auscultated on the left sternal border. This does not radiate to carotids but is accentuated by any decrease in preload [10, 16]. Furthermore, a displaced cardiac apex, and third or fourth heart sounds, may be appreciated [14].
Solanaceae glycoalkaloids: α-solanine and α-chaconine modify the cardioinhibitory activity of verapamil
Published in Pharmaceutical Biology, 2022
Szymon Chowański, Magdalena Winkiel, Monika Szymczak-Cendlak, Paweł Marciniak, Dominika Mańczak, Karolina Walkowiak-Nowicka, Marta Spochacz, Sabino A. Bufo, Laura Scrano, Zbigniew Adamski
Calcium ions play a crucial role in muscle contractions, and therefore, L-type calcium channels that move Ca2+ ions inward and trigger calcium release from the sarcoplasmic reticulum by activating the ryanodine receptor 2 (Striessnig et al. 2014) are just as important. Dysregulation of L-type Ca2+ channels is the basis of numerous cardiac disorders; therefore, they are also a common target in various therapies for cardiovascular diseases. L-type Ca2+ channel blockers, such as verapamil, are commonly used to treat hypertension, myocardial ischaemia, and arrhythmias (Limpitikul et al. 2018). The so-called α1 subunit forms the core of voltage-sensitive L-type Ca2+ channels. It associates with other subunits (β, α2δ, γ) to form heterooligomeric complexes. The β and α2/δ subunits are tightly but not covalently bound to the α1 subunit and modulate the biophysical properties and trafficking of the α1 subunit to the membrane (Bodi et al. 2005). The presence of L-type Ca2+ channels were also confirmed in the myocardium of Drosophila melanogaster (Limpitikul et al. 2018) and Musca domestica (Grabner et al. 1994). This tissue builds the dorsal vessel of the insect, traditionally called the heart. Even if not anatomically, the insect heart functionally and developmentally resembles the embryonic vertebrate heart. Thus, it offers an attractive alternative for studies conducted on mammals. Furthermore, many analyses can be performed in vivo without the need to sacrifice the test animal (Limpitikul et al. 2018).
Immunomodulatory properties of antihypertensive drugs and digitalis glycosides
Published in Expert Review of Cardiovascular Therapy, 2022
Paweł Bryniarski, Katarzyna Nazimek, Janusz Marcinkiewicz
Calcium channel blockers reduce the entry of calcium ions into muscle cells. Drugs from this class are divided into two subgroups. Both of these subgroups influence the arteries, relaxing them. Non-dihydropyridine derivatives (diltiazem, verapamil) affect the heart, slowing the frequency of its contractions and reducing its contractility. In contrast, dihydropyridine derivatives (nitrendipine, isradipine, nifedipine, amlodipine, lacidipine, and felodipine) do not have such effects. Indications for the use of calcium channel blockers are coronary artery disease (especially Prinzmetal’s angina), hypertension and arrhythmias (verapamil and diltiazem). The most important contraindications to the use of verapamil and diltiazem are symptomatic bradycardia, sick sinus syndrome, atrioventricular block, Wolf-Parkinson-White syndrome, too low blood pressure (hypotension) and heart failure. In the case of other calcium antagonists, the most important contraindications are severe aortic stenosis, hypertrophic cardiomyopathy with outflow tract obstruction, acute coronary syndrome, hypotension and heart failure. Side effects of calcium antagonists are swelling (mainly of the feet and shins), headache, facial flushing, constipation, slow heart rate, hypotension, and rash.
Treatment of brief episodes of highly symptomatic supraventricular and ventricular arrhythmias: a methodological review
Published in Expert Review of Medical Devices, 2021
Rita B. Gagyi, Mark Hoogendijk, Sing-Chien Yap, Tamas Szili-Torok
The diagnosis of short-lived arrhythmias is difficult; therefore, it can be established with certainty only by an electrophysiology (EP) study. The current mapping approaches are described in the next section. Data for an evidence-based choice of drugs for the pharmacological therapy of supraventricular arrhythmias are deficient. However, current guidelines recommend initiation of therapy with beta-blockers or calcium channel blockers. In the case of nonsustained or short-lived arrhythmias guidelines recommend no drug therapy but targeted CA [10]. At the ventricular level, guidelines recommend beta-blocker therapy for PVCs and nonsustained VTs as pharmacological approach. Catheter ablation, however, is an important treatment option for patients with ventricular arrhythmias when antiarrhythmic medication is ineffective, not tolerated or not desired by the patient [11].