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afya
secondary prevention
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<<forEachTiddler where 'tiddler.tags.contains(context.inTiddler.title)' sortBy tiddler.title ascending write '"*[["+tiddler.title+"]]\n"'>> <<tiddler AutoRefresh with: force>> All pts post MI should be on ''ACEi, BB, Aspirin, Statin'' Clopidogrel for first 12/12 Aldosterone antagonist (Eplerenone) - post MI with heart failure and LV systolic dysfuntion (start at 3-14 days post ACEi) Ischaemic cardiac events mostly caused by atheromatous plaques causing acute obstruction of coronary vessels inc if diabetic, smoker, HT cholesterol, age Aspirin reduces risk of events in high risk even at low dose Bleeding risk is less than ischaemic events risk and dec with dec dose Aspirin and Clopidogrel together is better than aspirin alone for first 9/12. Prasugrel better still. Bleeding risk inc with AandC but not life threatening bleed. Risk of bleeding is higher with Prasugrel. Aspirin and warfarin - dec events but no change in mortality bleeding risk inc Warfarin alone is more effectigve than aspirin but less convenient and more bleeding so AandC usually preferred Clopidogrel cf Aspirin C is slightly more effective with less bleeding but more diarrhoea and rash Other drugs BB - beneficial in HF - inc tiredness ? ACEi - beneficial in HF - inc cough, hypotension, renal dysfunction and hyperK ARB - less evidence but also beneficial - more hypoT than ACEi ACEi and ARB - no added benefit CCB - less useful Class 1 antiarrythmics (Flecainide, Quinidine etc) - inc mortality - DON'T use Amiodarone - dec mortality but lots SE - hypothyroidism, hyperthyroidism, peripheral neuropathy, lung infiltrates, bradycardia, and liver dysfunction HRT - no cardiovascular benefit Cholesterol reduction Statins dec mortality in line with dec in cholesterol SE - rhabdomyolysis(3.4), myopathy(11), peripheral neuropathy (12) out of 100,000 Antioxidants - no effect Cardiac rehab - helpful Diet - Mediterannean and fish oils - benefit, low fat and high fibre - no effect smoking cessation - benefit Outcome By 1 yr post MI 25%M 38%F will die By 6yrs post MI 18%M 35%F will have another MI, 22%M 46%F will have heart failure 7%M 6%F will have sudden death
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Thrombophylaxis, ACS