kpmle2
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A 54-year-old man is discharged from the hospital 3 days after undergoing stenting of the left anterior descending coronary artery for acute coronary syndrome. He is asymptomatic, and left ventricular function, blood pressure, and plasma glucose level are normal. The serum cholesterol level was high on admission. Telemetry showed frequent premature ventricular contractions with occasional couplets. At discharge, the patient was prescribed clopidogrel, 75 mg/d; aspirin, 325 mg/d; metoprolol, 50 mg twice a day; and simvastatin, 20 mg/d.
Which of the following medications would likely prevent future cardiac events?
A. Folic acid
B. Vitamin E
C. Ramipril
D. Isosorbide mononitrate
E. Propafenone
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| Aashi
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C. Ramipril
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| neuroblastoma
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C
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| Vietnamese
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C- Ramipril: prevent remodeling of post-MI myocardiac, it means that it prevents heart failure.
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| tamerbashir
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c
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| drduck
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i m a bit confused......is the Q asking what will prevent future attacks of coronary artery atherosclerosis..
or is it something related to prevention of complication......
patient not going into failure....
i think answer shud be Vit E.......prevents oxidative damage to the endothelium of cornary vessels and prevent atherosclerosis.
what is the answer??
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| Vietnamese
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Medication Vit E have yet to prove a true anti-oxidant, but natural Vit E have.
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| Ivonne
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Ramipril definetely decreases mortality but not sure if it will prevent future cardiac events, i don't know studies about vit E and cardiac events.
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| kpmle2
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The correct answer is C
Understand appropriate secondary prevention for patients who have coronary artery disease.
Folic acid therapy reduces high serum homocysteine levels, which are correlated with outcomes in patients who have coronary artery disease. Small trials have shown a reduction in the incidence of clinically apparent restenosis after stenting, but no reduction in the incidence of myocardial infarction or death. Several well-done clinical trials have shown no benefit of high-dose vitamin E. Although nitrates are sometimes given after angioplasty to prevent coronary vasospasm, with the advent of stents, this use has declined and there is no evidence that it has any long-term prophylactic value. Although frequent premature ventricular contractions are cause for concern in an asymptomatic patient who has normal left ventricular function, studies show an increase in the mortality rate as a result of the proarrhythmia effects of type Ia agents. Although propafenone is a class Ic antiarrhythmic, the incidence of proarrhythmia is probably similar in this group of patients. In randomized clinical trials, the angiotensin-converting enzyme inhibitor ramipril reduced the incidence of cardiac events in patients with coronary artery disease. The mechanism of this effect is unclear and seems unrelated to either left ventricular function or blood pressure control.
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