Long-Term Management of Patients After Myocardial Infarction

243 Pages·1987·13.35 MB·English

by  N. K. Wenger (auth.), C. T. Kappagoda, P. V. Greenwood (eds.)

LONG-TERM MANAGEMENT OF PATIENTS
AFTER MYOCARDIAL INFARCTION
DEVELOPMENTS IN CARDIOVASCULAR MEDICINE
Godfraind, T., Herman, A.S., Wellens, D., eds.: Entry blockers in cardiovascular and cerebral
dysfunctions. ISBN 0-89838-658-6.
Morganroth, J., Moore, E.N., eds.: Interventions in the acute phase of myocardial infarction. ISBN
0-89838-659-4.
Abel, F.L., Newman, W.H., eds.: Functional aspects of the normal, hypertrophied, and failing heart.
ISBN 0-89838-665-9.
Sideman, S., and Beyar, R., eds.: Simulation and imaging of the cardiac system. ISBN
0-89838-687-X.
van de Wall, E .. Lie, K.I., eds.: Recent views on hypertrophic cardiomyopathy. ISBN 0-89838-694-2.
Beamish, R.E., Singal, P.K., Dhalla, N.S., eds.: Stress and heart disease. ISBN 0-89838-709-4.
Beamish, R.E., Panagia, V., Dhalla, N.S., eds.: Pathogenesis of stress-induced heart disease. ISBN
0-89838-710-8.
Morganroth, J., Moore, E.N., eds.: Cardiac arrhythmias: New therapeutic drugs and devices.
ISBN 0-89838-716-7.
Mathes, P., ed.: Secondary prevention in coronary artery disease and myocardial infarction.
ISBN 0-89838-736-1.
Stone, H. Lowell, Weglicki, W.B., eds.: Pathology of cardiovascular injury. ISBN 0-89838-743-4.
Meyer, J., Erbel, R., Rupprecht, H.J., eds.: Improvement of myocardial perfusion. ISBN
0-89838-748-5.
Reiber, J.H.C., Serruys, P.W., Slager, C.J.: Quantitative coronary and left ventricular
cineangiography. ISBN 0-89838-760-4.
Fagard, R.H., Bekaert, I.E., eds.: Sports cardiology. ISBN 0-89838-782-5.
Reiber, J.H.C., Serruys, P.W., eds.: State of the art in quantitative coronary arteriography. ISBN
0-89838-804-X.
Roelandt, J., ed.: Color doppler flow imaging. ISBN 0-89838-806-6.
van de Wall, E.E., ed.: Noninvasive imaging of cardiac metabolism. ISBN 0-89838-812-0.
Liebman, J., Plonsey, R., Rudy, Y., eds.: Pediatric and fundamental electrocardiography. ISBN
0-89838-815-5.
Higler, H., Hombach, V., eds.: Invasive cardiovascular therapy. ISBN 0-89838-818-X.
Serruys, P.W., Meester, G.T., eds.: Coronary angioplasty: a controlled model for ischemia. ISBN
0-89838-819-8.
Tooke, J.E., Smaje, L.H., eds.: Clinical investigation of the microcirculation. ISBN
0-89838-833-3.
van Dam, Th., van Oosterom, A., eds.: Electrocardiographic body surface mapping. ISBN
0-89838-834-1.
Spencer, M.P., ed.: Ultrasonic diagnosis of cerebrovascular disease. ISBN 0-89838-836-8.
Legato, M.J., ed.: The stressed heart. ISBN 0-89838-849-X.
Safar, M.E., ed.: Arterial and venous systems in essential hypertension. ISBN 0-89838-857-0.
Roelandt, J., ed.: Digital techniques in echocardiography. ISBN 0-89838-861-9.
Dhalla, N.S., Singal, P.K., Beamish, R.E., eds.: Pathophysiology of heart disease. ISBN
0-89838-864-3.
Dhalla, N.S., Pierce, G.N., Beamish, R.E., eds.: Heart function and metabolism. ISBN
0-89838-865-1.
Dhalla, N.S., Innes, I.R., Beamish, R.E., eds.: Myocardial ischemia. ISBN 0-89838-866-X.
Beamish, R.E., Panagia, V., Dhalla, N.S., eds.: Pharmacological aspects of heart disease.
