Case 1:

JF is a 42-year old previously healthy farmer who presented with sudden onset central chest pain of one hour duration to the ED. The pain is associated with sweating and radiates to the left arm and jaw. The area of discomfort is about the size of the fist.

Ragavendra R. Baliga, M.D
Assistant Professor
Division of Cardiology
University Of Michigan

 

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Question 34 of 39:

Smoking cessation reduces rates of reinfarction and death within a year of quitting.

You clicked 'True'

Correct!

Smoking cessation is essential in patients with acute MI. Smoking triggers coronary spasm, reduces the anti-ischemic effects of ß-adrenoceptor blockers, and doubles mortality after acute MI. Smoking cessation reduces rates of reinfarction and death within a year of quitting, but one third to one half of patients with acute MI relapse within 6 to 12 months.

Houston-Miller and Taylor [1] advocate a stepped approach to smoking cessation:

  • Provide a firm, unequivocal message to quit smoking.
  • Determine if the patient is willing to quit.
  • Determine the best quitting method.
  • Plan for problems associated with withdrawal.
  • Set a quit date.
  • Help the patient cope with urges to smoke.
  • Provide additional help as needed.
  • Follow up by telephone call or visit.

Nicotine gum and patches have been shown to mitigate symptoms of nicotine withdrawal in recovering patients. These agents are not recommended during hospitalization due to the sympathomimetic effects of the active ingredient, nicotine. However, the dose of nicotine in gums and patches is significantly lower than that found in cigarettes and maybe preferable to cigarette smoking if the patient is experiencing acute withdrawal.

Clonidine has been shown to be effective in women but not men; the reason for this finding is unclear.

A new drug, bupropion, has been shown to help some smokers quit. Nicotine intake is reinforced by activating the central nervous system to release norepinephrine, dopamine, and other neurotransmitters. Bupropion is a weak inhibitor of the neuronal uptake of neurotransmitters. It reduced the weight gain common in smokers who quit. Bupropion appears to be another option for patients who need to quit smoking after AMI.

References:

1. Houston-Miller N, Taylor CB. Lifestyle Management for Patients With Coronary Heart Disease. Champaigne, Ill: Human Kinetics; 1995.

 
 
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