Cardiovascular Disease Ebooks Catalog

Your Heart and Nutrition

Your Heart and Nutrition

Prevention is better than a cure. Learn how to cherish your heart by taking the necessary means to keep it pumping healthily and steadily through your life.

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Natural Secrets For Healing Your Heart

This eBook is devoted to exposing the secrets that cardiologists and surgeons don't want you to know, and how to take control of your own heart and heal yourself. Eight out of every ten coronary bypasses will not actually help the patient. So why risk being in the 80% that will get no benefit from a bypass? Learn to heal your own heart and keep yourself healthy with this eBook guide. Bob Livingston has poured years of research into his findings, and is now sharing the methods that he has developed from careful, methodical research that the medical industry would never allow. It would make them go bankrupt! You will learn what supernutrient doctors don't want you to know about, and how to make an all-natural, chemical and drug-free blood thinner And even more information that doctors don't want revealed to the public. You don't have to be one of the 70% of Americans diagnosed with heart disease. You can heal your heart!

Natural Secrets For Healing Your Heart Overview

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Author: Bob Livingston
Price: $19.95

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Assessing the benefittoharm balance of lowdose aspirin in preventing strokes and heart attacks

Although there is clear evidence of benefit of acetyl-salicylic acid (aspirin) in secondary prevention of strokes and heart attacks, the question of whether aspirin should also be prescribed for primary prevention in asymptomatic people is still debatable. Trials in primary prevention have given contrasting results (9,10), and aspirin can cause major harms (for example severe gastrointestinal bleeding and hemorrhagic stroke). Furthermore, despite evidence of the efficacy of aspirin in secondary prevention, its use in patients at high risk of strokes and heart attacks remains suboptimal (11). A possible explanation for this underuse may be concern about the relative benefit in relation to the potential risk for serious hemorrhagic events. Accurate evaluation of the benefits and harms of aspirin is therefore warranted. Two meta-analyses have provided some information. The first examined the benefit and harms of aspirin in subjects without known cardiovascular or cerebrovascu-lar disease...

Use in myocardial infarction

In the acute infarction ramipril efficacy (AIRE) study, oral ramipril in 2006 patients with heart failure after acute myocardial infarction resulted in a substantial reduction in deaths within 30 days (11). More trials during and after myocardial infarction have been published and subjected to meta-analysis (12). This very large database provides valuable information on the rate of the most common adverse effects. Of all trials of the effects of ACE inhibitors on mortality in acute myo-cardial infarction, only the CONSENSUS II trial did not show a positive effect. In this trial, enalaprilat was infused within 24 hours after the onset of symptoms, followed by oral enalapril. The reasons for the negative result of CONSENSUS II remain unresolved, but hypotension and a proischemic effect linked to a poorer prognosis have been suggested.

Acute myocardial infarction

Given intravenously within 4-6 hours of the onset of the infarction these drugs can prevent ventricular dysrhythmias and cardiac rupture (335,336). When given orally during the first year after infarction, beta-adreno-ceptors reduce mortality by about 25 (337) and probably more in diabetic subjects (37). Since heart failure, hypotension, and bradycardia are complications of both myocardial infarction and beta-adrenoceptor blockade, it might be assumed that these effects would be more common when the two are combined. However, reviews of the relevant studies (335,338-346) do not suggest that beta-adrenoceptor antagonists, given after acute myocar-dial infarction, either acutely intravenously or for secondary prophylaxis, increase the incidence of adverse effects or the risk of any particular adverse effect. Nevertheless, patients were rigorously selected for inclusion in these trials less careful decisions to treat may carry increased risks.

Cardiovascular Disease and SERMs

A wealth of epidemiological, clinical, and experimental studies link estrogens with cardiovascular disease (CVD). This evidence has promoted CVD as a key area within the extragenital effects of estrogens. The question is of interest because it directly affects the wide clinical use of estrogens as contraceptive agents or as principal constituents of hormonal therapy (HT) formulations in postmenopausal women. The significance of the subject is further reinforced by the relevance of CVD as a cause of mortality and morbidity in both women and men. CVD is a generic denomination mainly integrated by coronary heart disease (CHD) and stroke. Although not considered as a form of CVD in some instances, venous thromboembolic disease (VTED) shares with the other forms of CVD the territorial assignment, the vascular tree, although clear differences exist in the main pathophysiological mechanisms. In most CVD forms, however, thrombus formation plays a crucial role.

Myocardial Infarction Heart Attack

Loss of myocardium and to improve survival of the patient. About one in ten patients who have unstable angina may develop acute myocardial infarction. Management of myocardial infarction often requires alternative drugs in order to deal more effectively with further complications. For example, the following measures have been indicated 1. Use of sublingual glyceryl trinitrate (if a severe attack of angina occurs, as opposed to myocardial infarction)

Cardiovascular Diseases

1 In 1900 heart disease killed 27,000 and strokes 21,000 U.S. population was about half of today's. A clearcut understanding of the exact pathological mechanism has not yet emerged. Cerebral blood flow, cardiac output, kidney and endocrine gland functions all appear to be normal, at least in the early stages of the disease. There has been no dearth of theories over the years regarding the etiology of the disease. A considerable pool of knowledge and understanding about the illness that, although not complete, has improved treatment. Much of it is due to better drugs and their proper utilization. For example, the benefits or even necessity of treating severe and even moderate hypertension was never seriously questioned. The risk factors of nontreatment were known for some time and are now well documented by large well-executed studies involving thousands of persons, primarily men. Cardiovascular complications ascribable to long-term untreated hypertension include congestive heart...

General Information

Abciximab is used for prevention of cardiac ischemic events in patients undergoing percutaneous coronary intervention and to prevent myocardial infarction in patients with unstable angina who do not respond to conventional treatment. It has also been used for throm-bolysis in patients with peripheral arterial occlusive disease and arterial thrombosis (2).

Drug Administration Drug administration route

The standard regimen for stress testing with intravenous adenosine is 140 micrograms kg minute for 6 minutes. However, in 599 patients a 3-minute infusion was associated with a lower frequency of some adverse effects (specifically flushing, headache, neck pain, and atrioventricular block) and had similar sensitivity in the diagnosis of coronary artery disease (43).

Organs and Systems Cardiovascular

Among other cardiovascular complications, cardiac dysrhythmias were reported in 6-10 of patients, angina pectoris or documented myocardial infarction in 3-4 , and mortality due to myocardial infarction in 1-2 (4). Severe myocardial dysfunction, myocarditis, and cardio-myopathy have been seldom reported (SED-13, 1103) (SEDA-20, 334) (SEDA-22, 406). At-risk patients include those with pre-existing cardiac disease, whereas age, performance status, and sex are not significantly associated with cardiopulmonary toxicity. In view of this risk, it is reasonable to monitor cardiac function and creatine kinase activity closely in all patients, or to exclude those with significant underlying coronary or cardiorespiratory disease. Pretreatment cardiac screening has greatly reduced the incidence of myocardial infarction, ischemia, and related dysrhythmias, and two-dimensional and Doppler echocardiography was suggested to be helpful to anticipate cardiovascular toxicity (25). A reduction in...

Diagnoses in Psychiatric Disorders

Panic Attacks A panic attack, also called an anxiety attack, is a discrete period of intense subjective anxiety accompanied by physical symptoms such as palpitations, shortness of breath, sweating, tremor, nausea, and fears of dying, having a heart attack, or going crazy. Panic attacks often begin suddenly and may last from a few minutes to a few hours. Panic disorder (PD) is the diagnostic label generally applied to people with the syndrome of panic attacks.

See also Prostaglandins General Information

Alprostadil is PGEi available for exogenous administration. Alprostadil is widely used in neonates with cyanotic congenital heart disease to maintain the patency of the ductus arteriosus. Reported adverse effects include fever, apnea, flushing, bradycardia, and hyperostosis. Continuous chronic infusion of alprostadil via a portable pump and neuromuscular electrical stimulation help to improve the quality of life in patients with severe chronic heart failure waiting for a donor heart, as both treatments can be performed at home.

