Abstract: In the treatment of heart failure, clinical signs are low cardiac output, therapy with positive inotropic agents in an acute cardiac care is mandatory. Three classes of inotropic drugs are currently used, including beta-adrenergic agonists (especially dobutamine), phosphodiesterase inhibitors (such as milrinone) and the recently developed calcium sensitizers such as levosimendan. The classic inotropic drugs offer short-term haemodynamic enhancement in heart failure patient and their use has been connected with poor prognosis. The inotropic drugs, the Ca²⁺-sensitizers, may offer a choice of long-lasting result.

Abstract: Chronic anemia is a risk factor for cardiovascular diseases outcome in patients with heart failure, dilated cardiomyopathy and uncontrolled hypertension. This study was performed to analyze the prevalence of anemia among cardiac patients and to determine the relationship between anemia and socio demographic characteristics. The study design is a cross sectional based on 300 cardiac patients ( ≥ 19 years) who were hospitalized in ALShifa hospital (Gaza) for 3 months period during the year 2012. The analysis includes socio demographic data, traditional risk factors for cardiovascular diseases (CVD), and Laboratory test included (hemoglobin and clearance creatinine measurement). Collected data was analyzed by using statistical package for social science version 20.0. Anemia was defined as Hemoglobin less than < 12 g/dl in female and less than 13 g/dl in male based on World health organization criteria. Among 300 patients, 181patients (60.3%) were anemic and 119 (39.7%) were non-anemic. The mean age for all population was 61.4 years. Mean age of patients with anemia tends to be higher (63.9 years) than non-anemic (57.7 years) and the differences between the two means reached statistical significant level (P value < 0.001). Anemia was more common in female (71.4%), older age (71.1%), diabetics (70%), impaired clearance creatinine (70%), hypertensive’s (65%) and low education level (64.5%). The highest proportion belonged to valvular heart disease (77.8%), congestive heart failure (74.6%) followed by hypertension (54%), and the lowest is coronary artery disease (46%). Logistic regression reveals that low education, low clearance creatinine level, smoking and diabetes are independently associated with anemia. We conclude that Anemia is common among cardiovascular disease patients, and worsens the prognosis of their clinical condition. Intervention policies to minimize anemia risk factors are needed.

Abstract: Background: Aortic valve stenosis causes gradual obstruction to left ventricular outflow tract. It is a common valvular disease that carries many life threatening complications. We hypothesized that the reduction or elimination of the pressure gradient across the aortic valve after correction of the stenotic lesion would lead to regression of left ventricular mass and improve left ventricular functions. Aim of the work is to assess the effectiveness of the correction and factors controlling these changes in left ventricular mass index and functions. Methods: preoperative and postoperative Electro-cardiography and echocardiography were performed for all patients. The corrective procedures included aortic valve replacement, balloon aortic valvuloplasty and open valve repair. Results: Sixty patients had correction of aortic valve stenosis (44 males, 16 females). ECG score preoperatively ranged between3 and 9 with a mean of 6 ± 1.63. Postoperatively, it ranged between 0 and 6 and mean of 3 ± 0.7. The mean LVED/BSA was reduced from 32.52 preoperatively to 30.41 postoperatively. The mean interventricular septal thickness index was reduced by 1.03. The mean left ventricular posterior wall thickness index was reduced by 0.99. Mean left ventricular mass index was reduced by 31.86 gm. The mean ejection fraction increased by 6.45. Mean trans-aortic peak gradient was reduced by 41.36 mmHg. Conclusions: Correction of aortic valve stenosis improves systolic and diastolic left ventricular function and a reduction in left ventricular mass index. Aortic root enlargement procedures can be safely avoided.