Steve Selig 1

1
Summary of drug treatments for heart disease
Reference MIMS
2
Summary of drug treatments for heart failure

• The drug treatment of heart failure, once simple,
  has become complex. Apart from a loop diuretic
  and digoxin, most patients should now be
  receiving an angiotensin-converting enzyme
  inhibitor (or angiotensin II receptor blocker), a
  beta-blocker and spironolactone.
• Nicholls MG, Lainchbury JG, Richards AM,
  Troughton RW, Yandle TG. Brain natriuretic
  peptide-guided therapy for heart failure. Ann
  Med. 200133422-7

3
Benefits of angiotensin converting enzyme (ACE)
blockade

• Heart Outcomes Prevention Evaluation (HOPE) study
  conclusively demonstrated that ramipril, an
  angiotensin-converting enzyme (ACE) inhibitor,
  reduces the risk of cardiovascular death.
• Patients Treated with Ramipril and Vitamin E
  (SECURE) substudy demonstrated that ramipril also
  reduced atherosclerosis. These results suggest
  that the renin-angiotensin system (RAS) has a
  more important role in the development and
  progression of atherosclerosis than previously
  believed.
• Yusuf S. From the HOPE to the ONTARGET and the
  TRANSCEND studies challenges in improving
  prognosis. Am J Cardiol. 20028918A-25A
  discussion 25A-26A.

4
Beneficial effects of angiotensin II blockade

• The use of angiotensin II receptor blockers
  (ARBs) as monotherapy in the absence of ACEIs
  or as combination therapy with ACEIs appears
  promising.
• Jong P, Demers C, McKelvie RS, Liu PP.
  Angiotensin receptor blockers in heart failure
  meta-analysis of randomized controlled trials. J
  Am Coll Cardiol. 200239463-70.

5
Beneficial effects of beta blockade

• Beta blocker, bisoprolol, prevents major
  cardiovascular events in patients with CHF with a
  high benefit-to-risk ratio and can be recommended
  for these patients.
• Leizorovicz A, Lechat P, Cucherat M, Bugnard F.
  Bisoprolol for the treatment of chronic heart
  failure a meta-analysis on individual data of
  two placebo-controlled studies--CIBIS and CIBIS
  II. Cardiac Insufficiency Bisoprolol Study. Am
  Heart J. 2002143301-7.

6
A brief glossary of terms

• Dysphasia or Aphasia impairment or loss of
  speech due to motor (expressive) or sensory
  (receptive) deficits
• Dysarthria imperfect articulation
• Hemiplegia paralysis on one side
• Hemiparesis weakness or partial paralysis on
  one side
• Basal ganglia extrapyramidal tracts for gross
  motor control
• Corpus callosum co-ordinating of activities
  between left and right

7
A brief glossary of terms, cont.

• Bruit abnormal sound
• Anomia can not recall names or labels
• Hemianopsia defective visual processing in one
  half on the field of both eyes
• Dysphagia difficulty in swallowing
• Dysmetria difficulty in measuring distance in
  physical acts
• Ataxia muscular incoordination
• Mastication chewing

8
A brief glossary of terms, cont.

• Hypesthesia decreased sensation
• Polycythemia vera proliferation of
  haematopoietic bone marrow increases RBC mass
  and BV associated with thrombocythemia
  (increased platelet production)
• Subclavian steal syndrome diversion of blood
  from basilar artery to subclavian artery due to
  occlusion