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Management of the manifest arrhythmia could involve discontinuation of offending proarrhythmic drugs, particular antiarrhythmic therapy with drugs, implantable devices, ablation, and surgical procedure. As a basic rule, antiarrhythmic brokers may be effective as adjunctive therapy in the management of arrhythmia-susceptible patients beneath 10 Sudden Cardiac Arrest: Meeting the Challenge particular circumstances. Because of potential adverse side effects of the obtainable antiarrhythmic drugs, these brokers should be used with warning. Many marketed cardiac and noncardiac drugs delay ventricular repolarization and have the potential to precipitate life-threatening ventricular tachyarrhythmias. Sotalol, like amiodarone, is effective in suppressing ventricular arrhythmias, nevertheless it has larger proarrhythmic effects and has not been proven to present a transparent increase in survival; worsening ventricular arrhythmias occur in 2% to 4% of handled patients. The efficacy of non-beta-blocker antiarrhythmic drugs is equivocal at finest, and each drug has important potential for adverse events together with proarrhythmia. Beta blockers are secure and effective antiarrhythmic brokers that may be considered the mainstay of antiarrhythmic drug therapy. The mechanism of antiarrhythmic efficacy of this class of medicine includes competitive adrenergicreceptor blockade of sympathetically mediated triggering mechanisms, slowing of the sinus price, and possibly inhibition of excess calcium launch by the ryanodine receptor. Amiodarone and Sotalol: Amiodarone has a spectrum of actions that includes block of potassium repolarization currents that may inhibit or terminate ventricular arrhythmias by increasing the wavelength for reentry. The total long-term survival profit from amiodarone is controversial, with most studies showing no clear advantage over placebo. Sotalol is effective in suppressing atrial and ventricular arrhythmias; the mix of beta blockers and amiodarone is another approach. Amiodarone has been used off-label for price management if other therapies are contraindicated, not tolerated, or ineffective. Eight percent of cardiac arrests occur in the house, and residential placement may be of value for these with sure genetic arrhythmias. Findings indicate that statins reduce the occurrence of life-threatening ventricular arrhythmias in high-threat cardiac patients with electrical instability. Because of the severity of underlying heart illness and the high prevalence of conduction abnormalities, adjunct gadget therapy should be strongly considered in these patients. Surgery and Revascularization Procedures: Surgical therapy for the management of ventricular arrhythmias could involve ablation or surgical resection of an arrhythmogenic focus, cardiac sympathectomy, or aneurysm resection. Surgical or percutaneous coro- nary revascularization with improved coronary blood circulate and discount in myocardial ischemia has favorable antiarrhythmic effects. Revascularization for Arrhythmia Management: In patients with ventricular arrhythmias, evaluation for the presence of obstructive coronary illness and active ischemia is essential. Coronary revascularization involving either percutaneous balloon/stent angioplasty or bypass surgical procedure is effective anti-ischemic therapy. Advanced life help activities, apart from these immediately associated to electrical strategies for management of tachyarrhythmias, led to the era of complicated protocols to guide responders. The basic targets of advanced life help are to establish hemodynamically effective cardiac rhythm, to optimize ventilation, and to preserve and help the restored circulation. A 1shock strategy is now recommended to minimize time between chest compressions and shock supply and resumption of chest compressions. Epinephrine, 1 mg intravenously, is run and adopted by repeated defibrillation makes an attempt at 360 J. Once this form of cardiac arrest is acknowledged, efforts should focus first on establishing management of the cardiorespiratory status (i. Possible reversible causes, notably for bradyarrhythmia and asystole, should be considered and excluded (or handled) promptly. The mechanisms of these arrhythmias may be completely different from these seen in persistent secure ischemic heart illness. Arrhythmias throughout acute ischemia may be associated to re-entry, abnormal automaticity, or triggered activity and are affected by a wide range of endogenous elements similar to potassium ranges and autonomic states. These arrhythmias could trigger many of the reported sudden deaths in patients with ischemic syndromes. Energy supply consists of 1 or more monophasic shocks at 360 J or biphasic shocks at a dose range demonstrated by manufacturer to be effective.
