Download Contemporary Geriatric Medicine: Volume 1 by Edmund H. Duthie Jr., Michael H. Keelan Jr. (auth.), Steven PDF

By Edmund H. Duthie Jr., Michael H. Keelan Jr. (auth.), Steven R. Gambert M.D. (eds.)

This quantity marks the 1st of a brand new sequence, modern Geriatric medication, becoming a member of the ever growing to be "Contemporary" relatives. As with the opposite "Contem­ porary" volumes, our target is to aid the reader in conserving foreign money in a swiftly altering box. possibly no box has proven such significant advances in this kind of couple of minutes as geriatrics. during the last a number of years, the "demographic impera­ tive" has develop into a resource of outrage for plenty of, together with clinicians, scientists, econ­ omists, and healthiness planners. Our geriatric wisdom base maintains to develop, frequently making it tricky to maintain abreast of advances and present healing modalities. modern Ger­ iatric medication offers the cutting-edge considering relating to quite a few subject matters all of significant problem to the doctor taking care of the aged individual. The authors, for the main half serving as participants of a reliable editorial board, have selected issues that are supposed to have instant curiosity to the readership. by way of having a reliable editorial board, continuity is ensured in successive volumes. each years, a next factor will both deal with new recommendations on already awarded subject matters or specialize in new subject matters of present curiosity. As with the opposite "Contempo­ rary" sequence volumes, the some other 12 months period is meant to permit new locate­ ings to advance and be proven. It additionally presents the authors with time to supply the best quality of work.

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3. Antiplatelet Agents The role of anti platelet agents in the management of chronic ischemic heart disease remains controversial. The proposed mechanisms of potential benefit have been summarized in reviews of major clinical trials of aspirin, dipyrimadole, and sulfinpyrazone. 32 Although there are hypothetical reasons for using one or more of these drugs, the clinical proof of efficacy has not been established. Pharmacologic management is the preferred therapeutic approach to the majority of stable symptomatic elderly patients with ischemic heart disease.

Vasodilators Major advances have been made in the pharmacologic approach to refractory heart failure. Vasodilators are now used routinely. 58 Impedance to ejection (afterload) is reduced with arterial vasodilators. Forward cardiac output is enhanced and symptoms of fatigue, cold extremities, and mental obtundation are improved. Systemic venous dilatation (preload reduction) decreases pulmonary capillary pressure with a resultant reduction in dyspnea. Nitrates, hydralazine, prazosin, and captopril have been used successfully (Table III).

6. 1. Amyloidosis The geriatric patient is subject to several forms of cardiomyopathy. Presbycardia or "senile heart" disease was a fashionable diagnosis to explain heart failure in patients with apparently normal hearts. 5% of 162 patients over age 75 years who died with heart failure. 38 The same author described cardiac amyloidosis in 18% of patients dying in heart failure. 38 Amyloid was found incidentally in 5% of 208 patients who did GERIATRIC CARDIOLOGY AND BLOOD PRESSURE 13 not exhibit signs of congestive failure.

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