Prevalence, Diagnostic and Therapeutic Characteristics - Right Ventricular Infarction

The current issue of the article published an article that was meant to provide a wholesome idea of the diagnosis, prognosis, treatment as well as sociodemographic correlations of right ventricular infarction. 

It was concluded that though right ventricular infarction are usually considered as rare occurrences, they are most often found to be associated with extension of persisting inferior myocardial infarction. Furthermore, the prognosis of the disease is even worse in patients with hemodynamic instability. Read More>>>>>>>>

Right Ventricular Dysfunction in Myocardial Infarction: A New Risk Factor for Clopidogrel Resistance?

Right ventricular dysfunction (RVD) in acute coronary syndromes occur either primary in infarction of the right ventricle mainly caused by proximal occlusion of the right coronary artery or secondary ininfarction of the left ventricle with consecutive increase of pulmonary pressure. 

The incidence of right myocardial infarction has ranged widely according to the diagnostic technique used and the patients profile. It is recognizable clinically in two thirds of hypotensive inferior infarction and most inferior infarctions with cardiogenic shock. The recommended treatment in acute myocardial infarction is percutaneous coronary intervention (PCI) with stent deployment in order to restore myocardial perfusion. Dual inhibition of platelet aggregation with a thienopyridine like clopidogrel and aspirin showed a dramatic reduction of major adverse cardiac events after PCI. Read More>>>>>>>>>>>

Exercise-Based Rehabilitation for Coronary Heart Disease: What does the Evidence Show?

Coronary heart disease (CHD) is the most common cause of death globally. Cardiac rehabilitation (CR) for patients with cardiovascular disease is recommended by practice guidelines, and includes multifaceted interventions to improve atherosclerotic risk markers, lifestyle, exercise capacity, quality of life, increases life expectancy, suppresses hospitalization frequency and has been shown to be cost effective. 

 

Anderson and colleagues evaluated a total of 63 studies with 14,486 participants with median follow-up of 12 months were included. The authors included randomized controlled trials with at least 6 months of follow-up, comparing to the CR-exercise controls Following myocardial infarction or revascularization, or with a diagnosis of angina pectoris or CHD defined by angiography. Studies were pooled using random effects meta-analysis, and stratified analyzes were undertaken to examine potential treatment effect modifiers. Read more>>>>>>>

2015 American Heart Association | American College of Cardiology

Hypertension is a major risk  factor for cardiovascular disease [1-9]. Hypertension is present in approximately 69% of patients with a first myocardial infarction. This editorial will discuss the 2015 American Heart Association/American College of Cardiology/American Society of Hypertension guidelines on treatment of hypertension in patients with coronary artery disease.Previous hypertension guidelines have recommended reducing the blood pressure in patients with coronary artery disease and hypertension to less than 140/90 mm Hg, to less than 130/80 mm Hg with consideration of lowering the blood pressure to less than 120/80 mm Hg if left ventricular systolic dysfunction is present to less than 140/90 mm Hg in patients younger than 80 years and the systolic blood pressure to 140-145 mm Hg if tolerated in patients aged 80 years and older, to less than 140/90 mm Hg in patients younger than 80 years and to less than 150/90 mm Hg in patients aged 80 years and older and to less than 140/90 mm Hg .

A study of 4,162 patients with acute coronary syndromes found that the lowest incidence of cardiovascular events occurred with a s blood pressure of 130-140/ 80-90 mm Hg. In a study of 8,354 coronary artery disease patients, the primary outcome of death, nonfatal myocardial infarction, or nonfatal stroke occurred in 9.36% with a systolic blood pressure (SBP) <140 mm Hg, in 12.71% with a 140-149 mm Hg SBP, and in 21.3% with a ≥ 150 mm Hg SB. Compared with a <140 mm Hg SBP, a 140 to 149 mm Hg SBP increased cardiovascular death 34%, all strokes 89%, and nonfatal stroke 70%. Compared with a SBP < 140 mm Hg, a ≥ 150 mm Hg SBP increased the primary outcome 82% , all-cause mortality 60%, cardiovascular death 218%, and all strokes 283%.

Get PDF Link

Right Ventricular Dysfunction in Myocardial Infarction: A New Risk Factor for Clopidogrel Resistance?

Introduction:

Right ventricular dysfunction (RVD) in acute coronary syndromes occur either primary in infarction of the right ventricle mainly caused by proximal occlusion of the right coronary artery or secondary ininfarction of the left ventricle with consecutive increase of pulmonary pressure. The incidence of right myocardial infarction has ranged w

idely according to the diagnostic technique used and the patients profile. It is recognizable clinically in two thirds of hypotensive inferior infarction and most inferior infarctions with cardiogenic shock. 

The recommended treatment in acute myocardial infarction is percutaneous coronary intervention (PCI) with stent deployment in order to restore myocardial perfusion . Dual inhibition of platelet aggregation with a thienopyridine like clopidogrel andaspirin showed a dramatic reduction of major adverse cardiac events after PCI .In the past years there have been several studies that showed the importance of sufficient response to clopidogrel to prevent thrombembolic complications. 

Furthermore, different studies showed the importance of an early detection of clopidogrel resistance as it is associated with worse outcome after PCI .

Since clopidogrel is a prodrug, which has to be metabolized into the active metabolite by two Cytochrome P-450 dependent steps in the liver, the inter individual variability for the responsiveness to clopidogrel is high. Especially in hemodynamically unstable patients with cardiogenic shock and multi organ dysfunction resorption and metabolization of clopidogrel may not be ensured.