Acute adverse effects of cannabis

Cardiovascular effects Cannabis has profound effects on the cardiovascular system. In inexperienced users it can cause a large increase in heart rate (up to a doubling) and this could be harmful to someone with a previous history of coronary artery disease or heart failure (3R, 4r, 9r). Such patients should therefore be excluded from clinical trials of cannabis-based medicines. The postural hypotension that can be caused by cannabis could also be distressing or possibly dangerous. These cardiovascular effects usually show rapid tolerance on repeated exposure to cannabis, so for healthy subjects they are not of concern.

Susceptibility Factors

The safety and efficacy of amiodarone for supraventricu-lar tachycardia have been studied in 50 infants (mean age 1.0 month, 35 boys) (222). They had congenital heart disease (24 ), congestive heart failure (36 ), or ventricular dysfunction (44 ). Six, who were critically ill, received a loading dose of intravenous amiodarone 5 mg kg over 1 hour, and all took 20 mg kg day orally for 7-10 days, followed by 100 mg day if this failed to control the dysrhythmia, oral propranolol (2 mg kg day) was added. Follow-up was for an average of 16 months. Rhythm control was achieved in all patients. Growth and

Drug Drug Interactions

Had a myocardial infarction or are in heart failure (190,247,248). In a systematic review, the beneficial interaction has been confirmed (249). Four groups of patients who had been studied in EMIAT and CAMIAT (SEDA-21, 198) were defined patients who had taken amiodarone plus beta-blockers, patients who had taken beta-blockers or amiodarone alone, and patients who had taken neither. The relative risks for all-cause mortality and all forms of cardiac death or resuscitated cardiac arrest were lower in the patients who had taken amiodarone plus beta-blockers than in the other three groups. The results of this post hoc analysis should be regarded with caution, but in view of previous similar reports they are suggestive of a beneficial interaction of amiodarone with beta-blockers in patients who have had a previous myocardial infarction. The interaction was statistically significant for cardiac deaths and for dysrhythmic deaths or resuscitated cardiac arrest. In all other cases the relative...

Make a Complete Diagnosis

We discussed the difficulties with making a diagnosis in part I. Nevertheless, you need to come to some understanding about the difficulties you are having in order to figure out how to help yourself most effectively. The conclusions you reach will affect the treatment you choose. For example, if you've suddenly begun to experience panic attacks and you feel that nothing in your life causes them, you are more likely to look for medication as a solution. On the other hand, if you connect the panic attacks with the feeling of being out of control ever since your father died of a sudden heart attack, you will probably be more open to psychotherapy and relaxation techniques. If you see schizophrenia strictly as a brain disease, then medication can seem like the only sensible treatment. If you see it as an illness that strongly affects you as a person, however, you are more likely to see the additional value provided by psychotherapy and rehabilitation to help you cope successfully with...

Medicolegal Death Investigation

Autopsy, cases can often be divided into two categories those with an anatomical cause of death and those without. Few drugs leave telltale signs so obvious that the pathologist can determine a manner and cause of death without additional testing. Obvious exceptions include liver necrosis caused by acetaminophen, or the severely hemorrhagic gastric mucosa and smell from cyanide exposure, or coronary artery disease and cardiac enlargement in a cocaine user. Negative findings require toxicological analyses.

General adverse effects

The adverse effects of beta-blockers are usually mild, with occurrence rates of 10-20 for the most common in most studies. Most are predictable from the pharmacological and physicochemical properties of these drugs. Examples include fatigue, cold peripheries, bradycardia, heart failure, sleep disturbances, bronchospasm, and altered glucose tolerance. Gastrointestinal upsets are also relatively common. Serious adverse cardiac effects and even sudden death can follow abrupt withdrawal of therapy in patients with ischemic heart disease. Most severe adverse reactions can be avoided by careful selection of patients and consideration of individual beta-blockers. Hypersensitivity reactions have been relatively rare since the withdrawal of practolol. Tumor-inducing effects have not been established in man.

Description And Effects

Crack also produces physical effects similar to those of cocaine, including increased temperature, elevated heart rate and blood pressure, constriction (narrowing) of blood vessels, loss of appetite, convulsions, muscle twitching, and irregular heartbeat. In rare instances, sudden death may occur directly as a result of use. According to the National Institute on Drug Abuse, crack-related deaths are often a result of heart attack or seizure followed by respiratory system failure.

Contraindications Precautions And Interactions

The NSAIDs are used cautiously in patients with bleeding disorders, renal disease, cardiovascular disease, or hepatic impairment and in the elderly. There is an increased risk of ulcer formation in patients older than 65 years. Most NSAIDs are classified as Pregnancy Category B. In general, the NSAIDs are used with extreme caution during pregnancy, especially in large doses or during the third trimester (see above).

Syndromes of Anxiety and Their Treatment

Panic Disorder The syndrome of panic disorder consists of panic attacks, the sudden onset of intense fearfulness accompanied by palpitations, shortness of breath, sweating, chest pain, nausea, and fears of dying or having a heart attack. Panic attacks can occur in a variety of situations and psychiatric disorders but most commonly occur in people who suffer from anxiety. The attacks themselves last from a few minutes to a few hours and are extremely unpleasant and intensely distressing. The worry about having another attack can be as disabling as the attacks themselves, especially if your worrying leads you to stay home and avoid anything that may precipitate an attack.

Long Term Effects Drug withdrawal

The possibility of a calcium antagonist withdrawal syndrome has been raised (118-127), as it has been reported that withdrawal of verapamil, nifedipine, and diltiazem can worsen angina or even cause myocardial infarction. However, in a randomized, double-blind study of withdrawal of nifedipine in 81 patients before coronary artery bypass surgery, angina at rest occurred only in patients who had experienced similar symptoms previously, and there were no early untoward effects of drug withdrawal (120). If a withdrawal syndrome does exist, it could be due to rebound coronary vasospasm, but the present weight of evidence suggests that withdrawal results in no more than the loss of a useful therapeutic effect or the unmasking of progressive disease (127). finding may have been spurious, as there was no relation between the cancer risk and the duration of drug use. Another study did not show any excess cancer risk with short-acting nifedipine after myocardial infarction in patients followed...

Contraindications

The skeletal muscle relaxants are contraindicated in patients with known hypersensitivity. Baclofen is con-traindicated in skeletal muscle spasms caused by rheumatic disorders. Carisoprodol is contraindicated in patients with a known hypersensitivity to meproba-mate. Cyclobenzaprine is contraindicated in patients with a recent myocardial infarction, cardiac conduction disorders, and hyperthyroidism. In addition, cycloben-zaprine is contraindicated within 14 days of the administration of a monoamine oxidase inhibitor. Oral dantro-lene is contraindicated in patients with active hepatic disease and muscle spasm caused by rheumatic disorders and during lactation. See Chapter 30 for information on diazepam.

Other features of the patient

People with pre-existing coronary artery disease may have an increased incidence of attacks of angina (103). In individuals who are vulnerable to schizophrenia, cannabis can precipitate psychoses or aggravate schizophrenia. The control of epilepsy may be impaired. Users undergoing anesthesia may react unexpectedly and may have enhanced nervous system depression. Because of impairment of judgement and psychomotor performance, users should not drive or operate machinery for at least 24 hours after administration.

Pi3k Inhibition Prospects For Drug Development

The prospects for the use of PI3-K inhibitors in the treatment of various diseases including cancer, other proliferative disorders, inflammation, and cardiovascular disease look promising (2,105). However, a limited number of in vivo studies (including side-effect and toxicological assessment) have been reported with the two well-characterized inhibitors, wortmannin and LY294002. Consequently, a number of questions regarding the merits of PI3-K inhibition remain unanswered. The PI3-K family of enzymes control a wide variety of cellular processes, thereby questioning whether an acceptable therapeutic index can be achieved from targeting this pathway. This may be possible when targeting tumors with PIK3CA mutations that activate the PI3-K pathway. In the last few years it has become apparent that individual PI3-K isoforms regulate distinct cellular events e.g., chemokine-stimulated neutrophil migration is controlled by PI3-Ky, and B-cell receptor signaling is mediated by PI3-K5....

Pregnancy Category None

Users have complained of headache and coughing. Lung injury is reported, ranging from fluid build-up and congestion to impaired breathing function and lung collapse. Unwanted effects can also include cardiac arrest, from which persons can seldom be resuscitated. A case report tells of a 14-year-old male who suffered a heart attack due to inhaling butane. Another case report describes a teenager who became paralyzed on one side of the body due to butane inhalation. Explosion is a common misadventure one hospital in South Korea found that 1.6 of all flame burn patients had been abusing butane. Most were teenagers. Accidents often happened in a group setting in bedrooms or motel rooms. Burns typically covered more than 25 of the body face, hands, arms, midsection. About half the victims required skin grafts, and the overall death rate was just over 10 . An American case study noted how treacherous treatment can be for such injuries. A female was hospitalized after striking a match in a...

