Coronary Heart Disease
Contraindications to thrombolytic therapy in HIV-infected patients with acute coronary syndrome include acute pericarditis, infective endocarditis, active cavitating pulmonary tuberculosis, and thrombocytopenia.
Primary percutaneous transluminal coronary angioplasty, if feasible, seems the most appropriate treatment in some HIV-infected patients [8]. In patients presenting with unstable angina or non-Q-wave myocardial infarction without specific therapeutic contraindications, the best approach may be medical therapy (i.v. nitroglycerin, aspirin, low-molecular-weight heparin, IIb/IIIa platelet inhibitor, betablockers). Patients with unstable angina at high risk (recent severe angina, elevated cTnI, ischemic ECG changes, hypertension, elevated cholesterol, diabetes, active smokers) or with myocardial infarction without ST-segment elevation should undergo coronary angiography to define their anatomy and optimize treatment to prevent ischemic injury and sudden death. Cardiac revascularization has been shown to be beneficial in the treatment of HIV-infected patients with coronary artery disease [9]. Indeed, the extraordinary fruits of a massive research effort have made it reasonable to perform elective surgery and to offer major surgery to patients independent of their immunologic status; additionally, the concern that the surgical team would be exposed to a significant risk of acquiring HIV infection during surgery has proved to be unfounded. Cardiac surgeons should have a heightened awareness for the possibility of successful surgical treatment of HIV-infected patients with a definitive clinical diagnosis of coronary artery disease [9].
Fig. 6 Wide-QRS complex supraventricular tachycardia in HIV-infected patients with echocardiographic diagnosis of dilated cardiomyopathy (left ventricular ejection fraction: 30%) and diagnosis of myocarditis confirmed by histological examination of endomyocardial biopsy specimens
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More on the topic Coronary Heart Disease:
- Coronary Heart Disease
- Ischemic Heart Disease
- Valvular Heart Disease
- CMR of Myocardial Infarction
- Barbaro Giuseppe, Boccara Franc (eds.). Cardiovascular Disease in AIDS. 2nd edition. — Springer,2009. — 169 p., 2009
- CONGENITAL HEART DISEASE
- The various cardiovascular diseases observed in HIV-infected patients and widely described in the literature have been predominantly coronary and peripheral arterial diseases (PAD) and remain poorly known.
- Coronary Artery Bypass Grafting
- Coronary Artery Lesions
- Macrovascular Complications of Diabetes Mellitus
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