Chitika

Sunday, March 27, 2011

Forex Trading Simulator


Forex Trading Simulator
FOREX TRADING SIMULATOR: "FOREX TESTER 2" SOFTWARE, AN IMPORTANT TOOL FOR PROFESSIONAL FOREX TRAINING AND FOREX STRATEGY TESTING.


For more detail about futures trading ,forex simulator trading ,account forex online trading ,forex tip trading,Forex Tester 2 Software, an important tool for Professional Forex Training and Forex strategy testing, make search in above tab

Bio-Technology General - BTGC- Profile


Bio-Technology General - BTGC- Profile
Bio-Technology General Corp. The Group's principal activity is to conduct research, development, manufacture and marketing of biopharmaceutical products. The Group through the internal research, development and agreement has a portfolio of therapeutic products. The products include OXANDRIN (r), BIO-TROPINTM, BIOLON (r), DELATESTRYL (r), MIRCETTE (r) and others. OXANDRIN(R) is used for the treatment of weight loss due to severe trauma, chronic inflection, extensive surgery or unknown pathophysiology. BIO-TROPIN(TM) for the treatment of growth hormone deficiency in children or turner syndrome. BIOLON (R) is used for the protection of the corneal endothelium during ophthalmic surgery. DELATESTRYL (R), for the treatment of hypogonadism and delayed puberty. On 30-Sep-2002, it acquired Rosemont Pharmaceuticals Ltd. During the year 2001, the Group acquired Myelos Corporation. Product sales accounted for 97% of 2002 revenues; Contract fees, 2% and Other revenues, 1%.

Speed of DNA ReplicationSpeed of DNA Replication


Speed of DNA ReplicationSpeed of DNA Replication
The Genome of complex eukaryotes is huge and the process of DNA Replication should be incredibly fast. It is amazing that a Chromosome of 250 million pair of bases can be replicated in several hours. The speed of DNA replication for the humans is about 50 nucleotides per second per replication fork (low speed comparing to the speed of the bacterial DNA Replication).But the human Genome can be copied only in a few hours because because many replication forks take place at the some time (multiple initiation sites)

When shopping around


Shop Around for the Best Mortgage Interest RateIf you are currently on the market for a new home, or you are looking to refinance your current mortgage, one of the most important things to you when shopping around for a home loan will be the mortgage interest rate.

Of course you will want your mortgage interest rate to be as low as possible, so take some time to shop around for the best deal.

Shopping around for the best mortgage interest rate is very important because you want to go with the best deal possible. Don't just settle for the first lender you come across and go with whatever rate they may offer you.

By shopping around you can compare rates and products. The difference in one percentage point on an interest rate can mean thousands of dollars in savings over the course of a thirty-year mortgage.

Think of shopping around for a mortgage the same as shopping around for a new car.

When you are on the market for a new car, you visit two or three car dealerships, you speak with a few different sales people, you test drive a few different cars, than make your decision on the best car at the best price.

Treat the concept of shopping for a mortgage the same as you would if you were shopping for a car.

The mortgage industry is a very competitive one, and the mortgage companies are all too happy to compete for your business. The last thing a mortgage company wants is for you to give your business to their competition.

When shopping around, let the mortgage brokers or loan officers you are dealing with know that you are shopping around. By supplying them with this knowledge, they will understand the importance of coming back at you with the best deal they have to offer to make sure they secure your business.

Once you have a handful of loan officers make you their best offer, give your consideration to the one with the best rate and to the scenario that sounds the most reasonable.

Remember, once an offer is made to you, ask to see all of the particulars in writing. A verbal offer may sound great to you, but without the paperwork to back it up, it is worthless

Obtaining a Mortgage On-line


Obtaining a Mortgage On-line
A mortgage for first time home buyers or people who are looking to refinance their homes has become much easier in later years' thanks to the internet and the ability to obtain a mortgage on-line.

Of course there is your local bank, where you can go, walk in, sit down with the branch manager, and have him set up an appointment with the banks mortgage representative.

That's all fine, but not everybody has time for that. So they resort to the internet, which isn't such a bad idea considering that there are literally thousands of lenders looking for your business across the country and using the internet as a tool to get it.

Using the internet for obtaining a mortgage on-line has its benefits because it gives you the opportunity to shop lenders and rates.

By filling out a simple on-line form with limited information, you will be putting lenders at your service within twenty-four hours of your submission.