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Black physicians are extra doubtless than White physicians to serve medically underserved areas and populations73 and have been proven to improve access to health care for Black sufferers,seventy four earn larger ranges of patient trust and satisfaction,75 and in some circumstances, spend extra time with Black sufferers than White physicians do. High ranges of racial discrimination have been associated with unfavorable birth outcomes. Researchers recommend that these antagonistic health traits are related to the hardships associated with persistent social inequality, and that these effects compound with age. Beyond the monetary costs, maternal mortality and morbidity have profound repercussions for women and their households. The problems associated with poor maternal health are lastly gaining visibility, however extra analysis into the causes and options is greatly wanted. Moreover, state and local practices range considerably in terms of the depth of information they collect, their dedication to analyzing it, and the steps they take to forestall future maternal health problems. Some states have taken proactive measures to understand and proper the systemic failures that result in maternal deaths by implementing maternal mortality review processes. Finally, a comprehensive maternal health analysis agenda should ensure that the insights gained from this analysis are shared with stakeholders and translated into sustainable, evidence-based options. This part presents an array of potential coverage choices aimed at bettering maternal health and ensuring the proper to secure and respectful maternal health care. The measures included here have been proposed by stakeholders from varied fields, together with human rights, public health, coverage, and reproductive justice. In some cases, examples are included to spotlight the work that advocates are already doing in support of those varied measures. Scope Because evidence shows that Black girls within the South are disproportionately affected by preventable maternal deaths and diseases, the measures included listed below are intentionally tailored to handle that disparity. However, different groups of women are additionally impacted by poor maternal health outcomes and low high quality care, together with Native American girls and Black girls living in different regions of the U. In many circumstances, extra analysis is required to absolutely understand the specific maternal health challenges faced by completely different subpopulations of women. Purpose State governments play an necessary function in shaping the environment during which we live. The policies that they pursue affect our health status, our access to care, and the sources that exist in our communities. To enhance maternal health, advocates will need to hold state and local decision-makers accountable for these coverage decisions, whereas additionally pushing forward new concepts that respect, defend, and fulfill our human proper to secure and respectful maternal health care. When it involves maternal health, states are strategically positioned to leverage regional data about community wants and obstacles, build stakeholder networks, and implement focused options. State leaders and lawmakers can take proactive measures to ensure that their states have efficient health care systems to deal with sickness and prevent illness and injury. They even have the facility to design and implement other forms of systems that create and promote health. The capability of states to affect factors past the biomedical model represents a robust opportunity to enhance health, which the World Health Organization defines as "a state of full bodily, mental and social well-being and never merely the absence of illness or infirmity. The vary of topics represented here acknowledges each the complexity of the issues concerned and the intersectional nature of present obstacles to maternal health and to secure, respectful care. A rising physique of analysis into the underlying social determinants of health helps such an expansive view of health coverage, and a human rights based strategy to maternal health actually requires it. A human rights based strategy to maternal health acknowledges that each one human rights are interdependent, and governments have an obligation to handle social inequalities that contribute to poor maternal health outcomes. This information is meant to be a springboard for visualizing a broad coverage landscape and for producing new concepts and deeper analysis. It contains quite a lot of coverage choices and guiding principles which have been proposed by specialists and stakeholders involved about maternal health. Steps for applying a human rights based strategy to maternal health coverage 1 2 3 30 Analyze and handle each the immediate and underlying causes of maternal mortality, morbidity, or mistreatment during being pregnant and childbirth. Identify responsibility for each of those factors, a few of which may transcend the health sector. Suggest and prioritize actions that completely different actors can take to change the conditions that are inflicting the problem. This part identifies policies to enhance access to health services and data that will permit girls to decide whether or not and when to become pregnant based on their particular person and family wants. However, medical health insurance stays out of attain for a significant variety of Black girls. As a end result, Black girls living in these states are at a disadvantage in terms of accessing medical health insurance.
