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Moggio RA, Hammond GL, Stansel HC Jr et al. Incidence of emboli with cloth-covered Starr-Edwards valve without anticoagulation and with varying forms of anticoagulation. J Thorac Cardiovasc Surg. Aspirin and extended-release dipyridamole can pass into your milk and may harm your baby. Talk to your healthcare provider about the best way to feed your baby if you take aspirin and extended-release dipyridamole capsules. American Heart Association Task Force on Practice Guidelines Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery. Available from website. Cardiac failure 2%; syncope 1%; angina pectoris, migraine postmarketing. order cheapest propranolol store usa propranolol

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Adenosine injection and 64% for exercise testing. The specificity was 54% for Adenosine injection and 65% for exercise testing. The 95% confidence limits for Adenosine injection sensitivity were 56% to 78% and for specificity were 37% to 71%. Retroperitoneal and intracranial hemorrhages were always considered major. In the knee replacement surgery trials, intraocular hemorrhages were also considered major hemorrhages. Enoxaparin Sodium Injection, 30 mg every 12 hours SC initiated 12 to 24 hours after surgery and continued for up to 14 days after surgery. Enoxaparin Sodium Injection, 40 mg SC once a day initiated up to 12 hours prior to surgery and continued for up to 7 days after surgery. Enoxaparin Sodium Injection, 40 mg SC once a day for up to 21 days after discharge.

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Table 21: Efficacy of Enoxaparin Sodium Injection in Treatment of Deep Vein Thrombosis with or without Pulmonary Embolism All patients were also treated with warfarin sodium commencing within 72 hours of Enoxaparin Sodium Injection or standard heparin therapy. The British Association of Urological. The capsule is imprinted axially with “AN” in yellow ink on the cap and “596” in red ink on the body. Used IV as an adjunct to thallous thallium chloride Tl 201 myocardial perfusion imaging in patients unable to exercise adequately. Enoxaparin Sodium Injection or unfractionated heparin.

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If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip themissed dose and resume your usual dosing schedule. Chesebro JH, Fuster V, Elveback LR et al. Trial of combined warfarin plus dipyridamole or aspirin therapy in prosthetic heart valve replacement: danger of aspirin compared with dipyridamole. Am J Cardiol. Advance Directive living will: A document that informs your family and providers of your wishes for extended medical treatment in times of emergency. SC administration was more than 8 hours before balloon inflation. Compared to patients treated with placebo, patients treated with Cilostazol 50 or 100 mg twice daily experienced statistically significant improvements in walking distances both for the distance before the onset of claudication pain and the distance before exercise-limiting symptoms supervened maximal walking distance. The effect of Cilostazol on walking distance was seen as early as the first on-therapy observation point of two or four weeks. order imitrex south africa

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Gender: Apparent clearance and A max derived from anti-Factor Xa values following single SC dosing 40 mg and 60 mg were slightly higher in males than in females. The source of the gender difference in these parameters has not been conclusively identified; however, body weight may be a contributing factor. Whitlock RP, Sun JC, Fremes SE et al. Antithrombotic and thrombolytic therapy for valvular disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. Electrophysiology EP Study: An EP study is a test that evaluates the electrical activity within your heart. This test is used to help your doctor find out the cause of your rhythm disturbance and the best treatment for you. During the test, your doctor may safely reproduce your abnormal heart rhythm and then give you medications or other treatments to see which one controls it best. Based on enoxaparin sodium pharmacokinetics, this difference in steady state is expected and within the therapeutic range. For resting scans, in which you do not exercise, you will be asked to remove your clothing above the waist, and you will be given a hospital gown to wear. Electrodes might be attached to your chest to keep track of your heartbeats. PDE cGMP-PDE thereby augmenting the increase in cGMP produced by EDRF endothelium-derived relaxing factor, now identified as nitric oxide. Steady-state enoxaparin activity levels are well predicted by single-dose pharmacokinetics. As Adenosine does not require renal function for its activation or inactivation, renal impairment would not be expected to alter its effectiveness or tolerability. This medication may rarely cause a severe intestinal condition -associated due to a type of bacteria. Do not use anti- products or pain if you have any of the following symptoms because these products may make them worse. May 6, 2017. Dipyridamole Chronic Kidney Disease - vegietokyo. MRHD in mice and about twice the MRHD in rats. Mutagenicity tests of Dipyridamole with bacterial and mammalian cell systems were negative. SC or heparin IV bolus 5000 IU followed by a continuous infusion administered to achieve an aPTT of 60 to 85 seconds in-patient treatment. All patients also received warfarin sodium as described in the previous study. Enoxaparin Sodium Injection or standard heparin therapy was administered for a minimum of 5 days. Enoxaparin Sodium Injection was equivalent to standard heparin therapy in reducing the risk of recurrent venous thromboembolism. Heparin, and that they should report any unusual bleeding or bruising to their physician. Hemorrhage can occur at virtually any site in patients receiving Heparin. Caution should be exercised when administering enoxaparin to patients with hepatic impairment.

