Dobutamine in chf patients
Background Dobutamine-atropine stress echocardiography is an efficient method in the evaluation of patients with coronary artery disease. However, because high-dose dobutamine is potentially arrhythmogenic, the safety of this stress modality has been questioned. Methods We performed a 24 h Holter monitoring, before and immediately after this test, in 73 consecutive patients 60 men and 13 women ; , mean age 60 12 years. Twentyeight patients had had a recent myocardial infarction, 25 had stable chronic angina, 10 chronic ischaemic cardiomyopathy and 10 idiopathic dilated cardiomyopathy. Dobutamine was progressively increased 540 ug . kg" ' . min~' ; and atropine was injected in 30 patients. Arrhythmias and ST-segment deviation before and after the stress test were evaluated. Results The mean peak dobutamine dose was 32 11 ug min ~ '. The heart rate at rest and at peak dose was, respectively, 69 16 and 110 28 beats . min ~ '. Side effects during the injection of dobutamine were mainly ventricular n 14 ; or atrial n 4 ; premature contractions. Three patients had non-sustained ventricular tachycardia andfivehad hypotension during the test. No sustained episode of supraventricular or ventricu.
8. Cannon JD, Zile MR, Crawford FA, et al. Aortic valve resistance as an adjunct to the Gorlin formula in assessing the severity of aortic stenosis in symptomatic patients. J Coll Cardiol. 1992; 20: 15171523. deFilippi CR, Willett DL, Brickner ME, et al. Usefulness of dobutamine echocardiography in distinguishing severe from non-severe valvular aortic stenosis in patients with depressed left ventricular function and low transvalvular gradients. J Cardiol. 1995; 75: 191194. Monin J-L, Monchi M, Gest V, et al. Aortic stenosis with severe left ventricular dysfunction and low transvalvular pressure gradients: risk stratification by low-dose dobutamine echocardiography. J Coll Cardiol. 2001; 37: 21012107. Schwammenthal E, Vered Z, Moshkowitz Y, et al. Dobutamine echocardiography in patients with aortic stenosis and left ventricular dysfunction: predicting outcome as a function of management strategy. Chest. 2001; 119: 1766 Nishimura RA, Grantham JA, Connolly HM, et al. Low-output, lowgradient aortic stenosis in patients with depressed left ventricular systolic function: the clinical utility of the dobutamine challenge in the catheterization laboratory. Circulation. 2002; 106: 809 Quiones MA, Otto CM, Stoddard M, et al. Recommendations for quantification of Doppler echocardiography: a report from the Doppler Quantification Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography. J Soc Echocardiogr. 2002; 15: 176 Pellikka PA, Roger VL, McCully RB, et al. Normal stroke volume and cardiac output response during dobutamine stress echocardiography in subjects without left ventricular wall motion abnormalities. J Cardiol. 1995; 76: 881 KEY WORDS: Editorials hemodynamics stenosis cardiomyopathy inotropic agents.
Severehypertension systolic bloodpressure 200mmHgor diastolicblood pressure i10 mmHg ; , 4 ; decrease the systolic in blood pressure 20 mmHg or more ; , 5 ; heart rate of more than 70% of the target heart rate, 6 ; maximal dobutamine infusion dose 30 ; Lgfkg-min ; , 7 ; new wall motion abnormality WMA ; on two-dimensional echocardiography and 8 ; ST-segment depres sion more than 4 mm on ECO. ECOs obtained during dobutamine infusion were graded as normal, ischemic or nondiagnostic. An ischemic response was defined as development of 1 mm horizontal or downsloping ST-segment depression 0.08 sec after J-point in a lead with a normal baseline ST segment. The ECOs were interpreted as non diagnostic if the ST depression has developed in a lead with baseline ST-segment abnormality.
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Fig. 2. Fluorescence of Sodium Green in MR cells is severely reduced in the presence of a Na ionophore but not a K ionophore. AC: lateral views of the yolk sac of 55-hpf larva stained with Sodium Green in the absence of any ionophore A ; , or in the presence of 1 M monensin B ; or 1 valinomycin C ; . Scale bars, 200 m. AJP-Regul Integr Comp Physiol VOL.
