By Reza Ardehali, Marco Perez, Paul Wang
Written, reviewed, and edited in a collaborative attempt by way of cardiology fellows and college of 1 of the main prestigious educational facilities within the kingdom, this concise quantity supplies cardiology fellows the e-book they've got lengthy needed. Keeping assurance of the underlying pathophysiology and mechanism of disorder to a minimal, the authors specialize in the analysis and therapy of cardiac problems. functional and simply available on the time of selection making, the ebook relays very important ideas via concise and to-the-point pearls and by using set of rules charts and illustrations.
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Extra info for A Practical Approach to Cardiovascular Medicine
Method: RCT 13 608 patients with moderate-to-high-risk ACS, including NSTEMI and STEMI, scheduled to undergo PCI were randomized to prasugrel or clopidogrel for 6–15 months. 9% (driven by reduction in nonfatal MI). 8%). Take-home message: Prasugrel reduces nonfatal MI after PCI in ACS at the expense of higher bleeding complications. Unstable Angina and Non-ST Elevation Myocardial Infarction 51 • Beta-blocker: • Indefinitely in all patients without contraindications • Long-term ACE-I or ARB: • HTN • DM • EF <40% • Consider ACE + ARB if persistent symptomatic CHF symptoms • CCB: • For ischemic symptoms if beta-blockers are contraindicated or ineffective • Lipids: • Begin statin therapy regardless of baseline level • Goal of therapy <70 mg/dL LDL • Consider adding fibrate or niacin if HDL<40 or TG >200 mg/dL • Other considerations: • Omega-3-fatty acid • Discontinue hormone replacement therapy in women after UA/NSTEMI • Discourage use of antioxidant supplements (vitamin C, E, folate).
Hypertension 25 All patients with pre-, stage I and II HTN must be counseled on lifestyle modifications when appropriate. Lifestyle modifications can result in significant BP decreases: weight loss: 5–20 mmHg/10 kg; DASH diet: ∼10 mmHg; decreased sodium intake: ∼7 mmHg; physical activity: ∼5 mmHg; decreased alcohol intake: 3 mmHg. While such modifications in lifestyle are to be encouraged, it should also be noted, however, that lifestyle modifications alone have not been shown to systematically reduce CVD events, including mortality.
Performance of >5 METs without ischemia on exercise treadmill test (ETT) confers a good prognosis. • Low-risk stress test <1% annual cardiac mortality, high risk >4% mortality. • A normal ECG does not rule out ACS. • ST segment elevation in aVR = higher prevalence of LM or three-vessel disease. • TWIs alone are not predictors of ischemic events, but deep symmetrical TWI across the precordium is often due to LAD ischemia. • >50% of patients older than 65 present with dyspnea and no chest pain.
A Practical Approach to Cardiovascular Medicine by Reza Ardehali, Marco Perez, Paul Wang