Adverse Reactions

Reserpine is used cautiously in patients with a history of depression, in patients with renal impairment or cardiovascular disease, and during pregnancy and lactation. Guanethidine, another peripherally acting antiadrenergic drug, is con-traindicated in patients with pheochromocytoma and congestive heart failure. The drug is used cautiously in patients with bronchial asthma and renal impairment and during pregnancy and lactation. Anorexiants, haloperidol, the monoamine oxidase inhibitors, tricyclic antidepressants, and phenothiazines decrease the hypotensive effects of guanethidine.

Pregnancy Category C

Doses gastrointestinal distress may occur, and persons suffering from stomach irritation are supposed to avoid the compound. A case report notes a deliberate overdose that destroyed part of a patient's stomach. Heart attack has occurred from chloral hydrate overdose, but that is unusual. In high quantities the compound interferes with heart rhythm and reduces blood pressure and breathing seizures are possible. Experiments using chloral hydrate on rats and mice have injured the liver, and inhaling the drug's vapor has caused lung damage in mice. Human physical contact with the compound can irritate the skin, lungs, and eyes. The substance is suspected of causing kidney damage and colon cysts and of aggravating a disease called porphyria. Reduction may occur in the number of white blood cells. Although the substance is a depressant, some persons are stimulated by the drug.

Comparative studies

In the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), over 40 000 participants aged 55 years or older with hypertension and at least one other risk factor for coronary heart disease were randomized to chlortalidone, amlodipine, doxazosin, or lisinopril (1,2). Doxazosin was discontinued prematurely because chlortalidone was clearly superior in preventing cardiovascular events, particularly heart failure (2). Otherwise, mean follow-up was 4.9 years. There were no differences between chlortalidone, amlodipine, and lisinopril in the primary combined outcome or all-cause mortality. Compared with chlortalidone, heart failure was more common with amlodipine and lisinopril, and chlortalidone was better than lisinopril at preventing stroke.

Gerontologic Alert

I stimulants and may exhibit excessive anxiety, nervousness, insomnia, and mental confusion. Cardiovascular disorders, common in the older adult, may be worsened by the CNS stimulants. Careful monitoring is important because the presence of these reactions may result in the need to discontinue use of the drug.

Drug Drug Interactions Alteplase

The safety of the thrombolytic drug alteplase (tPA) plus clomethiazole in patients with acute ischemic stroke has been assessed in a randomized, double-blind study (8). All received alteplase 0.9 mg kg, beginning within 3 hours of stroke onset, and then either intravenous clomethia-zole 68 mg kg (n 97) over 24 hours, or placebo (n 93) beginning within 12 hours of stroke onset. During follow-up for 90 days the number of serious adverse event reports was 47 in the clomethiazole group and 48 in the placebo group. There were 15 deaths in those given clomethiazole and nine in those given placebo, but this was not significantly different. Sedation was also greater with clomethiazole (42 ) than with placebo (13 ).

Acute Health Effects Of Cannabis

Cannabis increases heart rate and produces complex changes in blood pressure (Chesher & Hall, 1999). There have been reported deaths from myocardial infarction after cannabis use in young adults (e.g. Bachs & Morland, 2001), but these have been rare and they may have occurred in persons with pre-existing, undiagnosed heart disease (Kalant, 2004 and see below).

Systemic lupus erythematosus

In 539 patients with systemic lupus erythematosus, organ damage was associated with glucocorticoid therapy compared with controls (356). Oral prednisone 10 mg day for 10 years (cumulative dose 36.6 g) was significantly associated with osteoporotic fractures (RR 2.5 95 CI 1.7, 3.7), symptomatic coronary artery disease (RR 1.7 CI 1.1, 2.5), and cataracts (RR 1.7 CI 1.4, 2.5). Avascular necrosis was associated with high-dose prednisone (at least 60 mg day for at least 2 months RR 1.2 CI 1.1, 1.4). Intravenous pulses of methylprednisolone (1000 mg for 1-3 days) were associated with a small increase in the risk of osteoporotic fractures (RR 1.3 CI 1.0, 1.8).

Its getting harder every day

For most men sexual dysfunction in the form of erectile dysfunction comes without an effect on the desire to have sex. Simply put, they don't get their F-on because they can't get their F-on, not because they don't want to get their F-on. So, for many men, drugs like Viagra are real life-changers. Many doctors are concerned that the drug allows men to ignore the underlying cause of the problem though. This is of particular concern because erectile dysfunction can be a side-effect of serious blood pressure problems, heart disease and a host of other medical conditions. It is also common in men who have their prostate removed during cancer therapy. ago, it was discovered that long-term treatment of post-menopausal women with estrogen can lead to an increased risk of developing heart disease.

Second Generation Effects Pregnancy

Three cases of severe allergic reactions to dextran 70 (including one pregnant woman at the time of delivery) have been reported (31). All three had received previous hapten prophylaxis. Although the pregnant woman recovered, the baby had evidence of serious brain damage at birth. Another patient with a very high titer of dextran-reactive antibodies died from myocardial infarction, which happened at the same time. The third patient recovered without sequelae. The authors concluded that dextran 70 should be avoided in pregnancy until the baby is born, and that even in the presence of immune prophylaxis, these complications of dextran 70 can develop. Vigilant observation and resuscitation facilities are necessary in all cases.

[ 861 Homeostatic Effects of Prostaglandins

Cardiovascular effects of prostaglandins are more complex. The coagulation system is clearly modulated by platelet-derived thromboxanes, which have procoagulation effects and the anticoagulative effects of endothelial cell-derived prostacyclin. Thromboxanes are clearly COX-1 derived because platelets do not express COX-2. The source of endothelial cell prostacyclin production is less clear with both enzymes expressed and mixed opinions on the relative contribution of the two enzymes. Recent results with Vioxx, a selective COX-2 inhibitor, imply a modest effect on myocardial infarction rate in patients taking the compound but do not define whether this is caused by a change in ratio simply by a lack of platelet effect or that inhibition of endothelial cell prostacyclin also skews the pro- and anticoag- j

Treatment Options for Psychotic Disorders

Recreational Drugs Although marijuana, cocaine, heroin, hallucinogenics, and pain relievers can worsen your distress and should be avoided, the drugs that will probably cause you the most harm in the long run are alcohol, caffeine, and tobacco. Alcohol impairs your physical health, fuels despair, and lowers your motivation to pursue your life energetically and enthusiastically. Caffeine makes you more anxious and can worsen psychotic symptoms. The ritual of smoking tobacco may soothe you when you are upset, but smoking contributes to many health problems, including breathing difficulties, respiratory infections, heart disease, and cancer. a family history of diabetes are at a higher risk for developing these complications. These serious complications are associated with high blood pressure, heart attacks, strokes, and gallbladder problems. It's not clear if high doses are more likely to cause these problems than low doses. It's not clear if atypical antipsychotics cause these changes...

Ethnobotanical Approach

This approach entails selecting plants used in traditional medicine on the reasonable premise that remedies used to treat a certain ailment may have an associated biological activity. To enhance chances of success in detecting significant biological activity, we have concentrated on plants used to treat easily diagnosed illnesses such as sores, wounds, and intestinal parasites. Diagnosis by traditional healers of internal problems, such as cardiovascular disease and cancer, is more difficult to verify. The value of the ethnobotanical approach in our research is highlighted later in the chapter.

Ergotamine and dihydroergotamine

Ergotamine and dihydroergotamine have been used in preventing migraine attacks and dihydroergotamine in the treatment of hypotension (either orthostatic or caused by spinal or epidural anesthesia). When dihydroergotamine was given intravenously after coronary bypass surgery, despite increased filling pressure there was no rise in cardiac output, and despite increased cardiac work the bypass flow fell significantly. The significant decrease in regional myocardial vascular resistance found after the administration of dihydroergotamine may explain the absence of the expected increase in cardiac output and coronary bypass flow.

