TABLE OF CONTENTS

1. QuickView
   1. Zocor Medication Guide (Click icon to download)
2. What is Simvastatin
   1. Indications for Simvastatin
   2. Dosages for Simvastatin (Zocor)
   3. Possible Side Effects of Simvastatin
   4. Contra-indications and Cautions for Simvastatin
   5. Drug Interactions for Simvastatin
   6. Safety in Pregnancy for Simvastatin

QuickView

Brand Names: Flolipid, Zocor
Primary Use: Antihyperlipidemic Agent, reduces elevated LDL levels
Drug Classes: Antihyperlipidemic Agents, HMG-CoA Reductase Inhibitors (statins), Metabolic Agents
Generic Drug Synonyms and Salts: Simvastatin
Related Drugs: Atorvastatin, Rosuvastatin, Pravastatin Sodium, Lovastatin, Pitavastatin, Ezetimibe; Simvastatin
Schedule: Rx (Prescription required)
FDA Established Pharmacologic Class (EPC): HMG-CoA Reductase Inhibitor
Initial FDA approval date: 12/23/1991

What is Simvastatin

Simvastatin (Flolipid or Zocor) belongs to a class of drugs called statins and is currently the 10th most prescribed drug in America. It is prescribed by a doctor to lower cholesterol in people who have been diagnosed with high cholesterol (high levels of LDL cholesterol in the blood). Doctors diagnose high cholesterol through a simple blood test. Cholesterol (and triglycerides) are fats that are made in your body. While some cholesterol is necessary for the body, too much cholesterol is dangerous to your health. Cholesterol, specifically, is made in the liver. Lowering “bad” cholesterol and triglycerides and raising “good” cholesterol decreases the risk of heart disease and helps prevent strokes and heart attacks This drug can also lower the risk for heart attack or stroke in patients with diabetes.

Note: Some research has shown a possible relationship between the use of statins and the risk of diabetes, however, the risk of developing diabetes from the use of statins is very small.

Simvastatin is available under the following different brand names: Flolipid, Zocor.

ClinCalc Drug Statistics for Simvastatin

Indications for Simvastatin

Therapy with lipid-altering agents should be only one component of multiple risk factor intervention in individuals at significantly increased risk for atherosclerotic vascular disease due to hypercholesterolemia. Drug therapy is indicated as an adjunct to diet when the response to a diet restricted in saturated fat and cholesterol and other nonpharmacologic measures alone has been inadequate. In patients with coronary heart disease (CHD) or at high risk of CHD, ZOCOR1
can be started simultaneously with diet.

Reductions in Risk of CHD Mortality and Cardiovascular Events

In patients at high risk of coronary events because of existing coronary heart disease, diabetes, peripheral vessel disease, history of stroke or other cerebrovascular diseases, ZOCOR is indicated to:

• Reduce the risk of total mortality by reducing CHD deaths.
• Reduce the risk of non-fatal myocardial infarction and stroke.
• Reduce the need for coronary and non-coronary revascularization procedures.

Hyperlipidemia

• Reduce elevated total cholesterol (total-C), low-density lipoprotein cholesterol (LDL-C),
• apolipoprotein B (Apo B), and triglycerides (TG), and to increase high-density lipoprotein
• cholesterol (HDL-C) in patients with primary hyperlipidemia (Fredrickson type IIa, heterozygous
• familial and nonfamilial) or mixed dyslipidemia (Fredrickson type IIb).
• Reduce elevated TG in patients with hypertriglyceridemia (Fredrickson type lV hyperlipidemia).
• Reduce elevated TG and VLDL-C in patients with primary dysbetalipoproteinemia (Fredrickson type lll hyperlipidemia).
• Reduce total-C and LDL-C in patients with homozygous familial hypercholesterolemia as an adjunct to other lipid-lowering treatments (e.g., LDL apheresis) or if such treatments are unavailable.

Adolescent Patients with Heterozygous Familial Hypercholesterolemia (HeFH)

ZOCOR is indicated as an adjunct to diet to reduce total-C, LDL-C, and Apo B levels in adolescent boys and girls who are at least one-year post-menarche, 10-17 years of age, with HeFH, if after an adequate trial of diet therapy the following findings are present:

1. LDL cholesterol remains ≥190 mg/dL; or
2. LDL cholesterol remains ≥160 mg/dL and
   There is a positive family history of premature cardiovascular disease (CVD) or
   Two or more other CVD risk factors are present in the adolescent patient.

The minimum goal of treatment in pediatric and adolescent patients is to achieve a mean LDL-C <130 mg/dL. The optimal age at which to initiate lipid-lowering therapy to decrease the risk of symptomatic adulthood CAD has not been determined.

Limitations of use

ZOCOR has not been studied in conditions where the major abnormality is elevation of chylomicrons (i.e., hyperlipidemia Fredrickson types I and V).

Dosages for Simvastatin (Zocor)

Presentation

Simvastatin (Zocor) is available in tablet form in the strengths indicated below.

Storage And Handling

No. 8146 — Tablets ZOCOR 10 mg are peach, oval, film-coated tablets, coded MSD 735 on one side and plain on the other. They are supplied as follows:

• NDC 0006-0735-31 unit of use bottles of 30
• NDC 0006-0735-54 unit of use bottles of 90.

No. 8147 — Tablets ZOCOR 20 mg are tan, oval, film-coated tablets, coded MSD 740 on one side and plain on the other. They are supplied as follows:

• NDC 0006-0740-31 unit of use bottles of 30
• NDC 0006-0740-54 unit of use bottles of 90.

No. 8148 — Tablets ZOCOR 40 mg are brick red, oval, film-coated tablets, coded MSD 749 on one side and plain on the other. They are supplied as follows:

• NDC 0006-0749-31 unit of use bottles of 30
• NDC 0006-0749-54 unit of use bottles of 90.

No. 6577 — Tablets ZOCOR 80 mg are brick red, capsule-shaped, film-coated tablets, coded 543 on one side and 80 on the other. They are supplied as follows:

• NDC 0006-0543-31 unit of use bottles of 30
• NDC 0006-0543-54 unit of use bottles of 90.

Storage

Store at controlled room temperature 20 -25°C (68 -77°F).

Dosage

The usual dosage range is 5 to 40 mg/day. In patients with CHD or at high risk of CHD, ZOCOR can be started simultaneously with diet. The recommended usual starting dose is 10 or 20 mg once a day in the evening. For patients at high risk for a CHD event due to existing CHD, diabetes, peripheral vessel disease, history of stroke or other cerebrovascular disease, the recommended starting dose is40 mg/day. Lipid determinations should be performed after 4 weeks of therapy and periodically thereafter.

Hypercholesterolemia (High cholesterol)

Usual dosage range: 5-40 mg orally once/day

Initial: 10-20 mg orally once/day in the evening

Patients at high CHD risk: Start 40 mg/day

Children under 10 years: Safety and efficacy not established

Homozygous Familial Hypercholesterolemia (Genetic high cholesterol)

Recommended dose: 40 mg orally once/day in the evening

See limitations for 80 mg/day, listed below

Heterozygous Familial Hypercholesterolemia (Genetic high cholesterol)

Adolescents aged 10-17 years

• Initial: 10 mg orally once/day in the evening; not to exceed 40 mg/day
• Recommended dosing range: 10-40 mg/day; adjustments should be made at intervals of 4 weeks or more.

Prevention of Coronary Events

5-40 mg PO qDay in the evening

Moderate reduction of LDL-C desired: 5-10 mg PO qDay in the evening; adjust dose to achieve goal

Reduction of >40% of LDL-C desired: 40 mg PO qDay in the evening; adjust dose to achieve goal

Presence of CHD or at high risk for cardiovascular events, including patients with diabetes, PVD, history of stroke or other cerebrovascular disease: 40 mg PO qDay in the evening adjunct to diet therapy (initiate simultaneously); adjust dose to achieve goal

Primary and secondary prevention of atheroschlerotic cardiovascular disease (ASCVD)

ACC/AHA Cholesterol Guideline Recommendations (2013) for adults ≥21 years

Primary prevention

• LDL-C ≥190 mg/dL: High-intensity therapy agent atorvastatin or rosuvastatin recommended
• Type 1 or 2 diabetes (40-75 years of age): Moderate-intensity therapy: 20-40 mg simvastatin PO qDay
• Type 1 or 2 diabetes (40-75 years of age and 10 year estimated risk of ASCVD ≥7.5%): High-intensity therapy agent atorvastatin or rosuvastatin recommended
• 40-75 years of age and 10 year estimated risk of ASCVD ≥7.5% : Moderate-intensity therapy: 20-40 mg simvastatin PO qDay; may consider high-intensity therapy agent atorvastatin or rosuvastatin

Secondary prevention

• Presence of ASCVD, including stroke/TIA or peripheral arterial disease believed to be of atherosclerotic origin or post-CABG
• ≤75 years: Treat with high-intensity therapy agent atorvastatin or rosuvastatin
• >75 years: Administer 20-40 mg simvastatin PO qDay (moderate-intensity therapy); not candidate for high-intensity therapy

Dosage Modifications

Severe renal impairment (CrCl less than 30 mL/min): 5 mg once/day initially

Co-administration with dronedarone, verapamil, or diltiazem: Do not exceed 10 mg/day

Co-administration with amiodarone, amlodipine, or ranolazine: Do not exceed 20 mg/day

Co-administration with lomitapide: Reduce dose by 50%, and do not exceed 20 mg/day (or 40 mg/day in those previously tolerating 80 mg/day) when initiating lomitapide

People of Chinese descent taking lipid-modifying doses of niacin (i.e., 1 g/day or more): Increased risk of myopathy with 40 mg/day; consider lower dose

People of Asian descent should not receive 80 mg co-administered with lipid-modifying doses of niacin-containing products

Dosing Considerations

Lipid determinations should be performed after 4 weeks of therapy and periodically thereafter

Restricted dosing

• Patients tolerating 80 mg who need to be initiated on an interacting drug that is contraindicated or associated with a maximum dose should be switched to an alternative statin with less potential for drug-drug interactions
• Patients unable to achieve their LDL cholesterol goal utilizing 40 mg/day should not be titrated to 80 mg (increased risk for disease of muscle tissue) but should instead be placed on alternative LDL- cholesterol-lowering treatment that provides greater LDL- cholesterol-lowering

Overdose management

• Adverse side effects and drug reactions from overdose may include peripheral neuropathy, diarrhea, increased K+, myopathy, rhabdomyolysis, acute renal failure, elevated LFTs, and eye lens opacities
• Treatment is supportive

Possible Side Effects of Simvastatin

Simvastatin is generally well tolerated. Possible side effects may include any of the following and the side effects experienced may be transitory (clears up after a few days) or may remain. Consult your doctor immediately if you experiencing serious side effects. Note the list below is not exhaustive.

Common side effects of simvastatin include:

• CPK elevation (greater than 3x ULN)
• Constipation
• Upper respiratory infection
• Gas (flatulence)
• Transaminases increased (greater than 3x ULN)
• Headache
• Muscle pain, muscle damage, or muscle weakness
• Eczema
• Spinning sensation (vertigo)
• Abdominal pain

Less common side effects of simvastatin include:

• Muscle weakness
• Joint pain
• Arthritis
• Eosinophilia
• Chills
• Skin swelling
• Muscle wasting
• Abdominal pain

Postmarketing side effects of simvastatin reported include:

• Erectile dysfunction
• Interstitial lung disease
• Rare reports of cognitive impairment (e.g., memory loss, forgetfulness, amnesia, memory impairment, confusion) associated with statin use

Adverse reactions associated with Simvastatin therapy reported since market introduction, that are not listed above, regardless of causality assessment, include the following: anaphylaxis, angioneurotic edema, bullous rashes (including erythema multiforme, and toxic epidermal necrolysis), rhabdomyolysis, myositis, fatigue, tendon rupture, fatal and non-fatal hepatic failure, dizziness, depression, peripheral neuropathy, and pancreatitis.

There have been rare reports of immune-mediated necrotizing myopathy associated with statin use

Contra-indications and Cautions for Simvastatin

Contra-indications

Do not take Zocor if you are allergic to simvastatin or any ingredients contained in this drug.

Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately.

Cautions

Non-serious and reversible cognitive side effects may occur.

Increased blood sugar and glycosylated hemoglobin (HbA1c) levels reported with statin intake.

Heavy alcohol use, history of liver disease, renal failure.

Monitor LFTs before initiating treatment and thereafter when clinically indicated; reports of fatal and nonfatal hepatic failure in people taking statins .

Discontinue if markedly elevated CPK levels occur or myopathy is diagnosed or suspected.

Increases in HbA1c and fasting serum glucose levels reported with simvastatin.

Severe electrolyte, endocrine, or metabolic disorders.

Grapefruit juice increases simvastatin systemic exposure; avoid large quantities of grapefruit juice (i.e., 1 quart/day or more).

Simvastatin and myopathy risk:

• Dose adjustment required when co-administered with niacin, amiodarone, verapamil, diltiazem, amlodipine, and ranolazine
• Predisposing factors for myopathy include advanced age (older than 65 years), uncontrolled hypothyroidism, and renal impairment
• Increased risk for myopathy in Chinese people co-administered niacin greater than 1 g/day; they should not receive simvastatin 80 mg co-administered with lipid-modifying doses of niacin-containing products
• Withhold or discontinue if myopathy, renal failure, or transaminase levels greater than 3x ULN develop
• Risk of myopathy is greater in people taking simvastatin 80 mg/day, especially in the 1st year of treatment
• Rare reports of immune-mediated necrotizing myopathy (IMNM), characterized by increased serum creatine kinase that persists despite discontinuing statin
• Risk for myopathy increased when coadministered with other lipid-lowering drugs (other fibrates, 1 g/day of niacin or more, or, for patients with HoFH, lomitapide), colchicine, amiodarone, dronedarone, verapamil, diltiazem, amlodipine, or ranolazine
• See Contraindications for list of drugs contraindicated because of increased risk for myopathy when co-administered with simvastatin
• See Adult Dosing for dose limitations and modifications

Drug Interactions for Simvastatin

Your pharmacist will be aware of potential interactions between Simvastatin and any other medications you use. It’s wise to double-check with your pharmacist and always read package inserts and check the drugs you currently use for possible interactions. If in doubt, revert to your pharmacist with a list of all your medication. It’s a great idea if you own a smartphone to add all your medications to an app on your phone. This can be a lifesaver.

This drug has severe interactions with at least 32 different drugs.

This drug has serious interactions with at least 79 different drugs.

This drug has moderate interactions with at least 79 different drugs.

Mild Interactions

• aliskiren
• alvimopan
• ambrisentan
• armodafinil
• coenzyme Q10
• colestipol
• fexofenadine
• isradipine
• loratadine
• orlistat
• sacubitril/valsartan
• telmisartan
• trazodone
• valsartan

Contra Indicated

• atazanavir
• clarithromycin
• cobicistat
• cyclosporine
• danazol
• darunavir
• elvitegravir/cobicistat/emtricitabine/tenofovir DF
• erythromycin base
• erythromycin ethylsuccinate
• erythromycin lactobionate
• erythromycin stearate
• fosamprenavir
• gemfibrozil
• idelalisib
• indinavir
• itraconazole
• ketoconazole
• letermovir
• lonafarnib
• lopinavir
• mifepristone
• nefazodone
• nelfinavir
• ombitasvir/paritaprevir/ritonavir & dasabuvir
• posaconazole
• red yeast rice
• ritonavir
• saquinavir
• tipranavir

Serious – Use alternative

• abametapir
• afatinib
• amiodarone
• amlodipine
• apalutamide
• aprepitant
• armodafinil
• artemether/lumefantrine
• bosentan
• bosutinib
• butabarbital
• butalbital
• carbamazepine
• cimetidine
• colchicine
• conivaptan
• darifenacin
• darolutamide
• dasatinib
• dexamethasone
• diltiazem
• eltrombopag
• eluxadoline
• enzalutamide
• etravirine
• fenofibrate
• fenofibrate micronized
• fenofibric acid
• fluconazole
• fosphenytoin
• glecaprevir/pibrentasvir
• grapefruit
• griseofulvin
• hydrocortisone
• isoniazid
• ivosidenib
• lapatinib
• lasmiditan
• lomitapide
• lumefantrine
• marijuana
• mesterolone
• methylprednisolone
• metronidazole
• miconazole vaginal
• modafinil
• nafcillin
• nevirapine
• niacin
• nifedipine
• nilotinib
• oxcarbazepine
• pentobarbital
• pexidartinib
• phenobarbital
• phenytoin
• pomalidomide
• prednisone
• pretomanid
• primidone
• quinupristin/dalfopristin
• ranolazine
• rifabutin
• rifampin
• rifapentine
• riociguat
• rufinamide
• secobarbital
• St John’s Wort
• topiramate
• tucatinib
• verapamil
• voriconazole
• voxelotor
• zafirlukast

Monitor Closely

• amitriptyline
• apalutamide
• atorvastatin
• azithromycin
• bazedoxifene/conjugated estrogens
• bempedoic acid
• budesonide
• carbamazepine
• caspofungin
• cenobamate
• ceritinib
• cholestyramine
• cholic acid
• clobetasone
• clotrimazole
• conjugated estrogens
• conjugated estrogens, vaginal
• cortisone
• crizotinib
• crofelemer
• dabrafenib
• daptomycin
• deferasirox
• deflazacort
• dexamethasone
• digoxin
• docetaxel
• dronedarone
• duvelisib
• efavirenz
• elagolix
• elbasvir/grazoprevir
• eliglustat
• eluxadoline
• encorafenib
• eslicarbazepine acetate
• estradiol
• estropipate
• fedratinib
• fludrocortisone
• fostemsavir
• glyburide
• hydrocortisone
• iloperidone
• irinotecan liposomal
• istradefylline
• itraconazole
• ivacaftor
• ivermectin
• lanthanum carbonate
• levamlodipine
• loperamide
• lorlatinib
• lovastatin
• mestranol
• methylprednisolone
• metyrapone
• mipomersen
• mitotane
• paclitaxel
• paclitaxel protein bound
• paliperidone
• pazopanib
• pioglitazone
• ponatinib
• posaconazole
• prednisolone
• prednisone
• repaglinide
• ribociclib
• rifampin
• risperidone
• rosiglitazone
• sacubitril/valsartan
• sarecycline
• silodosin
• sirolimus
• sofosbuvir/velpatasvir
• stiripentol
• tacrolimus
• tazemetostat
• tecovirimat
• ticagrelor
• tolvaptan
• valsartan
• vinblastine
• vincristine
• vincristine liposomal
• warfarin

Safety in Pregnancy for Simvastatin

Simvastatin is not indicated for use in pregnant or breastfeeding women.

Pregnancy

Contraindicated in women who are or may become pregnant

Lipid lowering drugs offer no benefit during pregnancy, because cholesterol and cholesterol derivatives are needed for normal fetal development

Atherosclerosis is a chronic process, and discontinuation of lipid-lowering drugs during pregnancy should have little impact on long-term outcomes of primary hypercholesterolemia therapy

There are no adequate and well-controlled studies of use with statins during pregnancy; however, there are rare reports of congenital anomalies in infants exposed to statins in utero

Lactation

Unknown if simvastatin excreted in human milk; because a small amount of another drug in this class is excreted in human milk and because of the potential for serious adverse reactions in nursing infants, women taking simvastatin should not breastfeed

A decision should be made whether to discontinue nursing or discontinue drug, taking into account the importance of the drug to the mother

The post Simvastatin (Flolipid, Zocor) appeared first on Medika Life.

TABLE OF CONTENTS

1. QuickView
   1. Lipitor Medication Guide (Click icon to download)
2. What is Atorvastatin
   1. Indications for Atorvastatin
   2. Dosages for Atorvastatin
   3. Possible Side Effects of Atorvastatin
   4. Contra-indications and Cautions for Atorvastatin
   5. Drug Interactions for Atorvastatin
   6. Safety in Pregnancy for Atorvastatin

QuickView

Brand Names: Lipitor
Primary Use: Antihyperlipidemic Agent, reduces elevated LDL levels
Drug Classes: Antihyperlipidemic Agents, HMG-CoA Reductase Inhibitors (statins), Metabolic Agents
Generic Drug Synonyms and Salts: Atorvastatin Calcium, Atorvastatin Calcium Trihydrate, Atorvastatin
Related Drugs: Simvastatin, Rosuvastatin, Pravastatin Sodium, Lovastatin, Pitavastatin, Ezetimibe; Simvastatin
Schedule: Rx (Prescription required)
FDA Established Pharmacologic Class (EPC): HMG-CoA Reductase Inhibitor
Initial FDA approval date: 12/17/1996

What is Atorvastatin

Atorvastatin (Lipitor) belongs to a class of drugs called statins and is currently the most prescribed drug in America. It is prescribed by a doctor to lower cholesterol in people who have been diagnosed with high cholesterol (high levels of LDL cholesterol in the blood). Doctors diagnose high cholesterol through a simple blood test. Cholesterol (and triglycerides) are fats that are made in your body. While some cholesterol is necessary for the body, too much cholesterol is dangerous to your health. Cholesterol, specifically, is made in the liver. Lowering “bad” cholesterol and triglycerides and raising “good” cholesterol decreases the risk of heart disease and helps prevent strokes and heart attacks This drug can also lower the risk for heart attack or stroke in patients with diabetes.

Note: Some research has shown a possible relationship between the use of statins and the risk of diabetes, however, the risk of developing diabetes from the use of statins is very small.

Atorvastatin is available under the following different brand names: Lipitor.

ClinCalc Drug Statistics for Atorvastatin

Indications for Atorvastatin

Therapy with lipid-altering agents should be only one component of multiple risk factor intervention in individuals at significantly increased risk for atherosclerotic vascular disease due to hypercholesterolemia. Drug therapy is recommended as an adjunct to diet when the response to a diet restricted in saturated fat and cholesterol and other nonpharmacologic measures alone have been inadequate. In patients with CHD or multiple risk factors for CHD, Atorvastatin can be started simultaneously with diet.

Prevention Of Cardiovascular Disease In Adults

In adult patients without clinically evident coronary heart disease, but with multiple risk factors for coronary heart disease such as age, smoking, hypertension, low HDL-C, or a family history of early coronary heart disease, Atorvastatin is indicated to:

• Reduce the risk of myocardial infarction
• Reduce the risk of stroke
• Reduce the risk for revascularization procedures and angina

In adult patients with type 2 diabetes, and without clinically evident coronary heart disease, but with multiple risk factors for coronary heart disease such as retinopathy, albuminuria, smoking, or hypertension, Atorvastatin is indicated to:

• Reduce the risk of myocardial infarction
• Reduce the risk of stroke

In adult patients with clinically evident coronary heart disease, Atorvastatin is indicated to:

• Reduce the risk of non-fatal myocardial infarction
• Reduce the risk of fatal and non-fatal stroke
• Reduce the risk for revascularization procedures
• Reduce the risk of hospitalization for CHF
• Reduce the risk of angina

Hyperlipidemia

Atorvastatin is indicated:

• As an adjunct to diet to reduce elevated total-C, LDL-C, apo B, and TG levels and to increase HDL-C in adult patients with primary hypercholesterolemia (heterozygous familial and nonfamilial) and mixed dyslipidemia (Fredrickson Types IIa and IIb);
• As an adjunct to diet for the treatment of adult patients with elevated serum TG levels (Fredrickson Type IV);
• For the treatment of adult patients with primary dysbetalipoproteinemia (Fredrickson Type III) who do not respond adequately to diet;
• To reduce total-C and LDL-C in patients with homozygous familial hypercholesterolemia (HoFH) as an adjunct to other lipid-lowering treatments (e.g., LDL apheresis) or if such treatments are unavailable;
• As an adjunct to diet to reduce total-C, LDL-C, and apo B levels in pediatric patients, 10 years to 17 years of age, with heterozygous familial hypercholesterolemia (HeFH) if after an adequate trial of diet therapy the following findings are present:
  1. LDL-C remains ≥ 190 mg/dL or
  2. LDL-C remains ≥ 160 mg/dL and:
     • there is a positive family history of premature cardiovascular disease or
     • two or more other CVD risk factors are present in the pediatric patient

Limitations Of Use

Atorvastatin has not been studied in conditions where the major lipoprotein abnormality is the elevation of chylomicrons (Fredrickson Types I and V).

