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MONOGRAPH OF HYPERTONIC HEART DISEASE
CONTENTS
HYPERTONIC HEART DISEASE
1.1.
HYPERTONIC HEART DISEASE AS AN AUTONOMOUS CLINICAL ENTITY WITH A NEW
MEANING
The new meaning behind the concept of hypertonic heart disease The change in the concept of hypertonic heart disease – New meaning due to the better understanding of the complex clinical picture of hypertonic heart disease 1.2.
EPIDEMIOLOGY OF HYPERTONIC HEART DISEASE
Cardiovascular diseases and hypertension Epidemiological data on hypertension – age, gender, geographical distribution, Relationship between hypertension and metabolic syndrome Relationship between hypertension and diabetes mellitus 1.3.
PHARMACOLOGY OF HYPERTONIC HEART DISEASE
The principles of chronotherapy for hypertonic heart disease Significance of circadian rhythm in cardiovascular diseases Chronopharmacodynamics of conventional antihypertensive treatment Chronopharmacodynamics of calcium antagonists Chronopharmacodynamics of angiotensin-converting enzyme inhibitors (ACEIs) Chronopharmacodynamics of alpha-adrenoceptor antagonists Chronopharmacodynamics of beta-adrenoceptor antagonists Chronopharmacodynamics of angiotensin II receptor blockers (ARBs) Aspirin and the chronopharmacodynamics of antihypertensive treatment Chronotherapy for resistant high blood pressure Chronotherapy for (hypertonic) ischaemic heart disease Interactions between medications used for the treatment of hypertonic heart diease The role of genetic factors in interactions with the body Cardiovascular medication – food interactions Foodstuffs with high fat and oil contents Aims of the therapy of hypertonic heart diease Efficacy of blood pressure lowering treatment Aspects of choosing medications for the treatment of hypertonic heart disease The role of doctor’s care in improving patients’ quality of life The role of pharmaceutical care in the prevention and treatment of hypertonic heart disease Pharmaceutical care program for hypertonic heart disease Main objectives of pharmaceutical care in the field of hypertonic heart disease CARDIOLOGIC ASPECTS OF HYPERTONIC HEART DISEASE
2.1.
THE CARDIOLOGIC ASPECTS OF HYPERTENSION
Hypertension and ischaemic heart disease Impact of antihypertensive medication on cardiovascular risk Angiotensin-converting enzyme inhibitors (ACE-inhibitors) Cardiologic approach during examination and treatment of hypertonic patients 2.2.
CARDIAC FAILURE
The treatment of heart failure in practice Monitoring and management of heart failure patients, importance of heart failure centers 2.3.
HYPERTONIC ISCHAEMIC HEART DISEASE, MICROVASCULAR ANGINA PECTORIS
Hypertonic ischaemic heart disease, a novel concept Anatomy of the coronary microvasculature Intercapillary and dffusion distance and their significance Blood supply of the cardiac muscle, with special regard to the microvascular coronary circulation The renin-angiotensin-aldosterone system (RAAS) Role of adrenergic receptors in hypertonic ischaemic heart disease Impact of hormonal regulation on hypertonic ischaemic heart disease Epidemiology and prevalence of hypertonic ischaemic heart disease Justification for the use of the term „women’s ischaemic heart disease” Role of risk factors in hypertonic ischaemic heart disease Risk assessment using traditional risk factors and scoring New risk factors and their role in women’s ischaemic heart disease Evaluation of symptoms and the prevalence of ischaemia, gender differences Pathophysiology of hypertonic heart disease and consequent myocardial ischaemia An overview of pathophysiologic factors of hypertonic heart diease Factors influenced by non-pharmacological and pharmacological treatment Changes in coronary reactivity, gender differences New term for women’s ischaemic heart disease: microvascular angina pectoris General prognosis of women’s ischaemic heart disease Prognosis of non-obstructive coronary disease Factors influencing the risk of ischaemic heart disease in women Hypertonic heart disease and cardiac syndrome X Diagnosis of hypertension induced ischaemic heart disease Characteristics of hypertension induced angina decubitus Characteristics of hypertension induced effort angina pectoris Other symptoms of hypertension induced angina pectoris Physical diagnostics of hypertension induced angina Overview of instrumental diagnostics of hypertension induced ischaemic heart disease (angina Non-invasive examination of atherosclerosis Radiologic and nuclear cardiology techniques Concurrent 24 hour blood pressure and ECG monitoring Treatment of microvascular coronary disease 2.3.30.2.5. Thrombocyte aggregation inhibitors Treatment of women’s ischaemic heart disease Principles of pharmaceutical treatment of women’s ischaemic heart disease Treatment of ischaemic heart disease and non-obstructive coronary disease in women 2.4.
NEW METHOD FOR THE STAGING OF HYPERTONIC HEART DISEASE: MULTIFACTORIAL
ECHOCARDIOGRAPHIC ASSESSMENT
Definition of hypertonic heart disease and its new concept Principles, significance and necessity of hypertonic heart disease staging Short overview of the clinical forms of hypertonic heart diease diagnosable by echocardiography Clinical processes diagnosable by echocardiography Heart muscle ischaemia, microvascular coronary disease, cardiac syndrome X Development of cardial complications detected by echocardiography and their estimated duration in Hypertonic heart disease and its staging using multifactorial echocardiographic assessment General therapy principles for all disease stages 2.5.
ASSESSMENT OF LEFT VENTRICULAR HYPERTROPHY BY ECHOCARDIOGRAPHIC
METHODS
Nosology of left ventricular hypertrophy Conditions causing left ventricular hypertrophy Measurements to ascertain/stage hypertrophy 2.6.