Grontologie Alert

Angina is a common problem in older adults. When an older adult requires an antianginal drug, the dosage may be reduced to compensate for impaired renal function or heart disease. Older patients are at increased risk for postural hypotension. Blood pressure and ability to ambulate should be monitored closely.

Critical Thinking Exercises

Moore is admitted with severe chest pain and a possible myocardial infarction. After tests are done, her primary health care provider prescribes transdermal nitroglycerin for her angina. Develop a teaching plan that will show Ms. Moore how and when to apply the transdermal form of nitroglycerin.

Placebocontrolled studies

Hypervolemic hemodilution with agents such as ether-ified starches or dextran increases cerebral blood flow and can therefore reduce ischemic tissue damage in the penumbra zones when given within the therapeutic time window. However, the clinical benefit of such therapy has yet to be proven. Since etherified starch is considered to be the safer choice, in particular the recently developed lower molecular weight form (ether-ified starch 130 0.4), an explorative, randomized, placebo-controlled, safety trial of etherified starch for hypervolemic hemodilution in patients with acute ischemic stroke has been undertaken (5). This was a double-blind, randomized, placebo-controlled, parallel-group, multicenter study in 106 patients with acute ischemic stroke, who were recruited over 3 years. Treatment comprised high-dose hypervolemic hemodilu-tion with either etherified starch 130 0.4 or placebo within 6 hours of the start of symptoms, with a randomization ratio of 2 1 in favor of etherified...

Glyceryl trinitrate nitroglycerin

Drug withdrawal Adverse reactions to industrial exposure to glyceryl trinitrate were first reported in 1914 (6r), and subsequently there have been several reports of symptoms during the weekend resulting from withdrawal of the sustained vasodilator response of nitrates. Vasoconstriction ensues and can cause Raynaud's phenomenon, angina pectoris, or myocardial infarction, as has recently been reported again (7a). A 41-year-old man employed in a munitions factory was admitted with crushing chest pain on a Sunday morning. There was evidence of an acute inferior myocardial infarction, and cardiac catheterization showed 80 narrowing of the proximal right coronary artery, which was reduced to 10 by intracoronary administration of glyceryl trinitrate. The electrocardiogram became normal.

Flt3 Kinase Inhibitors

Sugen has developed and tested several more selective compounds (SU5416, SU5614, SU11248, and SU11657) that block FLT3 activation. The indolinone compound SU5416 was originally developed as vascular endothelial growth factor receptor-2 kinase domain receptor (VEGFR-2 KDR) inhibitor (144), and is currently being employed as an anti-tumor agent by its ability to inhibit angiogenesis in vivo (145-147). SU5416 also targets c-KIT and is a potent inhibitor of both wild-type and mutant FLT3 IC50 of SU5416 is 100 nM for inhibiting FLT3-ITD autophosphorylation in AMI. cell line MV4 11 (148). As a single agent, SU5416 has modest clinical activity in refractory AML and myelodyplastic syndromes, where in one study 5 of 55 patients achieved partial responses (reduction of blasts by at least 50 in bone marrow and peripheral blood) and 2 hematological improvement (149). In another phase 2 clinical study involving 43 patients with refractory AML, SU5416 treatment resulted in 16 PR and one patient...

Fibric Acid Derivatives

While the fibric acid derivatives have antihyperlipi-demic effects, their use varies depending on the drug. For example, Clofibrate (Atromid-S) and gemfibrozil (Lopid) are used to treat individuals with very high serum triglyceride levels who present a risk of abdominal pain and pancreatitis and who do not experience a response to diet modifications. Clofibrate is not used for the treatment of other types of hyperlipidemia and is not thought to be effective for prevention of coronary heart disease. Fenofibrate (Tricor) is used as adjunctive treatment for the reduction of LDL, total cholesterol, and triglycerides in patients with hyperlipidemia.

Coumarin And Indandione Derivatives

Develop as the result of venous stasis (decreased blood flow), injury to the vessel wall, or altered blood coagulation. Venous thrombosis most often occurs in the lower extremities and is associated with venous stasis. Deep vein thrombosis (DVT) occurs in the lower extremities and is the most common type of venous thrombosis. Arterial thrombosis can occur because of atherosclerosis or arrhythmias, such as atrial fibrillation. The thrombus may begin small, but fibrin, platelets, and red blood cells attach to the thrombus, increasing its size and shape. When a thrombus detaches itself from the wall of the vessel and is carried along through the bloodstream, it becomes an embolus. The embolus travels until it reaches a vessel that is too small to permit its passage. If the emboli goes to the lung and obstructs a pulmonary vessel, it is called a pulmonary embolism (PE). Similarly, if the embolus detaches and occludes a vessel supplying blood to the heart, it can cause a myocardial...

Cannabis Hempseed as a Basic World Food

In 1937, Ralph Loziers, general counsel of the National Institute of Oilseed Products, told the Congressional committee studying marijuana prohibition that hempseed. . . is used in all the Oriental nations and also in a part of Russia as food. It is grown in their fields and used as oatmeal. Millions of people every day are using hempseed in the Orient as food. They have been doing this for many generations, especially in periods of famine. That was over 60 years ago. Today we know hempseed is the plant kingdom's richest source of life-giving essential fatty acids, and may well be the cure for cancer and heart disease.

Hempseed Humanitys Best Single Food Source

These essential fatty acids were used by Dr. Joanna Budwig (nominated for the Nobel Peace Prize every year since 1979) to successfully treat terminal cancer patients, as well as those suffering from cardiovascular disease, glandular atrophy, gall stones, kidney degeneration, acne, dry skin, menstrual problems and immune deficiency.

Preadministration Assessment

During the preadministration assessment the nurse interviews the patient or family and notes any history of conditions that might contraindicate the use of a thrombolytic drug (see Contraindications). The nurse identifies any history of bleeding tendencies, heart disease, or allergic reactions to any drugs. In addition, a history of any drugs currently being taken is obtained. The nurse reports any relevant information to the primary health care provider before the drug is administered. Initial patient assessments include vital signs and a review of the diagnostic tests performed to establish a diagnosis. Most of these patients are admitted or transferred to an intensive care unit because close monitoring for 48 hours or more after therapy is necessary.

Clinical Applications

Directed to these references for detail. Other important and emerging areas include cancer, cardiovascular disorders, and hematology. It would be important to recognize the role of therapeutic drug monitoring (TDM) as a global phenotypic index including contributing pharmacokinetic, pharmacodynamic, drug-drug interaction, and other environmental factors. Thus, pharmacogenomic biomarkers might be readily characterized as an adjunct to enable the practice of personalized medicine. In order to update on these applications, a summary of recent examples would include pharmacogenomics for warfarin therapy and the treatment of colorectal cancer by irinotecan.

Hawthorn Leaves and Flowers in CHF

Iwamoto et al. 1981 conducted a controlled double-blind study in 102 patients with heart disease of ischaemic and or hypertensive origin (mostly NYHA Stages II and partly III) to evaluate the efficacy of Crataegutt vs. placebo (3 x 2 dragees of an extract from leaves, flowers and fruits or placebo over 6 weeks). The analysis of 80 patients (14 excluded for non-adherence to the test plan, 8 dropped out) showed a general improvement and improvement in cardiac function under verum vs. placebo (p < 0.01) as well as improvement in subjective symptoms (p < 0.001 for individual subjective symptoms verum vs. placebo dyspnoea, palpitation p < 0.01, cardiac oedemas p < 0.05). No group differences were noted for ECG. Side effects were observed in one patient under verum 55 . Until recently no long-term data have been available for the treatment of patients with CHF with hawthorn extracts. Yet in 1998 the SPICE (Survival and Prognosis Investigation of Crataegus Extract) trial started....

Disparaging disparities

These are pretty impressive facts, which raise the obvious questions are blacks genetically weaker than whites Are they more susceptible to disease because they did not evolve the capacity to fend off infection as well as whites Preposterous - but you'd be surprised what people glean from statistics. The fact is, when immunization programs targeted inner cities in the 1970s to lower the rate of measles, the rates lowered for African Americans. More recently, when breast cancer and heart disease awareness programs were enacted in the US, rates lowered as well, though there are still significant disparities between whites and blacks. The point is that a higher percentage of African Americans reside in poor neighborhoods where access to health education, healthcare and healthy lifestyle choices is far more limited than in the burbs, where more whites tend to live. This is a direct result of segregation policies and racism through the last century that are reverberating in society today....

