cardiovascular-agents and Thromboembolism

Myocardial infarction (MI) in the absence of obstructive coronary artery disease (MINOCA) is prevalent in around 5% of acute myocardial infarction (AMI) presentations. MINOCA is a heterogeneous entity with many different etiologies. It is important for health care providers to familiarize themselves with the disease process, presentation, and possible underlying causes in order to guide appropriate management strategies. In this article, the authors review the contemporary definition, etiologies and assessment, and management for AMI patients with MINOCA.

Topics: Aortic Dissection; Cardiomyopathy, Hypertrophic; Cardiovascular Agents; Coronary Artery Disease; Coronary Circulation; Coronary Vasospasm; Coronary Vessels; Humans; Myocardial Infarction; Myocarditis; Platelet Aggregation Inhibitors; Risk Factors; Severity of Illness Index; Takotsubo Cardiomyopathy; Thromboembolism

Atrial fibrillation is the most commonly encountered arrhythmia after cardiac surgery. Although usually self-limiting, it represents an important predictor of increased patient morbidity, mortality, and health care costs. Numerous studies have attempted to determine the underlying mechanisms of postoperative atrial fibrillation (POAF) with varied success. A multifactorial pathophysiology is hypothesized, with inflammation and postoperative β-adrenergic activation recognized as important contributing factors. The management of POAF is complicated by a paucity of data relating to the outcomes of different therapeutic interventions in this population. This article reviews the literature on epidemiology, mechanisms, and risk factors of POAF, with a subsequent focus on the therapeutic interventions and guidelines regarding management.

Topics: Anticoagulants; Atrial Fibrillation; Cardiovascular Agents; Humans; Incidence; Postoperative Complications; Prognosis; Risk Assessment; Risk Factors; Surgical Procedures, Operative; Thromboembolism

Chronic heart failure is a common public health problem. The disease has a poor prognosis with high mortality rate and the incidence increases continuously. Prognosis of chronic systolic heart failure can be improved by several different medications as well as by special cardiac interventions based on the newly-published European and American guidelines. In case of severe systolic dysfunction, hospitalization and mortality can be reduced using angiotensin converting enzyme inhibitors, angiotensin receptor blocking drugs, beta-receptor blocking agents and aldosterone antagonists, as evidenced in multicentric studies. In selected cases different cardiac interventions, such as intracardial defibrillator and/or cardiac desynchronization device implantation can be used for supporting the failing left ventricle. In terminal stage, special devices (ventricular assist device, intra-aortic balloon pump, arteficial heart) and, finally, heart transplantation can be applied. In this paper, the authors highlight therapeutic options of chronic systolic heart failure referring to recommendations of the latest, 2012 guideline from the European Society of Cardiology.

Topics: Adrenergic beta-Antagonists; Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Arrhythmias, Cardiac; Cardiovascular Agents; Chronic Disease; Digitalis Glycosides; Diuretics; Heart Failure, Systolic; Heart-Assist Devices; Humans; Mineralocorticoid Receptor Antagonists; Pacemaker, Artificial; Severity of Illness Index; Thromboembolism; Vasodilator Agents; Ventricular Dysfunction, Left

For most drug-metabolizing enzymes (DMEs), the functional consequences of genetic polymorphisms have been examined. Variants leading to reduced or increased enzymatic activity as compared to the wild-type alleles have been identified. This review tries to define potential fields in the therapy of major medical conditions where genotyping (or phenotyping) of genetically polymorphic DMEs might be beneficial for drug safety or therapeutic outcome. The possible application of genotyping is discussed for depression, cardiovascular diseases and thromboembolic disorders, gastric ulcer, malignant diseases and tuberculosis. Some drugs used for relief of these ailments are metabolized with participation of genetically polymorphic DMEs including CYP2D6, CYP2C9, CYP2C19, thiopurine-S-methyltransferase, dihydropyrimidine dehydrogenase, uridine diphosphate glucuronosyltransferase and N-acetyltransferase type 2. Current evidence suggests that taking genetically determined metabolic capacities of DMEs into account has the potential to improve individual risk/benefit relationship. However, more prospective studies with clinical endpoints are needed before the paradigm of 'personalized medicine' based on DME variants can be established.

