Rx Note

Introduction Stable ischaemic heart disease (SIHD) is caused by obstructive atherosclerotic plaque in one or more epicardial coronary arteries. Inappropriate, insufficient or untreated SIHD cannot only lead to MI and cardiac death, but also cause the development of heart failure , arrhythmias and valvular disease. Clinical Presentation Chest pain (angina) from exertion is the cardinal symptom of myocardial ischaemia in patients with SIHD. In this setting, the exertion produces an increase MVO 2 that exceeds what can be provided by the fixed decrease in myocardial oxygen supply from the obstructive atherosclerotic plaque. Typically, rest or the use of sublingual nitroglycerin relieves the symptoms. Management The treatment of patients with SIHD typically involves 2 complementary strategies. Slowing the progression of atherosclerosis and preventing complications such as MI, HF, stroke and death. It focuses on risk-factor modification and providing vasculoprotection therapies. Daily ...

Introduction Acute coronary syndrome (ACS) is an acute manifestation of coronary artery disease (CAD). Patients with ACS typically experience an acute reduction in coronary blood flow most often due to a ruptured atherosclerotic plaque and subsequent formation of an intracoronary thrombus. The reduction in coronary blood flow produces myocardial ischemia and, if left untreated, may lead to myocardial infarction (MI). Signs and Symptoms The "classic" presentation of ACS is abrupt onset of substernal chest pain often described as a sensation of squeezing, heaviness, or tightness in the chest that may radiate, typically to either or both arms or shoulders (radiation to the left side is more common), the neck or the jaw. Patients with ACS may also experience diaphoresis, nausea, vomiting and dyspnoea. As many as one-third patients may present with atypical symptoms that do not include chest pain. Epigastric pian Indigestion Stabbing Pleuritic chest pain Increasing exertional d...

Introduction Hypertensive disorders during pregnancy affect approximately 8-10% of all pregnant women and the complications can be associated with significant morbidity and mortality to the mother and baby. Major Hypertensive Disorders Major hypertensive disorders that can occur in pregnant women are: Chronic hypertension Hypertension (BP >140/90) that exist before pregnancy or diagnosed in the first 20 weeks of gestation. Gestational hypertension New-onset of hypertension after 20 weeks gestation Preeclampsia Hypertension occur after 20 weeks gestation with features of multi-organ involvement Symptoms of pre-eclampsia include severe headache, problems with vision, severe pain below ribs, vomiting and sudden swelling of hands, feet or face accompanied with significant proteinuria and blood pressure greater than 140/90 mg Hg. In 2013, the American College of Obstetricians and Gynaecologists removed proteinuria as an essential criterion for diagnosis of preeclampsia. Eclampsia Ne...

Introduction Kawasaki disease is a systemic febrile condition that predominantly affecting children <5 years old . The aetiology remains unknown, possible bacterial toxins or viral agents with genetic predisposition. Diagnostic Criteria Fever lasting at least 5 days PLUS at least 4 out of 5 of the following Bilateral non-purulent conjunctivitis Mucosal changes of the oropharynx (injected pharynx, red lips, dry fissured lips, strawberry tongue). Changes in extremities (oedema and/or erythema of the hands or feet, desquamation, beginning periungually). Rash (usually truncal), polymorphous but non vesicular Cervical lymphadenopathy Diseases with similar presentation should be excluded. NOTE: Clinical vigilance is needed to recognise patients with "incomplete" or "atypical" Kawasaki Disease. Management Early recognition and treatment are essential to reduce the risk of life-threatening complications. Up to 30% of untreated children develop coronary artery dilation...

Introduction Platelets maintain the integrity of the circulation. When platelets are activated, they undergo a series of reactions that are essential for haemostasis, important for healing of damaged blood vessels. Aspirin Low-dose aspirin in chronic use profoundly (>95%) inhibits platelet TXA 2 synthesis by irreversible acetylation of a serine residue in the active site of cyclo-oxygenase I (COX-1). Owing to association with Reye's syndrome , manufacturer advises aspirin-containing preparations should not be given to children under 16 years, unless specifically indicated , e.g. for Kawasaki disease . Contraindications to aspirin include a hypersensitivity to aspirin and major GI intolerance. Dipyridamole Dipyridamole inhibits platelet aggregation by several mechanisms, including Inhibition of phosphodiesterase, Block of adenosine uptake into red cells and Inhibition of TXA2 synthesis It is used in addition aspirin in some patients with stroke or transient ischaemic attack. T...