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19th February 2010, Friday
Patients with aortic (AS) stenosis and left ventricular dysfunction (low EF) have a low transvalvular pressure gradient despite significant valve narrowing.
1. Patients with pseudostenosis will manifest an increase in the calculated aortic valve area and a decrease in valve resistance in response to an elevation in cardiac output induced by dobutamine infusion.
2. The response is different in patients with severe true aortic stenosis in whom a dobutamine-induced increase in transvalvular flow will produce an increase in the mean transvalvular gradient but no change in aortic valve area.
(Dobutamine is started at 5 microg/kg per min and gradually increased to a maximal dose of 20 microg/kg per min)
3. In addition to its role in distinguishing between true stenosis and pseudostenosis, low–dose dobutamine echocardiography is helpful in risk stratifying patients with severe true aortic stenosis and in determining the appropriate therapy. Patients with contractile reserve have a much better outcome after surgery. Contractile reserve is defined as an increase in stroke volume of ≥20 percent above baseline or 10 mmHg increase in the mean transvalvular pressure gradient. (Excerpts from a symposium at Medanta: the Medicity)
Dr KK Aggarwal
Question of the day
Studies evaluating cancer and dysplasia risk in patients with ulcerative colitis have suggested a possible protective effect of 5–aminosalicylic acid (5–ASA) drugs.
eMedinewS Try this it Works : Easing the rectal exam
Calculation of lean body mass in women: Formula: Lean body weight (women) = (1.07 × weight [kg]) – 148 [Weight2/(100 × height in m2)]
Milestones in Neurology
LIST OF APPROVED DRUG FROM 1.01.2009 to 31.10.2009
Silicic Acid and Herbs: A New Approach.
Various clinical studies have proved that silicic acid as sodium metasilicate, has a synergistic effect with concomitant use of relevant herbal extracts when both are used in conjunction. Silicic acid and herbs compliment each other and in fact, the Herbs potentiate the absorption, assimilation and response to sodium metasilicate. Herbal extracts are known to enhance the Bio-availability of Sodium Metasilicate at the cellular Level and thus play a significant role to be a part of silicic acid supplementation. Interestingly, The most popular brands of silicic acid health Supplements, Available in the USA Market contain Herbal Extracts along with the Silicic acid as a major Ingredient. Sodium Metasilicate is NOW available in India as ZENIMMUNE Range of Products.
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