273 ) A 58 year old man with history of chronic smoking and coronary artery disease is seen in your office for a second opinion regarding smoking cessation. He suffered an acute myocardial infarction two years ago and has had percutaneous coronary intervention with stent placement. He has not had any coronary events in the past 2 years. He denies any chest pain. He was recently placed on Nicotine patches for treatment of tobacco use by his primary care physician. The patient is concerned that the nicotine may increase his risk of having a coronary event and requests you for a second opinion regarding nicotine patch therapy. Physical examination is unremarkable. Which of the following is the most appropriate response?
A) Nicotine replacement is contraindicated in patients with cardiovascular diseases
B) Periodic counselling alone is very effective for smoking cessation.
C) Nicotine patch is not an independent risk factor for acute myocardial infarction
D) Your doctor knows what is best for you and you should follow his recommendations.
E) Varenicline is completely safe smoking cessation strategy in patients with cardiovascular disease.
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C
A…..Although serious cardiac events associated with the nicotine patch are probably rare, we advise cautious use of nicotine replacementtherapyinpatientswithknowncoronaryar-
tery disease, in any patient who experiences chest pain duringuseofthisdrug,andinpatientswitharecenthis- toryof(increasing)anginapectoris.
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C) Nicotine patch is not an independent risk factor for acute myocardial infarction
C: Cardiovascular diseases – NRT is not an independent risk factor for
acute myocardial events. NRT should be used with caution among
particular cardiovascular patient groups: those in the immediate
(within 2 weeks) postmyocardial infarction period, those with serious
arrhythmias, and those with unstable angina pectoris.