Cardiology in review
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The most concerning adverse reaction with HMG-CoA reductase inhibitors (statins) is myotoxicity. Statins inhibit the production of mevalonate, a precursor of both cholesterol and coenzyme Q10, a compound believed to be crucial for mitochondrial function and the provision of energy for cellular processes. ⋯ Coenzyme Q10 supplementation has been shown to reverse statin-induced decreases in circulating coenzyme Q10 concentrations, although the effect of supplementation on tissue coenzyme Q10 concentrations and any resulting clinical benefit has not been adequately assessed. Although there is not much of a safety concern with coenzyme Q10 supplementation, there is also not enough evidence to support its routine use for preventing the adverse effects of statin therapy, and it is therefore not recommended for this purpose at this time.
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Cardiology in review · Sep 2004
ReviewCardiovascular pharmacotherapeutic considerations during pregnancy and lactation.
Table 2 summarizes the recommendations regarding the use of cardiovascular drugs during pregnancy and lactation.
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Cardiology in review · Jul 2004
ReviewCongenital and acquired long QT syndrome. Current concepts and management.
Congenital long QT syndrome (LQTS) is a rare but potentially lethal disease, characterized by prolongation of QT interval, recurrent syncope, and sudden death. In the pregenomic era (1959-1991), sympathetic imbalance was thought to be responsible for this disease. Since 1991 (postgenomic era), 7 LQTS genes have been discovered and more than 300 mutations have been identified to account for approximately 70% of patients affected. ⋯ For patients with a history of drug-induced LQTS, care must be taken to avoid further exposure to QT-prolonging drugs or conditions. Molecular genetic analysis could be useful to unravel subclinical mutations or polymorphisms. Physicians not only need to be aware of the pharmacodynamic and pharmacokinetic interactions of various important drugs, but also need to update their knowledge.
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Cardiology in review · May 2004
Case ReportsThe importance of the evolution of ST-T wave changes for differentiating acute pericarditis from myocardial ischemia.
A 28-year-old, moderately obese man with dyslipidemia (low-density lipoprotein 163 mg/dL, high-density lipoprotein 33 mg/dL), hypertension, active tobacco use (1 pack per day), and a family history for premature coronary artery disease (CAD) initially presented with burning, nonexertional chest discomfort exacerbated by deep inspiration. His initial electrocardiogram (ECG; Fig. 1A) was interpreted as pericarditis because of the diffuse mild ST-segment elevation and PR-segment depression. An echocardiogram demonstrated normal left ventricular systolic function and a trivial pericardial effusion. ⋯ The ECG returned to baseline within 3 minutes of recovery. He was referred for coronary angiography and was found to have a proximal left anterior descending (LAD) stenosis and underwent percutaneous coronary intervention with stenting. He was discharged home on postprocedure day 3.
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Cardiology in review · Mar 2004
Case ReportsUse of aminophylline in the treatment of severe symptomatic bradycardia resistant to atropine.
Bradycardia and cardiac arrest are known complications of acute spinal cord injuries and are usually temporary. If the general measures of correcting hypoxia and using atropine fail, placement of a temporary followed by a permanent pacemaker is typically considered. ⋯ Aminophylline had been used in the past for treating resistant bradycardia in settings such as acute inferior wall myocardial infarction, cardiac transplantation, and so on, but has never been used in the setting of acute spinal cord injuries. Aminophylline probably works in this setting by increasing cyclic adenosine monophosphate (cAMP) and activating the sympathoadrenal system.