The mortgage industry is a very competitive one, so these lenders will be fighting for your business, forcing them to offer you the lowest rates possible. You can than base your decision on the one that is most ideal for you, and most of all, the one that best meets your budget.

Also, if your situation is unique or special, such as having bad credit, no money to put down, or your looking for a specific program such as interest only, the internet is perhaps the best resource for you to find what you need.

f you ask anyone in the financ


f you ask anyone in the finance world what they think about investing or trading penny stocks, the answer that you will probably get will be: "Don't do it. You will lose your money since 90% of penny stock companies are scams. penny stock companies just want to sell shares and are not interested in developing their businesses." The truth is that investing or trading penny stocks is a very risky business. So here is the most important tip about penny stocks: Invest only money that you can afford to lose.

If penny stocks are so risky then, why do people invest in or trade them?
The answer is because you can make a lot of money in a short time if you know what you are doing.

If you are still reading and have decided that you want to trade penny stocks, you need the right tools and good advice to help you survive and even win some money.

Step # 1 - Finding the Right Penny Stock to Buy

To discover the right one stock, you will have to do some investigation, or Due Diligence. There are a lot of websites that will help you with your DD and you can find a list of useful ones at www.stocks-reporter.com.

The following points will guide you in learning important information about a company in which you are interested in investing:

1. Share structure: AS (Shares Authorized) and OS (Outstanding Stock and Float)
2. Transfer agent transparency
3. SEC filing
4. Financial track record
5. Competitive position in its industry
6. Business model
7. Earnings power
8. Valuation or the potential value of the company.

For example, when looking into share structure what you want to see is that there is no dilution. A good sign is when the company has maximized the OS and is close to AS. Watching Level 2 will also give you good indication if there is any dilution from the company. A good strategy is to follow insiders who know the company better than anyone else.

Step # 2 - Deciding When to Buy

After finding the penny stock that you plan to buy, you have to find your entry point and how to execute it the right way. Following the trading in that particular stock for a few days together with chart analyzing will give you a lot of valuable information. At this point it is highly recommended for anyone to learn some basic chart reading or at least let others analyze the chart for you. You can ask for help on many of the popular message boards that discuss stock trading and chart analyzing. An important tip about how to execute the trade in a penny stock is: Be very patient and always try to buy at the BID price.

Step # 3 - When to Sell or The Exit Strategy

The exit strategy is something very personal to different traders or investors.
It is very important to implement your strategy immediately after executing the buy order. In most cases, a good idea would be to set a sell order of 50% of your position at around 20%-30% PPS spike. Another 10%-20% rise of PPS and then sell another 50% of your current position and let the rest ride for a while. In general, your exit strategy should be very flexible and change with news, momentum, and volume. 90% of the time, though, you should sell at the ASK so it won't affect the run.

Make High Profits with Tax Certificates!Discover how you can build lasting wealth!... using little-known, real-deal government programs to easily invest in Government Tax Certificates, Tax Deeds, Tax Liens, and related Auctions. If earning huge, guaranteed profits (ranging from 14%, 16%, even up to 24% and more!!) on solid, secure, repeatable investments takes your breath away....plus the opportunity to buy real estate for pennies on the dollar...then read this special report for "fast-track" insider strategies!!
To get the critical information you need to purchase tax certificates you must contact the County Treasurer's office. (There are 3300 counties in the USA and endless money-making opportunities for you!) Usually a polite phone call will do the trick. Ask immediately for the official that deals with "auction properties that owe back-taxes". When you talk to county officials... be very specific about the information you need. Here is proven list of questions that will make the process easy and professional for both you and the County Treasurer!
Here's what you need to ask for when you talk to county officials:

- Sale Date? - All counties hold tax certificate auctions at different times of the year. Always nail the date down because it may involve planning and travel on your end.
- Where Will The Sale Be Held? - Usually at the county seat courthouse building - smaller counties may use any building in town... always check and have your maps handy. If all else fails... ask for directions. Be sure to get the details! - ask for the exact building in the county office complex and room number.
- Where will the Sale be Advertised? - The County Treasurer may send you a specially printed list of auction properties for a fee (usually between $4.00 and $15.00) or the list maybe so massive it is printed by the local newspaper in its own exclusive section! (It's not usual to find between10 to 30 thousand properties up for auction in large counties.) Now envision the perfect opportunities to make huge profits in real estate the easy way!
- What is required to register? - Once again, all counties have a different of rules. Be prepared to show any legal ID's (You may need multiple ID's and complete valid personal information.)
- What Kind of Funds Do I Need for a Tax Certificate Auction? - This a CORE question that will make it or break it! Some counties will only accept cashier's checks or hard cash. Many will accept your personal check and even have debit card processing capabilities. This is an important reality - other bidders may represent banks and financial institutions with deep, deep pockets. For a fact... you can do this on your terms and budget. Just make sure you know your target county's bidding requirements and "way to pay".

