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indications1 symptomatic patient with normal lv function ejection fraction 2 05 at rest if they are in class in or iv nyha surgery is recommended in
in patients with left ventricular failure and reduced ejection fractions the risk of lv thrombus formation and systemic arterial embolization
calcium antagonists are not recommended for the treatment of chf because of their negative inotropic effects however second-generation
catecholamines increase activation of ca2 via beta-adrenergic receptors and the adenyl cyclase systemdopamine has both alpha and beta and
phosphodiesterase inhibitors and other agentsamrinone and milrinone are prototypes of type iii pde inhibitors they decrease the breakdown of cyclic
symptoms of digitalis toxicity include anorexia nausea headache blurring or yellowing of vision and disorientation cardiac toxicity may take the form
amiodarone quinidine propafenone and verapamil may increase digoxin levels up to 100 per cent it is prudent to measure a blood level after 7-14 days
chronic aortic regurgitation several factors have to be taken into account before recommending surgery these include severity of symptoms and lv
arrhythmias especially in presence of hypokalemia lack of mortality benefit however their efficacy in reducing the symptoms of heart failure has been
chronic aortic regurgitation the aetiological factors leading to aortic regurgitation are 1 rheumatic 2 annulo aortic ectasia 3 native valve
the digitalis glycosides are the only orally active positive inotropic agents currently available the positive inotropic occurs through inhibition of
all currently available inotropic agents act to increase ca2 for activation in both normal and failing myocardium hurst the use of inotropic agents
acute aortic regurgitation the most dramatic presentation occurs in dissection of the aortic root endocarditis of the native or prosthetic
hydralazine is a potent arteriolar dilator and markedly increases cardiac output in patients with congestive heart failure however as a single agent
reversible airways obstructive disease advanced heart block or episodic decompensation vasodilatorsagents that dilate arteriolar smooth muscle and
beta-blockers have traditionally been considered contraindicated in patients with heart failure because they may block the compensatory actions of
results the risk of isolated aortic valve replacement is 3-4 per cent the long term survival for 5 10 and 15years is 75 per cent 60 per cent and 40
aldosterone mediates myocardial remodeling and fibrosis as well as sodium retention and potassium loss at the distal tubules the anti-aldosterone
technique the suitability of the pulmonary autograft for aortic valve replacement has to be studied by accurate measurement by echocardiogram of the
angiotensin receptor blockers block the final common pathway and provide a means of complete blockade of the systemone of two subtypes of aii
hypotension hyperkalemia taste disturbance angiedema renal insufficiency in the absence of any symptoms of hypotension and normal renal function and
angiotensin converting enzyme inhibitors acei has shown to reduce mortality in heart failure to the tune of 16-30 per cent in various large trialsthe
combination of diuretics may be indicated in patients previously resistant to furosemide alone profound diuresis and clinical improvement may occur
the potassium-sparing agents spironolactone triamterene and amiloride are often useful in combination with the loop diuretics and thiazides
ross operation in this technically demanding operation the aortic valve is replaced by patients own pulmonary valve autograft and a pulmonary or