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The use and warning of drugs

Patients with heart disease or people who often suffer from angina, also known as chest pain, will buy Inderal all the time. In fact, diseases like ischemic heart disease, coronary heart disease and high blood pressure have to be suppressed by the drug Inderal. If you have any of these diseases, do not stop taking them without your doctor's permission. If you stop taking Inderal after taking it for a long time, your condition may get worse.

The same applies to the opposite. If your doctor tells you to stop using Inderal, you should gradually reduce the dose and stop taking this medication after taking it regularly. However, if you are not reliant on this medication, you should allow yourself only slight physical activity, as you should not take the risk of straining your heart to extreme stages. In cases where you develop tightness or pressure on your chest, difficulty breathing and chest pain can spread to places like the arm. Get medical treatment for neck and jaw immediately.

Inderal is a beta-blocker which is primarily used to treat angina, migraines, high blood pressure, tremors and irregular heartbeats or diseases prescribed by a doctor. Some people can buy Inderal to use in acute heart attacks, improving their chances of survival. In general, Inderal inhibits the action of several natural chemicals in the body, such as B. Adrenaline that enters the blood vessels and heart, which lowers blood pressure, pressure on the heart, and heart rate. These then reduce the risk of heart attacks and kidney problems.

However, Inderal should be used according to the instructions recommended by the doctor or doctor. This is to ensure that you get the most out of the medication while not abusing it. It is best to take at the same time each day, not just when the pain or migraines attack. The dosage amount depends on your body condition and the reaction to the medication. Sometimes it can take up to a week or more for the medication to take full effect. Always consult your doctor for advice on continuing or stopping medication.

What cardiac patients should now know about implantable defibrillators

Economics is a passionate area of study in medicine, although the different formulas are often controversial. One area that is currently under discussion is the implantable defibrillator. These devices are certainly not cheap. But are they profitable in good patients?

An implantable defibrillator, nicknamed ICD, is similar to a pacemaker (in fact, it has a built-in pacemaker), but can also defibrillate the heart with a large burst of energy when the heart begins to accelerate.

These episodes are sometimes referred to as "sudden cardiac arrest" or "ACS", but the term is incorrect. The heart does not stop during the ACS. Rather, it tries to hit so quickly that it cannot open or contract fully. The result is that the heart muscle trembles and no blood is pumped. The common cause of ACS is an irregular heartbeat or arrhythmia.

ICDs are medical devices that need to be implanted in the body. A typical ICD lasts around four to six years, depending on the quantity used and the model implemented. If the ICD battery is empty, the entire ICD should be replaced.

ICD implantation is considered minimally invasive. It is often performed under what is known as "conscious sedation" (no general anesthesia) and can be done in a cardiac catheterization laboratory rather than in an operating room. If the patient is otherwise strong, the procedure can even be performed on an outpatient basis.

However, the cost of the CDI is the big factor. Depending on where you live and what type of ICD you need, the five digits will cost, sometimes up to $ 20,000 or more. If you add that to the surgery, you get a pretty high price for the therapy.

In the 1980s, when the first ICDs were approved and implantation started, most doctors (and even most patients) considered ICDs to be a last resort that should only be used in patients who had no other therapeutic approach. These were extreme treatments for patients with the most stubborn forms of heart disease.

At the end of the 1990s, a series of clinical studies were carried out that found something surprising. INNs saved lives.

The initial challenge with ICD therapy was to identify the right patient. If someone has had an ACS episode and survived, they can go to the doctor and get an ICD for the "next time." The problem with this is that SCA is a killer and many people do not survive their first attack. For this reason, medicine went to work to crack the code of warning signals or risk factors for people who may later suffer from ACS.

Initially, there were skeptics in the medical world who thought that looking for these risk factors was like looking for a needle in a haystack. But study by study, CDIs save lives.

In 2002, the New England Journal of Medicine published a historical article about a clinical trial with the funny name MADIT II (pronounced made-it two). In this clinical study, people who survived a heart attack (myocardial infarction and not ACS) received an implantable defibrillator. People in the MADIT II study had no history of arrhythmia and no previous episode of ACS. They mainly had two causes: a past heart attack (more than 40 days in the past) and impaired heart pumping capacity, as defined by a low ejection fraction (FE). EF is a percentage that indicates how much blood is pumped into the heart in a single heart contraction. A normal EF in a healthy person is around 50% (nobody has 100% EF). MADIT II subjects had an EF of 30% or less.

According to the old rules of the game, these people could never have gotten an ICD. They had no evidence of an ICD. However, the MADIT II study found that ICDs significantly reduced the risk of death in these patients.

MADIT II was just the beginning. More and more studies have shown that devices save lives, even for people who have not had cardiac arrhythmias in the past. This brings us back to the old problem of profitability.

The potential patient population that could benefit from ICDs, ie the number of people whose lives could be at risk if they do not receive ICDs, is enormous. He is much taller than anyone had ever thought. In addition, new studies are constantly being added (the last one came out this year, MADIT-CRT), which further increases the number of patients who can use an ICD. There are many new patients. If everyone had received a DAI, how could we pay for it?

Let's look at it like this. For example, if we implant an ICD into every human being, we could reduce the ACS rate on Earth to about zero. But can we really afford that? Of course not. But how do you decide where to draw the line?

At present, cost-benefit models are based on the formula of taking therapy every year to extend your life and then dividing it by the therapy costs to get the extra year of life. Some cost-benefit analyzes ask you to take measures to improve the quality of life so that not only is life extended, but good functions are also available.

Currently, ICDs are considered inexpensive by most standards. This does not mean that they are cheap. However, they are on a par with other recognized low-cost therapies such as dialysis.

However, this can be theoretical in that only about 25% of people would currently benefit from an INN (and who are entitled to one, and for which insurance or health insurance would be paid if the patient does so I have none. It is true Three out of four people who could benefit from ICD rescue treatment have none.

Ask the device experts about it and they will explain different theories to you. Maybe there is a mix of things that make this otherwise vital therapy undesirable.

First, many people don't want an implantable device, even if it could save their lives.

Second, it is difficult to get people to have surgery and equipment if they are not feeling sick or are at risk of cardiac arrest.

Third, some people either don't hear about their healthcare providers' ICDs or don't really understand the issues even then. After all, there are doctors who do not inform their patients about ICD therapy, even if the patients may be good candidates.

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