How to Lose Weight Healthily


How to Lose Weight Healthily and Keep Fats Off PermanentlyHow many times have you heard a friend say, "I am on a diet"? Then what happens is your friend would lose some weight for a while before putting them all back on again.

I'll bet you have also heard someone said that "Cardio exercise is the best way for losing weight". This person would then religiously pound the treadmill but results are agonizingly slow. Soon, he gives up and gains back all the weight he had lost, and sometimes even gaining some extra kilos!

Ah, so you thought you've finally found the answer to permanent weight loss. You went on a strict diet and ran your heart out. Yes, you dropped kilos real quickly. But somehow, something is wrong when you look into the mirror in your birthday suit.

Yes you have lost some weight, but somehow your body shape isn't as flattering as you would like it to be. And then suddenly, you hit a plateau. No matter how strict your diet and cardio workouts are, your weight just simply refuses to drop any further. Then horrors of horrors, your kilograms actually started piling on! You get disillusioned with the unrewarding program and soon you succumbed, gave up and blame it on your bad genes. Sounds familiar? Why???

Here's why. Firstly, the heading of the article said "Burn The Fats" and not "Lose Weight". My point is, by merely losing weight, you will also lose some muscle mass in the process. By losing muscles, you will lose body tone and thus your metabolism for burning calories will slow down correspondingly. Therefore, you have got to maintain or even build muscles while losing fats. You may even gain some weight because muscles are heavier than fats. See the paradox?

To lose fats and keep them off permanently, you have to combine healthy eating habits, incorporate cardio exercises and lift weights to build muscles. For every kg of muscles you pack, you will burn an extra 70-100 calories per day even without doing anything. Can you imagine the benefits of building up 5kg of extra muscles? You will be burning 350 to 500 extra calories a day even if you just laze around. You'll be burning a Big Mac everyday! To further illustrate my point, 1 kg = about 7,700 calories, thus if you burn 500 calories a day because of the extra muscles you have, you will be burning off about 1 kg every 2 weeks simply because of your higher metabolism rate! You'll also look good, healthy and well-toned too! Is it any wonder why body builders eat so much but do not put on fats as easily?

Everyone knows that intensive cardio and strict diets cause you to lose muscle mass along with fats. So while you will lose some weight at the beginning, you will look like, well, just a smaller version of you without any muscle tone. That's not what we want isn't it?

As you lose more and more muscles, your metabolism plummets. On top of that, your body will start conserving fats and 'eat' your muscles for energy because it is reacting to your strict diet and is now in the "famine" mode. What happens then is that you will hit a plateau and no matter what you do, you will not reduce anymore weight and your fats will start creeping up again. This, in a nutshell, is the 'yo-yo' dieting effect that we hear so much about.

Losing fats is simple. And notice that I said 'simple' but did not say that it is 'easy'. My pointers will be simple to understand, but the execution will take determination and discipline on your part. It is a lifestyle change to keep the fats off permanently and you will be glad you did because you will get used to the changes in only a few weeks. By then, it will become a cultivated habit for you, especially when you are rewarded with a fitter, healthier, hunkier and sexier you, together with a glowing complexion to boot!

Here is how you do it. Simply, losing fat just means you must burn more calories than you consume. Period.

Lift weights with compound exercises. Forget those puny biceps and triceps curls. Go for big muscle groups like legs, back and chest routines. Why? Because you are working with bigger parts with more mass, and that means more body muscles are working, translating into more calories being expended. If you are fit, do giant sets (4 or more exercises or sets with no rest in between sets or exercise).

Here's an example. Lift only one set of each exercise with no rest in between the exercises. Choose a weight of about 60%-70% of what you normally lift and go for at least 25 reps. Lift more if you can or until your muscles are fatigued, then stop. Leave the gym. The whole routine should not take you more than 40 minutes. But remember to warm up thoroughly and cool down with some light movements and stretching.

After thoroughly warming up, start with squats, then dip, bench press, barbell row and military press. Sounds simple? Not so. You will be huffing, puffing and sweating profusely. What is achieved? You will have combined a cardio workout with a weightlifting workout and your metabolism will burn for the next several hours. Do this 3 times a week with at least a day's rest in between lifting days.