ISBN 0-89838-867-8.
Ter Keurs, H.E.D.J., Tyberg, J.V., eds.: Mechanics of the circulation. ISBN 0-89838-870-8.
Sideman, S., Beyar, R., eds.: Activation metabolism and perfusion of the heart. ISBN
0-89838-871-6.
Aliot, E., Lazzara, R., eds.: Ventricular tachycardias. ISBN 0-89838-881-3.
Schneeweiss, A., Schettler, G.: Cardiovascular drug therapy in the elderly. ISBN 0-89838-883-X.
Chapman, J.V., Sgalambro, A., eds.: Basic concepts in doppler echocardiography. ISBN
0-89838-888-0.
Chien, S., Dormandy, J., Ernst, E., Matrai, A., eds.: Clinical hemorheology. ISBN 0-89838-807-4.
Morganroth, J., Moore, E. Neil, eds.: Congestive heart failure. ISBN 0-89838-955-0.
Heintzen, P.H., Bursch, J.H., eds.: Progress in digital angiocardiography. ISBN 0-89838-965-8.
Scheinman, M., ed.: Catheter ablation of cardiac arrhythmias. ISBN 0-89838-967-4.
Spaan, J.A.E., Bruschke, A.V.G., Gittenberger, A.C., eds.: Coronary circulation, ISBN
0-89838-978-X.
Bayes de Luna, A., ed.: Therapeutics in cardiology. ISBN 0-89838-981-X.
This book is a volume in the series, "Advances in Myocardiology" (N.S. Dhal/a, Series Editor).
"Advances in Myocardiology" is a subseries within "Developments in Cardiovascular Medicine".
LONG-TERM MANAGEMENT
OF PATIENTS AFTER
MYOCARDIAL INFARCTION
edited by
c.
T. Kappagoda
p . V. Greenwood
Department of Medicine
University of Alberta
Edmonton, Alberta, Canada
Division of Cardiology
Department of Medicine ~ 1.9.1. Pharma
University of Alberta
Edmonton
Martinus Nijhoff Publishing
a member of the Kluwer Academic Publishers Group
Boston/DordrechtiLancaster
Distributors
for North America: Kluwer Academic Publishers, 101 Philip Drive,
Assinippi Park, Norwell, MA 02061, USA
for the UK and Ireland: Kluwer Academic Publishers, MTP Press Limited,
Falcon House, Queen Square, Lancaster LAI IRN, UK
for all other countries: Kluwer Academic Publishers Group, Distribution
Centre, Post Office Box 322, 3300 AH Dordrecht, The Netherlands
Library of Congress Cataloging-in-Publication Data
Long-term management of patients after myocardial
infarction.
(Developments in cardiovascular medicine)
Includes bibliographies.
I. Heart-Infarction-Patients-Rehabilitation.
2. Coronary heart disease-Patients-Rehabilitation.
I. Kappagoda, C. T. II. Greenwood, P. V. III. Series.
[DNLM: I. Myocardial Infarction-rehabilitation.
2. Long Term Care. WI DE997VME / WG 300 L848]
RC685.16L66 1987 616.1'2406 87-28207
ISBN-13: 978-1-4612-9204-3 e-ISBN-13: 978-1-4613-2021-0
001: 10.1007/978-1-4613-2021-0
Copyright © 1988 by Martinus Nijhoff Publishing, Boston
Softcover reprint of the hardcover 1st edition 1988
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or
transmitted in any form or by any means, mechanical, photocopying, recording, or otherwise,
without the prior written permission of the publisher, Martinus Nijhoff Publishing, 101 Philip
Drive, Assinippi Park, Norwell, MA 02061.
We dedicate this book to our patients.