Topics: Anti-Ulcer Agents; Antidepressive Agents; Antineoplastic Agents; Antitubercular Agents; Cardiovascular Agents; Enzymes; Fibrinolytic Agents; Humans; Pharmaceutical Preparations; Polymorphism, Genetic; Thromboembolism

Atrial fibrillation is the most common sustained arrhythmia observed worldwide. Despite modern ablative treatment options, pharmacotherapy remains the first-line therapy in patients with atrial fibrillation.. Based on recently published guidelines for the management of atrial fibrillation, the present paper reviews the current and emerging concepts of pharmacotherapy in atrial fibrillation.. A MEDLINE search was conducted using the keyword 'atrial fibrillation' and 'drug therapy'. The reviewed literature included clinical trials and published reviews as well as clinical guidelines.. The mainstay of atrial fibrillation therapy is the prevention of thromboembolic events. With growing knowledge of the pathophysiology of atrial fibrillation new drug targets have been identified that promise improved outcomes in atrial fibrillation management and this will allow individual drug treatment in the near future.

Topics: Anti-Arrhythmia Agents; Atrial Fibrillation; Cardiovascular Agents; Clinical Trials as Topic; Fibrinolytic Agents; Heart Rate; Humans; Practice Guidelines as Topic; Thromboembolism

Pulmonary hypertension (PH) is common in the critical care setting, and may be a target for specific therapy. Moderate degrees of pulmonary hypertension are most often the consequence of acute or chronic heart failure, hypoxemia, or acute pulmonary embolism, and may be relatively rapidly reversible. The consequences of more severe forms of PH, both acute and chronic, can include hypotension; low cardiac output; right heart failure with congestion of the liver, gut, and kidneys; and varying degrees of hypoxemia, each of which can lead to death or severe disability. We review the physiology, definitions, classification, pathogenesis, diagnostic tools, and algorithms for diagnosis and specific treatments for the various causes of PH as seen in the critical care setting.

Topics: Acute Disease; Algorithms; Cardiovascular Agents; Chronic Disease; Critical Care; Humans; Hypertension, Pulmonary; Thromboembolism

In vitro and ex vivo interactions of betaadrenoceptor blocking drugs, antihistamines and chloroquine with blood platelets and polymorphonuclear leukocytes resulted in different alterations of regulatory functions of these blood cells. Inhibition of platelet aggregation, arachidonate regulatory pathway, 5-hydroxytryptamine transportation, removal of platelet membrane receptors, inhibition of second messenger pathways at subcellular level and suppression of phagocytosis are indicative of nonreceptor rather than specific receptor interactions. Binding of drugs with biomembranes is reversible depending on the ionic charge of the molecule and hydrophobicity of the bilayer, partition coefficient, pH and pKa of the amphiphilic molecules and other physico-chemical properties of amphiphilic drugs. Alterations in the drug molecule structure alters the drug-phospholipid binding profile. Any change in the metabolism of membrane phospholipids directly or indirectly influences one or more of the important components of the phospholipid-signalling pathway. In addition to changes in phospholipase A, C and D activities, protein kinase C, calmodulin-phosphodiesterase, Ca2+,Mg2+-ATPase, Na+,K+-ATPase and other messengers were found to be changed in cells and tissue after cationic amphiphilic drug (CAD) administration. Although not much has been understood of the mechanism by which some CAD affect immune functions, there are good reasons to suggest that these effects might occur. CADs share sufficient similarities in their structure even though they come from diverse pharmacological classes. CADs affect ion transport, immune functions, tumour growth, serotonin metabolism and several other functions in the body. Extensive therapeutic use and associated side effects have generated a great deal of interest in understanding the nonreceptor interactions with CADs.

Topics: Adjuvants, Immunologic; Animals; Antineoplastic Agents; Blood Platelets; Cardiovascular Agents; Chloroquine; Histamine H1 Antagonists; Humans; Inflammation; Leukocytes; Reperfusion Injury; Thromboembolism

In part VI of a series of papers on epidemiology and drug prevention of stroke and other thromboembolic complications of atrial fibrillation the authors analyze data of randomized trials comparing various approaches to the treatment of atrial fibrillation: cardioversion with subsequent use of antiarrhythmic drugs for maintenance of sinus rhythm and control of rate of ventricular rhythm with obligatory concomitant use of anticoagulants. Approach aimed at sinus rhythm maintenance by means of repetitive cardioversions and long term antiarrhythmic therapy has not been associated with lowering of mortality, rates of stroke or other thromboembolic complications. The use of antithrombotic drugs represent a sole reliable method of stroke prevention in patients with persistent and chronic AF. The paper contains consideration of indications for prescription of warfarin and aspirin to these patients.

Topics: Anti-Arrhythmia Agents; Anticoagulants; Aspirin; Atrial Fibrillation; Cardiovascular Agents; Electric Countershock; Fibrinolytic Agents; Humans; Randomized Controlled Trials as Topic; Stroke; Thromboembolism; Warfarin

Many patients undergoing elective surgery will be taking medicines for cardiovascular disorders. Here, in the fourth and final article in our series on drug therapy in the peri-operative period, we review the management of patients taking certain antithrombotic, antihypertensive, anti-anginal or anti-arrhythmic drugs.