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Although not appreciated on common examination, the c wave is famous on hemodynamic monitoring and interrupts the x descent. The c wave is initiated by the onset of right ventricular isovolumic systole with subsequent upward bulging of the tricuspid valve into the proper atrium. The later portion of the x descent reflects the continued fall in right atrial pressure during early ventricular systole, as the tricuspid valve ring is pulled caudally by the contracting right ventricle. The v wave terminates the x descent and results from the influx of caval blood into the proper atrium during late right ventricular systole when the tricuspid valve continues to be closed. The v wave roughly coincides with the carotid pulse and peaks simply after the second coronary heart sound. The y descent could be distinguished from the x descent because of the synchronicity of the latter with the carotid pulse; the y descent occurs out of section with the carotid pulse. Southern Medical Journal � Volume a hundred, Number 10, October 2007 1023 Devine et al � Jugular Venous Pulse: Window into the Right Heart Abnormal Jugular Venous Pulsations the Abnormal a Wave the amplitude of the a waves is heightened each time the proper atrium contracts towards elevated resistance. In this event, atrial and ventricular systole occur concurrently, and the proper atrium contracts towards a closed tricuspid valve. In truth, the presence of irregularly occurring cannon a waves could be a valuable clue in distinguishing ventricular tachycardia from supraventricular tachycardia with aberrancy within the patient with a wide advanced tachyarrhythmia. The a wave is enhanced secondary to atrial contraction into a stiff, noncompliant right ventricle. The Abnormal x Descent Vigorous right ventricular contraction results in systolic collapse of the jugular venous pulse and exaggeration of the x descent. The y descent could be attenuated and even absent in tachycardia because of a shortened diastole. In cardiac tamponade, early diastolic collapse of the proper ventricle because of growing intrapericardial pressure compromises right ventricular filling and can subsequently markedly attenuate the y descent. The presence of the y descent on bodily examination can function a useful clue for excluding pericardial tamponade in a patient presenting with hypotension and distended neck veins. A steep y descent is seen in diseases related to elevated right atrial pressure and subsequent rapid right atrial ejection, similar to tricuspid regurgitation, constrictive pericarditis, and restrictive cardiomyopathy. In tricuspid regurgitation, the exaggerated y descent results from aid of high right atrial pressure as the regurgitant enhanced right atrial volume is delivered back to the proper ventricle in diastole. Jugular Venous Pressure Estimation of jugular venous pressure is critical for each evaluation of volume status and for detection of disease states marked by elevated right atrial pressure, similar to cardiac tamponade, constrictive pericarditis, and restrictive cardiomyopathy. The central venous pressure is classically approximated by adding 5 cm to the height of the jugular venous pulsation above the sternal angle with the patient sitting at an angle of 30 to 60�. This method assumes that the proper atrium, which by convention has a venous pressure of zero, is roughly 5 cm under the sternal angle of Louis,22 discovered on the junction of the manubrium and sternum on the degree of the secondrib. However, at totally different angles of positioning, the average distance varied between eight and 10 cm. It has been instructed that when the thorax is elevated to 30� or more, 10 cm must be added to the height of the venous column from the sternal angle to greatest get hold of an estimate of the venous pressure24 (see Fig. The Abnormal v Wave Tricuspid regurgitation classically manifests distinguished v waves. A proposed mechanism is that the addition of left-to-right interatrial shunting to normal caval venous return during ventricular systole further increases right atrial pressure. The presence of an arteriovenous fistula in these patients and the next accelerated shunting of blood into the venous system can simulate distinguished v waves. It must be famous that the amplification of the jugular venous pulse in such patients is a peripheral phenomenon and not reflective of right atrial hemodynamics. The Abnormal y Descent A slow y descent suggests obstruction to right atrial outflow, ie, tricuspid valve stenosis or elevated resistance to right ventricular filling, as seen in extreme right ventricular Southern Medical Journal � Volume a hundred, Number 10, October 2007 1025 Devine et al � Jugular Venous Pulse: Window into the Right Heart atrial pressure. External compression and collapse of the superior vena cava by a mass or complete intraluminal obstruction by thrombus prevents retrograde transmission of the proper atrium waveform, leading to distended, but nonpulsatile, neck veins. Hepatojugular Reflux Patients suspected of having right coronary heart failure may have a normal resting jugular venous pressure. The hepatojugular or abdominojugular reflux take a look at is useful for ascertaining right ventricular reserve in these conditions. First described by William Pasteur in 1885,28 this take a look at is marked by application of firm, sustained pressure over the upper right abdominal quadrant for 10 to 15 seconds while the patient maintains normal quiet breathing. This maneuver increases intra-abdominal pressure and the pressure gradient for venous move from the abdomen to the thorax, leading to augmented venous return to the proper coronary heart.