An estrogen an androgen

The adverse effects of estrogen + androgen therapy include mild hirsutism and acne (5). One group of workers, who examined the use of Estratest'' (an esterified combination of estrogen and methyltestosterone), concluded that in their experience under 5 of women developed acne or facial hirsutism, a frequency similar to that experienced when using conjugated estrogens 0.625 mg day. Women had significantly less nausea with the estrogen + androgen treatment than with conjugated estrogen therapy. Cancers, cardiovascular disease, thromboembolism, and liver disease were stated to be rare among users of the combination. The only adverse events exceeding 4 of total reports were alopecia, acne, weight gain, and hirsutism (6). However, much higher rates of complications with such combinations have been reported from other centres (1).

Thiazolidinediones

The thiazolidinediones are contraindicated in patients with a hypersensitivity to the drug or any component of the drug and severe heart failure. These drugs are Pregnancy Category C drugs and should not be used during pregnancy unless the potential benefit of therapy outweighs the potential risk to the fetus. The thiazolidinediones are used cautiously in patients with edema, cardiovascular disease, and liver or kidney disease. These drugs may alter the effects of oral contraceptives.

Overall level of evidence for adverse effects B

Prevalence of myocardial infarction 2218 Blumentals WA, Gomez-Caminero A, Joo S, Vannappagari V. Should erectile dysfunction be considered as a marker for acute myocardial infarction Results from a retrospective cohort study. Int J Impot Res. 2004 Aug 16(4) 350-3. English 22236 Roumeguere T, Wespes E, Carpentier Y, Hoffmann P, Schulman CC. Erectile dysfunction is associated with a high prevalence of hyperlipidemia and coronary heart disease risk. Eur Urol. 2003 Sep 44(3) 355-9. English Myocardial infarction Sexual function questionnaire 34 of men with myocardial infarction 18 of men without cardiovascular disease No 2239 Stroberg P, Frick E, Hedelin H. Is erectile dysfunction really a clinically useful predictor of cardiovascular disease Scand J Urol Nephrol. 2005 39(1) 62-5. English

Ergonovine and Methylergonovine

Ergonovine is contraindicated in those with known hypersensitivity to the drug, hypertension, and before the delivery of the placenta. Ergonovine is used cautiously in patients with heart disease, obliterative vascular disease, renal or hepatic disease, and during lactation.

Gerontologie Alert

Older adults are at increased risk for adverse reactions from the antineoplastic drugs because of the increased incidence of chronic disease, particularly renal impairment or cardiovascular disease. When renal impairment is present, a lower dosage of the antineoplastic may be indicated. Creatinine clearance is used to monitor renal function in the older adult. Blood creatinine levels are likely to be inaccurate because of a decreased muscle mass in the older adult.

Glutamate And Excitotoxicity

Cause of neuronal death following acute injury such as ischemic stroke, mechanical trauma, or seizure (26-28). The excitotoxicity hypothesis may also explain some aspects of neuronal death observed in many chronic neurodegenerative diseases (22,29,30). On the other hand, NMDA receptors also have neuroprotective functions (2,31). It has been suggested that it is primarily the extrasynaptic NMDA receptors, as opposed to the synaptic NMDA receptors, that are involved in glutamate-stimulated cell death, and synaptic-NMDA-receptor-dependent Ca2+ influx mediates the expression of prosurvival genes (2). Several different rodent models have been employed to study excitotoxicity, and developmental hypersensitivity to glutamate receptor activation in these rodent models is well established (32-37).

Alpha2Adrenergic Drugs

The drug is contraindicated in patients with hypersen-sitivity to the drug or any component of the drug and in patients taking the monoamine oxidase inhibitors (MAOIs). Patients should wait at least 15 minutes after instilling brimonidine before inserting soft contact lenses because the preservative in the drug may be absorbed by soft contact lenses. The drug is used cautiously during pregnancy (Pregnancy Category B) and lactation and in patients with cardiovascular disease, depression, cerebral or coronary insufficiency, orthosta-tic hypotension, or Raynaud's phenomenon. When bri-monidine is used with central nervous system (CNS) depressants such as alcohol, barbiturates, opiates, sedatives, or anesthetics, there is a risk for an additive CNS depressant effect. Use the drug cautiously in combination with the beta blockers, antihypertensive drugs, and cardiac glycosides because a synergistic effect may occur.

Sympathomimetic Drugs

These drugs are used cautiously during pregnancy (epinephrine and apraclonidine, Pregnancy Category C dipivefrin, Pregnancy Category B) and lactation and in patients with hypertension, diabetes, hyper-thyroidism, heart disease, cerebral arteriosclerosis, or bronchial asthma. Some of these drugs contain sulfites that may cause allergic-like reactions (hives, wheezing, anaphylaxis) in patients with sulfite sensitivity. See Chapter 22 for information on interactions.

Beta Adrenergic Blocking Drugs

The p-adrenergic blocking drugs are contraindicated in patients with bronchial asthma, obstructive pulmonary disease, sinus bradycardia, heart block, cardiac failure, or cardiogenic shock and in patients with hypersensitivity to the drug or any components of the drug. These drugs are Pregnancy Category C and are used cautiously during pregnancy and lactation and in patients with cardiovascular disease, diabetes (may mask the symptoms of hypoglycemia), and hyperthyroidism (may mask symptoms of hyperthyroidism). The patient taking p-adrener-gic blocking drugs for ophthalmic reasons may experience increased or additive effects when the drugs are administered with the oral beta blockers. Co-administration of timolol maleate and calcium antagonists may cause hypotension, left ventricular failure, and condition disturbances within the heart. There is a potential additive hypotensive effect when the beta-blocking ophthalmic drugs are administered with the phenothiazines.

Vasoconstrictors Mydriatics

These drugs are contraindicated in individuals with hypersensitivity to the drug or any component of the drug and in patients with narrow angle glaucoma or anatomically narrow angle and no glaucoma and in patients with a sulfite sensitivity (some of these products contain sulfite). The drugs are used cautiously in patients with hypertension, diabetes, hyperthyroidism, cardiovascular disease, and arteriosclerosis. Local anesthetics can increase absorption of topical drugs. Systemic adverse reactions may occur more frequently when these drugs are administered with the p-adrenergic blocking drugs. When the mydriatics (drugs that dilate the pupil) are administered with the MAOIs or as long as 21 days after MAOI administration, exaggerated adrenergic effects may occur.

Actions and uses in noninfective conditions

In 202 patients with unstable angina pectoris, roxithro-mycin prevented death and re-infarction for at least 6 months after initial treatment (11). However, these findings could not be confirmed in another study in 302 patients with coronary heart disease and a seropositive reaction to Chlamydia pneumoniae who were treated with azithromycin. While global tests of markers of

Electrolyte balance

Some patients develop mild transient hypotension after the administration of bolus doses of intravenous magnesium sulfate (2,3). In patients with suspected myocardial infarction who received magnesium sulphate infusions there was an increased incidence of atrioventricular conduction disturbances (9).

Combinations of oral hypoglycemic drugs

In 12 patients with type 2 diabetes, a combination of nateglinide 120 mg or placebo with metformin 500 mg before each meal on two separate days was well tolerated (31). One patient taking nateglinide had a headache. One patient was withdrawn because of a myocardial infarction and had multivessel coronary artery disease on catheterization. In an open trial, 256 patients with type 2 diabetes with inadequate hypoglycemic control (HbA1c over 7.0 during previous therapy) took repaglinide (0.5-4 mg at meals), troglitazone (200-600 mg day), or a combination of the two for 22 weeks (36). Combination therapy was most effective. Repaglinide only was more effective than troglitazone only. Mean body weight increased in both groups. Serious adverse events were chest pain, cerebro-vascular disorders, malignancies, dysrhythmias, electro-cardiographic changes suggesting myocardial infarction, and increased aspartate transaminase activity (in one patient taking troglitazone). The serious adverse...

