American heart journal
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American heart journal · Aug 1999
ReviewOptimal treatment of patients with acute coronary syndromes and non-ST-elevation myocardial infarction.
Non-ST-elevation myocardial infarction is usually indistinguishable from unstable angina at the initial presentation. The diagnosis is made subsequently when cardiac enzymes are found to be elevated either at admission or within 18 hours. Our understanding of the pathophysiology of acute coronary syndromes has advanced dramatically, and coupled with this understanding has been the introduction of new antiplatelet and antithrombotic treatments. ⋯ Patients at intermediate risk should be treated with aspirin, unfractionated or low-molecular-weight heparin and, if unfractionated heparin is chosen, an adjunctive IIb/IIIa receptor antagonist. Patients at high risk should be treated with the same therapies and considered for expeditious angiography and revascularization as appropriate. A long-term secondary prevention strategy should be implemented.
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American heart journal · Aug 1999
Randomized Controlled Trial Clinical TrialShort-term and long-term hemodynamic and clinical effects of metoprolol alone and combined with amlodipine in patients with chronic heart failure.
Initiation of beta-blocker therapy is often limited by worsening congestive heart failure, which may manifest as worsening hemodynamics. Deleterious hemodynamic effects might be mitigated with the vasodilation of combined calcium channel/beta-blocker therapy. ⋯ There was no further measurable benefit with the addition of amlodipine to metoprolol compared with the effects of metoprolol alone. Therapy with metoprolol alone and the combination of metoprolol and amlodipine was well tolerated in patients with mild to severe heart failure, as evidenced by a lack of adverse effects on hemodynamic parameters over the short term and clinical and hemodynamic improvement with long-term treatment.