Dosages for Atorvastatin

Presentation

Atorvastatin is available in tablet form in the strengths indicated below.

Storage And Handling

10 mg tablets (10 mg of atorvastatin): coded “PD 155” on one side and “10” on the other.

NDC 0071-0155-23 bottles of 90
NDC 0071-0155-34 bottles of 5000
NDC 0071-0155-40 10 x 10 unit dose blisters
NDC 0071-0155-10 bottles of 1000

20 mg tablets (20 mg of atorvastatin): coded “PD 156” on one side and “20” on the other.

NDC 0071-0156-23 bottles of 90
NDC 0071-0156-40 10 x 10 unit dose blisters
NDC 0071-0156-94 bottles of 5000
NDC 0071-0156-10 bottles of 1000

40 mg tablets (40 mg of atorvastatin): coded “PD 157” on one side and “40” on the other.

NDC 0071-0157-23 bottles of 90
NDC 0071-0157-73 bottles of 500
NDC 0071-0157-88 bottles of 2500
NDC 0071-0157-40 10 x 10 unit dose blisters

80 mg tablets (80 mg of atorvastatin): coded “PD 158” on one side and “80” on the other.

NDC 0071-0158-23 bottles of 90
NDC 0071-0158-73 bottles of 500
NDC 0071-0158-88 bottles of 2500
NDC 0071-0158-92 8 x 8 unit dose blisters

Storage

Store at controlled room temperature 20 -25°C (68 -77°F).

Dosage

The recommended starting dose of Atorvastatin is 10 or 20 mg once daily. Patients who require a large reduction in LDL-C (more than 45%) may be started at 40 mg once daily. The dosage range of Atorvastatin is 10 to 80 mg once daily. Atorvastatin can be administered as a single dose at any time of the day, with or without food. The starting dose and maintenance doses of Atorvastatin should be individualized according to patient characteristics such as the goal of therapy and response. After initiation and/or upon titration of Atorvastatin, lipid levels should be analyzed within 2 to 4 weeks and dosage adjusted accordingly.

• Hyperlipidemia (10-20 mg PO qDay initially)
• Hypertriglyceridemia (10 mg PO qDay initially)
• Primary dysbetalipoproteinemia (10-80 mg PO qDay)
• Homozygous familial hypercholesterolemia (10-80 mg PO qDay)
• Cardiovascular Disease Prevention (10-80 mg PO qDay)

OVERDOSE

There is no specific treatment for Atorvastatin overdosage. In the event of an overdose, the patient should be treated symptomatically, and supportive measures instituted as required. Due to extensive drug binding to plasma proteins, hemodialysis is not expected to significantly enhance Atorvastatin clearance.

Possible Side Effects of Atorvastatin

Atorvastatin is generally well tolerated. Possible side effects may include any of the following and the side effects experienced may be transitory (clears up after a few days) or may remain. Consult your doctor immediately if you experiencing serious side effects. Note the list below is not exhaustive.

• Gastrointestinal symptoms such as diarrhea
• Cold symptoms such as a runny or stuffy nose
• Joint pain
• Insomnia
• Urinary tract infection
• Nausea
• Loss of appetite
• Indigestion symptoms such as stomach discomfort or pain
• Increased transaminases
• Muscle spasms with or without pain
• Musculoskeletal pain (pain that affects the muscles, ligaments, tendons bones, and joints
• Muscle pain
• Limb pain
• Mouth and throat pain
• Chest pain (angina)
• Lightheadedness and fainting
• Shortness of breath or other breathing problems
• Muscle weakness or loss of muscle strength
• Muscle ache
• Severe allergic reaction (anaphylaxis)
• Stevens-Johnson syndrome
• Muscle inflammation, with or without pain

Adverse reactions associated with atorvastatin therapy reported since market introduction, that are not listed above, regardless of causality assessment, include the following: anaphylaxis, angioneurotic edema, bullous rashes (including erythema multiforme, and toxic epidermal necrolysis), rhabdomyolysis, myositis, fatigue, tendon rupture, fatal and non-fatal hepatic failure, dizziness, depression, peripheral neuropathy, pancreatitis and interstitial lung disease.

There have been rare reports of immune-mediated necrotizing myopathy associated with statin use

Contra-indications and Cautions for Atorvastatin

Contra-indications

• Hypersensitivity to atorvastatin
• Active liver disease or unexplained transaminase elevation
• Your doctor should not prescribe this medication if you are a patient with liver problems
• Women who are pregnant or breastfeeding should not take atorvastatin

Cautions

• Non-serious and reversible cognitive side effects may occur.
• Lipitor may react adversely with erythromycin, especially in older patients
• Increased blood sugar and glycosylated hemoglobin (HbA1c) levels reported with intake of statins like Lipitor.
• Use with caution with Lipitor in the elderly; risk of myopathy.
• Heavy alcohol use, renal failure, history of liver disease or liver problems.
• Fatal and nonfatal liver failure reported (rare).
• Risk of rhabdomyolysis (breakdown of muscle tissue).
• Risk of myopathy: Increased by co-administration with fibrates, niacin, cyclosporine, macrolides, telaprevir, boceprevir, combinations of HIV protease inhibitors (e.g., saquinavir plus ritonavir, lopinavir plus ritonavir, tipranavir plus ritonavir, darunavir plus ritonavir, fosamprenavir, and fosamprenavir plus ritonavir), or azole antifungals.
• Withhold or discontinue medical treatment with this drug in any patient developing myopathy, kidney failure, or transaminase levels greater than 3x ULN.
• Rare reports of immune-mediated necrotizing myopathy (IMNM), characterized by increased serum creatine kinase that persists despite discontinuation of statin.
• In people with liver impairment, people with poor liver health, and people who have recently suffered a stroke.
• CYP3A4 substrate; avoid grapefruit products and caution with other CYP3A4 inhibitors.
• Secondary causes of high cholesterol should be ruled out before starting this medication.

Drug Interactions for Atorvastatin

Your pharmacist will be aware of potential interactions between Atorvastatin and any other medications you use. It’s wise to double-check with your pharmacist and always read package inserts and check the drugs you currently use for possible interactions. If in doubt, revert to your pharmacist with a list of all your medication. It’s a great idea if you own a smartphone to add all your medications to an app on your phone. This can be a lifesaver.

Severe interactions of atorvastatin include:

• cyclosporine
• gemfibrozil
• pazopanib
• red yeast rice
• telaprevir
• tipranavir

Atorvastatin has serious interactions with at least 45 different drugs and moderate interactions with at least 173 different drugs.

Mild interactions of atorvastatin include:

• alvimopan
• armodafinil
• coenzyme q10
• colestipol
• fexofenadine
• fluvoxamine
• isradipine
• loratadine
• orlistat
• ruxolitinib
• trazodone

Safety in Pregnancy for Atorvastatin

Atorvastatin is not indicated for use in pregnant or breastfeeding women.

Pregnancy and Lactation

• Do not use this drug if you are pregnant
• Health risks associated with this medicine outweigh potential benefits
• Your doctor will inform you of safer alternatives
• Because of the potential for adverse reactions and side effects that may affect the health of nursing infants, women taking atorvastatin should not breastfeed. This medication is contraindicated in nursing mothers because it may be excreted into human breast milk
• If you become pregnant while taking this medicine, call your doctor immediately

The post Atorvastatin (Lipitor) appeared first on Medika Life.

Date of Release: 14 Nov, 2020

NEW YORK /PRNewswire/ — New research presented today at the American Heart Association’s Scientific Sessions 2020 found that additional imaging tests can determine the underlying reason for heart attacks in most women without coronary artery narrowing. A correct diagnosis can guide appropriate medical treatment.

Led by researchers and clinicians at NYU Grossman School of Medicine, the study examined women with MINOCA, or myocardial infarction with non-obstructive coronary arteries, a condition that accounts for 6 to 15 percent of heart attacks and is 3 times more common among women than men with heart attack. It determined that coronary optical coherence tomography (OCT) and a cardiac MRI identified the underlying cause of heart attack in 85 percent of study participants.

“For a long time, women with symptoms and blood results of a heart attack whose coronary arteries were not blocked more than halfway were told they did not have a heart attack, and often were not given medical treatment for heart attack,” says Harmony R. Reynolds, MD, the study lead author and director of the Sarah Ross Soter Center for Women’s Cardiovascular Research at NYU Langone Health. “This left women with questions about what happened to them, and whether it was a heart problem. Our research provides answers for these women and vital information to guide doctors on how best to treat them.”

In the study, women diagnosed with MINOCA based on an angiogram had two additional imaging tests to determine the cause of their heart attack. During a coronary angiogram, the standard test to check on the arteries for patients with heart attack, a catheter is threaded up to the coronary arteries through a small incision in the wrist or groin. During the OCT test, an additional imaging catheter placed inside the coronary arteries uses light to take photographic images of the artery wall, and can find plaques and blood clots that an angiogram can miss. The second test, a cardiac MRI, shows which areas of the heart muscle have been injured and whether that injury is related to lower blood flow, inflammation, or another reason.

About the Study

Researchers enrolled 301 women who had a heart attack across 16 international sites. The median age of study participants was 60 years old, and 50 percent were non-Hispanic white women. Of this group, 170 women had MINOCA: 23 had contraindications to OCT, and the remaining 147 received OCT, with 145 having adequate OCT images; 116 of the women also received a cardiac MRI within a median time of 6 days from the heart attack.

Three quarters of the women with abnormal OCT or cardiac MRI results had evidence of heart damage from reduced blood flow. This reduced blood flow was determined to be due to ruptured plaque or recently ruptured plaque in most cases. Two thirds of those with a culprit finding on the OCT had MRI evidence of heart damage. About one third of women with cardiac MRI evidence of heart attack did not have a ruptured plaque to explain the reduction in blood flow. The investigators suggest those women without a recently ruptured plaque and with MRI evidence of heart damage most likely had either artery spasm or a blood clot or plaque rupture in the artery that was not seen. This is a major difference in patients with MINOCA from typical patients with heart attack with badly blocked arteries, since nearly all typical heart attack is caused by plaque with blood clotting.

Based on cardiac MRI, one in five of patients with MINOCA was found to have an alternate, non-ischemic diagnosis, such as myocarditis, Takotsubo syndrome, or another cardiomyopathy. Patients with these diagnoses receive different treatment than patients with heart attack in general.

For the remaining 16 percent of the women in the study, both the OCT and cardiac MRI scans were normal, and the cause of the heart attack was not found.

“These findings build upon our understanding of MINOCA and set the stage for the next frontier of women’s cardiovascular care,” says Dr. Reynolds. “Physicians no longer need to guess at the cause of heart attacks because we have the tools we need to correctly diagnose and successfully treat most patients.”

In addition to Dr. Reynolds, other NYU Langone researchers involved with the study are Nathaniel R. Smilowitz, MD; Kevin P. Marzo, MD; Anais Hausvater, MD; Yuhe Xia, MS; Hua Zhong, PhD; Binita Shah, MD; Michael J. Attubato, MD; Sripal Bangalore, MD; Louai Razzouk, MD, MPH; Ellen Hada; and Judith S. Hochman, MD.

Media Inquiries:
Rob Magyar
212-404-3591
Robert.magyar@nyulangone.org  

SOURCE NYU Langone Health

Related Links

http://www.med.nyu.edu

The post Another Step Forward to Addressing Women’s Cardio Health Inequalities appeared first on Medika Life.

Angina is chest pain or discomfort that occurs if an area of your heart muscle does not get enough oxygen-rich blood. It is a common symptom of ischemic heart disease, which limits or cuts off blood flow to the heart.