Scutellaria baicalensis

The roots of Scutellaria baicalensis Georgi (Labiatae) have been used in TEM to treat inflammatory and cardiovascular disease. S. baicalensis contains three major polyphenolic components, namely wogonin, baicalin, and baicalein (Fig. 16.1) These three polyphenols are as free-radical scavengers of hydroxyl, DPPH, and alkyl radicals 58 . Baicalein is the most effective compound of the three polyphenols tested in preventing glutamate toxicity 59 and is also known as a selective inhibitor of 12-lipoxygenase 60 . Baicalin also acts as a neuroprotectant during cerebral ischemia 61 .

Promoting an Optimal Response to Therapy

Decongestants are used only occasionally in the clinical setting. Because some of these products are available without a prescription, their use may be discovered during a patient history for other medical disorders. Nonprescription nasal decongestants should not be used by those with hypertension or heart disease unless such use is approved by the primary health care provider. After administering a topical nasal decongestant, some patients may experience a mild, transient stinging sensation. This usually disappears with continued use. To minimize the occurrence of rebound nasal congestion, the drug therapy should be discontinued gradually by initially discontinuing the medication in one nostril, followed by withdrawal from the other nostril.

The Dopamine Theory of Schizophrenia

It has become clear over time that while the classic antipsychotics that block dopamine receptors can quiet the voices, organize the speech, and diminish the paranoia, they do not adequately treat the deficit state or negative symptoms that remain. Some researchers have stated that despite more than twenty years of negative symptom research, there is still no proven pharmacological treatment for primary negative symptoms (Carpenter et al. 1995). And so the search continues for medications to ameliorate these negative symptoms. Medications that have been tried include dopamine agonists (enhancers), such as amphetamine. Amphetamine was used in psychiatry as early as 1936 (Meyerson 1936). Some stroke patients have been given amphetamine to enhance their motivation and hasten their recovery (Goldstein and Hulsebosch 1999). It is widely accepted that long-term use of high-dose amphetamine, sometimes called a psychostimulant, can produce paranoid psychosis in nonpsychiatric patients...

Cardiopulmonary Cardiorespiratory Effects

Marijuana use is associated with serious cardiovascular consequences. Acutely, marijuana increases heart rate, supine blood pressure, and, after higher doses, orthos-tatic hypotension it increases cardiac output, decreases peripheral vascular resistance, and dose-dependently decreases maximum exercise performance. With prolonged exposure, supine blood pressure falls, orthostatic hypotension disappears, blood volume increases, heart rate slows, and circulatory responses to exercise diminish, which is consistent with the centrally mediated, reduced sympathetic and enhanced para-sympathetic activity in animals. These studies were reviewed by Jones (14), who cautioned that although marijuana's cardiovascular effects do not seem to cause serious health problems for young, healthy users, marijuana smoking by older people with cardiovascular disease poses greater risks because of the resulting increased cardiac work, increased catecholamines, carboxyhemoglobin, and hypotension. On the basis...

Cocaine Use and Related Toxicity in the United States

Cocaine-related sudden death, cardiovascular disease, and reproductive disturbances (Benowitz 1992). Sudden death is believed to result from cardiac arrhythmias due to massive catecholamine release with or without acute myocardial ischemia. However, a review of 935 cocaine-related deaths reported in 1986 in New York City showed that the top causes of death were homicide (37.5 percent), acute narcotic exposure (12 percent), other natural causes (11.1 percent), and suicide (6.6 percent) (Litovitz et al. 1991). Another serious type of injury from cocaine use with consequences for long-term harm involves brain damage. Episodes of angina and myocardial infarction due to cocaine abuse have also become commonplace in reports from major U.S. metropolitan medical centers.

Display 422 Importance of the Systolic Blood Pressure

In most individuals, the systolic pressure increases sharply with age, whereas the diastolic pressure increases until about age 55 years and then declines. Older individuals with an elevated systolic pressure have a condition known as isolated systolic hypertension (ISH). When the systolic pressure is high, blood vessels become less flexible and stiffen, leading to cardiovascular disease and kidney damage. Research indicates that treating ISH saves lives and reduces illness. The treatment is the same for ISH as for other forms of hypertension. Myocardial infarction

Buyanghuanwu Decoction

A number of studies have demonstrated that BYHWD improves the outcome of ischemic stroke in clinical trials. BYHWD improves the metabolic imbalance of endothelin and calcitonin GCRP in patients with early cerebral infarction 203 . BYHWD promotes the proliferation of rat cortical neurons cultured in both normal and hypoxia conditions 204 . Pretreatment of BYHWD showed neuroprotective effects in the 4-VO rat model and suppressed the expression of caspase-3 p20 in the CA1 region 205 .

Cardiovascular Effects Of Cannabinoids

Related to cardioprotection, Wagner and colleagues (2001a) have reported that in a rat model of myocardial infarction due to coronary ligation in vivo, there is the release of anandamide and 2-arachidonoyl glycerol from monocytes and platelets. This release of endocannabinoids was associated with systemic hypotension but decreased mortality, as administration of SR141716A reduced the hypotension but increased mortality. This might suggest that the release of endocan-nabinoids may be protective. In this model, the release of endocannabinoids did not reduce the size of myocardial infarction. Subsequent studies have examined the effects of treatment of the CBj receptor antagonist AM251 or the CB agonist HU210 for 12 weeks after myocardial infarction (Wagner et al., 2003). The key findings from this study were that cannabinoid receptor antagonism promotes remodeling and that cannabinoid agonists may prevent endothelial dysfunction and hypotension. Therefore, it is possible that the...

Why Chronic Stress Is Bad For Your Immune System

People with type A personalities (the kind of people who are always under the gun, working 80-hour weeks, stressed all the time) have a higher risk of developing health-related problems such as heart disease. They also can develop problems with their immune systems. The body produces its own anti-inflammatory corticosteroids, namely Cortisol. Production of this hormone by the adrenal gland is especially increased during times of psychological stress, whether it is a normal stress response (such as anticipating a final exam, being stuck in traffic, or being chased by a grizzly bear) or an abnormal stress response (such as being chronically depressed). Although the antiinflammatory actions of cortisol can be beneficial in the short run in relieving pain and inflammation, the increases in overall cortisol production in chronically stressed individuals can actually damage the immune system. Cortisol and other corticosteroids suppress the immune system by killing off immune cells and also...

Alprostadil prostaglandin E1

Hematologic Prostaglandin E1 is widely used in neonates with cyanotic congenital heart disease to maintain the patency of the ductus arteriosus. Reported adverse effects of PGE1 include fever, apnea, flushing, bradycardia, and hyperostosis. Investigators from the Department of Pediatrics in Johns Hopkins Hospital, after seeing a neonate who had marked leuko-cytosis temporally related to PGE1, conducted a retrospective study of neonatal leukocytosis induced by PGE1 in 45 neonates (25C). They concluded that PGE1 infusion is a predictable cause of leukocytosis in neonates with congenital heart disease. PGE1-induced leukocytosis was especially prominent in three patients with splenic disorders associated with the heterotaxy syndrome. Many of the other adverse effects of PGE1, including respiratory depression, hypotension, fever, and lethargy, were also associated with sepsis. The authors considered that it is reasonable to look for sepsis in infants receiving PGE1, but that it is equally...

Pregnancy Category X

Oxymetholone can produce masculine physical characteristics in women (facial hair, deeper voice) and disrupt the menstrual cycle some authorities indicate that such masculinization is uncommon. Experimentation with male rats lowered their blood levels of testosterone and halted sexual activity. In human males oxymetholone may promote enlargement of the prostate gland. Men with prostate or breast cancer should avoid the drug, as should women who have both breast cancer and signs of a bone-weakening disease called osteoporosis. Oxymetholone can damage the liver and, in unusual circumstances, is associated with fatal harm to the spleen. Cholesterol levels can rise, increasing the risk of conditions leading to heart attack and stroke kidney dialysis patients are considered to be at special risk for such outcomes. Case reports attribute stroke to oxymetholone. The drug may cause fluid retention, a possible hazard for persons with heart, liver, or kidney dis-

Cardiac Arrhythmias And Clinical Therapy Arrhythmia

Despite considerable progress in management over the recent years, coronary artery disease (CAD) remains the leading cause of death in the industrialized world. It is estimated that CAD is responsible for causing 152,000 deaths per year in the United Kingdom. 400,000 deaths per year in the United State of America, and one in eight deaths worldwide. Many of these deaths are attributed to the development of cardiac arrhythmias, especially ventricular fibrillation during periods of myocardial ischemia or

Class IB Sodium Channel Blockers

Therapeutic uses It is the drug of choice for treating serious ventricular arrhythmias associated with acute myocardial infarction, cardiac surgery and electrical cardioversion (5,17). Lidocaine is also the drug of choice for emergency treatment of cardiac arrhythmias (5).