CONTENTS
Preface ix
1. Introduction: Long-Term Management of Patients After
Myocardial Infarction
N.K. Wenger
I. PATTERNS OF CORONARY ARTERY DISEASE AND SURVIVAL
2. Changing Patterns in the Epidemiology of Coronary Artery Disease:
Trends in Survival After Myocardial Infarction 17
D.R. Labarthe
3. Trends in Pre-Hospital Mortality 31
C.T. Kappagoda
4. Hospital and Post-Hospital Mortality After Myocardial Infarction 47
R.M. Norris
II. ASSESSMENT OF FUNCTION
5. Physiological Response to Exercise 69
R.F.J. Shepherd, J.T. Shepherd
6. Assessment of Ventricular Function in Man 83
M.I.M. Noble, A.J. Drake-Holland, S. Parker, C.J. Mills,
J.A. Innes, S. Pugh, N. Mehta
7. Stress Testing After Acute Myocardial Infarction 97
B.R. Chaitman
8. Coronary Angiography After Myocardial Infarction 111
J. Horgan
9. Exercise Echocardiography After Myocardial Infarction 117
M.H. Crawford
III. THERAPEUTIC OPTIONS
10. Beta Adrenoreceptor Blocking Drugs in Patients Who Have Suffered
Acute Myocardial Infarction 131
P. V. Greenwood
11. Percutaneous Transluminal Coronary Angioplasty After
Myocardial Infarction 145
M.G. Bourassa, P.R. David, R. Bonan, D.O. Williams,
R. Holubkov, S.F. Kelsey, K.M. Detre
viii
12. Current Role of Surgery in Long Term Management of Patients
After Myocardial Infarction 157
W.l. Keon, A. Koshal
13. Psychological Aspects of the Treatment of
Myocardial Infarction 165
R. Mayou
14. Management of Risk Factors 181
P. Puska
15. Benefits of Exercise: Effect on Mortality and
Physiological Function 189
M.L. Pollock
IV. FUTURE TRENDS
16. Calcium Channel Blockers and Ischemia: A Review 209
W.O. Nayler, W.l. Sturrock, S. Panagiotopoulos
17. Receptors in the Regulation of Lipoprotein Metabolism 223
C.l. Packard, 1. Shepherd
18. Thromboxane and Prostacyclin in Platelet/Blood Vessel Interaction:
A Commentary 233
1.M. Ritter
PREFACE
The management of patients who present with a myocardial
i nfarcti on has altered radi ca lly over the past two decades. The
expansion of knowledge relating to the epidemiology of the condition
together with a greater understanding of the causes of the early
mortality from it have resulted in major changes in the way these
pati ents are treated duri ng the acute phase of the illness. The
deve 1o pment of 'dedi cated' Coronary Care Units in hospitals and the
recogni ti on of the need for ' Mobile Coronary Care Units' in the
cOl1Ul1unity have made a major impact upon the early mortality from
myocardial infarction.
Over the past decade, a great deal of attention has been paid to
strategies designed to limit the size of a myocardial infarct. As an
extensi on of thi s approach, the 1980' s have seen the evo 1u ti on of
techniques for revascularization of ischemic tissue. All these
procedures while appearing to hold the promise of reducing the acute
mortality from myocardial infarction, create the need for a planned
approach to the long term management of these patients. While there
are some modest i ndi cati ons that coronary atherosc 1e rosi s coul d be
arrested or even reversed, for all practical purposes it remains a
chroni c progressi ve di sease. Thus there is an i ncreasi ng need to
blend the traditional approaches to the rehabilitation of these
patients with the therapeutic interventions which are being developed
for the 'in-hospital' phase of the illness. In this volume we have
attempted to do so by bringing together the views of individuals who
have made important contributions to our knowledge of the various
aspects of the long-term management of patients recovering from
myocardial infarction.
We feel that this book should be of value to both physicians and
non-physicians who are involved in the follow up care and
rehabilitation of patients after acute myocardial infarction.
Although some of the chapters deal with more specialized aspects
x
of cardiac care and will be of special interest to cardiologists. the
majority of the book should enable the general readers to get a
better perspective on present management and prepare them to
appreciate future developments in this rapidly evolving area.
We wish to acknowledge a huge debt of gratitude to our
secretari es, Mrs. Sharon Campbell and Mrs. Eri n Gardner who have
coped wi th all of the many problems in the producti on of thi s book
and prepared the final drafts of the manuscripts. In doing all this
they have managed to continue smiling and run the rest of the office
with much appreciated efficiency.
Finally, we would like to thank I.C.I. Pharma and Martinus
Nijhoff Publishing who have maintained their support for us in this
venture.
LONG-TERM MANAGEMENT OF PATIENTS
AFTER MYOCARDIAL INFARCTION