There are several types of angina, and the signs and symptoms depend on which type you have. Angina chest pain, called an angina event, can happen when your heart is working hard. It can go away when you stop to rest again, or it can happen at rest. This pain can feel like pressure or squeezing in your chest. It also can spread to your shoulders, arms, neck, jaw, or back, just like a heart attack. Angina pain can even feel like an upset stomach. Symptoms can be different for women and men.

Angina can be a warning sign that you are at increased risk for a heart attack. If you have chest pain that does not go away, call 9-1-1 immediately.

To diagnose angina, your doctor will ask you about your signs and symptoms and may run blood tests, take an X-ray, or order tests, such as an electrocardiogram (EKG), an exercise stress test, or cardiac catheterization, to determine how well your heart is working. With some types of angina, you may need emergency medical treatment to try to prevent a heart attack. To control your condition, your doctor may recommend heart-healthy lifestyle changes, medicines, medical procedures, and cardiac rehabilitation.

Types of Angina

The types of angina are stable, unstable, microvascular, and variant. The types vary based on their severity or cause.

Stable angina

Stable angina follows a pattern that has been consistent for at least 2 months. That means the following factors have not changed:

• How long your angina events last
• How often your angina events occur
• How well the angina responds to rest or medicines
• The causes or triggers of your angina

If you have stable angina, you can learn its pattern and predict when an event will occur, such as during physical exertion or mental stress. The pain usually goes away a few minutes after you rest or take your angina medicine. If the condition causing your angina gets worse, stable angina can become unstable angina.

Unstable angina

Unstable angina does not follow a pattern. It may be new or occur more often and be more severe than stable angina. Unstable angina can also occur with or without physical exertion. Rest or medicine may not relieve the pain.

Unstable angina is a medical emergency, since it can progress to a heart attack. Medical attention may be needed right away to restore blood flow to the heart muscle.

Microvascular angina

Microvascular angina is a sign of ischemic heart disease affecting the tiny arteries of the heart. Microvascular angina events can be stable or unstable. They can be more painful and last longer than other types of angina, and symptoms can occur during exercise or at rest. Medicine may not relieve symptoms of this type of angina.

Variant angina

Variant angina, also known as Prinzmetal’s angina, is rare. It occurs when a spasm—a sudden tightening of the muscles within the arteries of your heart—causes the angina rather than a blockage. This type of angina usually occurs while you are at rest, and the pain can be severe. It usually happens between midnight and early morning and in a pattern. Medicine can ease symptoms of variant angina.

Causes of Angina

Angina happens when your heart muscle does not get enough oxygen-rich blood. Medical conditions, particularly ischemic heart disease, or lifestyle habits can cause angina. 

Ischemic heart disease

Two types of ischemic heart disease can cause angina.

• Coronary artery disease happens when plaque builds up inside the large arteries that supply blood to the heart. This is called atherosclerosis. Plaque narrows or blocks the arteries, reducing blood flow to the heart muscle. Sometimes plaque breaks open and causes blood clots to form. Blood clots can partially or totally block the coronary arteries.
• Coronary microvascular disease affects the tiny arteries that branch off the larger coronary arteries. Reduced blood flow in these arteries causes microvascular angina. The arteries may be damaged and unable to expand as usual when the heart needs more oxygen-rich blood.

Spasm of the coronary arteries

A spasm that tightens your coronary arteries can cause angina. Spasms can occur whether or not you have ischemic heart disease and can affect large or small coronary arteries. Damage to your heart’s arteries may cause them to narrow instead of widen when the heart needs more oxygen-rich blood.

Risk Factors for Angina

You may have an increased risk for angina because of your age, environment or occupation, family history and genetics, lifestyle, other medical conditions, race, or sex.

Age

Genetic or lifestyle factors can cause plaque to build up in your arteries as you age. This means that your risk for ischemic heart disease and angina increases as you get older.Variant angina is rare, but people who have variant angina often are younger than those who have other types of angina.

Environment or occupation

Angina may be linked to a type of air pollution called particle pollution. Particle pollution can include dust from roads, farms, dry riverbeds, construction sites, and mines.

Your work life can increase your risk of angina. Examples include work that limits your time available for sleep, involves high stress, requires long periods of sitting or standing, is noisy, or exposes you to potential hazards such as radiation.

Family history and genetics

Ischemic heart disease often runs in families. Also, people who have no lifestyle-related risk factors can develop ischemic heart disease. These factors suggest that genes are involved in ischemic heart disease and can influence a person’s risk of developing angina.

Variant angina has also been linked to specific DNA changes.

Lifestyle habits

The more heart disease risk factors you have, the greater your risk of developing angina. The main lifestyle risk factors for angina include:

• Alcohol use, for variant angina
• Illegal drug use
• Lack of physical activity
• Smoking tobacco or long-term exposure to secondhand smoke
• Stress
• Unhealthy eating patterns

Other medical conditions

Medical conditions in which your heart needs more oxygen-rich blood than your body can supply increase your risk for angina. They include:

• Anemia
• A racing heart rate or blood vessel damage due to cocaine or methamphetamine use
• Cardiomyopathy, or disease of the heart muscle
• Damage to the heart caused by injury
• Heart failure
• Heart valve disease
• High blood pressure
• Inflammation
• Insulin resistance or diabetes
• Low blood pressure
• Metabolic syndrome
• Overweight or obesity
• Unhealthy cholesterol levels

Medical procedures

Heart procedures such as stent placement, percutaneous coronary intervention (PCI), or coronary artery bypass grafting (CABG) can trigger coronary spasms and angina. Although rare, noncardiac surgery can also trigger unstable angina or variant angina.

Race or ethnicity

Some groups of people are at higher risk for developing ischemic heart disease and one of its main symptoms, angina. African Americans who have already had a heart attack are more likely than whites to develop angina.

Variant angina is more common among people living in Japan, especially men, than among people living in Western countries.

Sex

Angina affects both men and women, but at different ages based on men and women’s risk of developing ischemic heart disease. In men, ischemic heart disease risk starts to increase at age 45. Before age 55, women have a lower risk for heart disease than men. After age 55, the risk rises in both women and men. Women who have already had a heart attack are more likely to develop angina compared with men.

Microvascular angina most often begins in women around the time of menopause.

Signs, Symptoms, and Complications- Angina

Signs and symptoms vary based on the type of angina you have and on whether you are a man or a woman. Angina symptoms can differ in severity, location in the body, timing, and how much relief you may feel with rest or medicines. Since symptoms of angina and of heart attack can be the same, call 9-1-1 if you feel chest discomfort that does not go away with rest or medicine. Angina can also lead to a heart attack and other complications that can be life-threatening.

Signs and symptoms

Pain and discomfort are the main symptoms of angina. Angina is often described as pressure, squeezing, burning, indigestion, or tightness in the chest. The pain or discomfort usually starts behind the breastbone. Some people say that angina pain is hard to describe or that they cannot tell exactly where the pain is coming from.

Other symptoms include:

• Fatigue
• Light-headedness or fainting
• Nausea, or feeling sick in the stomach
• Shortness of breath
• Sweating
• Weakness

Symptoms of angina can be different for women and men. Instead of chest pain, or in addition to it, women may feel pain in the neck, jaw, throat, abdomen, or back. Sometimes this pain is not recognized as a symptom of a heart condition. As a result, treatment for women can be delayed.

Because angina has so many possible symptoms and causes, all chest pain should be checked by a doctor. Each type of angina has certain typical symptoms. Learn more about the symptoms that are characteristic of each type.

Stable angina

• Discomfort that feels like gas or indigestion
• Pain during physical exertion or mental stress
• Pain that spreads from your breastbone to your arms or back
• Pain that is relieved by medicines
• Pattern of symptoms that has not changed in the last 2 months
• Symptoms that go away within 5 minutes

Unstable angina

• Changes in your stable angina symptoms
• Pain that grows worse
• Pain that is not relieved by rest or medicines
• Pain that lasts longer than 20 minutes or goes away and then comes back
• Pain while you are resting or sleeping
• Severe pain
• Shortness of breath

Microvascular angina

• Pain after physical or emotional stress
• Pain that is not immediately relieved by medicines
• Pain that lasts a long time
• Pain that you feel while doing regular daily activities
• Severe pain
• Shortness of breath

Variant angina

• Cold sweats
• Fainting
• Numbness or weakness of the left shoulder and upper arm
• Pain that is relieved by medicines
• Pain that occurs during rest or while sleeping
• Pain that starts in the early morning hours
• Severe pain
• Vague pain with a feeling of pressure in the lower chest, perhaps spreading to the neck, jaw, or left shoulder

Complications of Angina

Angina is not a heart attack, but it suggests that a heart attack or other life-threatening complications are more likely to happen in the future.

The following are other possible complications of angina:

• Arrhythmia
• Cardiomyopathy
• Sudden cardiac arrest

Diagnosing Angina

Your doctor may diagnose angina based on your medical history, a physical exam, and diagnostic tests and procedures. These tests can help assess whether you need immediate treatment for a heart attack. Some of these tests may help rule out other conditions.

Medical history

Your doctor will want to learn about your signs and symptoms, risk factors, personal health history, and family health history to determine whether your chest pain is angina or is caused by something else. Other heart and blood vessel problems or problems with your chest muscles, lungs, or digestive system can cause chest pain.

Tell your doctor if you notice a pattern to your symptoms. Ask yourself these questions:

• How long does the pain or discomfort last?
• How often does the pain occur?
• How severe is the pain or discomfort?
• What brings on the pain or discomfort, and what makes it better?
• Where do you feel the pain or discomfort?
• What does the pain or discomfort feel like?

Your doctor will also need information about ischemic heart disease risk factors and other medical conditions you might have, including diabetes and kidney disease. Even if your chest pain is not angina, it can still be a symptom of a serious medical problem. Your doctor can recommend steps you need to take to get medical care.

Physical examination

As part of a physical examination, your doctor will measure your blood pressure and heart rate, feel your chest and belly, take your temperature, listen to your heart and lungs, and feel your pulse.

Diagnostic tests and procedures

Your doctor may have you undergo some of the following tests and procedures.

• Blood tests to check the level of cardiac troponins. Troponin levels can help doctors tell unstable angina from heart attacks. Your doctor may also check levels of certain fats, cholesterol, sugar, and proteins in your blood.
• Chest X-ray to look for lung disorders and other causes of chest pain not related to ischemic heart disease. A chest X-ray alone is not enough to diagnose angina or ischemic heart disease, but it can help rule out other causes.
• Computed tomography angiography to examine blood flow through the coronary arteries. This test can rapidly diagnose ischemic heart disease as the source of your chest pain and help your doctor decide whether a procedure to improve blood flow will benefit your future health.
• Coronary angiography with cardiac catheterization to see if ischemic heart disease is the cause of your chest pain. This test lets your doctor study the flow of blood through your heart and blood vessels to confirm whether plaque buildup is the problem. The results of the scan can also help your doctor assess whether unstable angina might be relieved by surgery or other procedures.
• Echocardiogram to assess the strength of your heart beating, to help the doctor determine your risk of future heart problems.
• Electrocardiogram (EKG) to check for the possibility of a heart attack. Certain EKG patterns are associated with variant angina and unstable angina. These patterns may indicate serious ischemic heart disease or prior heart damage as a cause of angina. However, some people who have angina have normal EKGs.
• Hyperventilation testing to diagnose variant angina. Rapid breathing under controlled conditions with careful medical monitoring may bring on EKG changes that help your doctor diagnose variant angina.
• Magnetic resonance imaging or other noninvasive tests to check for problems with the heart’s movement or with blood flow in the heart’s small blood vessels.
• Provocation tests to diagnose variant angina. Your doctor may give you a medicine such as acetylcholine during coronary angiography to see if the coronary arteries start to spasm.
• Stress testing to assess your heart’s function during exercise. A stress test can show possible signs and symptoms of ischemic heart disease causing your angina. Stress testing in the early morning can help diagnose variant angina. Stress echocardiography tests can help your doctor diagnose the cause of your angina.

Treatment for Angina

Your doctor will decide on a treatment approach based on the type of angina you have, your symptoms, test results, and risk of complications. Unstable angina is a medical emergency that requires immediate treatment in a hospital. If your angina is stable and your symptoms are not getting worse, you may be able to control your angina with heart-healthy lifestyle changes and medicines. If lifestyle changes and medicines cannot control your angina, you may need a medical procedure to improve blood flow and relieve your angina.