Class II Beta Adrenegic Blockers

As a class, beta-blockers are being used more extensively because of their effectiveness and their ability to reduce mortality in a variety of clinical settings, including post-myocardial infarction and heart failure (6). With the exception of beta-blockers, none of the available antiarrhythmic drugs (23) have significantly improved survival after myocardial infarction. Propranolol reduces the incidence of sudden arrhythmic death after myocardial infarction. Esmolol is a very short-acting beta blocker used for intravenous administration in acute arrhythmias occurring during surgery or in emergency situations. Other useful drugs are pindolol, metoprolol, acebutolol, sotalol, atenolol, and timolol and nadolol (5,6,12,17,25).

Radioactive Tobacco The Untold Story

It is far and away the number one cause of preventable death in the U.S. today. Tobacco smokers have ten times the lung cancer of non-smokers, twice the heart disease, and are three times more likely to die of heart disease if they do develop it. Yet tobacco is totally legal, and even receives the highest U.S. government farm subsidies of any agricultural product in America, all the while being our biggest killer What total hypocrisy

Smallpox and bioterrorism

The threat of bioterrorism has made it necessary to consider again prevention and control strategies through vaccination and the potential hazards associated with the administration of smallpox vaccine. Guidelines for prevention and control of smallpox have been elaborated in many countries. The guidelines distinguish between pre-event vaccination programs (worldwide no re-emergence of smallpox) and postevent vaccination programs (re-emergence of smallpox confirmed). Taking into account the risk of smallpox vaccination, most countries have elaborated plans for postevent vaccination programs. During the US pre-event vaccination program, in 1 per 20000 members of the military who received primary smallpox vaccination, cardiac inflammation (myocarditis and or pericarditis), including one death (myocardial infarction), has been reported. Compared with the rate reported in an unvaccinated military population during 1998-2000, the rate of myocarditis pericarditis was substantially...

Congestive Heart Failure

Heart failure usually results from damage to the myocardium typically from ischemic heart disease, cardiomyopathy or myocarditis. Hypertension also contributes to cardiac failure especially if it is poorly controlled or results from damage to the heart valves and fluid overload. Apart from drugs, metabolic diseases such as, for example, thyrotoxicosis also makes a contribution. The overall result is that cardiac failure results in poor perfusion of vital organs and tissues and causes congestion of the lungs. Treatment of Congestive Heart Failure is mainly carried out by

Cardiac glycosides

Cardiac glycosides and suxamethonium can interact, resulting in an increased risk of dysrhythmias (280), perhaps through alterations in intracellular calcium (22). In 24 patients with ischemic heart disease taking digoxin who underwent abdominal surgery ventricular extra beats with bigemini or severe bradycardia were recorded in two patients and episodes of torsade de pointes occurred in two others during endotracheal intubation (281). The authors suggested that endotracheal intubation in digita-lized patients should be performed without suxametho-nium. However, considering the frequency with which digitalized patients receive suxamethonium and the paucity of reports of clinical problems, this interaction is probably of minor importance.

Ascorbic Acid Vitamin C

Ergothioneine was first discovered in 1909 in the sclerotia of the ergot fungus, Claviceps purpurea. It has since been found in blood, semen, and various mammalian tissues (principally the liver and kidneys), and was first synthesized in 1951. It is thought to work as a chemopreventive agent by helping the body to eliminate free radicals, which have been associated with both heart disease and cancer.

Olive Oil The Mediterranean Diet

It has been speculated for many years that the so-called Mediterranean Diet has a number of health benefits, including reduced risk of heart disease and cancer. In particular, red wine, tomatoes, and olive oil have all been suggested as likely beneficial components of this diet. Recently, two components of olive oil, oleic acid and oleocanthal, have been identified as likely chemopreventive components. These are described below along with lycopene, the proposed chemopreventive constituent of tomatoes.

Cardiovascular Effects

Whether or not these recognized cardiovascular effects are sufficient to actually trigger myocardial infarction is still debated, although there is ample evidence for concern. The acute onset of coronary syndromes is thought to result from the disruption of vulnerable plaque. Vulnerable plaques are not necessarily the largest plaques (i.e., they do not cause clinically significant obstruction of large epicardial arteries) but, rather, are comprised of thin-capped, lipid-rich lesions that may be located in second-order vessels. Triggers, whether intense athletic activity, marijuana smoking, or even intense sexual activity, result in homodynamic forces that can disrupt the thin fibrous cap, probably because changes in arterial pressure disrupt the underlying vulnerable plaque (19). Epidemiological evidence supports the triggering theory. Investigators in the Myocardial Infarction Onset Study interviewed 3882 patients (1258 women) hospitalized with acute myocardial infarction (20). Of...

ACE lD and AGTR1 Interaction In

Routine clinical practice, risk factors for disease tend to be either additive or synergistic. In general, a patient with hypertension, diabetes, and hyperlipidemia is at greater risk of suffering an acute coronary event compared with a patient with only one of these risk factors. Thus, interactions among polymorphism-may also be germane to pharmaco-genomic studies. To this end, several studies have examined the impact of both the ACE DD and AGTRl CC genotype. One study demonstrated an increased risk of myocardial infarction among patients with the DD and CC genotypes for the ACE and AGTRl genes, respectively (95). However, a recent case-control study failed to demonstrate an association between these two polymorphisms with the risk of myocardial infarction (96). Another study revealed that the risk of ventricular arrhythmias among patients with systolic heart failure was significantly increased in patients with the DD ACE genotype and the CC genotype for the ATI gene (97). Thus, once...

Single Gene Pharmacogenetic Studies in Genes influencing Disease Progression

Several studies have examined the impact of SNPs on the natural history of patients undergoing percutaneous coronary intervention (PCI) for the treatment of acute coronary syndromes. Risk of coronary artery disease Risk of myocardial infarction Risk cf venous thrombosis CHD, coronary heart disease PCI, percutaneous coronary intervention MI, myocardial infarction GP, glycoprotein BMI, body mass index. One of the major complications from PCI is restenosis of the target coronary artery, which occurs in as many as 40 of patients. Restenosis results in substantial morbidity and increases need for repeat coronary interventions. One study examined a polymorphism in the gene that encodes Factor VII. Factor VII has an integral role in the process of clot formation among patients with acute coronary syndromes. After plaque rupture, tissue factor released from the lipid core complexes with Factor VII, leading to the activation of Factor X, and ultimately Factor Ha...

Rio North America Findings

The findings show that 2-year treatment with rimonabant 20 mg significantly lowered weight, reduced abdominal fat, diminished cardiovascular risk factors, and decreased metabolic disorders in this patient population. Waist circumference, a simple measure of abdominal fat, in patients treated with rimonabant 20 mg for the full 2-year period was reduced by 8 cm (3.1 in.) vs 4.9 cm (1.9 in.) for rimonabant 5 mg and 3.8 cm (1.5 in.) in the placebo group (p < 0.001). Of the patients who received treatment with rimonabant 20 mg throughout the 2-year period, 62.5 lost more than 5 of their initial body weight vs 36.7 of those on rimonabant 5 mg and 33.2 of those on placebo (p < 0.001). In the same period, 32.8 of patients treated with rimonabant 20 mg lost in excess of 10 of their initial body weight vs 20 of those on rimonabant 5 mg and 16.4 of patients on placebo (p < 0.001). Although diabetic patients were not included in the study, patients on rimonabant 20 mg had significantly...

Gene Delivery for Myocardial Diseases

The method of direct pDNA injection was used to explore the effect of specific pathophysiological state on cardiac gene expression, such as ischemia (44), myocardial infarction, reperfusion injury, hypertension (45, 46), etc. Ischemia is a disease state formed when tissues are starved for blood supply and nutrients because of deficient supply of blood through possibly narrowed or blocked arteries. Sporadic myocardial ischemia is commonly associated with coronary arterial diseases. To eliminate the ischemia related disease phenotype, a therapeutic gene is required, which could be selectively up-regulated by the signals related to the heightened period of ischemic activity and consequently down regulated when the activity subdues. In this context, Prentice et al. (44) introduced expression plasmids containing muscle-specific a-MHC promoters and hypoxia-respon-sive enhancer (HRE) elements linked to a reporter gene in cultured cells or into the rabbit myocardium and measured the...