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Google and YouTube are preferred in India and Rwanda, whereas Facebook and WhatsApp groups are preferred in Malawi. WhatsApp and Facebook are also spaces to talk about and share data throughout areas. Adolescent ladies and younger girls in India search mostly for info on menstruation and sex. In Malawi, they search for info on contraception, sexual health, and abortion. Adolescent ladies and younger girls concern stigma and suspicion of sexual exercise among peers and family members. They concern both asking questions in individual and having their on-line search histories scrutinized. For example, adolescent ladies and younger girls would possibly fear about accidentally ending up on a pornographic web site. They also reported a concern of judgment and repercussions from family members if they came upon they looked for and acted on such info. Given this, they need to be engaged meaningfully in program design and implementation. Provide digital literacy schooling and increase alternatives to privately entry internetenabled gadgets. The situation is worse for minority groups, among whom structural barriers and socio-financial disparity are prevalent. The largest considerations about utilizing expertise had been knowledge safety and false info. Among at present married and sexuallyactive single girls, 15% of adolescent ladies and 46% of younger girls at present used a contemporary technique of contraception. Tune Me has 2 million users and four million page views throughout seven countries, including Malawi. It options four hundred person tales, adapted and translated for local audiences, on subjects starting from menstruation to gender-based mostly violence. Tune Me works on low- and high-end mobile gadgets in environments where high knowledge charges and poor community coverage limit entry to on-line companies. In partnership with Panoply Digital, Tune Me gathers knowledge on using its website to be able to repeatedly evolve and meet person wants. The Cybernurse feature allows youth to receive youth-pleasant, nonjudgmental info and companies from a skilled provider. Among at present married and sexually-active single girls, 2% of adolescent ladies and 20% of younger girls at present used a contemporary technique of contraception. Additionally, the study seeks to understand the barriers and alternatives for those with entry to digital platforms on cellphones in India, Malawi, and Rwanda. The evaluation sought world growth literature, as well as proof from every of the main focus countries explored within the study: India, Malawi, and Rwanda. Google Scholar and key journal databases corresponding to PubMed had been used, and the newest analysis and proof was prioritized. In Malawi, the study happened in city, semi-city, and rural areas in Zomba and Lilongwe, the capital of Malawi. In Rwanda, interviews happened in Nyarugenge, an city space within Kigali, the capital city of Rwanda, and Musanze, a semi-city space located in Northern Rwanda. It attracts on the ideas of meaningful youth engagement, human-centered design, and lean analysis. The screener sought respondents based mostly on gender, age, mobile entry, and common mobile usage. Recruiters had been equipped with quotas and recruitment screeners within the local language. Researchers employed several strategies to meet the recruitment criteria, including using community meetings and existing community packages.
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Interviews with officials on the Ministry of Youth and Sports revealed a number of contextual elements associated to authorized points. The latter are funded by the United Nations Population Fund, among whose actions are consciousness constructing and increasing access to info for younger people on household planning and reproductive well being. A authorized gap recognized by interviewees whose work focuses on service delivery on the group degree is the ambiguous authorized status of group well being workers (brokers communautaires). These workers are the core modality for outreach to deliver household planning and reproductive well being services to girls in peri-city and rural areas. The authorized status issue has arisen just lately from a controversy relating to which household planning strategies group well being workers ought to be capable of provide (see the discussion within the subsequent part on group well being workers and injectable contraceptives). Application and Implementation of Laws and Policies the primary level made by interviewees was the fact that legal guidelines associated to household planning have been incompletely utilized. Interviewees famous the prevalence of clandestine abortions as an indicator of lack of enforcement. As one provider summarized: According to native customs, parents want their feminine kids to marry younger after which have kids. Discussions surfaced authorized application and implementation points arising from the dearth of availability of physical copies of legal guidelines, decrees, laws, and policies. This absence of exhausting copies applies to well being sector officials, native authorities officials, suppliers, and citizens. Official paperwork of any sort are hardly ever made available, although some could also be discovered on authorities of Madagascar websites. Outside of large city areas, however, internet access is sort of restricted and few people have computer systems, tablets, or good phones. And in distant elements of the nation, a go to to a authorities workplace can contain hours of journey, so rural citizens have little chance to get hold of info even if they had been inclined to do so. These elements contribute to widespread ignorance on the part of most citizens of legal guidelines and laws associated to household planning and reproductive well being, and very restricted information among many native officials as nicely. An instance of the extent to which household planning info fails to penetrate past a small coterie of coverage and professional specialists emerged from a focus group discussion with group well being workers interviewed on the primary well being center (Centre de Sant� de Base) in Anjeva Gara. The girls had been unaware of any of the legal guidelines associated to household planning, both the old 1920 legislation or the draft new legislation. Few citizens take any sort of authorized recourse associated to well being points, corresponding to lodging a criticism about provider mistreatment or malpractice. Further, and especially the case for rural and distant residents, few citizens use the formal authorized system at all. Factors corresponding to restricted access and