Air pollution is positively associated with increased daily incidence of myocardial infarction and cardiovascular mortality. We hypothesize that air pollutants, primarily vapor phase organic compounds, cause an enhancement of coronary vascular constriction. Such events may predispose susceptible individuals to anginal symptoms and/or exacerbation of infarction. To develop this hypothesis, we studied the effects of nonparticulate diesel exhaust constituents on (1) electrocardiographic traces from ApoE-/- mice exposed whole-body and (2) isolated, pressurized septal coronary arteries from ApoE-/- mice. ApoE-/- mice were implanted with radiotelemetry devices to assess electrocardiogram (ECG) waveforms continuously throughout exposures (6 h/day x 3 days) to diesel exhaust (0.5 and 3.6 mg/m3) in whole-body inhalation chambers with or without particulates filtered. Significant bradycardia and T-wave depression were observed, regardless of the presence of particulates. Pulmonary inflammation was present only in the whole exhaust-exposed animals at the highest concentration. Fresh diesel exhaust or air was bubbled through the physiologic saline tissue bath prior to experiments to enable the isolated tissue exposure; exposed saline contained elevated levels of several volatile carbonyls and alkanes, but low to absent levels of polycyclic aromatic hydrocarbons. Vessels were then assayed for constrictive and dilatory function. Diesel components enhanced the vasoconstrictive effects of endothelin-1 and reduced the dilatory response to sodium nitroprusside. These data demonstrate that nonparticulate compounds in whole diesel exhaust elicit ECG changes consistent with myocardial ischemia. Furthermore, the volatile organic compounds in the vapor phase caused enhanced constriction and reduced dilatation in isolated coronary arteries caused by nonparticulate components of diesel exhaust.

The efficacy of intracoronary urokinase and streptokinase were compared in 80 patients with acute myocardial infarction in a prospective, randomized, double-blind study. Urokinase was infused into the occluded coronary artery at 6000 U/min, and streptokinase was infused at 2000 U/min. 756 MethodsThis was a randomized, double-blind, parallel study of the efficacy of intracoronary urokinase (Abbokinase; Abbott Pharmaceuticals) and streptokinase (Streptase; Hoechst-Roussel Pharmaceuticals, Inc.) in treating patients with acute myocardial infarction.Patients were eligible for inclusion in the study under the following conditions: (1) typical symptoms of myocardial infarction occurred less than 12 hr before infusion, (2) electrocardiogram showed short-term changes of myocardial infarction, (3) no specific contraindication to thrombolytic therapy existed, and (4) angiographic demonstration of a completely occluded vessel related to the infarct. After informed consent was obtained, the hospital pharmacy randomized the patient to receive either urokinase or streptokinase. Unlabeled thrombolytic solution, containing either streptokinase at a concentration of 500 IU/ml or urokinase at a concentration of 1500 U/ml, was supplied by the pharmacy. All medical personnel and the clinical investigators outside the pharmacy were blinded as to the thrombolytic drug used. Baseline coagulation studies before catheterization included measurements of serum fibrinogen, fibrin split products, thrombin time, prothrombin time, partial thromboplastin time, and plasminogen levels. In the catheterization laboratory, left ventricular and coronary angiography were performed. Heparin was given without knowledge of the treatment group in bolus doses ranging from 2500 U to 10,000 U. The thrombolytic solution was then infused into the occluded infarct-related vessel at a rate of 4 ml/min (

Background: Cardiovascular disease is the most frequent cause of morbidity and mortality throughout the world. The aim of the study was to determine assessment of risk factors and impact of patient counseling in health-related quality of life of the patient.Method: This was a prospective observational study conducted in the department of cardiology. A suitably designed standard SF-36 questionnaire was given to all patients enrolled in the study before and after counseling. All information relevant to the study were collected in suitably designed proforma from case records and discussions conducted with the patients and bystanders during ward rounds. Proper counseling was given to patients and bystanders and the score was analyzed using SAS descriptive analysis.Result: The most common risk factors encountered in the study are diabetes mellitus, hypertension, dyslipidemia, irregular exercise, smoking, alcoholism, obesity and family history. The health-related quality of life of the patients were assessed, a total of 67 patients QOL was improved after counseling and 27 patients with no improvement. We found that patient counseling was effective for majority of patients.Conclusions: We can conclude that the role of clinical pharmacist has a significant role in improving the health-related quality of life of patients through proper counseling. And more than half of the patients have a modifiable risk factor which can be managed through lifestyle modifications.

Coronary artery disease is a condition in which there is an inadequate supply of blood and oxygen to a portion of the myocardium. It is the major cause responsible for mortality more in younger age group than in elderly. Since it is an emergency condition where usage of many drugs during its management is common. The study of drug utilization is a component of a medical audit and periodic evaluation should be done to enable suitable modifications in the prescription of drugs and maximize the therapeutic benefit and minimize the adverse effects. When new drugs are used additional information on safety and efficacy may be generated. In this review most of the prescription contain anti-platelet drugs, ACE inhibitors/ ARBs, Statins, Beta-blockers, Nitrates, Calcium channel blockers and Diuretics.

Background: The aim of the study is to assess the proportion of types of coronary artery diseases and to analyze the trends of drug prescribing in coronary artery disease (CAD) by checking the compliance with the standard guidelines provided by the American College of Cardiology Foundation / American Heart Association (ACCF/AHA).Methods: A prospective observational study was conducted in the department of Cardiology for a period of 6 months. A total of 94 patients with varied categories of CAD were screened and analyzed. Study related data was collected from case records and by a structured interview. Data analysis was done by analyzing the prescribing trends of drug and assessing the proportion of CAD.Results: The current study found that most of the patients were of the age group of 61-70 years. The proportion of Non-ST segment elevation myocardial infarction (NSTEMI) was remarkably higher in patients with CAD (55.3%) followed by ST-elevated myocardial infarction (STEMI) (39.4%) and Unstable angina (5.3%). Chi square test shows that prescription of Antiplatelets were apparent in all the prescriptions (100%), followed by Statins (Atorvastatin 98.9%), Antihypertensives (94.7%), Anticoagulants (90.4%), Nitrates (76.6%), Antidiabetics (75.5%) and Potassium channel opener (Nicorandil 36.2%). By analyzing the prescription, it was observed that most of the drugs were prescribed rationally according to the standard treatment guidelines (ACCF/AHA).Conclusions: This study provides an overall insight of proportion of CAD and prescribing pattern in patients with CAD which reveals the rational prescribing of drugs in accordance with the standard guidelines.