Topics: Cardiovascular Agents; Contraindications; Humans; Perioperative Care; Postoperative Complications; Thromboembolism

The long-term benefits of the maze procedure in patients with chronic atrial fibrillation undergoing mechanical valve replacement who already require lifelong anticoagulation remain unclear.. We evaluated adverse outcomes (death; thromboembolic events; composite of death, heart failure, or valve-related complications) in 569 patients with atrial fibrillation-associated valvular heart disease who underwent mechanical valve replacement with (n=317) or without (n=252) a concomitant maze procedure between 1999 and 2010. After adjustment for differences in baseline risk profiles, patients who had undergone the maze procedure were at similar risks of death (hazard ratio, 1.15; 95% confidence interval, 0.65-2.03; P=0.63) and the composite outcomes (hazard ratio, 0.82; 95% confidence interval, 0.50-1.34; P=0.42) but a significantly lower risk of thromboembolic events (hazard ratio, 0.29; 95% confidence interval, 0.12-0.73; P=0.008) compared with those who underwent valve replacement alone at a median follow-up of 63.6 months (range, 0.2-149.9 months). The effect of superior event-free survival by the concomitant maze procedure was notable in a low-risk EuroSCORE (0-3) subgroup (P=0.049), but it was insignificant in a high-risk EuroSCORE (≥4) subgroup (P=0.65). Furthermore, the combination of the maze procedure resulted in superior left ventricular (P<0.001) and tricuspid valvular functions (P<0.001) compared with valve replacement alone on echocardiographic assessments performed at a median of 52.7 months (range, 6.0-146.8 months) after surgery.. Compared with valve replacement alone, the addition of the maze procedure was associated with a reduction in thromboembolic complications and improvements in hemodynamic performance in patients undergoing mechanical valve replacement, particularly in those with low risk of surgery.

Topics: Adult; Aged; Anticoagulants; Atrial Appendage; Atrial Fibrillation; Cardiovascular Agents; Catheter Ablation; Combined Modality Therapy; Cryosurgery; Endocarditis; Female; Heart Valve Prosthesis Implantation; Hemodynamics; Humans; Kaplan-Meier Estimate; Male; Microwaves; Middle Aged; Mitral Valve Insufficiency; Postoperative Complications; Postoperative Hemorrhage; Prospective Studies; Thromboembolism; Treatment Outcome; Tricuspid Valve Insufficiency; Ultrasonography; Ventricular Dysfunction, Left

The effectiveness of drug remaxol inclusion in the scheme of treatment of patients with myocardial infarction on the background of degree III - III acute cardiac insufficiency was evaluated by the analysis of clinical and laboratory data of 126 patients with newly diagnosed acute myocardial infarction including ST-segment elevation on the background of acute cardiac insufficiency. Depending on the regimen, patients were divided into two groups. The first (control) group included 60 patients who received conventional thrombolytic therapy; the second (main) group included 66 patients which, after thrombolytic therapy, received remaxol (single daily intravenous administration, 400 mL at 3 - 4 mL/min rate) with controlled central venous pressure, arterial pressure, and diuresis. The course lasted for 3 - 5 days, depending on the severity of condition. A high efficiency of the treatment regimen including remaxol was established as characterized by more rapid (in comparison to conventional therapy) stabilization of disturbed systemic hemodynamics and recovery of weakened myocardial contractility, decreased risk of cardiac arrhythmias, and relieved hyperhomocysteinemia that, in turn, reduced the risk of complications such as thrombosis and thromboembolism.

Topics: Aged; Arrhythmias, Cardiac; Blood Pressure; Cardiovascular Agents; Case-Control Studies; Drug Administration Schedule; Female; Fibrinolytic Agents; Heart Rate; Humans; Hyperhomocysteinemia; Injections, Intravenous; Male; Middle Aged; Shock, Cardiogenic; Succinates; Thromboembolism; Thrombolytic Therapy; Thrombosis; Treatment Outcome