After 4-8 weeks, change the sequence of the exercises. So if you usually squat first, then squat last. Then after another 4-8 weeks, change some of the exercises, like substituting squats with dead lift, or bar bell rows with lat pull down. This is to shock your muscles so that they continue to adapt and grow.

For cardio, go for a run first thing in the morning before breakfast. If you are jogging at normal speed, sustain the jog for at least 45 minutes. If you are running at 65% to 80% of your maximum heart rate (you will be panting and unable to sing or complete a sentence while running), then 20-30 minutes will be enough. Anything more than that may cause muscle break down. You may intersperse the speed with slower jogs in between to catch your breath. Do these 5-6 times a week.

Eating habits? Just eat less of what you normally eat. For example if you have 2 slices of bread with 2 eggs in the morning, now take just one slice and an egg. Just eat half of what you eat but eat more regularly. Have 5 to 6 meals a day if you can. This is to feed your body frequently so that it will not go into starvation mode and start to conserve fats. At the same time, it will boost metabolism because your body burns calories while digesting the food. Chuck away all soft drinks, sugared drinks and stop adding sugar into your coffee and tea. Just by abstaining from sugary drinks, you may already have gotten rid yourself of 200 calories per day. Drink plenty of water instead and double the amount if you can.

Oh, by the way, all work and no play make Jack a dull tired boy and an exhausted Jill. Do choose a day to relax a week. No exercise on that day. Indulge in your favorite food if you must. Hey, pat yourself on the back and reward yourself for passing another grueling week. After all, your body needs to recover too.

As you reach your fat loss goals and you are happy with your muscular development, you can then take things a little easier. Hit the gym less frequently, have shorter runs and even relax a little in your diet. Because of your greater musculature, your body is now a fat-burning machine. You have earned that luxury.

Alternatives For Cellulite Reduction


Alternatives For Cellulite ReductionAre there any cellulite reduction alternatives? With the rare exception, liposuction is generally considered cosmetic surgery. For this reason liposuction is not considered as medically necessary.

Because of this, the decision is up to you whether or not to undergo liposuction procedure. You may decide that it is not right for you. And you can make that determination right up to the point of actually having the procedure.

Liposuction Alternatives
Exercise
Accept your body and appearance as it is.
Change diet to lose some excess body fat.
Use clothing or makeup to downplay or emphasize body or facial features.
Try some of the other methods such as topicals or body wrapping.
Whatever method you select for cellulite reduction make certain that, you have done your due diligence and select the most suitable method with the least amount of risk to obtain the results you desire.

There really is no alternate for good, old-fashioned, healthy nutrition and exercise. The tried and true methods do work:
1. Watch your diet.
2. Incorporate fresh and natural foods into your diet.
3. Get plenty of fiber.
4. Avoid high fat foods.
5. Drink plenty of water to avoid dehydration.
6. Limit the consumption of caffeine and alcohol
7. Quit or cut down on smoking.
8. Get plenty of exercise.
9. Avoid medications not necessary to health and well being.

You can rid your body of excess toxins and promote a general state of health by following a regimen of good health, nutrition and exercise that is optimum for pursuing any program for dealing with cellulite.

In todays competive


In todays competive business world a website is no longer a optional marketing channel, but instead a necessity. With the cost of website development being so low and the increased number of consumers using the internet to search for businesses, every business should have a website; medical practices are no exception. Here are some things you may want Publish Post to consider So what should you consider when selecting a company to build a custom website for your practice?

There are two types of websites to choose from: custom and prefabricated. Custom interactive websites will prove to be far more effective, look more professional, and have longer-lasting value than the cheaper prefabricated versions. Every practice is different, so a design company should take the time to understand what the practice has to offer and convey that in their site.

Effective websites take into account common practice management tasks, and integrate them with online tools that not only create a marketing presence but also empower the practice in its daily operations. Specific tools include keeping in touch with patients through email newsletters, greeting cards, and special promotions.

A few companies that specialize in chiropractic websites compile newsletters that they prepare and delivery automatically on behalf of a doctor to his or her patient database. Such newsletters, which can be updated on a regular basis on the website and automatically emailed to patients, are extremely helpful in keeping in touch with patients that do not come in as often. Additionally, patients who subscribe may forward it to others, which could serve as a form of referrals.

