0521779407-C02 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:53
316 Chronic Coronary Artery Disease (CAD)➣Revascularization if symptoms not controlled or patient has pro-
gressive symptoms despite optimal Rx and is not febrile, anemic,
or thyrotoxic, and is compliant with mediations (see ACS chap-
ter).
Drug eluting stent, bare metal stent, or balloon angioplasty
(see ACS chapter)
Coronary bypass surgerySide Effects & Complications
■ASA: bleeding, allergy
■Statin, fibrate: abnormal LFTs; rhabdomyolysis
■Niacin: abnormal LFTs; glucose intolerance
■NTG and long-acting nitrates: headaches; nitrate tolerance; hypo-
tension
■Beta-blockade: bradycardia, hypotension, fatigue, decreased libido
and cognition; exacerbation of asthma; decreased LV function and
diabetes are not contraindications
■Calcium antagonists: bradycardia (except dihydropyridines); ortho-
static hypotension; amlodipine OK in CHF; short-acting prepara-
tions contraindicated
■ACE inhibitors: renal dysfunction; hyperkalemia; cough
■Hydrochlorothiazide: worsening diabetes, gout, renal insufficiency,
hypokalemia
■Angiotensin II receptor antagonists: renal dysfunction; hyper-
kalemia
■Clonidine: bradycardia, fatigue, decreased congnition
■Hormone replacement therapy: higher morbidity and mortality vs.
control in pts when started long after menopause. Long-term benefit
not proved if started at time of menopause(see above).
■Angioplasty/stent: Acute MI. Restenosis with recurrent angina (usu-
ally in first 6 months, more likely in diabetics; incidence less with
drug eluting stents and clopidogrel Rx)
■Coronary bypass surgery: Acute: arrhythmias, bleeding, pericarditis,
MI, stroke. Chronic: graft occlusion (usually venous graft); dimin-
ished cognition.
■Avoid COX-2 inhibitors unless arthritic symptoms are otherwise not
controllable; if used, employ lowest possible dose for shortest pos-
sible time.
follow-up
■History at each visit regarding stability of symptoms,
➣compliance with medications and lifestyle changes