Thrombocytopenia and thromboembolism(s) may develop in heparin immune-mediated thrombocytopenia (HIT) patients after reexposure to heparin. At the Onassis Cardiac Surgery Center, 530 out of 17,000 patients requiring heart surgery over an 11-year period underwent preoperative HIT assessment by ELISA and a three-point heparin-induced platelet aggregation assay (HIPAG). The screening identified 110 patients with HIT-reactive antibodies, out of which 46 were also thrombocytopenic (true HIT). Cardiac surgery was performed in HIT-positive patients under heparin anticoagulation and iloprost infusion. A control group of 118 HIT-negative patients received heparin but no iloprost during surgery. For the first 20 patients, the dose of iloprost diminishing the HIPAG test to ≤5% was determined prior to surgery by in vitro titration using the patients' own plasma and donor platelets. In parallel, the iloprost "target dose" was also established for each patient intraoperatively, but before heparin administration. Iloprost was infused initially at 3 ng/kg/mL and further adjusted intraoperatively, until ex vivo aggregation reached ≤5%. As a close correlation was observed between the "target dose" identified before surgery and that established intraoperatively, the remaining 90 patients were administered iloprost starting at the presurgery identified "target dose." This process significantly reduced the number of intraoperative HIPAG reassessments needed to determine the iloprost target dose, and reduced surgical time, while maintaining similar primary clinical outcomes to controls. Therefore, infusion of iloprost throughout surgery, under continuous titration, allows cardiac surgery to be undertaken safely using heparin, while avoiding life-threatening iloprost-induced hypotension in patients diagnosed with HIT-reactive antibodies or true HIT.

Topics: Adult; Aged; Aged, 80 and over; Antibodies; Anticoagulants; Aortic Aneurysm; Blood Platelets; Cardiac Valve Annuloplasty; Cardiovascular Agents; Coronary Artery Bypass; Drug Administration Schedule; Drug Monitoring; Female; Heparin; Humans; Iloprost; Male; Middle Aged; Perioperative Care; Platelet Aggregation; Platelet Count; Thrombocytopenia; Thromboembolism; Treatment Outcome

Isolated left ventricular noncompaction (LVNC) is a rare hereditary cardiomyopathy characterized by prominent intraventricular trabeculations separated by deep intertrabecular recessus. While cardiac ischemia due to microvascular dysfunction is common in these patients, ST-segment elevation myocardial infarction (STEMI) is rare and usually seen as a consequence of coincidental coronary artery disease. We report the case of a 20 year-old male patient admitted to our emergency department with a complaint of squeezing chest pain who was subsequently diagnosed with STEMI according to electrocardiographic findings, although an emergent coronary angiogram demonstrated normal coronary arteries. Echocardiography revealed isolated LVNC, and the diagnosis was confirmed via magnetic resonance imaging. Repeat coronary catheterization with acetylcholine infusion and coronary flow reserve measurement failed to demonstrate vasospasm or microvascular dysfunction. As no apparent cause was found, this case was designated 'idiopathic' myocardial infarction. Coronary thromboembolism due to stagnation of blood in the left ventricular cavity remained as the most probable mechanism underlying myocardial infarction.

Topics: Cardiac Catheterization; Cardiovascular Agents; Coronary Angiography; Coronary Circulation; Echocardiography, Stress; Electrocardiography; Humans; Isolated Noncompaction of the Ventricular Myocardium; Magnetic Resonance Imaging; Male; Microcirculation; Microvascular Angina; Myocardial Infarction; Thromboembolism; Young Adult

Topics: Algorithms; Biomarkers; Cardiovascular Agents; Diagnostic Techniques, Cardiovascular; Exercise Tolerance; Heart Diseases; Humans; Hypertension, Pulmonary; Hypoxia; Lung Transplantation; Prognosis; Pulmonary Veno-Occlusive Disease; Referral and Consultation; Risk Factors; Terminal Care; Thromboembolism

Topics: Adolescent; Adult; Blood Pressure; Cardiovascular Agents; Child; Child, Preschool; Diagnosis, Differential; Female; Humans; Hypertension, Pulmonary; Male; Middle Aged; Oxygen Inhalation Therapy; Pulmonary Circulation; Thromboembolism; Vasoconstriction

Topics: Adult; Aged; Cardiovascular Agents; Electrocardiography; Female; Humans; Male; Middle Aged; Pacemaker, Artificial; Prognosis; Sick Sinus Syndrome; Thromboembolism

Topics: Anticoagulants; Cardiovascular Agents; Deoxyribonuclease I; Muscle Relaxants, Central; Streptodornase and Streptokinase; Streptokinase; Syndrome; Thromboembolism

Topics: Aminobenzoates; Anticoagulants; Biomedical Research; Cardiovascular Agents; Ergot Alkaloids; Oxytocics; Phenylbutazone; Plant Extracts; Thromboembolism

Topics: Aminobenzoates; Biomedical Research; Cardiovascular Agents; Ergot Alkaloids; Oxytocics; Thromboembolism

Topics: Cardiovascular Agents; Ergot Alkaloids; Female; Obstetric Labor Complications; Oxytocics; Secale; Thromboembolism