Coronary heart disease medical therapy
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Coronary heart disease medical therapy On the Web
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Goals for treating coronary artery disease include lowering blood pressure, maintaining HbA1c levels to less than 7%, and lowering LDL cholesterol. Long-term treatment will generally depend on the symptoms and severity of disease, and include aspirin, ACE inhibitors, and other ani-coagulant and anti-platelet regimens. The mainstay of treatment for stable angina which occurs with exertion, includes nitroglycerin. When unstable angina causes symptoms at rest, or in the setting of an acute myocardial infarction, the immediate therapy is morphine, oxygen, nitrate and aspirin. Angioplasty may also be required in cases of acute coronary syndrome.
Goals of Treatment
- Goals for treating people who have coronary artery disease:
- Treatment depends on symptoms and how severe the disease is. Medications to treat CHD, include:
Medical Therapy for Angina
Angina that occurs regularly with activity, upon awakening, or at other predictable times is termed stable angina and is associated with high grade narrowings of the heart arteries. The symptoms of angina are often treated with nitrate preparations such as nitroglycerin, which come in short-acting and long-acting forms, and may be administered transdermally, sublingually or orally. Many other more effective treatments, especially of the underlying atheromatous disease, have been developed.
Angina that changes in intensity, character or frequency is termed unstable. Unstable angina may precede myocardial infarction, and requires urgent medical attention. It is treated with morphine, oxygen, intravenous nitroglycerin, and aspirin. Interventional procedures such as angioplasty may be done.
- Beta-blockers to lower heart rate, blood pressure, and oxygen use by the heart. These reduce the risk of arrhythmias and improve survival after a heart attack or with heart failure.
- Calcium channel blockers to relax arteries, lower blood pressure, and reduce strain on the heart.
- Diuretics to lower blood pressure and treat congestive heart failure.
- Nitrates (such as nitroglycerin) to stop chest pain and improve blood supply to the heart.
- Statins to lower cholesterol.
Coronary heart disease is considered an absolute contraindication to the use of the following medications:
- Drospirenone and Ethinyl estradiol
- Ethynodiol diacetate and ethinyl estradiol
- Norethindrone acetate and Ethinyl estradiol
- Norgestimate and Ethinyl estradiol
- Norgestrel and Ethinyl estradiol
- Norelgestromin and Ethinyl Estradiol
2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease
ACCF/AHA/SCAI 2011 Guideline for Percutaneous Coronary Intervention and 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death (DO NOT EDIT)
Intravenous Antiplatelet Therapy in Sudden Ischemia Heart Disease (SIHD)
|"1. In patients undergoing elective PCI treated with unfractionated heparin (UFH) and not pretreated with clopidogrel, it is reasonable to administer a GP IIb/IIIa inhibitor (abciximab, double-bolus eptifibatide, or high-bolus dose tirofiban). (Level of Evidence: B)"|
|"1. In patients undergoing elective PCI with stent implantation treated with unfractionated heparin (UFH) and adequately pretreated with clopidogrel, it might be reasonable to administer a GP IIb/IIIa inhibitor (abciximab, double-bolus eptifibatide, or high-bolus dose tirofiban). (Level of Evidence: B)"|
Ventricular Arrhythmias with High Lipids
|"1. Statin therapy is beneficial in patients with CHD to reduce the risk of vascular events, possibly ventricular arrhythmias, and SCD. (Level of Evidence: A)."|
|"1. n-3 polyunsaturated fatty acid supplementation may be considered for patients with ventricular arrhythmias and underlying CHD. (Level of Evidence: B)"|
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