Attenuation of coronary vascular resistance by selective alpha1,-adrenergic blockade in patients with coronary artery disease

Alpha-adrenergic-mediated coronary vasoconstriction during stress such as cold pressor testing may contribute to myocardial ischemia by increasing coronary vascular resistance in patients with severe coronary artery disease. Nonselective alpha-receptor blockade with phen-tolamine abolishes both the peripheral and coronary vasoconstriction during cold pressor testing, but causes reflex tachycardia and increased inotropy. To determine the role of selective alpha1-receptor blockade, the changes in coronary vascular resistance during cold pressor testing were measured in 18 patients with coronary artery disease before and after intravenous administration of 100 mg of trimazosin. Cold pressor testing was performed at a constant paced subanginal heart rate of 95 ± 5 beats/min (± 1SD). Before trimazosin, cold pressor testing increased mean arterial pressure by 9 ± 4% (102 ± 14 to 111 ± 14 mm Hg, p < 0.001) with no change in coronary sinus blood flow, but significantly increased coronary vascular resistance by 15 ± 19% (1.02 ± 0.46 to 1.15 ± 0.57 units, p < 0.05). Five minutes after trimazosin, cold pressor testing increased mean arterial pressure by 6 ± 5% (p < 0.001) with a marked attenuation of the increase in coronary vascular resistance (6 ± 11%, p = NS), which was significantly less than before trimazosin (p < 0.02). Trimazosin did not increase plasma norepinephrine concentration at rest, suggesting that in the dosage used trimazosin caused selective alpha1-receptor blockade.These data suggest that although the hypertensive response to cold pressor testing is somewhat blunted by selective alpha1,-adrenoceptor blockade, the reflex coronary vasoconstriction during adrenergic stimulation in some patients with coronary artery disease can be significantly attenuated. Use of agents that block alpha2-adrenoceptors has been clinically unsatisfactory because of the adverse myocardial effects of increased norepinephrine release. Selective alpha1-receptor blockade may have an additional advantage over nonselective alpha-adrenergic blockade in that the release of norepinephrine is also attenuated, thus potentially producing less augmentation of heart rate and myocardial oxygen demand

Transcatheter and Doppler waveform correlation in transcatheter aortic valve replacement

Transcatheter aortic valve replacement (TAVR) has become the preferred therapy for treatment of severe aortic stenosis in patients at intermediate to high risk of perioperative mortality following surgical aortic valve replacement. Haemodynamic assessment is an integral part of the procedure, and it is crucial for the operator to have an in-depth understanding of the haemodynamic alterations that occur during balloon aortic valvuloplasty and transcatheter valve deployment. Comprehension of the haemodynamic tracings is also pivotal for early recognition of periprocedural complications. With expanding indications for TAVR, it is imperative for members of the structural heart team to have an in-depth, nuanced understanding of transcatheter haemodynamic waveforms and their correlation with echocardiographic Doppler waveforms that are obtained periprocedurally during TAVR. This review provides a collection of transcatheter haemodynamic tracings and their corresponding Doppler echocardiography correlates that are demonstrative of physiological alterations and pathological lesions (complications) that occur during TAVR

Get Organised: The 'Do's' Preceding Successful Field Research

There is no shortage in the political science literature on field research regarding issues of research design, methodology, and data evaluation. Yet, the practical and organisational intricacies that precede successful fieldwork are frequently overlooked. This lack of methodical advice may be due to the impression that field research is highly contextual, and so case-specific that general guidelines, which apply to all field research endeavours alike, are inconceivable. While we acknowledge the organisational complexity of field research, we disagree with the notion that the preparatory dimension of fieldwork is by necessity unique for every undertaking. Rather, recommendations for common challenges that occur during the preparation and organisation phase of a field trip can be identified and formulated. Consequently, we present and discuss ten organisational ?do's? preceding successful field research. Current graduate students and future field researchers will regard these ten pointers as useful hints in the organisation of their own endeavour. While the list is by no means exhaustive, the ten recommendations will lower the organisational entry costs of aspiring field researchers, and enable them to hit the ground running when arriving in the field