However, because it causes your heart to work harder, dobutamine can cause chest pain, shortness of breath, or pounding heart beats and docetaxel.
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ICARIS 2004, 3rd Int'l Conf. Artificial Immune Systems, 1316 Sept., Catania, Italy. Contact ICARIS 2004, Dept. of Mathematics and Computer Science, Univ. of Catania, City Univ., V.le A. Doria 6, 95125 Catania, Italy; phone + 39 095 7383074; fax + 39 095 330094; icaris04 dmi ct.it. See artificial-immune-systems ICARIS-2004 icaris2004 . ICRODIC 2004, 4th WSEAS Int'l Conf. Robotics, Distance Learning, and Intelligent Communication Systems, 1416 Sept., Izmir, Turkey. See worldses conferences 2004 turkey icrodic index . PPSN VIII, 8th Int'l Conf. Parallel Problem Solving from Nature, 1822 Sept., Birmingham, UK. Contact PPSN VIII, c o Delia Sexton, School of Computer Science, Univ. of Birmingham, Edgbaston, Birmingham B15 2TT, UK; phone 44 121 414 fax + 44 121 414 ppsn04 cs.bham.ac . See : events.cs.bham.ac ppsn04. CSIMTA 2004, Complex Systems, Intelligence, and Modern Technological Applications, 1922 Sept., Cherbourg, France. Contact Marc Rouff, Site Univ. de Cherbourg, Laboratoire Univ. des Sciences Appliques de Cherbourg, LUSAC BP 78, 50130 Cherbourg Octeville, France; phone + 33 2 fax + 33 2 marc.rouff chbg caen ; or Michel Cotsaftis, Laboratoire des Techniques Mcatronique et Electronique, 53 rue de Grenelle, 75007 Paris, France; phone + 33 1 fax + 33 1 mcot ece . See chbg caen. fr lusac CSIMTA. ASAI 2004, 6th Argentine Symp. Artificial Intelligence, 2021 Sept., Crdoba, Argentina. Contact asai2004 exa cen .ar. See exa cen. edu.ar ~asai2004. ECML PKDD 2004, 15th European Conf. Machine Learning and 8th European Conf. Principles and Practice of Knowledge Discovery in Databases, 2024 Sept., Pisa, Italy. Contact ecmlpkdd isti.cnr.it. See : ecmlpkdd.isti.cnr.it.
4 5.60.2 1.190.56 + 1.2 0.96 + 0.54 1.300.48t 1, + 348t Dobutamine 37954 13 5.1 + 1.1 0.860.17t 0.05 + 0.05 Dipyridamole 232 + 94 * Ischemia 13 5.50.4 0.990.48 + 0.08 4.5 + 0.8t 0.760.25 * 0.370.38 330125 Reperfusion Values are meanSD; n, number of experiments. * p 0.05 vs. nonintervention; tp 0.01 vs. nonintervention and docusate.
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11. A retrospective cohort analysis of over 2000 patients with a principle diagnosis of ADHF showed that the in-hospital mortality rate and length of stay were significantly less for nesiritide compared with dobutamine or milrinone. a. True. b. False.
| Dobutamine indicationsDobutamine has little effect on mean arterial pressure in normotensive patients, but in patients who are hypotensive, because of low output, mean arterial pressure rises with the increase in cardiac output and dofetilide
Dobutamine infusions in stable, critically ill children: pharmacokinetics and hemodynamic actions
Which offers our patients the maximum possibility of a successful pregnancy. Acknowledgements and dok.
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Intravenous inotropes milrinone or dobutamine ; may be considered to relieve symptoms and improve end-organ function in patients with advanced HF characterized by LV dilation, reduced LVEF, and diminished peripheral perfusion or end-organ dysfunction low output syndrome ; , particularly if these patients have marginal SBP 90 mm HG ; , have symptomatic hypotension despite adequate filling pressure, or are unresponsive to, or intolerant of, intravenous vasodilator. Strength of Evidence C.
