Acute Coronary Syndromes

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Increased left ventricular end-diastolic pressure increases the workload of the heart. Wall tension is one of the greatest determinants of myocardial oxygen needs. Increases in oxygen demand secondary to hypertension may result in angina. Myocardial infarction may also develop particularly among those with fixed lesions in coronary arteries, preventing appropriate delivery of required oxygen. Acute left ventricular failure with pulmonary edema may also develop. Treatment of left-sided heart failure should include agents that decrease both preload and afterload. other agents that have been used as adjuvant therapy include oxygen, morphine sulfate, and diuretics. The use of agents that increase myocardial oxygen demand, such as diazoxide, hydralazine, and minoxidil, should be avoided.

In cases of hypertension and angina, immediate blood pressure reduction is indicated to prevent myocardial damage, and therapy should be initiated with nitroglycerin, either sublingually or parenterally. For a greater degree of pressure reduction, sodium nitroprusside may be started.

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