Another useful feature is the ability to easily send out pre-scheduled email cards for birthdays, appointments, various holiday, etc. Such e-cards, with fun, professional designs, provide another great opportunity to keep in touch with patients and improve patient relations, while minimizing the cost of traditional cards and postage, not to mention save time.
Practices should also consider providing potential patients with an incentive to visit the office by having printable promotions or coupons on their website, where allowable by law. After all, the hardest part is getting the patient to come in for the first time.

Website can also feature patients the ability to schedule appointments, access patient forms, and even verify insurance. This way, rather than request patients to come in fifteen to twenty minutes early, practices can post their forms online and request patient go online, print and complete them before coming in.

The opportunities for patient education online are almost limitless; a doctor can provide informational resources on preventative care and exercises, explanatory diagrams and illustrations, and descriptions of the unique services of their practice.

A website can also assist the practice in selling different products and supplements to anyone, anywhere, and any time-not just to the existing patient base of the practice. Doctors should not limit their opportunities - current studies show the public is looking for health information, by the millions. Having an online presence now is crucial, not only in reaching new patients but also retaining existing ones. By not being online, a doctor misses out on 100 percent of the Internet-derived business he or she could see.

Panic Attack Medication: What Is Best For Me?


Panic Attack Medication: What Is Best For Me?
If you are one of those living with panic attack symptoms, you know it can almost take over your life. Living with the fear that you will have to suffer through another period of grief, pain, and discomfort is sometimes enough to bring on a panic attack. When it comes to treating a panic attack, some medication has been known to significantly reduce the symptoms, enabling people to continue living a life that is not ruled by the fearful unknown. The following provides information about some of the most effective medications available to consumers.

Alprazolam (al-PRAZ-zo-lam)
This medication is one of the more common prescriptions for general anxiety treatment. It is a benzodiazepine, which is used to treat short term panic attack symptoms in many people every day. This medication is not meant to treat ongoing and daily forms of a panic attack, but is very useful to people who experience these symptoms periodically.

Azapirones (a-zah-PIE-ronz)
Azapirones is a drug which works on the central nervous system by relieving the many symptoms of anxiety. This drug can be found in many antidepressants and is the reason many people who normally would not take antidepressants do, because of their panic attack symptoms. It is used to calm the nervous system, putting it somewhat into sleep mode.

Benzodiazepines (ben-zo-die-AZ-a-peens)
This is a tranquil medication, used to help fight anxiety and insomnia. The drug is very potent, and a fear of becoming addicted to it is shared with both physicians and patients. For extreme cases of anxiety, this is the medication most commonly used, but it's also something that can significantly alter your mood or personality if not used properly or for longer periods of time than prescribed.

Selective Serotonin Reuptake Inhibitors (SSRIs)
These are a newer type of anti-depressant introduced into the US in the 1980s beginning with Prozac. They work differently to traditional antidepressants and they do so by increasing and assisting the brain to maintain levels of the neurotransmitter serotonin which is often found to be low in people sufferering from depression, Obsessive Compulsive Disorder (OCD) and anxiety and panic disorders.

Diastolic heart failure


Diastolic heart failure

Diuretics if congested
Ca++  channel blockers in some cases
NO ROLE for digoxin.

The rapid relief of acute myocardial ischemia is often effective when diastolic dysfunction is secondary to this condition. The reduction in heart rate caused by beta-blockers has several beneficial on diastolic function, including a prolongation of the filling period and an amelioration of ischemia. calcium channel blockers, especially Verapamil, have been shown to accelerate ventricular relaxation in patients with hypertrophic cardiomyopathy and have been reported to be useful in the treatment of diastolic dysfunction characteristic of this condition. Other beneficial mechanisms are reduction in heart rate, control of hypertension, reduced microvascular ischemia and oxygen demand, amelioration of intracellular calcium overload and regression of left ventricular hypertrophy.

Ventricular filling pressure and secondary venous congestion may be reduced by restriction of sodium intake and the administration of diuretics and venodilators. Even in the absence of ischemia, nitrates, by reducing preload, are useful in managing diastolic dysfunction and in the treatment and prevention of consequent severe pulmonary congestion. Nitroglycerin may be administered intravenously or sublingually in emergency situations, and long acting nitrates, such as isosorbide dinitrate, are often effective in the long term. In the long term, however, excessive preload reduction should be avoided because these patients often require higher-than-normal filling pressures to maintain an adequate stoke volume.

