Sam is a 60-year-old male heart attack survivor who had an unremarkable recovery after the successful coronary artery stenting in the middle of the night of his presentation. Now it is 3 months and Sam feels absolutely grand. At follow-up, his cardiologist insists that he should continue all the prescribed medications. He read on the internet some bad press about statin medications and thought, “surely, nothing will happen if I stop taking statins?!”
Read moreAtrial Fibrillation and Coronary Artery Disease: Aspirin and Oral Anticoagulants
A normally well 76-year-old lady had an NSTEMI 2 years ago and had successful stenting with a drug eluting stent (DES) for a severe left anterior descending artery narrowing. She had residual mild diffuse disease elsewhere.
After 12 months of dual antiplatelet therapy with Aspirin and Ticagrelor, she is now on Aspirin, in addition to Atorvastatin 40mg and Cilazapril 2.5mg for hypertension.
When seen in clinic, she reported no angina but was found to have new incidental asymptomatic atrial fibrillation. She had no history of stroke or TIA.
The best strategy for managing her stroke risk is
1) Aspirin alone
2) Aspirin plus Warfarin
3) Aspirin plus Dabigatran
4) Warfarin alone
5) Dabigatran alone
Read moreDual anti-platelet therapy and non-cardiac surgery
Ticagrelor - Chemical structure
A 75-year-old male is now 7-month post anterior myocardial infarction. He had successful proximal LAD drug eluting stent, currently on Aspirin and Ticagrelor. He is awaiting total hip joint replacement, and the orthopaedic surgeon would like to know whether he could stop his anti-platelets.
Read moreVitamin D and stain myalgia
55M IHD with prior stents; prior myalgia with Simvastatin and Atorvastatin; but yet still more myalgia with Pravastatin. The treating physician decided to check his vitamin D level and his coenzyme Q10 level.
Which one, vitamin D level or coenzyme Q10 level, is relevant in statin myalgia?
Read moreStatin Intolerance - the 2015 Approach
Scenario = 55M IHD with stents, trialed simvastatin, atorvastatin and pravastatin, all causing myalgia, without CK rise
Question = what to do?
Read more