Table I-24. Estimated Work-Rate Times in Hours ; in MOPP 3 and 4 for Heavy Work111 and dolasetron
Tracings of the aortic valve orifice are completed, the probe is then advanced back to the gastric position for continued blood flow and wall motion monitoring. Because calculation of CO requires measurements of ascending aortic flow and AVA, each CO determination requires two probe manipulations and two measurements. To simplify Doppler CO monitoring via TEE to a less labor-intensive and more clinically useful protocol, the initial AVA obtained in each patient has been used for all subsequent Doppler CO calculations 3 ; . A potential shortcoming of this modified approach stems from the fact that AVA is not remeasured each time transvalvular flow or hemodynamics change 1 ; . This method, therefore, does not account for alterations in AVA that may occur secondary to changes in transvalvular flow or intraaortic blood pressure. The extent to which altered hemodynamics and flow affect AVA orifice dimensions remains to be clarified. Current understanding of the effects of hemodynamics on human AVA is mainly derived from patients with valvular aortic stenosis. In vivo planimetric studies of hemodynamic-induced changes in AVA have used dobutamine 4 ; or other inotropes 5 ; to compare AVA at baseline to AVA at the maximal drug dose, and have shown little change in AVA. In patients with aortic stenosis, additional studies using the continuity equation and a similar dobutamine protocol revealed no change.
1986; 58: 1167-1172 Sawada SG, Segar DE, Brown SE, Howard NB, Ryan P, Armstrong WF, Feigenbaum H: Dobutamine stress echocardiography for evaluation of coronary disease. Circulation 1989 and doral.
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TXUNOS KI, 1 Dropped: CTR PROVIDER NUM DON ORG1 of December 31. J.0 Staffing: full-time and part-time positions open and DON ORG DON ORG3 not filled as of December. NEG XM New variables are listed in Appendix D, Data File Descrip- PREVFD PREVFD3 tions, under CMS CDC ESRD Annual Facility, page 75. PREVFDT PRVTXD Variables CHAIN ID, NU HBFS, and NU P NP These three variables were previously populated with values PRVTXD3 from 001 to 003 inclusive. For the 006 SAF CDs, they PRVTXDT are also populated with values from 1988 to 000 inclusive. TRANSF PROVIDER NUM The population of CHAIN ID resulted in the addition of TX PROCEDUR TY KI TX PROCEDUR TY LU Year-to-Year Comparison of Number of Records in USRDS Standard Analysis Files SAF ; SAF PATIENTS RESIDENC MEDEVID RXHIST FACILITY TX TXWAIT 000 1, 090, 11 , 619, 179 , 830 06, 750 00 1, 70, 001 , 006, 657 669, 00 1, 516, 51 , 15, 953 786, * 313, 6 005 , 388, 98 896, * 37, 56 006 , 587, 007 1, * 378, 6 and dobutamine.
Versteegh F . Pertussis: a concise historical review including diagnosis, incidence, clinical manifestations and the role of treatment and vaccination in management. Reviews in medical microbiology 2005; 16 3 ; : 79. Tamura M, Nogimori K, Murai S, Yajima M, Ito K, Katada T, et al. Subunit structure of islet-activating protein, pertussis toxin, in conformity with the A-B model. Biochemistry 1982; 21 22 ; : 5516-22. Lyons AB. Pertussis toxin pretreatment alters the in vivo cell division behaviour and survival of B lymphocytes after intravenous transfer. Immunol Cell Biol 1997; 75 1 ; : 712. Brito GA, Souza MH, Melo-Filho AA, Hewlett EL, Lima AA, Flores CA, et al. Role of pertussis toxin A subunit in neutrophil migration and vascular permeability. Infect Immun 1997; 65 3 ; : 1114-8. Meade BD, Kind PD, Manclark CR. Lymphocytosis-promoting factor of Bordetella pertussis alters mononuclear phagocyte circulation and response to inflammation. Infect Immun 1984; 46 3 ; : 733-9. Prasad SM, Yin Y, Rodzinski E, Tuomanen EI, Masure HR. Identification of a carbohydrate recognition domain in filamentous hemagglutinin