scholarly journals Nitrates as an Integral Part of Optimal Medical Therapy and Cardiac Rehabilitation for Stable Angina: Review of Current Concepts and Therapeutics

2012 ◽  
Vol 35 (5) ◽  
pp. 263-271 ◽  
Author(s):  
William E. Boden ◽  
Aloke V. Finn ◽  
Dharmesh Patel ◽  
W. Frank Peacock ◽  
Udho Thadani ◽  
...  
Keyword(s):  
Cardiac Rehabilitation ◽  
Medical Therapy ◽  
Stable Angina ◽  
Optimal Medical Therapy

scholarly journals P870 The role of transthoracic doppler echocardiography in chronic total occlusion diagnosis in a patient with stable angina and cerebral atherosclerosis

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
N Pavlova
Keyword(s):  
Coronary Angiography ◽  
Medical Therapy ◽  
Doppler Echocardiography ◽  
Stable Angina ◽  
Left Ventricular ◽  
Optimal Medical Therapy ◽  
Actual Problem ◽  
Transthoracic Doppler Echocardiography ◽  
Eversion Endarterectomy ◽  
Stress Echo

Abstract Introduction The issue of sudden cardiac death (SCD) remains one of the most actual problem in healthcare. Several reports underscores that about 50-80% of SCD is linked to ischemic heart disease (IHD). The usage of contemporary risk-stratification criteria of SCD and implementation of new noninvasive ultrasound methods allow to improve patient’s prognosis through early start of optimal medical therapy and surgical treatment. Material and methods: 63 years-old male with moderate class II stable angina. Patient undergone eversion endarterectomy 2 years prior to initial admittance due to an 80% left internal carotid stenosis and received appropriate optimal medical therapy provided by the modern dyslipidemia guidelines. We’ve used ECG (MAC 1600, GE); transthoracic doppler echocardiography, stress-echo, triplex scanning (VIVID E9, E95, GE); ergometry stress test (eBike, GE), quantitative coronary angiography (Innova 3100, GE). Results ECG (sinus rhythm, 62bpm, left ventricular hypertrophy) and brachiocephalic arteries triplex scan were unremarkable. Patient had dyslipidemia with low HDL. Transthoracic echocardiography revealed no region wall motion abnormalities, concentric remodeling, mild diastolic dysfunction, preserved ejection fraction (57%, Simpson). Transthoracic doppler echocardiography showed retrograde mid-LAD flow and patient was scheduled for noninvasive stress-echocardiography (Level III, 100W 2:00 min). Stress-echo was positive with apical anterior and lateral akinesia, septal and mid-lateral hypokinesia, GLS rest 15 %, GLS peak 13% and dynamic ST-segment changes in V4-V6. Invasive coronary angiography showed LAD CTO and subtotal LCx lesion. Then LAD and LCx PTCA with stenting were performed with good clinical outcome. Conclusion Novel methods of cardiac and coronary visualization are feasible in coronary flow reserve assessment and chronic total occlusions identification, especially in patients with multifocal atherosclerosis.

Abstract 12910: Use of Optimal Medical Therapy in Patients With Cardiovascular Disease Undergoing Cardiac Rehabilitation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
S Hammad Jafri ◽  
Pavel Huschsa ◽  
Gisele Bousquet ◽  
Sonis Lindsay ◽  
Lutfy Christine ◽  
...  
Keyword(s):  
Cardiac Rehabilitation ◽  
Medical Therapy ◽  
Left Ventricular Systolic Dysfunction ◽  
Beta Blockers ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Optimal Medical Therapy ◽  
Neprilysin Inhibitor ◽  
Angiotensin Receptor Neprilysin Inhibitor ◽  
Artery Disease

Introduction: Optimal Medical Therapy (OMT) in patients with Coronary Artery Disease (CAD) or Heart Failure (HF) is underused despite known benefits. The rate of OMT use among patients enrolled in Cardiac Rehabilitation (CR) is not well known. Purpose: To describe prevalence and characteristics of OMT use in patients with CAD or HF undergoing CR. Methods: CAD patients were defined as those with prior MI, PCI, CABG, or angina. OMT for CAD patients required all currently guideline-recommended medications (aspirin or antiplatelet, statins, beta-blockers (BB); and ACEi/ARB for concurrent HF or DM). The HF group included patients referred to CR for HFrEF or for another indication and had documented left ventricular systolic dysfunction (LVEF<40%, echocardiography). OMT for HF required BB, spironolactone and either ACEi/ARB or Angiotensin Receptor Neprilysin Inhibitor (ARNI) use. Predictors of OMT were identified using with multivariable logistic regression. Results: From January 2015 to December 2019, 612 patients (mean age: 65, 23% female) with CAD were enrolled in CR, with 483 (79%) patients meeting all OMT criteria. CAD patients on OMT were more likely to have hypertension (85%), hyperlipidemia (94%) but less angina (8%). Prior MI, hypertension, hyperlipidemia, and 6-minute walk distance were significantly associated with OMT use.Of 131 HF patients (mean age: 64, 21% female) enrolled in CR, 23 (18%) met all 3 OMT criteria—99 (76%) and 128 (98%) patients met only 2 or 1 of OMT criteria, respectively. Use of spironolactone (least prescribed), ARNI, and ACEi/ARBs all increased over the study period. Study limitations include lack of control for contraindications to medications. Conclusion: Although it has improved over time, OMT use remains low (HF 18%, CAD 79%) among patients enrolled in CR. CR may represent a unique opportunity to enhance OMT use.

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