New PDF release: Kelley's textbook of internal medicine
By H. David Humes MD, Herbert L. DuPont MD, Laurence B. Gardner MD, John W. Griffin MD, Edward D. Harris Jr. MD, William R. Hazzard MD, Talmadge E. King Jr. MD, D. Lynn Loriaux MD PhD, Elizabeth G. Nabel MD, Robert F. Todd III MD PhD, Peter G. Traber MD
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Extra resources for Kelley's textbook of internal medicine
Before class I drugs are given, the ventricular rate must be slowed (as described in the section on atrial fibrillation). RA-7 dysfunction (stunning) and thrombus formation. Therefore, unless a contraindication is present, short-term anticoagulation before and after cardioversion is necessary in the care of all patients with atrial fibrillation that persists for more than 2 days or is of unknown duration. Absence of a left atrial thrombus on a transesophageal echocardiogram has been demonstrated to allow safe cardioversion without prior anticoagulation.
Angiotension-converting enzyme inhibitors have been shown to prolong life among patients with left ventricular dysfunction or cardiac failure. Patients with an ejection fraction of 45% or less should routinely receive these agents. Four β-blockers (timolol, propranolol, metoprolol, and atenolol) have been shown to prolong life after Q-wave MI. One of these drugs should be given to patients with Q-wave MI who do not have contraindications to use of such a drug, including uncompensated heart failure, asthma, and conduction disturbances, and who meet one or more of the following criteria: age older than 60 years, ischemia demonstrated at exercise testing, ejection fraction less than 45%, concomitant angina or hypertension, or an episode of sustained ventricular tachycardia or fibrillation during the hospital stay.
Elevation of troponin T and troponin I levels is associated with increased risk of death. Variant angina Most patients have angiographically significant atherosclerotic CAD and therefore are at risk of MI and sudden death. The chest discomfort usually occurs at rest, although the vasospasm can be triggered by exercise. The duration is somewhat longer than that of stable angina. DIFFERENTIAL DIAGNOSIS Several conditions may produce an anginal syndrome indistinguishable from that caused by atherosclerotic CAD.