Medicines

If you are diagnosed with angina, your doctor will prescribe fast-acting medicines you can take to control angina events and relieve pain. Often other medicines are also prescribed to help control angina long-term. The choice of medicines may depend on what type of angina you have.

• Anticoagulant medicines, or blood thinners, such as heparin, to prevent dangerous blood clots and future complications, such as a heart attack or another angina event.
• Antiplatelet medicines to prevent blood clots from forming. If you have stable or unstable angina, your doctor may recommend aspirin to treat angina and reduce the risk of complications of ischemic heart disease. Other platelet inhibitors, such as clopidogrel, may also be prescribed.
• Beta blockers to help your heart beat slower and with less force. These drugs are often prescribed to help relieve angina. If you cannot take beta-blockers for some reason, long-acting nitrates are the preferred alternative.
• Calcium channel blockers to keep calcium from entering the muscle cells of your heart and blood vessels. This allows blood vessels to relax. Calcium channel blockers may be an alternative medicine if you are unable to take beta blockers or nitrates. For variant angina, your doctor is likely to order calcium channel blockers and avoid giving you beta blockers.
• Nitrates to widen and relax blood vessels, which allows more blood to flow to the heart while reducing the heart’s workload. Nitrate pills or sprays, including nitroglycerin, act quickly and can relieve pain during an event. Long-acting nitrates are available as pills or skin patches. If you are hospitalized for chest pain, your doctor may order intravenous (IV) nitrates to relieve your angina pain.
• Statins to prevent plaque from forming and to relieve blood vessel spasms or inflammation, reducing the risk of a heart attack or other complications after emergency treatment.

If you still have symptoms or experience side effects, your doctor may prescribe other medicines, including:

• Morphine to relieve pain and help relax the blood vessels. Your doctor may suggest it if other medicines have not helped.
• Ranolazine to help you have angina symptoms less often. When given with other anti-angina medicines, ranolazine can also increase the length of time you can be physically active without pain. This medicine may work for coronary microvascular disease, which causes microvascular angina. Ranolazine may be a substitute for nitrates for men with stable angina who take drugs for erectile dysfunction.

Procedures

If lifestyle changes and medicines do not control angina, you may need a medical procedure to treat the underlying heart disease.

• Coronary artery bypass grafting (CABG) to treat ischemic heart disease and relieve angina. CABG can improve blood flow to your heart, relieve chest pain, and possibly prevent a heart attack.
• Percutaneous coronary intervention (PCI), also known as coronary angioplasty, to open narrowed or blocked blood vessels that supply blood to the heart. This procedure requires cardiac catheterization. If PCI includes certain medicines to expand coronary arteries, the procedure may be helpful for some people who have variant angina.

The post Angina, understanding this heart condition appeared first on Medika Life.

• Myocardial infarction (MI)
• Acute myocardial infarction (AMI)
• Acute coronary syndrome
• Coronary thrombosis
• Coronary occlusion

A heart attack happens when the flow of oxygen-rich blood to a section of heart muscle suddenly becomes blocked and the heart can’t get oxygen. If blood flow isn’t restored quickly, the section of heart muscle begins to die.

Heart attack treatment works best when it’s given right after symptoms occur. If you think you or someone else is having a heart attack, even if you’re not sure, call 9–1–1 right away.

Heart attacks most often occur as a result of ischemic heart disease, also called coronary heart disease or coronary artery disease. Ischemic heart disease is a condition in which a waxy substance called plaque builds up inside the coronary arteries. These arteries supply oxygen-rich blood to your heart.

When plaque builds up in the arteries, the condition is called atherosclerosis. The buildup of plaque occurs over many years.

Eventually, an area of plaque can rupture (break open) inside of an artery. This causes a blood clot to form on the plaque’s surface. If the clot becomes large enough, it can mostly or completely block blood flow through a coronary artery.

If the blockage isn’t treated quickly, the portion of heart muscle fed by the artery begins to die. Healthy heart tissue is replaced with scar tissue. This heart damage may not be obvious, or it may cause severe or long-lasting problems.

Heart With Muscle Damage and a Blocked Artery

A less common cause of heart attack is a severe spasm (tightening) of a coronary artery. The spasm cuts off blood flow through the artery. Spasms can occur in coronary arteries that aren’t affected by atherosclerosis.

Heart attacks can be associated with or lead to severe health problems, such as heart failure and life-threatening arrhythmias.

Heart failure is a condition in which the heart can’t pump enough blood to meet the body’s needs. Arrhythmias are irregular heartbeats. Ventricular fibrillation is a life-threatening arrhythmia that can cause death if not treated right away.

Don’t Wait – Get Help Quickly

Acting fast at the first sign of heart attack symptoms can save your life and limit damage to your heart. Treatment works best when it’s given right after symptoms occur.

Many people aren’t sure what’s wrong when they are having symptoms of a heart attack. Some of the most common warning symptoms of a heart attack for both men and women are:

• Chest pain or discomfort. Most heart attacks involve discomfort in the center or left side of the chest. The discomfort usually lasts more than a few minutes or goes away and comes back. It can feel like pressure, squeezing, fullness, or pain. It also can feel like heartburn or indigestion.
• Upper body discomfort. You may feel pain or discomfort in one or both arms, the back, shoulders, neck, jaw, or upper part of the stomach (above the belly button).
• Shortness of breath. This may be your only symptom, or it may occur before or along with chest pain or discomfort. It can occur when you are resting or doing a little bit of physical activity.

Other possible symptoms of a heart attack include:

• Breaking out in a cold sweat
• Feeling unusually tired for no reason, sometimes for days (especially if you are a woman)
• Nausea (feeling sick to the stomach) and vomiting
• Light-headedness or sudden dizziness
• Any sudden, new symptom or a change in the pattern of symptoms you already have (for example, if your symptoms become stronger or last longer than usual)

Not all heart attacks begin with the sudden, crushing chest pain that often is shown on TV or in the movies, or other common symptoms such as chest discomfort. The symptoms of a heart attack can vary from person to person. Some people can have few symptoms and are surprised to learn they’ve had a heart attack. If you’ve already had a heart attack, your symptoms may not be the same for another one. 

Quick Action Can Save Your Life: Call 9–1–1

If you think you or someone else may be having heart attack symptoms or a heart attack, don’t ignore it or feel embarrassed to call for help. Call 9–1–1 for emergency medical care. Acting fast can save your life.

Do not drive to the hospital or let someone else drive you. Call an ambulance so that medical personnel can begin life-saving treatment on the way to the emergency room. Take a nitroglycerin pill if your doctor has prescribed this type of treatment.

What causes a Heart Attack

Coronary Heart Disease

A heart attack happens if the flow of oxygen-rich blood to a section of heart muscle suddenly becomes blocked and the heart can’t get oxygen. Most heart attacks occur as a result of ischemic heart disease.

Ischemic heart disease is a condition in which a waxy substance called plaque builds up inside of the coronary arteries. These arteries supply oxygen-rich blood to your heart.

When plaque builds up in the arteries, the condition is called atherosclerosis. The buildup of plaque occurs over many years.

Eventually, an area of plaque can rupture (break open) inside of an artery. This causes a blood clot to form on the plaque’s surface. If the clot becomes large enough, it can mostly or completely block blood flow through a coronary artery.

If the blockage isn’t treated quickly, the portion of heart muscle fed by the artery begins to die. Healthy heart tissue is replaced with scar tissue. This heart damage may not be obvious, or it may cause severe or long-lasting problems.

Coronary Artery Spasm

A less common cause of heart attack is a severe spasm (tightening) of a coronary artery. The spasm cuts off blood flow through the artery. Spasms can occur in coronary arteries that aren’t affected by atherosclerosis.

What causes a coronary artery to spasm isn’t always clear. A spasm may be related to:

• Taking certain drugs, such as cocaine
• Emotional stress or pain
• Exposure to extreme cold
• Cigarette smoking

Risk Factors

Certain risk factors make it more likely that you’ll develop ischemic heart disease and have a heart attack. You can control many of these risk factors.

Risk Factors You Can Control

The major risk factors for a heart attack that you can control include:

• Smoking
• High blood pressure
• High blood cholesterol
• Overweight and obesity
• An unhealthy diet (for example, a diet high in saturated fat, trans fat, cholesterol, and sodium)
• Lack of routine physical activity
• High blood sugar due to insulin resistance or diabetes

Some of these risk factors—such as obesity, high blood pressure, and high blood sugar—tend to occur together. When they do, it’s called metabolic syndrome.

In general, a person who has metabolic syndrome is twice as likely to develop heart disease and five times as likely to develop diabetes as someone who doesn’t have metabolic syndrome.

Risk Factors You Can’t Control

Risk factors that you can’t control include:

• Age. The risk of heart disease increases for men after age 45 and for women after age 55 (or after menopause).
• Family history of early heart disease. Your risk increases if your father or a brother was diagnosed with heart disease before 55 years of age, or if your mother or a sister was diagnosed with heart disease before 65 years of age.
• Preeclampsia (pre-e-KLAMP-se-ah). This condition can develop during pregnancy. The two main signs of preeclampsia are a rise in blood pressure and excess protein in the urine. Preeclampsia is linked to an increased lifetime risk of heart disease, including CHD, heart attack, heart failure, and high blood pressure.

Signs, Symptoms, and Complications

Not all heart attacks begin with the sudden, crushing chest pain that often is shown on TV or in the movies. In one study, for example, one-third of the patients who had heart attacks had no chest pain. These patients were more likely to be older, female, or diabetic.

The symptoms of a heart attack can vary from person to person. Some people can have few symptoms and are surprised to learn they’ve had a heart attack. If you’ve already had a heart attack, your symptoms may not be the same for another one. It is important for you to know the most common symptoms of a heart attack and also remember these facts:

• Heart attacks can start slowly and cause only mild pain or discomfort. Symptoms can be mild or more intense and sudden. Symptoms also may come and go over several hours.
• People who have high blood sugar (diabetes) may have no symptoms or very mild ones.
• The most common symptom, in both men and women, is chest pain or discomfort.
• Women are somewhat more likely to have shortness of breath, nausea and vomiting, unusual tiredness (sometimes for days), and pain in the back, shoulders, and jaw.

Some people don’t have symptoms at all. Heart attacks that occur without any symptoms or with very mild symptoms are called silent heart attacks.

Most Common Symptoms

The most common warning symptoms of a heart attack for both men and women are:

• Chest pain or discomfort. Most heart attacks involve discomfort in the center or left side of the chest. The discomfort usually lasts for more than a few minutes or goes away and comes back. It can feel like pressure, squeezing, fullness, or pain. It also can feel like heartburn or indigestion. The feeling can be mild or severe.
• Upper body discomfort. You may feel pain or discomfort in one or both arms, the back, shoulders, neck, jaw, or upper part of the stomach (above the belly button).
• Shortness of breath. This may be your only symptom, or it may occur before or along with chest pain or discomfort. It can occur when you are resting or doing a little bit of physical activity.

The symptoms of angina can be similar to the symptoms of a heart attack. Angina is chest pain that occurs in people who have ischemic heart disease, usually when they’re active. Angina pain usually lasts for only a few minutes and goes away with rest.

Chest pain or discomfort that doesn’t go away or changes from its usual pattern (for example, occurs more often or while you’re resting) can be a sign of a heart attack.

All chest pain should be checked by a doctor.

Other Common Signs and Symptoms

Pay attention to these other possible symptoms of a heart attack:

• Breaking out in a cold sweat
• Feeling unusually tired for no reason, sometimes for days (especially if you are a woman)
• Nausea (feeling sick to the stomach) and vomiting
• Light-headedness or sudden dizziness
• Any sudden, new symptoms or a change in the pattern of symptoms you already have (for example, if your symptoms become stronger or last longer than usual)

Not everyone having a heart attack has typical symptoms. If you’ve already had a heart attack, your symptoms may not be the same for another one. However, some people may have a pattern of symptoms that recur.

