Treatment of ischemic heart disease: role of drugs, surgery, and angioplasty in unstable angina patients

Facial pain associated with cardiac origin

BACKGROUND

Ischemic heart disease manifests as pain on the left side, in the retrosternal or the precordial region, with subsequent radiation to the ipsilateral shoulder, face, and cervical region. Less frequently, it may manifest solely as face pain.

CASE DESCRIPTION

A 57-year-old man sought care at the Massachusetts General Hospital Oral and Maxillofacial Pain Center with a symptom of pain in the mandibular left posterior region, in the medial aspect of the ipsilateral eye, and in the left side of the neck. The pain had started approximately 8 months previously as a mild, constant dull ache in the mandibular left posterior region. However, it became severe in intensity and sharp in quality and radiated toward the medical aspect of the ipsilateral eye and lateral neck region after intense physical activity. Results from comprehensive diagnostic evaluation and a series of diagnostic tests suggested that the facial pain was associated with cardiovascular disease. There was complete resolution of pain symptoms after the patient received appropriate pharmacotherapy.

PRACTICAL IMPLICATIONS

Association of pain with exercise and termination of pain with rest and the presence of risk factors for cardiovascular disease necessitate a thorough investigation of rare and fatal causes of facial pain.

The influence of the hypertensive patient's education in compliance with their medication

The purpose of this study was to examine the relationships between patient's education in compliance with their medical regimen and the external variables: (1) "years of schooling," (2) duration of treatment, and (3) compliance with the medical regimen. The hypothesis tested in this study was as follows: "Hypertensive individuals who are educated about the importance of their medication and about the consequences of not taking the prescribed dosage will show better compliance with their prescribed drug regimen than those who are not thus educated." The sample of the study consisted of 40 hypertensive patients. A "posttest-only" control group design was used in this study. The hypothesis of the study was tested by using the Mann-Whitney U test. For the relationship between the external variables (years of schooling, duration of treatment, and compliance with the medical regimen), the Spearman test was used. The findings of the study revealed a statistically significant difference between compliance levels in the experimental group and in the control group (U = 130, p < 0.05), a positive correlation between "years of schooling" and compliance (rs = 0.33, p = 0.04), and a negative correlation between duration of treatment and compliance (rs = -0.45, p = 0.005). The findings support the hypothesis of the study.

Congestive heart failure

The differentiation between systolic and diastolic CHF is clinically important because it allows one to formulate an appropriate therapeutic regimen. As a rule, ACE inhibitors have become a major component in the treatment of systolic heart failure; diuretics, digoxin, and other vasodilators are used in conjunction with them. Optimal therapy for diastolic heart failure remains to be defined. Further research is required for this subset of patients. Numerous other support measures, such as counseling, activity, diet, patient knowledge of medications, and compliance, all affect the patient's outcome.