Antiplatelet therapy is one of the most important methods in the treatment of ischemic heart disease. Dual antiplatelet therapy is performed widely along with coronary stenting. The potential combination of antiplatelet and new anticoagulant drugs will be discussed.
During recent years, several new anticoagulants have been introduced to the market. The pharmacokinetic assessments of these drugs have shown few drug and food interactions, predictable dose responses, and rapid onset and offset, thus resulting in simplified management of patients requiring anticoagulant therapy. Furthermore, the risk of major bleeding is one-half that of warfarin. We describe the advantages and potential limitations of the new anticoagulants.
Statins, inhibitors of 3-hydroxy-3-methylglutaryl-CoA reductase, attenuate the biosynthesis of cholesterol to increase the number of LDL-cholesterol (LDL-C) receptors, and consequently decrease serum LDL-C levels. Statins represent one of the key medication classes for both primary and secondary prevention of ischemic heart disease.
Primary pharmacotherapy of atrial fibrillation has two options: 1) rhythm control that aims to restore and maintain sinus rhythm by antiarrhythmic drugs, and 2) rate control that aims to reduce the rapid ventricular rate, while often sustaining atrial fibrillation. During the administration of anticoagulants, these therapies are clinically determined according to each individual patient′s conditions.
Medication is not always necessary when a patient with ventricular arrhythmia is asymptomatic. The use of antiarrhythmic drugs is based on underlying cardiac diseases. In general, antiarrhythmic drugs with Na+ channel blockers impair cardiac contractility. Therefore, the selection of antiarrhythmic drugs in patients with cardiac dysfunction needs special consideration.
The pathophysiological basis of Brugada syndrome (BrS) remains controversial. We attempted to isolate the origin of provoked ventricular tachycardia/ventricular fibrillation (VT/VF) associated with BrS through noncontact mapping of the right ventricle (RV). Programmed ventricular stimulation was performed in 3 patients with BrS. Rapid VT of a similar morphology that degenerated into VF was induced from the RV apex (n = 2) or RV outflow tract (RVOT, n = 1). These VTs arose from the RVOT wall or the RV free wall. The RV as the primary origin of VT may be a key target for BrS therapies.
A 46-year-old woman who suffered from abdominal pain and vomiting was referred to our hospital′s emergency room. Intussusception was revealed by abdominal computed tomography and partial resection of the small intestine was performed. She was diagnosed with Peutz-Jeghers syndrome after a close inspection of the whole body. Cancer was suspected in the right breast and ileocecal region and an operation was performed that histopathologically confirmed the malignancy in the right breast. Peutz-Jeghers syndrome is frequently associated with malignancy and careful follow up is therefore considered important for such patients.