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What are the possible side effects of aspirin and extended-release dipyridamole capsules? Patency Rate: The likelihood that a vessel will remain open. Cardiologist: Doctor specializing in the diagnosis and treatment of heart disease. Dipyridamole is a coronary vasodilator in man. The mechanism of vasodilation has not been fully elucidated, but may result from inhibition of uptake of adenosine, an important mediator of coronary vasodilation. The vasodilatory effects of dipyridamole are abolished by administration of the adenosine receptor antagonist theophylline. Hypertrophy: An abnormal enlargement of an organ or thickening of its tissue. Ventricular hypertrophy is the name given to a thickened ventricle. Inhibits the uptake and metabolism of adenosine in platelets, endothelial cells and erythrocytes. Stent: A small tube, inserted after angioplasty, that acts as a scaffold to provide support inside the coronary artery. They are usually made of metal and is permanent, but can also be made of a material that the body absorbs over time. Some stents have medicine that helps keep the artery from getting blocked again. May 22, 2016. Methods To Execute a Gall Bladder Test - Types of Medical. The beneficial effect of enoxaparin on the primary end point was consistent across key subgroups including age, gender, infarct location, history of diabetes, history of prior myocardial infarction, fibrinolytic agent administered, and time to treatment with study drug see ; however, it is necessary to interpret such subgroup analyses with caution. Insert piercing pin of administration set into port with a twisting motion until the set is firmly seated. NOTE: When using a vented administration set, replace bacterial retentive air filter with piercing pin cover. Insert piercing pin with twisting motion until shoulder of air filter housing rests against the outlet port flange. neurontin

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What are aspirin and extended-release dipyridamole capsules? Adenosine injection has been given with other cardioactive drugs such as beta adrenergic blocking agents, cardiac glycosides, and calcium channel blockers without apparent adverse interactions, but its effectiveness with these agents has not been systematically evaluated. Mediates coronary vasodilation by inhibiting reuptake and thereby allowing accumulation of adenosine in vascular smooth muscle. You may feel a brief stinging or burning sensation when the IV is inserted into your vein. Combinations of dipyridamole and aspirin have not been evaluated for effects on fertility and reproductive performance. Similar findings have been documented by other studies and case reports. All pregnancies have a background risk of birth defect, loss, or other adverse outcome regardless of drug exposure. The fetal risk summary below describes the potential of enoxaparin sodium to increase the risk of developmental abnormalities above the background risk. What are Cilostazol tablets, USP? Since coconut oil has a high fat content, there is concern that it might increase weight if used in large amounts or that it might increase cholesterol levels. However, these concerns have not been proven in scientific research. Patients received one capsule twice daily morning and evening. Efficacy assessments included analyses of stroke fatal or nonfatal and death from all causes as confirmed by a blinded morbidity and mortality assessment group. There were no differences with regard to efficacy based on age or gender; patients who were older had a trend towards more events. This information should not be used to decide whether or not to take pentoxifylline or any other medicine. Only your health care provider has the knowledge and training to decide which medicines are right for you. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about pentoxifylline. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to pentoxifylline. This information is not specific medical advice and does not replace information you receive from your health care provider. You must talk with your health care provider for complete information about the risks and benefits of using pentoxifylline. Avoid using aspirin in patients with a history of active peptic ulcer disease, which can cause gastric mucosal irritation and bleeding. Find the cause of chest pain or pressure brought on by exercise. Epistaxis 2%; hearing loss postmarketing. The dose of dipyridamole will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of dipyridamole. If your doctor instructs you to use this medication regularly for a long time, laboratory and medical tests such as a test, vitamin B-12 levels may be performed periodically to monitor your progress or check for side effects. Keep all regular medical and laboratory appointments.

