Swiss medical weekly
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Swiss medical weekly · Feb 1994
[Aortic valve stenosis in the old age: clinical and echocardiographic aspects].
Among 380 consecutive patients > 70 years of age, patients with a systolic heart murmur were investigated both clinically and by doppler echocardiography. The aim of the study was to compare the validity of the clinical diagnosis of valvular aortic stenosis in elderly patients with the results of doppler echocardiography. 138/380 patients (36%) had a systolic heart murmur. 130 were investigated by doppler echocardiography. 23/130 patients with systolic murmur (18%) had moderate or severe aortic stenosis. Clinically, patients with moderate or severe aortic stenosis had a pulsus parvus et tardus of the carotid artery more often than patients with only slight or no evidence of aortic stenosis (61% vs 16%; p < 0.0001). ⋯ We conclude that moderate or severe aortic stenosis is a frequent finding in elderly patients. Diagnosis by clinical examination may be difficult. For this reason, doppler echocardiography should be performed, especially when therapeutic consequences are to be expected from the diagnosis, such as aortic valve replacement or vasodilator treatment in the case of congestive heart failure.
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Swiss medical weekly · Feb 1994
[Role of the respiratory muscles in weaning from mechanical ventilation].
Weaning from mechanical ventilation is difficult when the respiratory muscles are unable, because of weakness or fatigue, to assume the entire work of breathing. Partial ventilatory support may then be used to rest the respiratory muscles. However, the degree of muscle rest achieved varies according to the ventilatory mode. ⋯ With noninvasive techniques, muscle rest is better achieved by positive pressure than by negative pressure ventilation. The opposite option, training of the respiratory muscles, has also been found to facilitate difficult weaning. The role of resting and overloading the respiratory muscles in the management of difficult weaning remains to be established.