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However order red viagra online now erectile dysfunction pills cialis, in the presenceofunderly- ing cardiacdisease order on line red viagra erectile dysfunction statistics age, complex ventricular ectopy does have prognos- tic implications buy cheapest red viagra erectile dysfunction pills canada. The presenceofunexpectedcomplex ventricular ectopy should thus promptan evaluation for undiag- nosedcardiacdisease cheap kamagra polo 100mg. It is possible to estimate a patient’s risk of suddendeath by consid- ering the presence of three simple clinical factors:previous myocar- dial infarction buy lasix australia, depressed left ventricular ejection fraction (i. If previous myocardial infarction or depressed ventricular function are present (as noted, the presenceofcomplex ectopy alone carries no prognostic signifi- cance), the 1-year risk of suddendeath isapproximately 5%. If any tworisk factors are present, the 1-year risk of suddendeath isap- proximately 10%. Thus, patients who have survivedmyocar- dial infarction or who have depressed ventricular function from any cause have increased risk of suddendeath. Treating ventricular ectopy The association betweencomplex ectopyand the risk of sudden death has been recognized for decades, and for many years, it was assumed that antiarrhythmic drug therapyaimed at eliminat- ing complex ectopy would improve that risk. Not only did getting rid of the ectopyfailto improve outcomes, but also the use of antiarrhythmic drugs itself (presumably duetoproarrhythmia) increasedmortality. Inconceptualizing the treatmentofcomplex ventricular ectopy, the bear droppings theory is instructive—ifyou are walking in the woodsand see bear droppings, your chances of being eaten by a bear are higher thanif there were no bear droppings. However, if you take outyour gun and shoot the bear droppings, you are not reducing yourrisk. In fact, you might even induce the bear to come by to investigate the disturbance. Complex ectopy is best viewed as an indication of increased risk (like bear droppings), and not as an indication for therapy. The prophylactic empiric use of amiodarone has also been ad- vanced as a way of treating patients with underlying heart dis- ease who have complex ventricular ectopy, and several random- ized trials have now examined thisquestion. Unfortunately, these results do not provide definitive evidence that prophylactic use of amiodarone is helpful. Overall, these findingssuggest that amiodarone-related toxicity may largely negate anyreductioninsuddendeath. However, in distinct contrast to the Class I drugs, amiodarone is not associatedwith an 154 Chapter 12 Table 12. The bottom line is that treating ventricular ectopy with antiar- rhythmic drugs has not been associatedwith an improvedclinical outcome, despite the fact that numerous clinical trials have been conducted to examinethisquestion. Therefore, it is not appropriate to treat these patients with antiarrhythmic drugs for the purpose of improving theirsurvival. However, on occasion, it may be appropriate to treat ventricu- lar ectopy if the ectopic beats themselves are producing significant symptoms. Here, obviously, the goal istoimprove symptoms(and not necessarily to abolish the ectopy completely).

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