The more signs and symptoms you have, the more likely it is that you’re having a heart attack.

Quick Action Can Save Your Life: Call 9–1–1 

The signs and symptoms of a heart attack can develop suddenly. However, they also can develop slowly—sometimes within hours, days, or weeks of a heart attack.

Any time you think you might be having heart attack symptoms or a heart attack, don’t ignore it or feel embarrassed to call for help. Call 9–1–1 for emergency medical care, even if you are not sure whether you’re having a heart attack. Here’s why:

• Acting fast can save your life.
• An ambulance is the best and safest way to get to the hospital. Emergency medical services (EMS) personnel can check how you are doing and start life-saving medicines and other treatments right away. People who arrive by ambulance often receive faster treatment at the hospital. 
• The 9–1–1 operator or EMS technician can give you advice. You might be told to crush or chew an aspirin if you’re not allergic, unless there is a medical reason for you not to take one. Aspirin taken during a heart attack can limit the damage to your heart and save your life.

Diagnosing a Heart Attack

Your doctor will diagnose a heart attack based on your signs and symptoms, your medical and family histories, and test results.

Diagnostic Tests

EKG (Electrocardiogram)

An EKG is a simple, painless test that detects and records the heart’s electrical activity. The test shows how fast the heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through each part of the heart.

An EKG can show signs of heart damage due to ischemic heart disease and signs of a previous or current heart attack.

Blood Tests

During a heart attack, heart muscle cells die and release proteins into the bloodstream. Blood tests can measure the amount of these proteins in the bloodstream. Higher than normal levels of these proteins suggest a heart attack.

Commonly used blood tests include troponin tests, CK or CK–MB tests, and serum myoglobin tests. Blood tests often are repeated to check for changes over time.

Coronary Angiography

Coronary angiography is a test that uses dye and special x rays to show the insides of your coronary arteries. This test often is done during a heart attack to help find blockages in the coronary arteries.

To get the dye into your coronary arteries, your doctor will use a procedure called cardiac catheterization.

A thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck. The tube is threaded into your coronary arteries, and the dye is released into your bloodstream.

Special x rays are taken while the dye is flowing through the coronary arteries. The dye lets your doctor study the flow of blood through the heart and blood vessels.

If your doctor finds a blockage, he or she may recommend a procedure called percutaneous coronary intervention (PCI), sometimes referred to as coronary angioplasty. This procedure can help restore blood flow through a blocked artery. Sometimes a small mesh tube called a stent is placed in the artery to help prevent blockages after the procedure.

Treatment

Early treatment for a heart attack can prevent or limit damage to the heart muscle. Acting fast, by calling 9–1–1 at the first symptoms of a heart attack, can save your life. Medical personnel can begin diagnosis and treatment even before you get to the hospital.

Immediate Treatment

Certain treatments usually are started right away if a heart attack is suspected, even before the diagnosis is confirmed. These include:

• Aspirin to prevent further blood clotting
• Nitroglycerin to reduce your heart’s workload and improve blood flow through the coronary arteries
• Oxygen therapy
• Treatment for chest pain

Once the diagnosis of a heart attack is confirmed or strongly suspected, doctors start treatments promptly to try to restore blood flow through the blood vessels supplying the heart. The two main treatments are clot-busting medicines and percutaneous coronary intervention, also known as coronary angioplasty, a procedure used to open blocked coronary arteries.

Clot-Busting Medicines

Thrombolytic medicines, also called clot busters, are used to dissolve blood clots that are blocking the coronary arteries. To work best, these medicines must be given within several hours of the start of heart attack symptoms. Ideally, the medicine should be given as soon as possible.

Percutaneous Coronary Intervention

Percutaneous coronary intervention is a nonsurgical procedure that opens blocked or narrowed coronary arteries. A thin, flexible tube (catheter) with a balloon or other device on the end is threaded through a blood vessel, usually in the groin (upper thigh), to the narrowed or blocked coronary artery. Once in place, the balloon located at the tip of the catheter is inflated to compress the plaque and related clot against the wall of the artery.

This restores blood flow through the artery. During the procedure, the doctor may put a small mesh tube called a stent in the artery. The stent helps to keep the blood vessel open to prevent blockages in the artery in the months or years after the procedure.

Other Treatments for Heart Attack

Other treatments for heart attack include:

• Medicines
• Medical procedures
• Heart-healthy lifestyle changes
• Cardiac rehabilitation

Medicines

Your doctor may prescribe one or more of the following medicines.

• ACE inhibitors. ACE inhibitors lower blood pressure and reduce strain on your heart. They also help slow down further weakening of the heart muscle.
• Anticlotting medicines. Anticlotting medicines stop platelets from clumping together and forming unwanted blood clots. Examples of anticlotting medicines include aspirin and clopidogrel.
• Anticoagulants. Anticoagulants, or blood thinners, prevent blood clots from forming in your arteries. These medicines also keep existing clots from getting larger.
• Beta blockers. Beta blockers decrease your heart’s workload. These medicines also are used to relieve chest pain and discomfort and to help prevent another heart attack. Beta blockers also are used to treat arrhythmias (irregular heartbeats).
• Statin medicines. Statins control or lower your blood cholesterol. By lowering your blood cholesterol level, you can decrease your chance of having another heart attack or stroke.

You also may be given medicines to relieve pain and anxiety, and treat arrhythmias. Take all medicines regularly, as your doctor prescribes. Don’t change the amount of your medicine or skip a dose unless your doctor tells you to. 

Medical Procedures

Coronary artery bypass grafting also may be used to treat a heart attack. During coronary artery bypass grafting, a surgeon removes a healthy artery or vein from your body. The artery or vein is then connected, or grafted, to bypass the blocked section of the coronary artery. The grafted artery or vein bypasses (that is, goes around) the blocked portion of the coronary artery. This provides a new route for blood to flow to the heart muscle.

Heart-Healthy Lifestyle Changes

Treatment for a heart attack usually includes making heart-healthy lifestyle changes. Your doctor also may recommend:

• Heart-healthy eating
• Aiming for healthy weight
• Managing stress
• Physical activity
• Quitting smoking

Taking these steps can lower your chances of having another heart attack.

Cardiac Rehabilitation

Your doctor may recommend cardiac rehabilitation (cardiac rehab) to help you recover from a heart attack and to help prevent another heart attack. Nearly everyone who has had a heart attack can benefit from rehab. Cardiac rehab is a medically supervised program that may help improve the health and well-being of people who have heart problems.

The cardiac rehab team may include doctors, nurses, exercise specialists, physical and occupational therapists, dietitians or nutritionists, and psychologists or other mental health specialists.

Rehab has two parts:

• Education, counseling, and training. This part of rehab helps you understand your heart condition and find ways to reduce your risk for future heart problems. The rehab team will help you learn how to cope with the stress of adjusting to a new lifestyle and how to deal with your fears about the future.
• Exercise training. This part helps you learn how to exercise safely, strengthen your muscles, and improve your stamina. Your exercise plan will be based on your personal abilities, needs, and interests.

The post A Heart Attack or Myocardial Infarction appeared first on Medika Life.

Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood. Over time, plaque hardens and narrows your arteries. This limits the flow of oxygen-rich blood to your organs and other parts of your body.

Atherosclerosis can lead to serious problems, including heart attack, stroke, or even death.

Atherosclerosis-Related Diseases

Atherosclerosis can affect any artery in the body, including arteries in the heart, brain, arms, legs, pelvis, and kidneys. As a result, different diseases may develop based on which arteries are affected.

Ischemic heart disease

Ischemic heart disease happens when the arteries of the heart cannot deliver enough oxygen-rich blood to the tissues of the heart when it is needed during periods of stress or physical effort.

Coronary heart disease, also called coronary artery disease, is a type of ischemic heart disease caused by the buildup of plaque in the coronary arteries that supply oxygen-rich blood to your heart.

This buildup can partially or totally block blood flow in the large arteries of the heart. If blood flow to your heart muscle is reduced or blocked, you may have angina (chest pain or discomfort) or a heart attack.

Coronary microvascular disease is another type of ischemic heart disease. It occurs when the heart’s tiny arteries do not function normally.

Carotid Artery Disease

Carotid (ka-ROT-id) artery disease occurs if plaque builds up in the arteries on each side of your neck (the carotid arteries). These arteries supply oxygen-rich blood to your brain. If blood flow to your brain is reduced or blocked, you may have a stroke.

Peripheral Artery Disease

Peripheral artery disease (P.A.D.) occurs if plaque builds up in the major arteries that supply oxygen-rich blood to your legs, arms, and pelvis. If blood flow to these parts of your body is reduced or blocked, you may have numbness, pain, and, sometimes, dangerous infections.

Chronic Kidney Disease

Chronic kidney disease can occur if plaque builds up in the renal arteries. These arteries supply oxygen-rich blood to your kidneys. Over time, chronic kidney disease causes a slow loss of kidney function. The main function of the kidneys is to remove waste and extra water from the body.

Causes of Atherosclerosis

The exact cause of atherosclerosis isn’t known. However, studies show that atherosclerosis is a slow, complex disease that may start in childhood. It develops faster as you age.

Atherosclerosis may start when certain factors damage the inner layers of the arteries. These factors include:

• Smoking
• High amounts of certain fats and cholesterol in the blood
• High blood pressure
• High amounts of sugar in the blood due to insulin resistance or diabetes

Plaque may begin to build up where the arteries are damaged. Over time, plaque hardens and narrows the arteries. Eventually, an area of plaque can rupture (break open).

When this happens, blood cell fragments called platelets (PLATE-lets) stick to the site of the injury. They may clump together to form blood clots. Clots narrow the arteries even more, limiting the flow of oxygen-rich blood to your body.

Depending on which arteries are affected, blood clots can worsen angina (chest pain) or cause a heart attack or stroke.

Risk Factors associated with Atherosclerosis

The exact cause of atherosclerosis isn’t known. However, certain traits, conditions, or habits may raise your risk for the disease. These conditions are known as risk factors. The more risk factors you have, the more likely it is that you’ll develop atherosclerosis.

You can control most risk factors and help prevent or delay atherosclerosis. Other risk factors can’t be controlled.

Major Risk Factors

• Unhealthy blood cholesterol levels. This includes high LDL cholesterol (sometimes called “bad” cholesterol) and low HDL cholesterol (sometimes called “good” cholesterol).
• High blood pressure. Blood pressure is considered high if it stays at or above 140/90 mmHg over time. If you have diabetes or chronic kidney disease, high blood pressure is defined as 130/80 mmHg or higher. (The mmHg is millimeters of mercury—the units used to measure blood pressure.)
• Smoking. Smoking can damage and tighten blood vessels, raise cholesterol levels, and raise blood pressure. Smoking also doesn’t allow enough oxygen to reach the body’s tissues.
• Insulin resistance. This condition occurs if the body can’t use its insulin properly. Insulin is a hormone that helps move blood sugar into cells where it’s used as an energy source. Insulin resistance may lead to diabetes.
• Diabetes. With this disease, the body’s blood sugar level is too high because the body doesn’t make enough insulin or doesn’t use its insulin properly.
• Overweight or obesity. The terms “overweight” and “obesity” refer to body weight that’s greater than what is considered healthy for a certain height.
• Lack of physical activity. A lack of physical activity can worsen other risk factors for atherosclerosis, such as unhealthy blood cholesterol levels, high blood pressure, diabetes, and overweight and obesity.
• Unhealthy diet. An unhealthy diet can raise your risk for atherosclerosis. Foods that are high in saturated and trans fats, cholesterol, sodium (salt), and sugar can worsen other atherosclerosis risk factors.
• Older age. As you get older, your risk for atherosclerosis increases. Genetic or lifestyle factors cause plaque to build up in your arteries as you age. By the time you’re middle-aged or older, enough plaque has built up to cause signs or symptoms. In men, the risk increases after age 45. In women, the risk increases after age 55.
• Family history of early heart disease. Your risk for atherosclerosis increases if your father or a brother was diagnosed with heart disease before 55 years of age, or if your mother or a sister was diagnosed with heart disease before 65 years of age.