distance, unfamiliarity, costs concerned, schooling, and literacy levels all play a job, as does a cultural norm of battle avoidance and non-confrontation. Several interviewees talked about examples of oldsters complaining to a neighborhood official about a well being service provider who gave contraceptive merchandise to their adolescent youngster. The different instance of issues with household planning that elicited a authorized response was the accusation that volunteer group well being workers had been diverting the Depo-Provera injectable contraceptive, which contains the hormone progestin, for use in fattening hogs. This led to requires elevated regulation of group well being workers and pharmacies, in addition to the suggestion in some quarters that group well being workers be barred from 13 the Legal Environment for Family Planning and Reproductive Health in Madagascar delivering Depo-Provera to their shoppers, which, provided that injectables are the popular contraceptive for girls in rural areas, would result in negative impacts on access and utilization. Socio-cultural and Informal Factors As the quote that opens this report-which a number of interviewees repeated to us-reveals, Madagascar is a strongly pronatalist society for a mix of cultural, social, and economic causes. Traditional families comply with gender norms that lead them to exert pressure on their girls to marry early. Family planning campaigns have sought to sensitize people on the risks of early being pregnant, but as the interviewees collectively recounted, such efforts have but to generate a big impression. Family planning is commonly considered as selling infidelity among married girls and promiscuity among youth. Informants within the Ministry of Youth and Sports indicated that while their major sex schooling and well being consciousness campaigns and curriculum growth are targeted towards youth, in addition they promote packages for folks in an effort to affect societal norms. However, regardless of these widespread conservative attitudes, interviewees concurred that household planning is considered positively by rising numbers of people, including husbands and parents, and its role in contributing to a healthy inhabitants is increasingly acknowledged. A study of household dynamics and use of contraceptives confirms the point of view of the interviewees (see Hajason et al. Providers interviewed said that there seems to be a pattern that after a lady (or a woman) has her first youngster, curiosity in, and openness to, household planning increases.
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Summary If the patient presents with sudden onset (<seventy two hours) of leg swelling, a deep vein thrombosis should be ruled out using a Doppler examination. Common Causes of Leg Edema Venous Insufficiency the analysis is usually made clinically however may be confirmed with a Doppler examine. Common Causes of Leg Edema Pregnancy venous pressure ensuing from an enlarging uterus near time period generally leads to decrease extremity edema and varicosities. Edema is commonly present in patients with preeclampsia however is not thought of a consider making the analysis. Increased Common Causes of Leg Edema Heart Failure Patients with congestive coronary heart failure complain of dyspnea, dependent edema, and fatigue. Common Causes of Leg Edema Pulmonary Hypertension Pulmonary hypertension generally outcomes from sleep apnea and is beneath-acknowledged as a cause of edema. Other causes of pulmonary hypertension include left coronary heart failure and chronic lung illness. Common Causes of Leg Edema Pulmonary Hypertension Treating sleep apnea may enhance the leg edema that outcomes from pulmonary hypertension, however this also is unknown. Common Causes of Leg Edema Idiopathic Edema Idiopathic edema occurs only in menstruating girls and is commonest within the 20s and 30s. Idiopathic edema leads to pathologic fluid retention within the upright place, and girls usually discover a weight acquire of >1. Common Causes of Leg Edema Idiopathic Edema Patients usually complain of face and hand edema in addition to leg swelling. Several confirmatory tests are available, however the analysis is usually made clinically after ruling out systemic illness by historical past and physical examination. Common Causes of Leg Edema Secondary lymphedema Is far more common than primary, and the trigger is usually apparent from the historical past. Common Causes of Leg Edema Secondary lymphedema: Filariasis Common Causes of Leg Edema Secondary lymphedema Chronic lymphedema is usually distinguished from venous edema primarily based on attribute pores and skin adjustments, absence of pitting, and historical past of an inciting trigger. The dorsum of the foot is prominently concerned and will have a squared-off appearance. The physical examination is often unreliable and patients with acute edema usually require further evaluation, which may include a D-dimer willpower and a Doppler examine. Williams7 and Rogerio Souza eight Number four within the series "Proceedings of the sixth World Symposium on Pulmonary Hypertension" Edited by N. Haemodynamic definitions and up to date medical classification of pulmonary hypertension. This article is open access and distributed beneath the terms of the Creative Commons Attribution Non-Commercial Licence four. This definition is, due to this fact, not arbitrary, however primarily based on a scientific method. The updates of groups 2, three and four are offered within the respective Task Force articles on this problem of the European Respiratory Journal [10, 32, 33]. Cases of extreme portopulmonary hypertension have occurred with novel methods of direct-acting antivirals, together with sofosbuvir for hepatitis C virus infection [forty, forty one]. The energetic pharmaceutical ingredient of Qing-Dai is indirubin, which could induce apoptosis of pulmonary endothelial cells in vitro . These outcomes counsel a particular entity with a definite medical course, characterised by significantly better prognosis, distinctive management and different pathophysiology (table 2). While these options are better studied, sarcoidosis remains categorised into group 5. We propose that adjustments be made only after the technology of strong information to help such reclassification. Important new insights for groups 2, three and four have been addressed by the respective Task Forces on this problem of the European Respiratory Journal [10, 32, 33]. References 1 2 three four 5 6 7 eight 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 World Health Organization. Pulmonary arterial pressure throughout rest and exercise in healthy subjects: a scientific evaluate.
