Perioperative cardiovascular evaluation and treatment of elderly patients undergoing noncardiac surgery
Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich in Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
Patients with severe mitral stenosis are at increased risk for complications from noncardiac surgery and should be managed similarly to patients with aortic stenosis. The major concerns in the patient with mitral stenosis undergoing noncardiac surgery are (1) maintaining hemodynamic stability; and (2) decreasing the incidence of perioperative arrhythmia such as atrial fibrillation (AF). Increases in heart rate reduce LV filling across the stenotic mitral valve and increases the transmitral pressure gradient. Patients with mitral stenosis can become symptomatic with tachycardia, which frequently manifests during the perioperative period. Beta-blockers may be used to reduce heart rate in an attempt to optimize hemodynamic conditions. Antiarrhythmic agents may be considered to prevent the development of AF since this arrhythmia is particularly likely in these patients.
Resistant Hypertension: Medical Treatment
Giuseppe Mancia, Guido Grassi, Konstantinos P. Tsioufis, Anna F. Dominiczak, Enrico Agabiti Rosei in Manual of Hypertension of the European Society of Hypertension, 2019
Specialist advice should be sought at a dedicated tertiary BP clinic if BP remains uncontrolled (3–5). At this stage, a stepwise addition of a beta-blocker (with exception of atenolol), an alpha-blocker and a centrally acting alpha-agonist is preferred (Figure 48.1). Beta-blockers can be used particularly in patients with coronary artery disease, heart failure, arrhythmia or chronic kidney disease (3–5). Direct vasodilators (hydralazine or minoxidil) should be avoided, because they may induce fluid retention and tachycardia (3–5). Dual RAS blockade with ACEI and ARBs or with direct renin inhibitors should not be used (3,4) because such combinations (i) are not effective for lowering BP 47, and (ii) are associated with a higher risk of hyperkalaemia, hypotension and acute renal failure (48).
Headache associated with vascular disease: migraine and stroke
Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby in Headache in Clinical Practice, 2018
Epidemiologic studies indicate that migraine is an independent risk factor for stroke (especially in young women). Certainly, migraine patients should be advised not to smoke. Vasoconstrictive medications should be limited or avoided when patients have hemiplegic migraine, basilar migraine, and migraine with prolonged aura. Despite controlled trials that show they are safe and effective, there is some controversy about the use of beta-blockers in migraine with aura. Bl-selective blockers, which have no adverse effect on platelet function, can be used in preference to nonselective beta-blockers, which can increase platelet aggregability. We prefer to use calcium-channel blockers, such as verapamil, as preventive treatment for patients with migraine with aura. Divalproex sodium, a Food and Drug Administration-approved migraine medication, is not vasoactive and is an excellent first-choice drug for preventive therapy for migraineurs with aura, especially those for whom vasoactive medications are contraindicated.195 Topiramate, gabapentin, and lamictalT (lamotrigne) are other options.196
Effects of interval training versus continuous training on coronary artery disease: an updated meta-analysis of randomized controlled trials
Published in Physiotherapy Theory and Practice, 2021
Lei Chen, Lin Tang
Reportedly, beta-blocker therapy is a useful method in patients with CAD. Beta-blockers have a significant influence on hemodynamic parameters, which can reduce the blood pressure, heart contractility, and HR during exercise (Wonisch et al., 2003). Díaz-Buschmann, Jaureguizar, Calero, and Aquino (2014) have observed that resting HR, peak HR, and HRR are significantly lower in patients with beta-blocker treatment than without treatment. As a result, the optimal intensity of exercise should be different between patients with and without beta-blocker treatment, briefly, patients not treated with a beta-blocker should exercise at HR85%, while patients on a beta-blocker should at HR80%, accordingly, recommendations of exercise training were a difference for these patients. However, the effect of beta-blocker was not involved in the present study, which should be conducted in further study.
Common systemic medications that every optometrist should know
Published in Clinical and Experimental Optometry, 2022
Rachel Williams, Alex Hui
Hypertension is defined as sustained elevation of resting systolic blood pressure (≥ 130 mmHg), diastolic blood pressure (≥ 80 mmHg), or both. Hypertension is a common and important risk factor for cardiovascular and renal diseases. In 2017, an estimated 4.1 million working-age Australians (25.9%) had hypertension, of whom an estimated 21.6% were treated and controlled, 17% were treated but uncontrolled, and 61.4% were untreated.6 The pathogenesis of hypertension is multifactorial and complex. The most common blood pressure medications are angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers, beta blockers, and diuretics. However, many patients use more than one class of medication to adequately control their hypertension. Vasodilators such as ACE inhibitors and calcium channel blockers aim to reduce blood pressure through vessel dilation. Beta blockers reduce cardiac output by reducing sympathetic influences. Diuretics are effective in reducing blood volume and cardiac output by increasing urine output from the kidneys.7
Focus on cardiometabolic risk factors
Published in Acta Cardiologica, 2023
Patrizio Lancellotti
Glucagon-like peptide-1 receptor agonists (GLP-1RAs), a group of novel antidiabetic agents, demonstrated beneficial cardiovascular effects in recent large, placebo-controlled randomised clinical trials (RCTs) [18]. In patients with type 2 diabetes mellitus, treatment with GLP-1RAs does not significantly affect the risk for major cardiac arrhythmias [19]. The abnormal composition of the gut microbiota is linked to the pathogenesis and propagation of CVD and CVD risk factors. Nagarajan’s review discussed various aspects of the interaction between the microbiome and the immune system in order to reveal causative links relating dysbiosis and autoimmune diseases with special emphasis on rheumatic heart disease [20]. Hypothyroidism can result in decreased cardiac output, increased systemic vascular resistance, decreased arterial compliance, and atherosclerosis. Subclinical hypothyroidism is a highly prevalent disease worldwide but remains challenging to diagnose. The influence of subclinical thyroid dysfunction on the heart and cardiovascular system has been much less studied, necessitating additional studies [21]. Beta-blockers block are widely prescribed for angina, heart failure and some heart rhythm disorders, and to control blood pressure. In patients with myocardial bridge, beta-blockers have a beneficial effect on left ventricular function [22].
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