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Arthralgia 6%; back pain 5%; arthritis 2%; arthrosis, myalgia 1%; rhabdomyolysis postmarketing. The maximum doses administered in both rat and mouse studies were, on a systemic exposure basis, less than the human exposure at the MRHD of the drug. Cilostazol tested negative in bacterial gene mutation, bacterial DNA repair, mammalian cell gene mutation, and mouse in vivo bone marrow chromosomal aberration assays. It was, however, associated with a significant increase in chromosomal aberrations in the in vitro Chinese Hamster Ovary Cell assay. Consult your doctor before -feeding. Stroke Definition A stroke is the sudden death of brain cells in a localized area due to inadequate blood flow. What could have caused my kidney stones? Do not use Rayos if you are allergic to prednisone. An abnormal swelling of tissue in the lungs due to fluid build-up. Cardiac Arrest: When the heart stops beating suddenly and respiration breathing and other body functions stop as a result. Read this Patient Information leaflet before you start taking Cilostazol tablets, USP and each time you get a refill. There may be new information. This information does not take the place of talking to your doctor about your medical condition or your treatment. The half-life of Adenosine is less than 10 seconds and adverse reactions of Adenosine injection usually resolve quickly when the infusion is discontinued, although delayed or persistent reactions have been observed. Methylxanthines, such as caffeine, aminophylline, and theophylline, are competitive Adenosine receptor antagonists and theophylline has been used to terminate persistent adverse reactions. In clinical trials, theophylline 50 to 125 mg slow intravenous injection was used to attenuate Adenosine injection adverse reactions in approximately 2% of patients. Renal Impairment: A linear relationship between anti-Factor Xa plasma clearance and creatinine clearance at steady state has been observed, which indicates decreased clearance of enoxaparin sodium in patients with reduced renal function. Avoid use in the third trimester of pregnancy and during labor and delivery. purchase cheapest ziprasidone online shopping

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MRHD on a systemic exposure basis. Annulus: A ring of tough fibrous tissue that is attached to and supports the leaflets of the heart valve. Sometimes more pictures are taken after you rest for 2 to 4 hours. Most people can resume their normal diet and activities after the final set of scans. There is no specific information comparing use of dipyridamole in children younger than 12 years of age with use in other age groups. Enoxaparin is a low molecular weight heparin which has antithrombotic properties. American Stroke Association. Stroke. Take this product by as directed. Follow all directions on the product package. Discontinue Adenosine injection in any patient who develops severe respiratory difficulties. Cox C, Sutherland W, Mann J, et al. Effects of dietary coconut oil, butter and safflower oil on plasma lipids, lipoproteins and lathosterol levels. Sankaranarayanan K, Mondkar JA, Chauhan MM, et al. Oil massage in neonates: an open randomized controlled study of coconut versus mineral oil. When applied to the skin, coconut oil has a moisturizing effect. Take Cilostazol tablets, USP 30 minutes before you eat or 2 hours after you eat. Grotta JC. Current medical and surgical therapy for cerebrovascular disease. N Engl J Med. In a second study, patients undergoing hip replacement surgery were treated, while hospitalized, with Enoxaparin Sodium Injection 40 mg SC, initiated up to 12 hours prior to surgery. All patients were examined for clinical signs and symptoms of venous thromboembolic VTE disease. In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make.

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Loeliger EA. Does dipyridamole have antithrombotic potential? Bundle Branch Block: Normally, the electrical impulse travels down both the right and left bundle branches at the same speed and the ventricles contract at the same time. If there is a block in one of the branches, it's called a bundle branch block. A bundle branch block causes the electrical impulse to travel more slowly through the blocked bundle. As a result, one ventricle contracts just after the other ventricle. Vasodilator: A type of medication that relaxes and dilates the blood vessels, allowing increased blood flow. May 11, 2017. Effect of Dipyridamole plus Aspirin on Hemodialysis Graft. Liau KM, Lee YY, Chen CK, Rasool AH. An open-label pilot study to assess the efficacy and safety of virgin coconut oil in reducing visceral adiposity. The pharmacologic and toxic effects of these agents may be increased by aspirin. Weinmann P, Moretti JL, Leynadier F "Anaphylaxis-like reaction induced by dipyridamole during myocardial scintigraphy. Coconut oil comes from the nut fruit of the coconut palm. The oil of the nut is used to make medicine. Some coconut oil products are referred to as "virgin" coconut oil. Unlike olive oil, there is no industry standard for the meaning of "virgin" coconut oil. The term has come to mean that the oil is generally unprocessed. For example, virgin coconut oil usually has not been bleached, deodorized, or refined. Do not crush, break, or chew this medication. Swallow the capsules whole. If you have trouble swallowing the capsule, you may open the capsule if it is not sealed and carefully sprinkle its contents on a spoonful of soft, cool applesauce. Swallow all of the mixture right away without chewing it. Then drink a glass of cool water to make sure you have swallowed all of the dose. Do not prepare the mixture ahead of time for later use. Doing so may destroy the drug. cheap decadron 10 mg

