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|FIRST NATIONAL DAILY eMEDICAL NEWSPAPER OF INDIA|
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27th February 2010, Saturday
How does young CAD clinically present?
The clinical presentation of CAD in younger patients differs from that in older patients. A higher proportion of young patients do not experience angina.
What is the the first clinical presentation of young MI?
An acute coronary syndrome (ACS) that progresses rapidly to MI (most often an ST– elevation MI) if left untreated is the first manifestation of CHD.
Is the diagnosis always easy in young CAD?
A potential diagnostic problem encountered most in younger subjects is that myocarditis can mimic an acute MI. This disorder should be particularly considered in young patients with a clinical presentation of an ACS who have a normal coronary angiogram.
What are the typical angiographic findings?
Younger patients have a higher incidence of normal coronary arteries, mild luminal irregularities, and single vessel coronary artery disease than do older patients.
How is MI treated in the young?
The overall approach to therapy in MI is generally not dependent upon age.
What is the role of risk factor reduction in young MI?
Risk factor reduction plays a central role in survivors of the MI. This includes smoking cessation; aggressive lipid lowering, and, in appropriate patients, treatment of diabetes and hypertension.
How is ST–elevation MI treated?
Young patients with an acute ST–elevation MI should be treated with primary PCI or, if not available, thrombolytic therapy. Both young and old patients have a better outcome with PCI than thrombolysis. However, young patients do better than older patients regardless of the therapy received. Young patients also appear to respond well to thrombolytic therapy.
How is non–ST elevation ACS treated?
Patients with a non–ST elevation ACS — non–ST elevation (non–Q wave) MI or unstable angina — are first stabilized with medical therapy since they do not appear to benefit from immediate coronary reperfusion. Once stable, most such patients undergo coronary angiography and revascularization, if appropriate. The current recommendtion is not to go for routine coronary angiography in young patients who have had a non–ST elevation ACS. These patients should undergo exercise stress testing, and only those with high–risk features should be referred for cardiac catheterization.
What is the prognosis after MI?
Myocardial infarction occurring at an early age raises the disturbing potential of a malignant atherosclerotic diathesis and an adverse prognosis. However, many such patients do not have severe coronary disease and most series have noted favorable short– and long–term prognosis in such patients.
What is the in–hospital mortality?
The in–hospital mortality in young patients has ranged from 0 to 4 percent, a value lower than that in older patients.
What is the long–term outcome of young CAD?
Young patients also have a good long–term outcome after MI. Survival rates at seven years after an MI are 84 versus 75 percent for young and older men and 90 versus 77 percent for young and older women.
How common is recurrence?
Recurrent coronary events are not uncommon.
What is the management of chronic CAD?
The management of stable angina, including the indications for revascularization, is similar in younger and older patients. Routine coronary angiography is not recommended in young patients who have stable CAD. However, when indicated, both PCI and CABG are effective and are associated with lower risks in younger compared to older patients.
Management should also include intensive risk factor reduction including smoking cessation, initiation of an exercise program. aggressive lipid lowering, screening for depression, and, in appropriate patients, treatment of diabetes and hypertension.
Question of the day
Patients with toxic megacolon (i.e. those with colonic dilation of 6 cm or greater who appear toxic) who do not respond to therapy within 72 hours should be considered candidates for colectomy. Surgical consultation should be obtained early on in such patients. Less severely ill patients usually respond to parenteral corticosteroids within 7–10 days. Despite advances in therapy, rates of colectomy for severe ulcerative colitis have not changed substantially in more than 30 years.
(Suggested reading: Turner D, Walsh CM, Steinhart AH, et al. Response to corticosteroids in severe ulcerative colitis: a systematic review of the literature and a meta–regression. Clin Gastroenterol Hepatol 2007;5:103–10)
eMedinewS Try this it Works
Dr Good Dr Bad
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Oxygen uptake (VO2)
Vo2 = Co x (Cao2 – Cvo2)
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Mistakes in Clinical Practice
Beware of decimal points, which can lead to excessive dosing if misinterpreted
1–7 April Prostate Disease Awareness Week: Prostate SMS of the Day (Dr Anil Goyal)
No man under the age of 30 has evidence of BPH. The prevalence rises with age with 88% of men above 80 years of age having prostatic enlargement.
Reducing risks of developing kidney diseases
Check kidney functions, if one has one or more of the ‘high-risk’ factors
Kidney terms (Dr G M Singh)
Lab test (Dr Navin Dang)
Discourage marriage between thalassemias carriers to prevent birth of a child with thalassemia disease.
List of Approved drug from 1.01.2009 to 31.10.2009
ZEN IMMUNE–FACT SHEET
ZEN IMMUNE POWER a known IMMUNITY BOOSTER with ability to help REDUCE ABSORPTION OF ALUMINUM FROM THE GI TRACT AND ENHANCE EXCRETION THROUGH KIDNEYS; A KEY TO ELIMINATE ALUMINUM TOXICITY AND THE RELATED SYSTEMIC INVOLVEMENT. .
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Stress Management Workshop (April 17–18)
A stress management workshop with Dr KK Aggarwal and Experts from Brahma Kumaris will be organized on April 17–18, 2010.
Organizers: eMedinews, Brahma Kumaris, Heart Care Foundation of India, in association with IMA New Delhi Branch and IMA Janak Puri Branch
Venue: Om Shanti Retreat Center, National Highway 8, Bilaspur Chowk Pataudi Road, Near Manesar.
Timings: On Saturday (2pm onwards) and Sunday (7am 4pm). There will be no registration charges, limited rooms, kindly book in advance, stay and food (satvik) will be provided. For booking e–mail to email@example.com or sms to Dr KK Aggarwal 9811090206/ BK Sapna 9811796962
Why do people on cholesterol-lowering drugs still have heart attacks?
What role does cholesterol really play?
How can you lower your risk of heart disease and stroke?
What to Do About High Cholesterol
To get answer to these questions and to know why lowering your LDLs (the bad cholesterol) is even more important than previously thought. COME & JOIN: DR.K.K.AGGERWAL CME's STUDY GROUP FREE CLASSES, It includes a step-by-step approach to clinical management. Next class Sunday 28th Feb. Subject Diabetes [DR.G.M.SINGH]