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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
cryo preserved allografts homograft as these are not mounted a free hand suturing in two layers has to be done the valve is thawed by protocol
tissue valves tissue valves mounted on a frame with a sewing ring are inserted by the same technique as used in the case of prosthetic
diuretic therapyone of the aims of treatment of congestive heart failure is directed toward controlling salt and water retention central or
continuous suture technique monofilament 20 prolene sutures which slide through easily are used for this technique three double armed prolene sutures
in the long term reversible causes of heart failure like valvular lesions myocardial ischemia uncontrolled hypertension arrhythmias alcohol negative
interrupted suture technique synthetic braided 2 0 sutures ethibond with 17mtn needles on either end and a pledget is used alternate green and white
restriction of physical activities to reduce myocardial work and oxygen consumption however care should be taken to prevent deep vein thrombosis-
aortic valve replacement the initial steps of the operation have been described earlier ascending aorta is cannulated a single two-stage
the goals of treating heart failure are relief of symptoms improvement in exercise tolerance and reduction in the number of hospitalizations
over the past decade the conceptual understanding of heart failure has changed significantly several large clinical trials have demonstrated that