from Bordetella pertussis. Infect Immun 1993; 61 7 ; : 2780-5. Saukkonen K, Cabellos C, Burroughs M, Prasad S, Tuomanen E. Integrin-mediated localization of Bordetella pertussis within macrophages: role in pulmonary colonization. J. Exp. Med. 1991; 173 5 ; : 1143-1149. Barenkamp SJ. Outer membrane proteins and lipopolysaccharides of nontypeable Haemophilus influenzae. J Infect Dis 1992; 165 Suppl 1: S181-4. Brennan MJ, Li ZM, Cowell JL, Bisher ME, Steven AC, Novotny P, et al. Identification of a 69-kilodalton nonfimbrial protein as an agglutinogen of Bordetella pertussis. Infect Immun 1988; 56 12 ; : 3189-95. Emsley P, McDermott G, Charles IG, Fairweather NF, Isaacs NW. Crystallographic characterization of pertactin, a membrane-associated protein from Bordetella pertussis. J Mol Biol 1994; 235 2 ; : 772-3. Storsaeter J, Hallander HO, Gustafsson L, Olin P. Levels of anti-pertussis antibodies related to protection after household exposure to Bordetella pertussis. Vaccine 1998; 16 20 ; : 1907-1916. Cherry JD, Gornbein J, Heininger U, Stehr K. A search for serologic correlates of immunity to Bordetella pertussis cough illnesses. Vaccine 1998; 16 20 ; : 1901-1906. Mooi FR, van Oirschot H, Heuvelman K, van der Heide HG, Gaastra W, Willems RJ. Polymorphism in the Bordetella pertussis virulence factors P.69 pertactin and pertussis toxin in The Netherlands: temporal trends and evidence for vaccine-driven evolution. Infect Immun 1998; 66 2 ; : 670-675. He Q, Makinen J, Berbers G, Mooi FR, Viljanen MK, Arvilommi H, et al. Bordetella pertussis protein pertactin induces type-specific antibodies: one possible explanation for the emergence of antigenic variants? J Infect Dis 2003; 187 8 ; : 1200-1205. Mooi FR, ter Avest A, van der Heide HG. Structure of the Bordetella pertussis gene coding for the serotype 3 fimbrial subunit. FEMS Microbiol Lett 1990; 54 1-3 ; : 327-31. Preston NW. Essential immunogens in human pertussis: the role of fimbriae. Dev Biol Stand 1985; 61: 137-41. WHO. WHO Expert Committee on Biological Standardization, 30th Report. Technical Report Series 1979; 638: 61-65. Van Buynder PG, Owen D, Vurdien JE, Andrews NJ, Matthews RC, Miller E. Bordetella pertussis surveillance in England and Wales: 1995-7. Epidemiol Infect 1999; 123 3 ; : 403-411 and dovonex.
Dobutamine myocardial perfusion imaging
Figure 1: Patient 13. A, Basal short-axis electrocardiographically gated inversion-recovery gradientecho MR image repetition time msec echo time msec, 8 4.3; 30 flip angle ; obtained 20 minutes after infusion of gadopentetate dimeglumine prior to CABG. Infarction is seen in inferior and lateral walls from 2- to 8-o'clock position ; that subtends 30% of transmural extent of myocardial wall thickness. Predictive value for recovery in this segment is intermediate on the basis of IT alone. B-G, Short-axis steady-state free precession cine MR series 3.1 1.6, 60 flip angle ; . B, End-diastolic image before revascularization ED pre ; . C, Enddiastolic image obtained during infusion of 10 g min of dobutamine ED dob ; . D, End-diastolic image 5 months after revascularization ED post ; . E, End-systolic image before revascularization ES pre ; demonstrates akinesis of lateral and posterior segments from 2- to 6-o'clock position, two of six segments ; . Mean wall thickening in these segments was 5%. F, End-systolic image obtained during infusion of dobutamine ES dob ; demonstrates lack of improvement in the same lateral and posterior segments mean wall thickening, 6% ; . Remaining segments show increase in wall thickening with dobutamine. G, End-systolic image after revascularization ES post ; demonstrates no recovery of function in lateral and posterior segments mean wall thickening, 6% ; . Remaining segments show improvement with revascularization.
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