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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.
Drug therapy in the cardiac catheterisation laboratory: A guide to commonly used drugs
Published in John Edward Boland, David W. M. Muller, Interventional Cardiology and Cardiac Catheterisation, 2019
John Edward Boland, Fuyue Jiang, Andrew Fenning
Usual dose is 5–10 mg intravenously over 5–10 minutes and can be given orally for long-term therapy. Combination therapy with beta-blockers can be potentially dangerous as the combination can induce profound bradycardia and heart block. Diltiazem has similar rate controlling effects. Dihydropyridine calcium channel blockers such as amlodipine and felodipine do not slow ventricular rate and can be used in combination with beta blockers, but should not be used unopposed in patients with ischaemic heart disease, as they may induce ischaemia due to tachycardia.
Systemic hypertension in the elderly
Published in Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich, Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
Wilbert S. Aronow, William H. Frishman
Short-acting dihydropyridine calcium channel blockers have the potential to increase cardiovascular events and should be avoided (94). Verapamil and diltiazem depress the sinus node and the atrioventricular node and are contraindicated in patients with severe sinus bradycardia, sinoatrial disease, and marked first-degree, second-degree, and third-degree atrioventricular block (94,95).
Safety of ramucirumab treatment in patients with advanced hepatocellular carcinoma and elevated alpha-fetoprotein
Published in Expert Opinion on Drug Safety, 2022
Overall management includes routine blood pressure monitoring, regular urinalysis, risk stratification, fluid restriction, and administration of the appropriate antihypertensive and/or renoprotective agents. Hypertension, proteinuria, and peripheral edema are mechanistically correlated; therefore, the management shares beneficial interactions. Angiotensin-converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARBs) are recommended therapeutic choices owing to their pleiotropic protective effects on the cardiovascular and renal systems [59]. Dihydropyridine calcium channel blockers are safe alternatives in patients with contraindications to ACEi or ARB. Stricter targets for hypertensive control may be followed to the established evidence such as the Systolic Blood Pressure Intervention Trial [60]. Based on known mechanistic interactions between NO and VEGF inhibition, in addition to discontinuation of ramucirumab, long-acting nitrates or phosphodiesterase inhibitors could be administered in refractory and severe cases [61]. Renal biopsy evaluation is warranted to determine the etiology, guide further interventions and permanent discontinuation of therapy, in patients with nephrotic syndrome or renal function decline [62].
Cardiovascular involvement in patients affected by multiple myeloma: a comprehensive review of recent advances
Published in Expert Review of Hematology, 2021
Massimiliano Camilli, Giulia La Vecchia, Rosa Lillo, Giulia Iannaccone, Priscilla Lamendola, Rocco Antonio Montone, Stefan Hohaus, Nadia Aspromonte, Massimo Massetti, Gaetano Antonio Lanza, Filippo Crea, Francesca Graziani, Antonella Lombardo
Hypertension is the most common CV comorbidity reported in cancer registries, in which elevated blood pressure is usually found in more than one-third of the patients [114]. Among MM regimens, PIs (carfilzomib) have demonstrated a direct pressor effect. Indeed, for patients on carfilzomib who develop uncontrolled hypertension, drug dosage reduction should be considered [22]. High blood pressure may, however, frequently occur with each of the MM regimens cited. Patients developing high blood pressure (>140/90 mmHg), or showing an increase in diastolic blood pressure >20 mmHg compared with pre-treatment values, should initiate or optimize antihypertensive therapy [114]. For this purpose, ARBs and dihydropyridine calcium channel blockers are proposed as first-line therapies, with a combination strategy frequently needed [5]. Moreover, ACEi and BBs are the preferred antihypertensive drugs in patients with concomitant HF or at risk for LV dysfunction [5,105]. On the other hand, patients with AL-CA present an increased risk of postural and/or exertional arterial hypotension due to autonomic dysregulation. The most commonly used drug in autonomic neuropathy is midodrine, an α1 agonist which increases vascular tone and hence elevates BP [67,86]. In case of unresponsiveness, fludrocortisone may be considered, and other possible treatments are pyridostigmine and droxidopa [67,86].
Angiotensin axis antagonists increase the incidence of haemodynamic instability in dihydropyridine calcium channel blocker poisoning
Published in Clinical Toxicology, 2021
Jessica Huang, Nicholas A. Buckley, Katherine Z. Isoardi, Angela L. Chiew, Geoffrey K. Isbister, Rose Cairns, Jared A. Brown, Betty S. Chan
Dihydropyridine calcium channel blockers (CCBs) such as amlodipine, felodipine, lercanidipine and nifedipine are used as first-line treatment for essential hypertension [1]. In 2015, amlodipine was the fourth most commonly dispensed medication in Australia and the second most commonly prescribed antihypertensive medication by defined daily dose per day [2]. Dihydropyridine CCBs are perceived to be safer at therapeutic doses than non-dihydropyridine CCBs, such as verapamil and diltiazem, as they have more vascular selectivity and less negative chronotropy and inotropy [3]. Despite this, amlodipine is the leading contributor to cardiovascular drug related poisoning deaths (31.5%) in the USA [4]. Dihydropyridine overdose involves a loss of vascular selectivity [5,6] and a decrease in systemic vascular resistance to cause haemodynamic instability with hypotension and reflex tachycardia [7]. This may lead to vasodilatory shock [8,9].