Although age and a family history of early heart disease are risk factors, it doesn’t mean that you’ll develop atherosclerosis if you have one or both. Controlling other risk factors often can lessen genetic influences and prevent atherosclerosis, even in older adults.

Studies show that an increasing number of children and youth are at risk for atherosclerosis. This is due to a number of causes, including rising childhood obesity rates.

Emerging Risk Factors

Scientists continue to study other possible risk factors for atherosclerosis.

High levels of a protein called C-reactive protein (CRP) in the blood may raise the risk for atherosclerosis and heart attack. High levels of CRP are a sign of inflammation in the body.

Inflammation is the body’s response to injury or infection. Damage to the arteries’ inner walls seems to trigger inflammation and help plaque grow.

People who have low CRP levels may develop atherosclerosis at a slower rate than people who have high CRP levels. Research is under way to find out whether reducing inflammation and lowering CRP levels also can reduce the risk for atherosclerosis.

High levels of triglycerides (tri-GLIH-seh-rides) in the blood also may raise the risk for atherosclerosis, especially in women. Triglycerides are a type of fat.

Studies are under way to find out whether genetics may play a role in atherosclerosis risk.

Other Factors That Affect Atherosclerosis

Other factors also may raise your risk for atherosclerosis, such as:

• Sleep apnea. Sleep apnea is a disorder that causes one or more pauses in breathing or shallow breaths while you sleep. Untreated sleep apnea can raise your risk for high blood pressure, diabetes, and even a heart attack or stroke.
• Stress. Research shows that the most commonly reported “trigger” for a heart attack is an emotionally upsetting event, especially one involving anger.
• Alcohol. Heavy drinking can damage the heart muscle and worsen other risk factors for atherosclerosis. Men should have no more than two drinks containing alcohol a day. Women should have no more than one drink containing alcohol a day.

Signs, Symptoms, and Complications

Atherosclerosis usually doesn’t cause signs and symptoms until it severely narrows or totally blocks an artery. Many people don’t know they have the disease until they have a medical emergency, such as a heart attack or stroke.

Some people may have signs and symptoms of the disease. Signs and symptoms will depend on which arteries are affected.

Coronary Arteries

The coronary arteries supply oxygen-rich blood to your heart. If plaque narrows or blocks these arteries (causing a disease called ischemic heart disease), a common symptom is angina. Angina is chest pain or discomfort that occurs when your heart muscle doesn’t get enough oxygen-rich blood.

Angina may feel like pressure or squeezing in your chest. You also may feel it in your shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion. The pain tends to get worse with activity and go away with rest. Emotional stress also can trigger the pain.

Other symptoms of ischemic heart disease are shortness of breath and arrhythmias (ah-RITH-me-ahs). Arrhythmias are problems with the rate or rhythm of the heartbeat.

Plaque also can form in the heart’s smallest arteries. This disease is called coronary microvascular disease (MVD). Symptoms of coronary MVD include angina, shortness of breath, sleep problems, fatigue (tiredness), and lack of energy.

Carotid Arteries

The carotid arteries supply oxygen-rich blood to your brain. If plaque narrows or blocks these arteries (a disease called carotid artery disease), you may have symptoms of a stroke. These symptoms may include:

• Sudden weakness
• Paralysis (an inability to move) or numbness of the face, arms, or legs, especially on one side of the body
• Confusion
• Trouble speaking or understanding speech
• Trouble seeing in one or both eyes
• Problems breathing
• Dizziness, trouble walking, loss of balance or coordination, and unexplained falls
• Loss of consciousness
• Sudden and severe headache

Peripheral Arteries

Plaque also can build up in the major arteries that supply oxygen-rich blood to the legs, arms, and pelvis (a disease called peripheral artery disease).

If these major arteries are narrowed or blocked, you may have numbness, pain, and, sometimes, dangerous infections.

Renal Arteries

The renal arteries supply oxygen-rich blood to your kidneys. If plaque builds up in these arteries, you may develop chronic kidney disease. Over time, chronic kidney disease causes a slow loss of kidney function.

Early kidney disease often has no signs or symptoms. As the disease gets worse it can cause tiredness, changes in how you urinate (more often or less often), loss of appetite, nausea (feeling sick to the stomach), swelling in the hands or feet, itchiness or numbness, and trouble concentrating.

Diagnosing Atherosclerosis

Your doctor will diagnose atherosclerosis based on your medical and family histories, a physical exam, and test results.

Specialists Involved

If you have atherosclerosis, a primary care doctor, such as an internist or family practitioner, may handle your care. Your doctor may recommend other health care specialists if you need expert care, such as:

• A cardiologist. This is a doctor who specializes in diagnosing and treating heart diseases and conditions. You may go to a cardiologist if you have peripheral artery disease (P.A.D.) or coronary microvascular disease (MVD).
• A vascular specialist. This is a doctor who specializes in diagnosing and treating blood vessel problems. You may go to a vascular specialist if you have P.A.D.
• A neurologist. This is a doctor who specializes in diagnosing and treating nervous system disorders. You may see a neurologist if you’ve had a stroke due to carotid artery disease.
• A nephrologist. This is a doctor who specializes in diagnosing and treating kidney diseases and conditions. You may go to a nephrologist if you have chronic kidney disease.

Physical Exam

During the physical exam, your doctor may listen to your arteries for an abnormal whooshing sound called a bruit (broo-E). Your doctor can hear a bruit when placing a stethoscope over an affected artery. A bruit may indicate poor blood flow due to plaque buildup.

Your doctor also may check to see whether any of your pulses (for example, in the leg or foot) are weak or absent. A weak or absent pulse can be a sign of a blocked artery.

Types of Diagnostic Tests

Your doctor may recommend one or more tests to diagnose atherosclerosis. These tests also can help your doctor learn the extent of your disease and plan the best treatment.

Blood Tests

Blood tests check the levels of certain fats, cholesterol, sugar, and proteins in your blood. Abnormal levels may be a sign that you’re at risk for atherosclerosis.

EKG (Electrocardiogram)

An EKG is a simple, painless test that detects and records the heart’s electrical activity. The test shows how fast the heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through the heart.

An EKG can show signs of heart damage caused by CHD. The test also can show signs of a previous or current heart attack.

Chest X Ray

A chest x ray takes pictures of the organs and structures inside your chest, such as your heart, lungs, and blood vessels. A chest x ray can reveal signs of heart failure.

Ankle/Brachial Index

This test compares the blood pressure in your ankle with the blood pressure in your arm to see how well your blood is flowing. This test can help diagnose P.A.D.

Echocardiography

Echocardiography (echo) uses sound waves to create a moving picture of your heart. The test provides information about the size and shape of your heart and how well your heart chambers and valves are working.

Echo also can identify areas of poor blood flow to the heart, areas of heart muscle that aren’t contracting normally, and previous injury to the heart muscle caused by poor blood flow.

Computed Tomography Scan

A computed tomography (CT) scan creates computer-generated pictures of the heart, brain, or other areas of the body. The test can show hardening and narrowing of large arteries.

A cardiac CT scan also can show whether calcium has built up in the walls of the coronary (heart) arteries. This may be an early sign of CHD.

Stress Testing

During stress testing, you exercise to make your heart work hard and beat fast while heart tests are done. If you can’t exercise, you may be given medicine to make your heart work hard and beat fast.

When your heart is working hard, it needs more blood and oxygen. Plaque-narrowed arteries can’t supply enough oxygen-rich blood to meet your heart’s needs.

A stress test can show possible signs and symptoms of CHD, such as:

• Abnormal changes in your heart rate or blood pressure
• Shortness of breath or chest pain
• Abnormal changes in your heart rhythm or your heart’s electrical activity

As part of some stress tests, pictures are taken of your heart while you exercise and while you rest. These imaging stress tests can show how well blood is flowing in various parts of your heart. They also can show how well your heart pumps blood when it beats.

Angiography

Angiography (an-jee-OG-ra-fee) is a test that uses dye and special x rays to show the inside of your arteries. This test can show whether plaque is blocking your arteries and how severe the blockage is.

A thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck. Dye that can be seen on an x-ray picture is injected through the catheter into the arteries. By looking at the x-ray picture, your doctor can see the flow of blood through your arteries.

Other Tests

Other tests are being studied to see whether they can give a better view of plaque buildup in the arteries. Examples of these tests include magnetic resonance imaging (MRI) and positron emission tomography (PET).

Treatment for Atherosclerosis

Treatments for atherosclerosis may include heart-healthy lifestyle changes, medicines, and medical procedures or surgery. The goals of treatment include:

• Lowering the risk of blood clots forming
• Preventing atherosclerosis-related diseases
• Reducing risk factors in an effort to slow or stop the buildup of plaque
• Relieving symptoms
• Widening or bypassing plaque-clogged arteries

Medicines

Sometimes lifestyle changes alone aren’t enough to control your cholesterol levels. For example, you also may need statin medications to control or lower your cholesterol. By lowering your blood cholesterol level, you can decrease your chance of having a heart attack or stroke. Doctors usually prescribe statins for people who have:

• Coronary heart disease, peripheral artery disease, or had a prior stroke
• Diabetes
• High LDL cholesterol levels

Doctors may discuss beginning statin treatment with people who have an elevated risk for developing heart disease or having a stroke.
Your doctor also may prescribe other medications to:

• Lower your blood pressure
• Lower your blood sugar levels
• Prevent blood clots, which can lead to heart attack and stroke
• Prevent inflammation

Take all medicines regularly, as your doctor prescribes. Don’t change the amount of your medicine or skip a dose unless your doctor tells you to. You should still follow a heart healthy lifestyle, even if you take medicines to treat your atherosclerosis.

Medical Procedures and Surgery

If you have severe atherosclerosis, your doctor may recommend a medical procedure or surgery.

Percutaneous coronary intervention (PCI), also known as coronary angioplasty, is a procedure that’s used to open blocked or narrowed coronary (heart) arteries. PCI can improve blood flow to the heart and relieve chest pain. Sometimes a small mesh tube called a stent is placed in the artery to keep it open after the procedure.

Coronary artery bypass grafting (CABG) is a type of surgery. In CABG, arteries or veins from other areas in your body are used to bypass or go around your narrowed coronary arteries. CABG can improve blood flow to your heart, relieve chest pain, and possibly prevent a heart attack.

Bypass grafting also can be used for leg arteries. For this surgery, a healthy blood vessel is used to bypass a narrowed or blocked artery in one of the legs. The healthy blood vessel redirects blood around the blocked artery, improving blood flow to the leg.

Carotid endarterectomy is a type of surgery to remove plaque buildup from the carotid arteries in the neck. This procedure restores blood flow to the brain, which can help prevent a stroke.

The post Atherosclerosis, Arteriosclerosis or Hardening of the Arteries appeared first on Medika Life.

Heart disease is a catch-all phrase for a variety of conditions that affect the heart’s structure and function. Coronary heart disease is a type of heart disease that develops when the arteries of the heart cannot deliver enough oxygen-rich blood to the heart. It is the leading cause of death in the United States.

Coronary heart disease is often caused by the buildup of plaque, a waxy substance, inside the lining of larger coronary arteries. This buildup can partially or totally block blood flow in the large arteries of the heart. Some types of this condition may be caused by disease or injury affecting how the arteries work in the heart. Coronary microvascular disease is another type of coronary heart disease. It occurs when the heart’s tiny blood vessels do not work normally.

Symptoms of coronary heart disease may be different from person to person even if they have the same type of coronary heart disease. However, because many people have no symptoms, they do not know they have coronary heart disease until they have chest pain, a heart attack, or sudden cardiac arrest.

If you have coronary heart disease, your doctor will recommend heart-healthy lifestyle changes, medicines, surgery, or a combination of these approaches to treat your condition and prevent complications.

Causes of Coronary Heart Disease

There are three main types of coronary heart disease: obstructive coronary artery disease, nonobstructive coronary artery disease, and coronary microvascular disease. Coronary artery disease affects the large arteries on the surface of the heart. Many people have both obstructive and nonobstructive forms of this disease. Coronary microvascular disease affects the tiny arteries in the heart muscle.

The cause depends on the type of coronary heart disease. The condition may also have more than one cause, including plaque buildup or problems that affect how the heart’s blood vessels work. 

