Unstable Angina Case Study

High cholesterol level is a condition in which the concentration of high density lipids (HDL) specifically cholesterol, has significantly increased in the blood. The build up of these lipids in arteries reduce the supply of blood and hence, oxygen to the heart. Consequently, high cholesterol can lead to stroke or heart attack. Apo – Atorvastatin (Atorvastatin Calcium Tablets) is a medication that helps lower the concentration of cholesterol and other HDL in the blood (Apo-Atorvastatin, 2011) and is manufactured by Apotex Inc.

A higher level of fats in the body puts the patient at higher risk for Cardiovascular diseases(CAD). The patient's' family has a history of CAD. Her mom and one of her sister have CAD (Lewis et al., 2014, pp. 733-734). The patient states that she has been taking her meds for cholesterol atorvastatin regularly. Her lipase level was 8272 on 11/11/16 and 2829 on 11/12/16 U/L 1069 on 11/13/16 (Ref range 73-393 U/L). Her HDL cholesterol level was 21 ( ref range>49 mg/dl), LDL Cholesterol level 148 ( ref range: <130 mg/dL). Patient statin drug was on hold because it is contradicted on the patient with an elevated level of ALT 80, 61(Ref range 0-50 U/L) and AST 61 on 11/12/16 and 64 on 11/13/16 (ref range 0-45 U/L). The uncontrolled level of could be the cause of concern for stroke or acute myocardial

The word angina is well derived from origin of Latin word “Angere” which means “to choke” and “pectus” means “chest” or it is also derived from origin of Greek word “Ankhone” which means a “strangling”. (Marc D Haber, Feb 18, 2015)

Ivabradine has captured the attention of scientists and has opened up new possibilities for the treatment of stable angina and chronic heart failure. Ivabradine is being developed as an anti-angina drug in patients with stable coronary artery disease and was found to reduce heart rate by selectively inhibiting the pacemaker (If) current in the sinoatrial node (Jedlickova et al., 2015). Recent studies have noted how the reduction of heart rate caused by ivabradine has broader implications on heart health, and also how ivabradine can potentially improve cardiovascular disease (CVD) by mechanisms other than heart rate reduction. Studies have also looked at using ivabradine in more than just treating stable chronic angina, but also in other types of CVD and even chest pains. O 'Connor et al., (2016) examined the effects of ivabradine following myocardial infarction in mice and Jedlickova et al., (2015) through studying ivabradine used as an angina treatment in humans, looked at the effects of ivabradine on endothelial function. These studies have highlighted how ivabradine may not only be beneficial as a treatment via heart rate reduction, but also through pleiotropic mechanisms (Heusch and Kleinbongard, 2016). Ivabradine is an important area of research because it can be useful in more than one context.

Hypertension. His blood pressure is great here in the office. I will have him continue with his same medication and I will continue to follow along and he was asked also monitor for signs of hypotension and I did review with him what to be monitoring for.

Amanda L Bowles is a 35 y.o. female enrolled on CTN 1302 who presents today for Cycle 1 Day 15 of maintenance Ixazomib. Patient reports having heart palpitations that started Saturday and were continuous. She has had palpitations in the past but were intermittent. On Monday she began experiencing 4/10 chest pain, lightheadedness, SOB, and headache. That day she went to her local emergency department for work-up. Based on the paperwork provided by the patient she was diagnosed with palpitations and atrial bigeminy. They increased her metoprolol dose from 25mg to 75mg. She was not admitted to the hospital and reports the chest pain and palpitations have since resolved.

