Saturday, July 11, 2009
2008 - Classification of AMI
In 2007 the powers-that-be came up with a new classifcation for MI:
To be diagnosed with an acute MI, need a rise in enzymes + symptoms of ischaemia, or, enzymes + ECG changes (ST-T or LBBB or Q), or enzymes + RWMA.
To be diagnosed with a prior MI, need to either see pathological Q waves or a thin and poorly contractile wall without any non-ischaemic reason being able to explain it.
Definitions were also created for PCI-related MI:- 3 x the upper limit of normal rise in enzymes. Then there is a subclassification of "myocardial necrosis" which is defined as above the upper limit of normal rise in enzymes.
Finally, definitions were created for CAGS-related MI:- 5 x upper limit PLUS ECG changes (new Q or new LBBB) or on imaging, new loss of viable myocardium, or an angiogram showing a new occlusion in a graft or native vessel.
To be diagnosed with an acute MI, need a rise in enzymes + symptoms of ischaemia, or, enzymes + ECG changes (ST-T or LBBB or Q), or enzymes + RWMA.
To be diagnosed with a prior MI, need to either see pathological Q waves or a thin and poorly contractile wall without any non-ischaemic reason being able to explain it.
Definitions were also created for PCI-related MI:- 3 x the upper limit of normal rise in enzymes. Then there is a subclassification of "myocardial necrosis" which is defined as above the upper limit of normal rise in enzymes.
Finally, definitions were created for CAGS-related MI:- 5 x upper limit PLUS ECG changes (new Q or new LBBB) or on imaging, new loss of viable myocardium, or an angiogram showing a new occlusion in a graft or native vessel.
2008 - effects on cyclosporine levels
Cya is broken down by Cyp 3a4
diltizem - is broken down by the same enzyme. Therefore, in transplantation medicine you give a cardiac drug! (diltiazem) because it means that the blood levels of Cya will be higher and therefore you can lower the dose that you give.
digoxin - is secreted out by kidney cells into the urine. Cyclosporin, 'cos it screws around with cells, stops this. This was first discovered when some cardiac transplant patients suddenly developed digoxin toxicity.
allopurinol - CyA levels go sky high when patients are started on allopurinol. No idea why.
phenytoin - ramps up the liver and so more CyA gets chewed up and CyA blood levels fall.
So, the important message is that if someone is on CyA then there will probably be a drug interaction with some of the other drugs they are on, and you should always check for what this interaction will be, before prescribing.
diltizem - is broken down by the same enzyme. Therefore, in transplantation medicine you give a cardiac drug! (diltiazem) because it means that the blood levels of Cya will be higher and therefore you can lower the dose that you give.
digoxin - is secreted out by kidney cells into the urine. Cyclosporin, 'cos it screws around with cells, stops this. This was first discovered when some cardiac transplant patients suddenly developed digoxin toxicity.
allopurinol - CyA levels go sky high when patients are started on allopurinol. No idea why.
phenytoin - ramps up the liver and so more CyA gets chewed up and CyA blood levels fall.
So, the important message is that if someone is on CyA then there will probably be a drug interaction with some of the other drugs they are on, and you should always check for what this interaction will be, before prescribing.
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