Miotic Direct Acting

These drugs are contraindicated in patients with hyper-sensitivity to the drug or any component of the drug and in conditions where constriction is undesirable (eg, iritis, uveitis, and acute inflammatory disease of the anterior chamber). The drugs are used cautiously in patients with corneal abrasion, pregnancy (Pregnancy Category C), lactation, cardiac failure, bronchial asthma, peptic ulcer, hyperthyroidism, gastrointestinal spasm, urinary tract infection, Parkinson's disease, recent myocardial infarction, hypotension, or hypertension. These drugs are also used cautiously in patients with angle closure glaucoma because miotics can, occasionally, precipitate angle closure glaucoma by increasing the resistance to aqueous flow from posterior to anterior chamber. See Chapter 24 for information on interactions.

Drug Drug Interactions Ethanol

Besides its hepatotoxic effects, beta-carotene supplementation can also cause cardiovascular complications in smokers and potentiate carcinogenicity. The Alpha-Tocopherol, Beta-Carotene and Cancer Prevention Study (ATBC) (72) and CARET (99) showed that supplementation of beta-carotene in smokers increased the incidence of death from coronary artery disease. Recent results suggest that beta-carotene participates as a pro-oxidant in the oxidative degradation of LDL, and that raised LDL concentrations may cancel the protective effect of alpha-tocopherol (102).

Everett H Ellinwood Jr and Tong H Lee Introduction

Several types of toxicities are responsible for stimulant-related morbidity and mortality (figure 3). Reported cardiovascular toxicities include acute myocardial infarction, stunned myocardium syndrome, arrhythmias, myocarditis, and ruptured aorta (Cregler and Mark 1986). Significantly, a history of underlying disease appears not to be a prerequisite. For example, acute myocardial infarction following administration of cocaine has been documented in patients without fixed or spastic coronary diseases or history of cardiac symptoms (Isner et al. 1986). Interestingly, cocaine appears to be more frequently associated with the above cardiac complications than are amphetamines. The exact reason for this preponderance of cocaine-associated toxicity is not clear the significant local anesthetic effect of cocaine may contribute to its cardiac toxicity. Alternatively, because of its ultrashort half-life, cocaine may be more liable to overdosing with attempts to maintain effective plasma...

Amitriptyline Elavil Laroxyl Triptyzol

- Do not administer if recent myocardial infarction, arrhythmia, impaired liver function, acute mania. Do not administer to children. - Administer with caution, under medical supervision, in epilepsy, cardiovascular disease, hepatic or renal failure, prostatic hyperplasia, thyroid disease.

Effects And Risks Of Smoking

Besides the danger of nicotine addiction, cigarette use poses a wide range of threats to the user's health. The main health dangers include increased risk of heart attack, respiratory diseases such as emphysema and lung cancer, cancer of the mouth and throat, and pancreatic cancer. About one in six men who continue to smoke tobacco will develop lung cancer compared to one in 75 nonsmokers. Male smokers are also 85 percent more likely to suffer from impotence than nonsmokers are. Other diseases linked to smoking include various forms of cancer, stroke, cardiovascular disease, bronchitis, cataracts,

Physical And Emotional Contraindications

Beyond anything encountered in everyday life. It is therefore essential to screen out in advance individuals for whom intense emotions can be dangerous or even fatal. It was mentioned earlier that this involves in the first place persons with serious cardiovascular problems, such as a high degree of arteriosclerosis, thrombosis with a danger of embolism, malignant hypertension, vascular aneurysms, a history of myocardial infarction, myocarditis, decompensated cardiac failure, and bruin hemorrhage. Where there is the slightest doubt, the candidate for un LSD session should have a physical examination, including an electrocardiogram. In case of mild cardiovascular problems, one should be conservative with the dosage and proceed with caution. We have to bear in mind that we are not talking about direct noxious effects of LSD on the heart or vessels, but the risks associated with intense emotions. Although higher dosages usually evoke more powerful affective responses, this relationship...

Ecgonine phenylacetylmethylester

Many problems users encounter with MDMA are similar to those found with the use of am-fetamines and cocaine. They are Psychological difficulties, including confusion, depression, suicide, sleep problems, drug craving, severe anxiety, and paranoia-during and sometimes weeks after taking MDMA (even psychotic episodes have been reported) Physical symptoms such as muscle tension, involuntary teeth-clenching, nausea, blurred vision, rapid eye movements, faintness, and chills or sweating increases in heart rate and blood pressure, a special risk for people with circulatory or heart disease. 2. South African colloquial term for nutmeg oil. Intense joy or delight rapture. From Greek ek-stasis, astonishment, ex-, out of, histanai, to

Diethylstilbestrol stilbestrol

Cardiovascular The findings of the randomized Heart and Estrogen progestin Replacement Study (HERS) suggested that in women with clinically recognized heart disease, HRT might be associated with early harm but late benefit in terms of coronary events. The findings of that study seem in the meantime to have been confirmed by some further US work. In one study the histories and subsequent course of 981 postmenopausal women who had survived a first myocardial infarct and had thereafter used estrogen or estrogen plus progestogen were examined (25C). Relative to the risk in a parallel group of women not currently using hormones there was a suggestion of increased risk during the first 60 days after starting hormone therapy (RR 2.16 CI 0.94, 4.95) but of reduced risk with current hormone use for longer than 1 year (RR 0.76), although the confidence intervals were wide. Hematologic It has been firmly concluded, in the light of all prior evidence, that HRT increases the risk of venous...

Pharmacology and general adverse effects

The use of amfetamine-type stimulants for depression, fatigue, and psychasthenia has fallen into disfavor since the early 1970s, because of the potential for abuse and the low rates of success, especially after tolerance is established. However, there have been reports and reviews of successes in carefully selected groups of patients (3-5). The underlying symptoms of patients who respond to stimulants are mild anhedonia, lack of mental and physical energy, easy fatiguability, and low self-esteem, but in the absence of the marked depressed mood disturbance, guilt, and hopelessness that are associated with major depression. Examples include patients with dysthymic disorders, medically ill patients (especially after a stroke), depressed patients, hospitalized cancer patients, and patients with significant cardiovascular disorders, all of whom can have anergia and easy fatiguability. HIV-related neuropsychiatric symptoms, including depression, respond to psychostimulants (4-6). Withdrawn...

Clormetaminodiazepoxid Chlordiazepoxide

Many problems MDMA users encounter are similar to those found with the use of amphetamines and cocaine. Psychological difficulties can include confusion, depression, sleep problems, severe anxiety, and paranoia. Physical problems can include muscle tension, involuntary teeth clenching, nausea, blurred vision, faintness, and chills or sweating. Use of the drug has also been associated with increases in heart rate and blood pressure, a special risk for people with circulatory or heart disease. Recent research also links Ecstasy use to long-term damage to those parts of the brain critical to thought, memory, and pleasure. Club soda Mixer of carbonated water with some minerals (midway between seltzer and mineral water). Acute toxic reactions may occur in both the naive experimenter and the chronic abuser of cocaine. They include a panic-like delirium, hyperpyrexia, hypertension. (sometimes with subdural or subarachnoid haemorrhage), cardiac arrhythmias, myocardial infarction, in

Monoamine Oxidase Inhibitors Isocarboxazid Phenelzine Tranylcypromine Selegiline Moclobemide

Tricyclic Antidepressant Diagram

MAOIs prevent breakdown of not just serotonin, dopamine, and norepinephrine but also a similarly shaped molecule called tyramine. Tyramine is not a neurotransmitter and plays no role in the brain but does have a significant influence on blood pressure. Thus if tyramine levels rise too high, a hypertensive reaction can develop. With monoamine oxidase blocked, there is no way to clear ingested tyramine, potentially producing rises in blood pressure so extreme that a heart attack can ensue. Even if a patient is able to follow a special diet, there are other predisposing factors that make MAOIs too risky to use. People with heart problems, high blood pressure, epilepsy, or asthma are all unsuitable candidates for MAOIs. There have also been incidences of liver damage (however, this kind of toxicity rarely occurs with MAOIs currently on the market).