Plaque buildup

Plaque buildup in the arteries is called atherosclerosis. When this buildup happens in the heart’s arteries over many years, the arteries become narrower and harden, reducing oxygen-rich blood flow to the heart. The result is coronary artery disease.

Obstructive coronary artery disease means the heart’s arteries are more than 50% blocked. The blood flow may eventually be completely blocked in one or more of the three large coronary arteries. In nonobstructive coronary artery disease, the large arteries may be narrowed by plaque, but not as much as they are in obstructive disease.

Small plaques can also develop in the small blood vessels in the heart, causing coronary microvascular disease.

Problems affecting the blood vessels

Problems with how the heart’s blood vessels work can cause coronary heart disease. For example, the blood vessels may not respond to signals that the heart needs more oxygen-rich blood. Normally, the blood vessels widen to allow more blood flow when a person is physically active or under stress. But if you have coronary heart disease, the size of these blood vessels may not change, or the blood vessels may even narrow.

The cause of these problems is not fully clear. But it may involve:

• Damage or injury to the walls of the arteries or tiny blood vessels from chronic inflammation, high blood pressure, or diabetes.
• Molecular changes that are part of the normal aging process. Molecular changes affect the way genes and proteins are controlled inside cells.

In nonobstructive coronary artery disease, damage to the inner walls of the coronary arteries can cause them to spasm (suddenly tighten). This is called vasospasm. The spasm causes the arteries to narrow temporarily and blocks blood flow to the heart.

These problems can also happen in the tiny blood vessels in the heart, causing coronary microvascular disease (sometimes called coronary syndrome X). Coronary microvascular disease can happen with or without obstructive or nonobstructive coronary artery disease.

Risk Factors

There are many risk factors for coronary heart disease. Your risk of coronary heart disease goes up with the number of risk factors you have and how serious they are. Some risk factors—such as high blood pressure and high blood cholesterol—can be changed through heart-healthy lifestyle changes. Other risk factors, such as sex, older age, family history and genetics, and race and ethnicity, cannot be changed.

Age

Genetic or lifestyle factors cause plaque to build up in your arteries as you age. In men, the risk for coronary heart disease starts to increase around age 45. Before menopause, women have a lower risk of coronary heart disease than men. After around age 55, women’s risk goes up. This is likely because women make less estrogen (a female hormone) after menopause. Also, changes in the small blood vessels of the heart as you age raise the risk for coronary microvascular disease.

Environment and occupation

Air pollution in the environment can put you at higher risk of coronary heart disease. The increase in risk may be higher in older adults, women, and people who have diabetes or obesity. Air pollution may cause or worsen other conditions, such as atherosclerosis and high blood pressure, which are known to increase your risk for coronary heart disease.

Your work life can also raise your risk if you:

• Come into contact with toxins, radiation, or other hazards
• Have a lot of stress at work
• Sit for long periods
• Work more than 55 hours a week, or work long, irregular, or night shifts that affect your sleep

Family history and genetics

A family history of early heart disease is a risk factor for coronary heart disease. This is especially true if your father or brother was diagnosed before age 55, or if your mother or sister was diagnosed before age 65. Research shows that some genes are linked with a higher risk for coronary heart disease.

Lifestyle habits

Over time, unhealthy lifestyle habits increase your risk of coronary heart disease because they can lead to plaque buildup in the heart’s blood vessels. Unhealthy lifestyle habits that are risk factors include the following:

• Being physically inactive, which can worsen other heart disease risk factors, such as high blood cholesterol and triglyceride levels, high blood pressure, diabetes and prediabetes, and overweight and obesity.
• Not getting enough good quality sleep, including waking up often throughout the night, which may raise your risk of coronary heart disease. While you sleep, your blood pressure and heart rate fall. Your heart does not work as hard as it does when you are awake. As you begin to wake up, your blood pressure and heart rate increase to the usual levels when you are awake and relaxed. Waking up suddenly can cause a sharp increase in blood pressure and heart rate, which has been linked to angina and heart attacks.
• Smoking tobacco or long-term exposure to secondhand smoke, which can damage the blood vessels.
• Stress, which can trigger the tightening of your arteries, which increases your risk of coronary heart disease, especially coronary microvascular disease. Stress may also indirectly raise your risk of coronary heart disease if it makes you more likely to smoke or overeat foods high in fat and added sugars.
• Unhealthy eating patterns, such as consuming high amounts of saturated fats or trans fats and refined carbohydrates (white bread, pasta, and white rice). This can lead to overweight and obesity, high blood cholesterol, atherosclerosis, and plaque buildup in the heart’s arteries.

Other medical conditions

Other medical conditions that can raise your risk of developing coronary heart disease include:

• Atherosclerosis
• Autoimmune and inflammatory diseases such as Crohns disease, ulcerative colitis, psoriasis, lichen planus, pemphigus, histiocytosis, lupus erythematosus, and rheumatoid arthritis
• Chronic kidney disease
• Congenital coronary artery defects
• Diabetes
• High blood LDL cholesterol (sometimes called “bad cholesterol”)
• High blood pressure
• High blood triglycerides
• HIV/AIDS, especially among older adults. Part of the risk might be due to side effects of HIV treatments.
• Mental health conditions, including anxiety, depression, and posttraumatic stress disorder (PTSD)
• Metabolic syndrome
• Overweight and obesity
• Sleep disorders, such as sleep apnea or sleep deprivation and deficiency

Race or ethnicity

Coronary heart disease is the leading cause of death for people of most racial and ethnic groups in the United States, including African Americans, Hispanics, and whites.

For Asian Americans or Pacific Islanders and American Indians or Alaska Natives, heart disease is second only to cancer. People of South Asian ancestry are at higher risk of developing coronary heart disease and serious complications than other Asian Americans.

Sex

Coronary heart disease affects men and women. Obstructive coronary artery disease is more common in men. However, nonobstructive coronary artery disease is more common in women. Since the nonobstructive type is harder to diagnose, women may not be diagnosed and treated as quickly as men.

If you are a woman having chest discomfort or shortness of breath during physical activity, ask your doctor about tests to check for nonobstructive coronary artery disease or coronary microvascular disease.

Women may have a higher than normal risk for developing coronary heart disease if they have one of the following conditions.

• Endometriosis, which raises the risk for heart disease in younger women
• Gestational diabetes, which can raise the risk for diabetes and metabolic syndrome even after pregnancy and the risk of developing coronary heart disease
• Polycystic ovary syndrome
• Preeclampsia, a condition that can happen during pregnancy and is linked to an increased lifetime risk for coronary heart disease
• Early menopause (before age 40)

Signs, Symptoms, and Complications

Some people have severe symptoms of coronary heart disease. Others have no symptoms at all. If you have “silent” coronary heart disease, you may not have any symptoms until you have a heart attack or other complication.

Signs and symptoms

An acute coronary event, such as a heart attack, may cause the following symptoms:

• Angina, which can feel like pressure, squeezing, burning, or tightness during physical activity. The pain or discomfort usually starts behind the breastbone, but it can also occur in the arms, shoulders, jaw, throat, or back. The pain may feel like indigestion.
• Cold sweats
• Dizziness
• Light-headedness
• Nausea or a feeling of indigestion
• Neck pain
• Shortness of breath, especially with activity
• Sleep disturbances
• Weakness

Women are somewhat less likely than men to experience chest pain. Instead, they are more likely to experience:

• Dizziness
• Fatigue
• Nausea
• Pressure or tightness in the chest
• Stomach pain

Women are also more likely than men to have no symptoms of coronary heart disease.

Chronic (long-term) coronary heart disease can cause symptoms such as the following:

• Angina
• Shortness of breath with physical activity
• Fatigue
• Neck pain

The symptoms may get worse as the buildup of plaque continues to narrow the coronary arteries. Chest pain or discomfort that does not go away or happens more often or while you are resting might be a sign of a heart attack. If you do not know whether your chest pain is angina or a heart attack, call 9-1-1 right away. All chest pain should be checked by a doctor.

Complications

Coronary heart disease can cause serious complications, including the following:

• Acute coronary syndrome, including angina or heart attack
• Arrhythmia
• Heart failure
• Cardiogenic shock
• Sudden cardiac arrest

Complications of coronary heart disease can be life-threatening and may lead to disability.

Treating Coronary Heart Disease

Your treatment plan depends on how severe your disease is, the severity of your symptoms, and any other health conditions you may have. Possible treatments for coronary heart disease include heart-healthy lifestyle changes, medicines, or procedures such as coronary artery bypass grafting or percutaneous coronary intervention.

Your doctor will consider your 10-year risk calculation when deciding how best to treat your coronary heart disease.

Heart-healthy lifestyle changes

Your doctor may recommend that you adopt lifelong heart-healthy lifestyle changes, including:

• Aiming for a healthy weight. Losing just 3% to 5% of your current weight can help you manage some coronary heart disease risk factors, such as high blood cholesterol and diabetes. Greater amounts of weight loss can also improve blood pressure readings.
• Being physically active. Routine physical activity can help manage coronary heart disease risk factors such as high blood cholesterol, high blood pressure, or overweight and obesity. Before starting any exercise program, ask your doctor what level of physical activity is right for you.
• Heart-healthy eating, such as the DASH (Dietary Approaches to Stop Hypertension) eating plan. A heart-healthy eating plan includes fruits, vegetables, and whole grains and limits saturated fats, trans fats, sodium (salt), added sugars, and alcohol.
• Managing stress. Learning how to manage stress, relax, and cope with problems can improve your emotional and physical health.
• Quitting smoking. Visit Smoking and Your Heart and the National Heart, Lung, and Blood Institute’s Your Guide to a Healthy Heart. Although these resources focus on heart health, they include basic information about how to quit smoking. For free help and support to quit smoking, you can call the National Cancer Institute’s Smoking Quitline at 1-877-44U-QUIT (1-877-448-7848). Talk to your doctor if you vape. There is scientific evidence that nicotine and flavorings found in vaping products may damage your heart and lungs.
• Get enough good-quality sleep. The recommended amount for adults is 7 to 9 hours of sleep a day.

Medicines

Your doctor may recommend medicines to manage your risk factors or treat underlying causes of coronary heart disease. Some medicines can reduce or prevent chest pain and manage other medical conditions that may be contributing to your coronary heart disease.

• ACE inhibitors and beta blockers to help lower blood pressure and decrease the heart’s workload.
• Calcium channel blockers to lower blood pressure by allowing blood vessels to relax.
• Medicines to control blood sugar,such as empagliflozin, canagliflozin, and liraglutide, to help lower your risk for complications if you have coronary heart disease and diabetes.
• Metformin to control plaque buildup if you have diabetes.
• Nitrates, such as nitroglycerin, to dilate your coronary arteries and relieve or prevent chest pain from angina.
• Ranolazine to treat coronary microvascular disease and the chest pain it may cause.
• Statins and/or non-statin therapiesto control high blood cholesterol. Your doctor may recommend statin therapy if you have a higher risk for coronary heart disease or stroke or if you have diabetes and are between ages 40 and 75. Non-statin therapiesmay be used to reduce cholesterol when statins do not lower cholesterol enough or cause side effects. Your doctor may prescribe non-statin drugs, such as, ezetimibe, bile acid sequestrants, alirocumab, or evolocumab to lower cholesterol or omega-3 fatty acids, gemfibrozil, or fenofibrate to reduce triglycerides.

Procedures

You may need a procedure or heart surgery to treat more advanced coronary heart disease.

• Percutaneous coronary intervention (PCI) to open coronary arteries that are narrowed or blocked by the buildup of atherosclerotic plaque. A small mesh tube called a stent is usuallyimplanted after PCI to prevent the artery from narrowing again.
• Coronary artery bypass grafting (CABG) to improve blood flow to the heart by using normal arteries from the chest wall and veins from the legs to bypass the blocked arteries. Surgeons typically use CABG to treat people who have severe obstructive coronary artery disease in multiple coronary arteries.
• Transmyocardiallaser revascularization or coronary endarterectomy to treat severe angina associated with coronary heart disease when other treatments are too risky or did not work.

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