The maintenance of heart rhythm and rate is of critical importance. Tachycardia, whatever the underlying mechanism, must be controlled, thereby increasing the fraction of each cardiac cycle available for ventricular filling. Maintenance of sinus rhythm with synchronized atrioventricular sequential pacing may be crucial in permitting atrial augmentation of ventricular filling. Digoxin and other inotropic agents have no established place in these patients with relatively well preserved ejection fraction, and could, in principle, have an adverse effect in this group. Exercise training induces significant improvement in exercise capacity in patients with dilated cardiomyopathy and a pattern of abnormal left ventricular relaxation. Finally, it has been shown that endogenous nitric oxide released from the coronary microcirculation selectively enhances left ventricular relaxation in the isolated ejecting guinea pig heart. These findings may lead to a new therapeutic approach to diastolic heart failure, with treatments aimed at the coronary microcirculation.

The American College of Cardiology / American Heart Association task force divides pharmacologic treatment into three classifications for the management of diastolic HF : Class I refers to drugs that are always indicated, such as diuretics and nitrates, and drugs suppressing atrioventricular conduction and anticoagulation if atrial fibrillation is present. Class II agents are " acceptable "; however, their efficacy is uncertain. These include calcium channel blockers, beta-blockers, ACE inhibitors and anticoagulation in patients with intracardiac thrombus. Class III drugs are not indicated and include drugs with positive inotropic effects.

Systolic heart failure


Systolic heart failure

 Headlines:



 


www.doctorslounge.com / cardiology / diseases / heart_failure.htm
Back to Cardiovascular Diseases


Heart failure

Definition

The heart cannot produce enough blood flow to satisfy the body�s needs or can do so only with difficulty.

Aetiology

Heart dysfunction may be either systolic or diastolic.

Systolic dysfunction: systole is the act of contraction by  the heart and is governed by 2 cardiac properties (1) contractility (the ability of the muscle to contract) and (2) afterload (the force against which the heart is pumping).

     Decreased contractility: myocardial infarction, valvular heart disease, hypertension, cardiomyopathy.

     Increased afterload such as hypertension, aortic valve stenosis.

Diastolic dysfunction: diastole is the phase of relaxation of the heart muscles after pumping and is governed by active and passive properties. Active relaxation occurs early in diastole when Ca++ is pumped outside the myocardium. It is active because it utilizes energy and is impaired by ischemia. Passive relaxation occurs when the mitral and tricuspid valves open thus letting the blood pooled in the atria enter the ventricles. It is impaired by increased stiffness of the ventricles as occurs in concentric hypertrophy and in infiltrative diseases of the heart.

Clinical suspicion

Heart failure is suspected by clinical presentation. Symptoms include shortness of breath on effort, palpitations, syncope, cough, swelling of the legs. Radiographic evidence of large heart size and pulmonary vasculature redistribution strengthens the suspicion.

Diagnosis

The diagnosis should be confirmed by echocardiography, radionuclide ventriculography, or cardiac catheterization with left ventriculography.

Treatment

The ideal treatment would be to remove the cause, if not then attempt at removing the precipitating cause however most of the time this is not possible.



   
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Systolic heart failure

General strategy of management if patient's blood pressure >90/60

Vasodilators

These dilate the vessels in the body.

Angiotensin - converting enzyme inhibitors (ACE inhibitors)

1st line therapy for the entire spectrum of congestive heart failure, whether asymptomatic or severe; unless contraindicated.

Rationale: heart failure is accompanied by compensation mechanisms one of which is vasoconstriction. This increases venous return and arterial tone which maintains blood pressure and perfusion. However, it also increases impedance to ventricular ejection (afterload). This results in a vicious cycle in which decreased stroke volume results in more intense vasoconstriction which further decreases stroke volume. Hence vasodilator therapy breaks the cycle. vasodilator therapy was the only therapy in congestive heart failure found to prolong survival associated with improved quality of life.

Contraindications: not given in patients with predominant diastolic failure or with those in which heart failure results from aortic stenosis / mitral stenosis. Not given in patients with impaired renal function or with bilateral renal artery stenosis. Do not give concomitant potassium sparing diuretic with angiotensin converting enzyme and monitor blood pressure carefully when initially instituted in combination with a diuretic.

ACE inhibition should be started 72 h after any acute myocardial infarction with symptoms or echocardiographic evidence of systolic dysfunction.

ACE inhibition should not be started within the first 24 h of an acute myocardial infarction.

Dose and type: start with small doses (1/4 to 1/2 a tablet) of ACE inhibitors and give in sitting position to avoid first dose hypotension. Gradually titrate the dose every other dosing schedule to reach 3 tablets daily (maximum dose is 50mg tds).