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ADVANCE Study
ADVANCE Study

... At baseline, 35 patients (3.5%) had NYHA class I symptoms, 168 patients (16.9%) were in NYHA class II, 672 patients (67.4%) in NYHA class III, and 122 patients (12.2%) in NYHA class IV. At 30 days, 84.2% of the followed patients were in NYHA class I or II and 86.9% at 12 months. Pre-specified clinic ...
Is Cardiac Magnetic Resonance Imaging Underutilized in the
Is Cardiac Magnetic Resonance Imaging Underutilized in the

... stiffness.6,7 This technique may provide a means to detect pulmonary vascular remodeling at an earlier stage of development, and may also ultimately be considered a target for PH-specific therapies. One potential role of CMR is detection in those patients who are “at risk” (ie, scleroderma patients) ...
Assessment of systemic right ventricular function using tissue
Assessment of systemic right ventricular function using tissue

... to be a challenge for cardiologists due to its specific anatomic features which cannot be described with a simple geometric model [5, 6]. Thus, it is particularly important to use different available echocardiographic techniques for the systematic evaluation of patients with functionally univentricu ...
Cardiology - New England EMS Institute
Cardiology - New England EMS Institute

... Dysrhythmias are the most common complication within the first few hours of chest pain ...
Left ventricular wall mechanics in hypertension
Left ventricular wall mechanics in hypertension

... the extent of left ventricular hypertrophy and left ventricular systolic performance in hypertensive patients. Left ventricular cavity measurements and wall thickness at the end diastole and end systole and shortening fraction were obtained with the precision by M - mode echocardiography. Fractional ...
Sympathetic neural hyperactivity and its
Sympathetic neural hyperactivity and its

... clinical complications (re-infarction and heart failure respectively), and stable microneurographic data could not be obtained in a further four. Complete data were, therefore, obtained from 14 patients with uncomplicated AMI, nine patients with UA, 14 NCs, 11 patients with stable CAD and nine patie ...
Pediatric Cardiothoracic Surgery
Pediatric Cardiothoracic Surgery

... • Chest physiotherapy is not beneficial and should not be performed in children with empyema. [D] • Secondary thrombocytosis (platelet count >500 x109/L) is common but benign; antiplatelet therapy is not necessary. [D] ...
Signs of PAH
Signs of PAH

... – echo may underestimate pulmonary pressures – echo can miss congenital anomalies – echo may underestimate LV disease • Only proven tool to accurately assess hemodynamic response to treatment – repeat catheterization indicated before changing therapy Gaine et al. Lancet. 1998;352:719. ...
Two cases of inflammatory muscle disease presenting with raised
Two cases of inflammatory muscle disease presenting with raised

... patient’s family doctor as is standard protocol. The patient was admitted to the cardiac ward for further investigations. Subsequently, her electrocardiogram was normal and an exercise stress test showed no evidence of myocardial ischaemia; echocardiography was also normal. The troponin T concentrat ...
Adult basic life support
Adult basic life support

... • Serial oxygen saturation measurements are made at different levels from the superior vena through the atrium and the right ventricle into the pulmonary artery. • At the level of the left-to-right shunt there will be a step up increase of the oxygen saturation as blod flow from the left side enters ...
Nutrition in Pediatric Cardiac Intensive Care
Nutrition in Pediatric Cardiac Intensive Care

reaction volume of 10 L with 0.5 M each of the
reaction volume of 10 L with 0.5 M each of the

... serum and LiHeparin-plasma samples (n ⫽ 54) collected at the same time from the same subject (Fig. 1B). Results in LiHeparin plasma and serum were not significantly different [2.4% lower in serum (95% confidence interval, ⫺1.3% to 6.1%)]. Plasma and serum showed a correlation coefficient of 0.9975. ...
Diagnosis and Management of Heart Failure
Diagnosis and Management of Heart Failure

... Does the patient’s body appear swollen? Generalized edema is another sign of worsening heart failure. Measure the patient’s body weight and height. Small fluctuations in weight may indicate fluid retention and worsening of heart failure. Height is needed to accurate calculate medication dosage. Exam ...
Exercise training and skeletal muscle inflammation in chronic heart
Exercise training and skeletal muscle inflammation in chronic heart

... The classical definition of “heart failure” (HF) holds that “heart failure occurs when an abnormality of cardiac function causes the heart to fail to pump blood at a rate required by the metabolizing tissues or when the heart can do so only with an elevated pressure” (1). However, the repeated clini ...
National Medical Policy
National Medical Policy

... cardioembolic source, such as a patent foramen ovale or AF. When potential cardiovascular etiologies have been ruled out during an initial workup consisting of various imaging studies and ECGs, then it's considered to be a ‘Cryptogenic’ stroke. Studies on Implantable Cardiac Monitors with Suspected ...
Chapter 19 *Lecture PowerPoint  The Circulatory
Chapter 19 *Lecture PowerPoint The Circulatory

