Clinical cardiology
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Clinical cardiology · Jun 2010
Randomized Controlled Trial Multicenter Study Comparative StudyNatriuretic and neurohormonal responses to nesiritide, furosemide, and combined nesiritide and furosemide in patients with stable systolic dysfunction.
In patients with heart failure, few data describe the neurohormonal response to nesiritide and furosemide either alone or in combination. This study systematically compared the effects of nesiritide, furosemide, and their combination on natriuresis/diuresis and plasma aldosterone in patients with chronic stable heart failure who were relatively diuretic resistant. ⋯ Furosemide alone produced natriuresis/diuresis and a prompt rise in plasma aldosterone values. Nesiritide alone produced no significant natriuresis/diuresis, but decreased plasma aldosterone values. When furosemide was administered on a background of nesiritide infusion, the observed natriuresis/diuresis was similar to that seen with furosemide alone, without the anticipated increase in plasma aldosterone observed with furosemide alone.
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Clinical cardiology · Nov 2009
Randomized Controlled TrialDo media players cause interference with pacemakers?
Electrical devices generate electromagnetic fields that may interfere with pacemakers. Media players cause telemetry interference with pacemakers, but it is not known whether they cause direct interference with pacemakers. The purpose of this study was to examine the interaction between pacemakers and 3 different media players. ⋯ Media players cause telemetry interference with pacemakers, but they do not directly interfere with pacemaker function.
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Clinical cardiology · Dec 2008
Randomized Controlled TrialEffects of levosimendan on left atrial functions in patients with ischemic heart failure.
With further progression of left ventricular (LV) dysfunction, the left atrial (LA) contribution to LV filling gradually decreases, and LA dysfunction deteriorates the decreased LV filling in patients with heart failure (HF). ⋯ Left atrial functions respond better to levosimendan than to dobutamine in decompensated HF.
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Clinical cardiology · Jul 2005
Randomized Controlled Trial Multicenter Study Clinical TrialGlobal differences in blood pressure control and clinical outcomes in the INternational VErapamil SR-Trandolapril STudy (INVEST).
The INternational VErapamil SR-Trandolapril Study (INVEST), a prospective, randomized, antihypertensive trial, found that two different medication regimens produced similar blood pressure (BP) control with equivalent cardiovascular (CV) outcomes (death from any cause, nonfatal myocardial infarction [MI], or nonfatal stroke). ⋯ In INVEST, regional differences in medication utilization, BP control, and CV outcomes were identified. These disparities warrant further investigation to define appropriate care for patients with hypertension and stable CAD from an international public health perspective.
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Clinical cardiology · Jan 2004
Randomized Controlled Trial Clinical TrialNeed for hospice and palliative care services in patients with end-stage heart failure treated with intermittent infusion of inotropes.
Hospice and palliative care programs to relieve suffering and optimize management of terminally ill patients have grown rapidly in the United States. However, there are no data on the need for these services among patients with end-stage heart failure receiving intermittent infusion of intravenous inotropes. ⋯ Our results demonstrate that intermittent infusion of intravenous inotropes can be safely administered and can improve symptoms in a significant number of patients, probably by slowing the natural progression of heart failure. Although the full clinical impact of inotrope therapy in an outpatient setting has not been fully defined, other nonhemodynamic-related benefits should be sought and investigated. Our results suggest that intermittent infusion of intravenous inotropes is one of the prominent variables that requires particular attention. In our experience, the institution of intermittent infusions of intravenous inotropes can, in fact, modify end-stage heart failure symptoms that, in most patients, are currently perceived to lead to a terminal event. Thus, appropriate use of intermittent infusion of intravenous inotropes may not only improve functional class and symptoms in a significant number of patients identified as terminal by their poor response to conventional therapy, but it may also facilitate better utilization of hospice and palliative care resources among patients with end-stage heart failure. Furthermore, the need for hospice and palliative care in patients with heart failure should be revisited in view of adjuvant treatment options such as intermittent infusion of intravenous inotropes.