By Diana Holdright, Hugh Montgomery
(BMJ Books) UCL Hospitals, London, united kingdom. greater than a hundred questions are replied by way of best cardiologists. useful advisor to administration of complex occasions. For practitioners and citizens. Softcover.
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Additional resources for 100 Questions in Cardiology
G. g. 5mg) will lower the blood pressure smoothly in most patients. There is less experience with newer antihypertensive agents. Nifedipine given via the sublingual route may produce a rapid and unpredictable reduction in BP and should be avoided. Similarly, angiotensin-converting enzyme inhibitors should also be avoided because of the risk of first dose hypotension. Older drugs such as hydralazine (25–50mg 8 hourly), or methyldopa (10–20mg 8 hourly) have been used successfully and are an alternative in individuals in whom ␤adrenoceptor blockers are contraindicated.
References 1 Hamm CW, Goldmann BU, Heeschen C et al. Emergency room triage of patients with acute chest pain by means of rapid testing for cardiac troponin T or troponin I. N Engl J Med 1997; 337: 1648–53. 2 Lindahl B, Venge P, Wallentin L, for the FRISC Study Group. Relation between troponin T and the risk of subsequent cardiac events in 93: 1651–57. unstable coronary artery disease. Circulation 1996;9 3 Ohman EM, Armstrong PW, Christensen RH et al. for the GUSTO IIa Investigators. Cardiac troponin T levels for risk stratification in acute 335: 1333–41.
In general, an estimate more than 1 or 2% is high risk and should lead to a cardiac catheterisation that provides the “road map” for intervention. Certainly a clinical history consistent with congestive heart failure raises the annual mortality of any patient with angina and this is not considered in the DUKE score. Exercise capacity has been a consistent predictor of prognosis and disease severity. This is best measured in METs (multiples of basal oxygen consumption). In clinical practice this has been estimated from treadmill speed and grade but future studies may show the actual analysis of expired gases to be more accurate.
100 Questions in Cardiology by Diana Holdright, Hugh Montgomery