... • Myocardial infarction—sudden death of a patch of myocardium resulting from long-term obstruction of coronary circulation – Atheroma (blood clot or fatty deposit) often obstructs coronary arteries – Cardiac muscle downstream of the blockage dies – Heavy pressure or squeezing pain radiating into the ...
Full text (PDF file)
Full text (PDF file)

... Fig. 1. Sources of left ventricle activation in biventricular pacing. A scheme of three potential sources of LV activation in patients after implantation of biventricular pacemaker. The contribution of the intrinsic conduction system depends on AV delay setting. The maximum intraventricular synchron ...
Echocardiographic Left Ventricular Hypertrophy as
Echocardiographic Left Ventricular Hypertrophy as

... Organization (WHO).19 All patients were in WHO Stage II, with no target organ damage apart from LVH as evidenced by echocardiography. In particular, cardiothoracic ratio was normal and cardiac transverse diameter did not exceed 10% above the predicted value.20 In two patients, electrocardiography re ...
Definition, leads, limb, augmented limb, precordial, Characteristics
Definition, leads, limb, augmented limb, precordial, Characteristics

... amplitude in same lead  U wave direction is the same as T wave direction in that lead  U waves are more prominent at slow heart rates and usually best seen in the right precordial leads.  Origin of the U wave is thought to be related to after depolarizations which interrupt or follow repolarizati ...
MUSCLE TISSUE
MUSCLE TISSUE

... MUSCLE TISSUE ...
chapter 5 sudden and unexpected death
chapter 5 sudden and unexpected death

... complete occlusion occurs in a coronary artery, and if the collateral circulation is not sufficient to maintain the muscle. If 70% or more of the lumen of a major branch is blocked, an infarct commonly develops. The effect of a large infarct is either to reduce cardiac function because of pump failu ...
Atrioventricular valve abnormalities in infancy: Two
Atrioventricular valve abnormalities in infancy: Two

... prompt opacification of the right ventricle, with contrast medium passing over the crest of the ventricular septum in systole (Fig. 6B). No early opacification of the right ventricle occurred in the two patients whose echocardiogram showed attachment of the leaflets directly to the septum. In the tw ...
In Hospital Outcome of Acute Inferior with Right
In Hospital Outcome of Acute Inferior with Right

... intravenous fluids. Therapy with nitrates and morphine is associated with precipitation of complications such as hypotension and not usually indicated. Very few studies have been conducted in Pakistan on acute RVMI and posterior myocardial infarction. The aim of this study was to find out the preval ...
Low-frequency heart rate variability
Low-frequency heart rate variability

... variability is due to the time of day, and some may be due to familiarity with the measurement ; both of these effects are recognized with other autonomic function tests. It is possible that the underlying state of the autonomic nervous system is itself a moving target, so that attempts to pin it do ...
New QT and JT correction methods in right bundle branch block in
New QT and JT correction methods in right bundle branch block in

... Introduction: QT interval prolongation on the surface ECG is a marker of abnormal repolarization and the potential for arhythmogenesis. In patients with right bundle branch block (RBBB), the assessment of ventricular repolarization remains controversial. We set out to compute the best derived QT and ...
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Cardiac contractility modulation



Cardiac contractility modulation (CCM) is a treatment for patients with moderate to severe left ventricular systolic heart failure (NYHA class II–IV). The short- and long-term use of this therapy enhances both the strength of ventricular contraction and the heart’s pumping capacity. The CCM mechanism is based on stimulation of the cardiac muscle by non-excitatory electrical signals (NES). CCM treatment is delivered by a pacemaker-like device that applies the NES, adjusted to and synchronized with the electrical action in the cardiac cycle.In CCM therapy, electrical stimulation is applied to the cardiac muscle during the absolute refractory period. In this phase of the cardiac cycle, electrical signals cannot trigger new cardiac muscle contractions, hence this type of stimulation is known as a non-excitatory stimulation. However, the electrical CCM signals increase the influx of calcium ions into the cardiac muscle cells (cardiomyocytes). In contrast to other electrical stimulation treatments for heart failure, such as pacemaker therapy or implantable cardioverter defibrillators (ICD), CCM does not affect the cardiac rhythm directly. Rather, the aim is to enhance the heart’s natural contraction (the native cardiac contractility) sustainably over long periods of time. Furthermore, unlike most interventions that increase cardiac contractility, CCM is not associated with an unfavorable increase in oxygen demand by the heart (measured in terms of Myocardial Oxygen Consumption or MVO2). This may be explained by the beneficial effect CCM has in improving cardiac efficiency. A meta-analysis in 2014 and an overview of device-based treatment options in heart failure in 2013 concluded that CCM treatment is safe, that it is generally beneficial to patients and that CCM treatment increases the exercise tolerance (ET) and quality of life (QoL) of patients. Furthermore, preliminary long-term survival data shows that CCM is associated with lower long-term mortality in heart failure patients when compared with expected rates among similar patients not treated with CCM.
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