ISCHAEMIC HEART DISEASE, ECHOCARDIOGRAPHY
Role of echocardiography in ischaemic heart disease and hypertension Real-time 3-dimensional echocardiography Three-dimensional „speckle tracking” 2.7.
ECG ABNORMALITIES DETECTED IN HYPERTONIC DISEASE
Theoretical approach to ECG abnormalities ECG abnormalities detected in hypertonic disease ECG signs of left ventricular hypertrophy Duration of the QRS and the time of the onset of the intrinsiciod deflection ST-segment and T-wave abnormalities (secondary repolarization abnormalities) Indices used to assess left ventricular hypertrophy Romhilt-Estes point score system for the characterization of left ventricular hypertrophy Other ECG phenomena related to left ventricular hyperthrophy 2.7.2.4.4.1. Increased left ventricular systolic pressure 2.7.2.4.4.2. Cardiac conduction abnormalities 2.7.2.4.4.3. Left anterior fascicular block 2.7.2.4.4.4. Ventricular ectopics, sudden death 2.7.2.4.4.5. Signs of increased left ventricular pressure. Atrial fibrillation Problems with the ECG criteria for left ventricular hypertrophy Left ventricular hypertrophy detected by ECG is a sign of cardiovascular events 2.8.
CARDIAC ABNORMALITIES IN HYPERTENSION – RADIOLOGY – ISOTOPE DIAGNOSTICS
Significance of MR (magnetic resonance) imaging in left ventricular hypertrophy (2) Determination of regional left ventricular function Significance (role) of nuclear cardiology in hypertonic heart disease Nuclear cardiology (isotope diagnostic) methods in hypertension induced heart disease 2.8.3.2.1.1. Myocardial perfusion stress test 2.8.3.2.1.2. Examinations using radiopharmaceuticals for myocardial SPECT imaging Quantitative analysis of myocardial perfusion by PET, detection of heart muscle viability using PET PET (Positron emission tomography) myocardial perfusion imaging PET- (SPECT) imaging of myocardial viability and metabolism Indications of MUGA scan in congestive cardiomyopathy Evaluation cardiac sympathetic innervation Practical and diagnostic value of nuclear cardiology methods in hypertonic heart disease Detection of left ventricular hypertrophy – determination of the ventricular wall Diastolic and systolic funtion impairment Detection of ischaemia and necrosis induced by coronary microvascular disease Detection of myocardial ischaemia and necrosis induced by coronary sclerosis Forecasting of dangerous ventricular arrhythmia Determination of left ventricular dilatation MULTIDISCIPLINAR ASPECTS OF HYPERTONIC HEART DISEASE
3.1.
DIABETOLOGIC ASPECTS OF HYPERTONIC HEART DISEASE
Aggravating role of impaired nitrogen-monoxide (NO) metabolism Effect of the dysfunction of the G-protein coupled receptor signaling system Role of the increased activity of the renin-angiotensin system Increased activity of the renin-angiotensin system The most significant factors often accompanying or influencing diabetic, hypertonic heart disease Effects of clinically barely detectable, low-grade tissue inflammation 3.2.
LIPIDOLOGIC APPREACH TO HYPERTONIC HEART DISEASE
Significance of simultaneous treatment of hypertension and dyslipidaemia Endothelial dysfuncion and atherosclerosis caused by hypertension and high cholesterol levels Clinical gain from the treatment of dyslipidemia Significance of postprandial trigliyeride levels Reducing inflammation, the JUPITER analysis Lipidologic aspects of microvascular angina Lipidologic and anti-atherosclerotic effects of blood pressure lowering Lipid-modulating effects of antihypertensive drugs Anti-atherosclerotic effect of calcium antagonists Simultaneous administration of statin and blood pressure lowering drugs Side effects and monitoring of statin treatment 3.3.
ENDOCRINE ASPECTS OF HYPERTONIC HEART DISEASE
Relationship of cardiovascular damage and endocrine hypertension Essential hypertension – endocrine (secondary) hypertension Therapeutic principles and possibilities in the treatment of endocrine hypertension 3.4.
ANGIOLOGIC ASPECTS OF HYPERTONIC HEART DISEASE
Relationship of hypertension and vascular abnormalities Hypertension and microvascular dysfunction 3.5.
HYPERTONIC HEART DISEASE AND RENAL DISEASE
3.6.
HYPERTONIC HEART DISEASE AND SPORTS
Role of regular exercise int he prevention and treatment of hypertension Characteristics of the athlete’s heart Regular exercise and hypertonic heart diseases Physiological and pathological left ventricular hypertrophy The role of regular exercise in the prevention of other hypertonic heart diseases Who benefits from regular physical exercise? How much and what kind of exercise may be recommended? Pharmaceutical treatment of hypertension and sport GENERAL PRACTICE ASPECTS OF HYPERTONIC HEART DISEASE
4.1.
HYPERTONIC HEART DISEASE FROM THE GENERAL PRACTITIONER’S POINT OF VIEW IN
FAMILY PRACTICE
Incidence of hypertension and hypertonic ischaemic heart disease Important and indispensable basic terms of hypertension Normal and pathological blood pressure levels and the definition of hypertension Ambulatory blood pressure monitoring (ABPM) 4.1.2.1.3.1. Possible indications of ABPM measurement Limits of general practitioner’s competency List of general practice competencies, limits of competency Special characteristics of hypertonic heart disease Treatment of hypertonic ischaemic heart disease and heart failure Treatment choices in ischaemic heart disease 4.1.6.1.1.1. Indications of ACE-inhibitor therapy in heart failure 4.1.6.1.10. Beta-adrenoceptor antagonists Patient education: educating people about health and diseases

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