Patient A.S. is 87-year-old female with a diagnosis of Acute onset chronic systolic heart failure, Afib, CHF, and hypothyroidism. She has a past medical history of Hypertension, diabetes mellitus, CAD (Stent 2001). The patient was admitted to Lutheran Augustana Center on January 4, 2016 and was evaluated for therapy on January 5, 2016. Her current medications include Albuterol and Ipratropium via nebulizer to address shortness of breath. A combination of drugs to treat the symptoms of congestive heart failure and other comorbid diagnosis include: Eliquis, Furosemide, hydralazine, and metoprolol. Other medications include Synthroid to treat hypothyroidism, Tradjenta for hyperglycemia, and Zocor for hyperlipidemia. The patient also presented with skin problems. She has bilateral ecchymosis in her lower extremities and abdomen. Lotrisone lotion was prescribed for atopic dermatitis. Edema was also present in her lower extremities.

In Focus on Pharmacology Essentials For Health Professionals, Jahangir Moini states “angina pectoris is a common form of ischemic heart disease and often precedes and accompanies MI” (Moini, 2013. p.359). When having angina, a patient will feel pressure in the chest like a squeezing sensation and the pain can travel to the jaw, down the arm, into the neck, shoulders, or back.

statins reduce the blood cholesterol level and decrease atherosclerosis build up in the coronary arteries.

A recent systematic review of observational data (6 studies) found that the total mortality rate in angina patients was 2.8% to 6.6% per annum(121). At present it is thought that stable angina does not cause permanent myocardial damage. However prompt diagnosis and treatment is important to prevent further complications. Initiation of pharmacological intervention has been shown to retard plaque disease progression and to stabilise the surface endothelium(131).

Presently, the treatment strategies used are risk factor modification, conventional pharmacology and surgical revascularization. These strategies have hitherto not been of enormous solution as the disease progression still result in recurrent symptoms. This has now led to the exploitation of advances in comprehending the vascular biology of atherogenesis to introduce novel cell and molecular-based therapies. The application of immunomodulation, lipid-lowering agents like statins, gene transfer, antisense technology and so on has resulted in new therapeutic strategies to interrupt cell proliferation and disorder of the vessel wall. In this essay, immunomudulation and lipid-lowering agent shall be discussed.

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;In today’s society, people are gaining medical knowledge at quite a fast pace. Treatments, cures, and vaccines for various diseases and disorders are being developed constantly, and yet, coronary disease remains the number one killer in the world.

Angina is a pain in the chest and surrounding areas of the body that happens when the heart does not get enough oxygen. Your blood carriers oxygen, which your heart muscle need to survive. When your heart muscle is not getting oxygen due to heart arteries narrowing from fatty buildup or fatty breakup, which can lead to block of blood flow.7 There are two types of angina: stable and unstable angina. Stable angina is the chest pain that occurs usually in the morning that lasts for only a few minutes with the same pattern, length of time, and symptoms.6 Unstable angina is the new start chest pain that occurs at any time of day and has a worsen pattern.2

Medications that can cause interactions include anticoagulants, probenecid, bisphosphonates, angiotensin-converting enzyme (ACE) inhibitors, anticoagulants (Warfarin), antiplatelet medicines (Clopidogrel), aspirin, corticosteroids (Prednisone), heparin, other NSAIDs (Ibuprofen), Rivaroxaban, or Selective Serotonin Reuptake Inhibitors (SSRIs) (Fluoxetine) due to the risk of stomach bleeding may be increased. Bisphosphonates (Alendronate), Cyclosporine, Hydantoins (Phenytoin), Lithium, Methotrexate, Quinolones (Ciprofloxacin), Sulfonamides (Sulfamethoxazole), and Sulfonylureas (Glipizide) side effects may be increased by Naproxen. The effectiveness of Angiotensin-converting enzyme (ACE) inhibitors (Enalapril), Beta-blockers (Propranolol), or diuretics (Furosemide, Hydrochlorothiazide) may be decreased by Naproxen (Lexi-Comp,

The most compelling evidence of a non–lipid-lowering effect of a statin is the rosuvastatin-mediated reduction in venous thromboembolic events, a prespecified endpoint, in JUPITER. This trial demonstrated a 43% reduction in venous thromboembolic events in patients treated with rosuvastatin, 20 mg daily, compared with placebo during a median follow-up period of 1.9 years (Glynn et al., 2009).