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Effect of ramipril on mortality and morbidity of survivors of acute myocardialinfarction with scientific proof of coronary heart failure. Simultaneous evaluation of myocardial perfusion and left ventricular operate during transient coronary occlusion. Assessment of cardiac operate by three-dimensional echocardiography in contrast with typical noninvasive strategies. Myocardial contrast echocardiography: a brand new device for the evaluation of myocardial perfusion. Myocardial contrast echocardiography precisely reflects transmurality of myocardial necrosis and predicts contractile reserve after acute myocardial infarction. Current contrast brokers have an excellent safety profile, and complications are rare. However, in sufferers with intracardiac or intrapulmonary proper-to-left shunts, the potential for adverse events are barely greater. Superiority of visible versus computerized echocardiographic estimation of radionuclide left ventricular ejection fraction. Left ventricular dyssynchrony predicts benefit of cardiac resynchronization remedy in sufferers with finish-stage coronary heart failure earlier than pacemaker implantation. Noninvasive in vivo clot dissolution without a thrombolytic drug: recanalization of thrombosed iliofemoral arteries by transcutaneous ultrasound mixed with intravenous infusion of microbubbles. Predictors of cardiac events after major vascular surgery: role of scientific characteristics, dobutamine echocardiography, and beta-blocker remedy. Accuracy of dipyridamole myocardial contrast echocardiography for the detection of residual stenosis of the infarct related artery and multivessel illness early after acute myocardial infarction. Usefulness of myocardial contrast echocardiography using low-power steady imaging early after acute myocardial infarction to predict late functional ventricular restoration. A scientific trial of the angiotensin-converting-enzyme inhibitor trandolapril in sufferers with left ventricular dysfunction after myocardial infarction. Subjective visible echocardiographic estimate of left ventricular ejection fraction as an alternative choice to typical echocardiographic strategies: comparison with contrast angiography. Correspondence of left ventricular ejection fraction determinations from twodimensional echocardiography, radionuclide angiography and contrast cineangiography. Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study Investigators. Unreliability of Mmode left ventricular dimensions for calculating stroke quantity and cardiac output in sufferers without coronary heart illness. Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. Improved endocardial visualization with second harmonic imaging in contrast with fundamental two-dimensional echocardiographic imaging. Prognostic significance of regional wall movement abnormality in sufferers with prior myocardial infarction: a potential correlative research of two-dimensional echocardiography and angiography. Echocardiographic destruction of albumin microbubbles directs gene supply to the myocardium. Improving survival for sufferers with atrial fibrillation and superior coronary heart failure. Improving survival for sufferers with superior coronary heart failure: a research of 737 consecutive sufferers. New index of mixed systolic and diastolic myocardial efficiency: a easy and reproducible Chapter 5 / Ventricular Systolic Function measure of cardiac operate-a research in normals and dilated cardiomyopathy. Problems in echocardiographic quantity determinations: echocardiographicangiographic correlations within the presence of absence of asynergy. Improved echocardiographic delineation of left ventricular thrombus with using intravenous second technology contrast picture enhancement. Effect of enalapril on mortality and the development of coronary heart failure in asymptomatic sufferers with decreased left ventricular ejection fractions.