Denise D. Hermann

HFSA Guidelines for Management of Patients With Heart Failure Caused by Left Ventricular Systolic Dysfunction—Pharmacological Approaches

A bar code communication system and method uses a bar code reader to scan a bar code to develop an audible signal that is acoustically coupled to a telephone line. The signal on the telephone line is received by a called station, decoded and the content of the bar code reported back to the calling party, using voice synthesis, for confirmation. The received signal may then be used to control a VCR or other external apparatus.

Clinical Benefit and Approach of Ultrafiltration in Acute Heart Failure

Because of the increasing incidence of acute heart failure admissions to critical care units, nephrologists have been asked to become more involved in the management of these patients. Renal dysfunction is a major element in impeding clinical recovery. In acute heart failure, renal function is often abnormal. The judicious application of ultrafiltration techniques may represent an efficacious adjunct to present conventional practice. In patients with refractory congestive heart failure, the ability to provide continuous, daily, large volume removal not only improves volume status but also the clinical symptoms of the decompensated patient. A thorough literature review supports the premise that starting hemofiltration is an appropriate alternative for difficult and unstable cardiac patients. An optimal strategy utilizing continuous renal replacement therapy can dramatically improve the patient’s clinical condition, mitigate the neurohumoral stimulation, increase urinary output and promote absorption of excessive extravascular fluid.

Naturoceutical agents in the management of cardiovascular disease.

During the past decade, complementary and alternative medicine (CAM) has grown in attractiveness to the Western public, and in recognition by practitioners of traditional medicine. The incorporation of effective CAM therapies into traditional practice is termed ‘integrative medicine’. One form of CAM demonstrating exponential growth through mass public consumerism is the use of naturoceuticals. Naturoceutical (or nutraceutical) agents are defined as mega-dose vitamins, herbal products or other ‘natural’ supplements purchased and consumed with premeditated ‘pharmaceutical’ intention to treat or prevent an illness or disease. Dietary supplements per se, are intended to supply adequate nutrients that may be lacking from the diet, and are thus, generally health promoting. A regulatory paradox exists since naturoceuticals are classified as dietary supplements although many possess measurable pharmacologic activity.In reference to cardiovascular disorders, consumers use naturoceuticals for three distinctly recognizable purposes. These are the primary and secondary prevention of cardiovascular diseases and the treatment of diagnosed disorders such as heart failure, angina pectoris or arrhythmia. The evidence base supporting the routine use of naturoceutical products for these intentions is sparse, although the likelihood of harm from their consumption is low for an average, healthy adult. Evidence of significant harm (including fatalities) has been observed when certain herbal products are used in excess or in combination with, other herbs or prescription drugs. The safety of use at the extremes of age, or by persons with cardiac, renal or hepatic impairment is also a concern.Healthcare professionals should routinely document patient naturoceutical use, be alert for and report suspected adverse effects. Until well-designed clinical trials determine the proper indication(s), dose safety profile and risk/benefit ratio for these products, their routine use should not be advocated. Thus, the role of naturoceutical agents in the integrative management of cardiovascular disorders remains undefined.