Jones & Bartlett Learning Medicine Blog

    Pre-Procedural Statins Reduce the Incidence of Peri-procedural Cardiac Events

    Posted by admin on May 20, 2011 2:07:07 PM

    Dr. Joseph Esherick Monthly Blog - May 2011

    Initiation of statins during the acute period has been shown to be beneficial during an acute coronary syndrome and immediately following an ischemic stroke. [1,2,3] It is believed that statins, HMG-CoA reductase inhibitors, have pleiotropic properties that have anti-inflammatory effects, improve endothelial function and inhibit the body’s thrombogenic response.  The properties are in addition to the lipid lowering effects of statins.  These pleiotropic effects are felt to be the principal mechanism by which statins decrease recurrent cardiovascular and cerebrovascular events when started acutely during an acute coronary syndrome or immediately after an ischemic stroke.  Statins have also been shown in two randomized controlled trials to decrease the incidence of peri-procedural myocardial infarction if started soon before percutaneous coronary intervention or before major vascular surgery. [4,5]

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    Topics: Cardiac Events, Authors, Statins, Cardiology, cardiology, Hospital Medicine Blog

    Treatment & Management of Acute Coronary Syndrome

    Posted by admin on Apr 25, 2011 1:15:24 PM

    Dr. Joseph Esherick Monthly Blog - April 2011

    The leading cause of death in the United States is cardiovascular mortality.  Therefore, the early identification and appropriate management of acute coronary syndrome is essential for all hospital-based physicians.  The American College of Cardiology Foundation and the American Heart Association have recently updated their practice guidelines on the management of patients with unstable angina (UA) and non-ST-elevation myocardial infarction (NSTEMI)1.

    This blog will focus on the primary changes in the management of non-ST-elevation acute coronary syndrome.  The Level 1 recommendations are that patients with definite UA/NSTEMI at medium to high risk should receive 325 mg of aspirin and a second antiplatelet agent on presentation.  Dual antiplatelets should be given regardless of whether an invasive or conservative strategy is chosen.  The second antiplatelet agent could be either a loading dose of clopidogrel, prasugrel, or a GP IIb/IIIa inhibitor (preferably eptifibatide or tirofiban).  The major change in the recommendations is that dual antiplatelet therapy is now routinely recommended upstream of percutaneous coronary intervention (PCI).  In patients undergoing PCI, both aspirin and a thienopyridine, clopidogrel or prasugrel, should be continued for at least 12 months.  For those treated conservatively, dual antiplatelet therapy should continue for at least 1 month and ideally for 1 year.

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    Topics: medication, American Heart Association, American college of cardiology, Cardiology, cardiology, Hospital Medicine Blog

    Fall Prevention in Hospitalized Elderly Patients

    Posted by admin on Mar 17, 2011 1:21:54 PM

    Dr. Joseph Esherick Monthly Blog - March 2011

    Falls are a major cause of morbidity and mortality in elderly Americans.  One out of three people age 65 years and older fall each year.[1] These falls led to 2.2 million emergency department visits and 581,000 hospitalizations in 2009.  Twenty to thirty percent of falls in older adults lead to serious injuries,[2] including hip fractures and traumatic brain injuries.  Falls are also the leading cause of injury-related death in adults age 65 years and older in the United States.  The end result of these unintentional falls is an annual cost to the United States of over $19 billion.[3]

    These are the statistics for community-dwelling elderly Americans.  We also know that hospitalization increases a person’s fall risk primarily because of acute illness, residence in an unfamiliar environment, connection to multiple tubes and monitors, and an increased risk of delirium.[4] A serious fall can also create a fear in falling for elderly adults; this fear in falling initiates a progressive slide towards reduced mobility, leading to progressive loss of function and, therefore, an increased risk of falls.[5] For this reason, it is of paramount importance to put systems in place to prevent falls in our older adults.

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    Topics: elderly, fall prevention, Hospital Medicine Blog, hospitalization, patient education

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