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Common Congenital Heart Lesions - page 69 / 126

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69 / 126

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        Beta antagonists: decrease force of contraction, decrease HR, relieve ischemia, increase time spent in diastole

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        Decrease rates of recurrent infarction following acute MI

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        FIRST LINE TREATMENT FOR CAD

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        Side effects and contraindications:

        • Bronchospasm, if non-selective is used

        • Avoid any type of beta blocker in pts w/ obstructive airway disease

        • Avoid using them with decompensated LV dysfunction (reduced CTY)

        • Avoid using them in patients with bradycardia

        • Avoid using them in patients with diabetes mellitus

        • Cause fatigue

        • Cause sexual dysfunction

  • Calcium Channel Blockers: antagonize voltage gated L-type calcium channels

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      Dihydropyridines

      • VASODILATOR (oxygen demand—reduce wall stress, oxygen supply—coronary dilation)

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        Nondihydropyridines (verapamil, diltiazem)

        • Less potent vasodilator

        • Decrease force of contraction

        • Slow heart rate

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        Short acting calcium channel blockers

        • Associated with increased risk of MI

        • Avoid

No drugs have been found to slow or reverse the process of arterial lesions in CAD. Although beta blockers have been shown to increase survival after an MI, none of these drugs will improve survival for patients with chronic stable angina.

Prevention of MI and Death:

  • Antiplatelet therapy (aspirin)

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      STANDARD ADDITION to the drugs used in treating CAD

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        Substitute with clopidogrel in patients allergic to aspirin

  • Lipid Lowering Therapy

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        Statins: can improve endothelial cell dysfunction

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        Get LDL below 100 mg/dL in patients with CAD

  • ACE inhibitors

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      Reduce risk of MI and death in patients with CAD

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        Improve ventricular function

More intensive interventions

  • Mechanical revascularization: 2 types

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