Coronary Artery Disease
Jahangir Moini, Matthew Adams, Anthony LoGalbo in Complications of Diabetes Mellitus, 2022
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.
Angina
Clive Handler, Gerry Coghlan, Nick Brown in Management of Cardiac Problems in Primary Care, 2018
Measure the pulse rate and assess the rhythm. Feel for foot pulses and if they are not present, feel for all the leg pulses. Feel for dilatation or abnormal pulsation of the abdominal aorta, which would prompt investigation (ultrasound or CT) for an aneurysm. Feel the carotid artery upstroke. If it is slow, aortic stenosis should be suspected. If it is hyperdynamic, this may be due to severe anxiety, thyrotoxicosis or another cause of high cardiac output, or to aortic regurgitation. Patients with a heart rate of < 50 bpm or > 100 bpm should have an ECG. If the heart rate is < 50 bpm, β-blockers, diltiazem and ivabradine as antianginal treatments are contraindicated.
Angina pectoris in the elderly
Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich in Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
Given the pharmacological considerations of drug therapy in elderly patients, the specific antianginal drugs can be very effective in controlling symptoms and modifying the underlying pathophysiological process in elderly patients with angina. The classes of drugs commonly used include (1) nitrates; (2) beta-blockers; (3) calcium channel blockers; and (4) antiplatelet and/or anticoagulant agents.
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.
Optimal medical treatment of hypertension in patients with coronary artery disease
Published in Expert Review of Cardiovascular Therapy, 2018
Dhruv Mahtta, Islam Y. Elgendy, Carl J. Pepine
In hypertensive patients with symptomatic chronic CAD, beta-blockers and calcium channel blockers assert well-established antianginal/anti-ischemic effects and in addition, contribute to optimization of BP among younger patients. These two drug classes are often chosen over other agents (such as ACE-I, ARB, or diuretics) which do not provide additional antianginal benefit. A comparison of beta-blockers and non-dihydropyridine calcium channel blockers specifically in patients with hypertension and co-existing CAD showed no significant differences in terms of death, nonfatal myocardial infarction, or nonfatal strokes between the two drug classes [36]. In the light of the results from INVEST and other large randomized trials, no specific recommendations exist regarding the choice of anti-hypertensive agents for patients with CAD. However, the choice of anti-hypertensives should be tailored toward an individual patients’ symptoms (such as exertional angina) or co-morbid conditions (heart failure, diabetes, chronic kidney disease, left ventricular dysfunction, or valvulopathies).
Readmission for Acute Decompensated Heart Failure among Patients Successfully Treated with Transcatheter Aortic Valve Replacement: A PARTNER-1 Substudy
Published in Structural Heart, 2018
John L. Petersen, Eugene H. Blackstone, Jeevanantham Rajeswaran, David J. Cohen, Pamela S. Douglas, Rebecca T. Hahn, Susheel Kodali, Lars G. Svensson, Martin B. Leon
In addition, medications at baseline and hospital discharge were considered. Cardiovascular medications were categorized as antianginal, antiarrhythmic, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, anticoagulant, antiplatelet, alpha blocker, beta blocker, calcium-channel blocker, diuretic, long acting nitrate, non-statin lipid lowering, renin aldosterone antagonist, and statin medications. Noncardiac medications were categorized as antacid, antimicrobial, antiemetic, arthritis, gout, cancer, insulin, oral hypoglycemic, hormonal, ophthalmologic, erectile dysfunction or pulmonary hypertensive medication, immunosuppressive, and urologic. Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers were prescribed to 34% of patients at discharge, beta blockers to 57%, calcium channel blockers to 26%, and aldosterone antagonists to 6% (Table 2).
Related Knowledge Centers
- Angina
- Beta Blocker
- Calcium Channel Blocker
- Coronary Artery Disease
- Nitrate
- Nitroglycerin
- Vasodilation
- Medication
- Endothelium-Derived Relaxing Factor
- Pentaerythritol Tetranitrate