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Do not take medications containing aminophylline or oxtriphylline while using theophylline. There are no adequate and well-controlled studies of the use of aspirin and extended-release dipyridamole in pregnant women. If aspirin and extended-release dipyridamole is used during pregnancy, or if the patient becomes pregnant while taking aspirin and extended-release dipyridamole, inform the patient of the potential hazard to the fetus. An amino acid. High levels of homocysteine are a risk factor for coronary artery disease. However, treatment of high homocysteine levels have not been shown to lower the risk of heart disease. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. Effects on circulating plasma lipids have been examined in patients taking Cilostazol. What should I avoid while using aspirin and extended-release dipyridamole capsules? SC, based on anti-Factor Xa activity is approximately 100% in healthy subjects. Accidental overdosage following administration of Enoxaparin Sodium Injection may lead to hemorrhagic complications. Injected enoxaparin sodium may be largely neutralized by the slow IV injection of protamine sulfate 1% solution. The dose of protamine sulfate should be equal to the dose of enoxaparin sodium injected: 1 mg protamine sulfate should be administered to neutralize 1 mg enoxaparin sodium, if enoxaparin sodium was administered in the previous 8 hours. Salicylic acid is widely distributed to all tissues and fluids in the body, including the central nervous system, breast milk and fetal tissues. Read the Patient Information Leaflet if available from your before you start taking this product and each time you get a refill. If you have any questions, ask your doctor or pharmacist. Angina also called angina pectoris: Discomfort or pressure, usually in the chest, caused by a temporarily inadequate blood supply to the heart muscle. Discomfort may also be felt in the neck, jaw, or arms. Unstable Angina: This type of angina is considered an acute coronary syndrome. It may be a new symptom or a change from stable angina. It may come more often, occur at rest, or feel more severe. Although this angina can be relieved with oral medications, it is unstable and may progress to a heart attack. Usually medical treatment or a procedure is required in the near future. The antithrombotic action of aspirin and extended-release dipyridamole is the result of the additive antiplatelet effects of dipyridamole and aspirin.

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Enoxaparin Sodium Injection is indicated for the prophylaxis of ischemic complications of unstable angina and non-Q-wave myocardial infarction, when concurrently administered with aspirin. HIT is a serious antibody-mediated reaction resulting from irreversible aggregation of platelets. HIT may progress to the development of venous and arterial thromboses, a condition known as HIT with thrombosis. Thrombotic events may also be the initial presentation for HIT. These serious thromboembolic events include deep vein thrombosis, pulmonary embolism, cerebral vein thrombosis, limb ischemia, stroke, myocardial infarction, thrombus formation on a prosthetic cardiac valve, mesenteric thrombosis, renal arterial thrombosis, skin necrosis, gangrene of the extremities that may lead to amputation, and possibly death. Monitor thrombocytopenia of any degree closely. See "What is the most important information I should know about Cilostazol tablets, USP? In postmarketing reporting experience, there have been rare reports of hypersensitivity reactions such as rash, urticaria, severe bronchospasm, and angioedema larynx edema, fatigue, malaise, myalgia, arthritis, nausea, dyspepsia, paresthesia, hepatitis, thrombocytopenia, alopecia, cholelithiasis, hypotension, palpitation, and tachycardia. The risk of QT prolongation may be increased if you have certain medical conditions or are taking other drugs that may cause QT prolongation. Before using cilostazol, tell your doctor or pharmacist of all the drugs you take and if you have any of the following conditions: certain problems , slow heartbeat, QT prolongation in the family history of certain heart problems QT prolongation in the EKG, sudden cardiac death. Belching; bloating; dizziness; flushing; gas; indigestion; nausea; stomach discomfort or upset; vomiting. Cilostazol tablets, USP stops a protein called phosphodiesterase III from working. Other similar drugs which affect this protein may cause death if you already have heart problems, called class 3 to 4 III-IV heart failure. Do not take Cilostazol tablets, USP if you have heart failure of any kind. How should I take Cilostazol tablets, USP? Acute anaphylaxis, hypersensitivity, laryngeal edema postmarketing. Hypersensitivity to Dipyridamole and any of the other components. In severe cases, hyperthermia and hypovolemia are the major immediate threats to life. Using dipyridamole with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines. SEM plasma concentration-time profile at steady state after multiple dosing of Cilostazol 100 mg twice daily. buspirone

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Suspend container from hanger. Whenever possible, agents which may enhance the risk of hemorrhage should be discontinued prior to initiation of Enoxaparin Sodium Injection therapy. These agents include medications such as: anticoagulants, platelet inhibitors including acetylsalicylic acid, salicylates, NSAIDs including ketorolac tromethamine dipyridamole, or sulfinpyrazone. Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. 'Multum' is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Fatal and nonfatal cardiac arrest, sustained ventricular tachycardia requiring resuscitation and myocardial infarction have occurred following Adenosine infusion. Avoid use in patients with symptoms or signs of acute myocardial ischemia, for example, unstable angina or cardiovascular instability; these patients may be at greater risk of serious cardiovascular reactions to Adenosine injection. Original Article. Effect of Dipyridamole plus Aspirin on Hemodialysis Graft Patency. Drugs such as acetylsalicylic acid, dextran, phenylbutazone, ibuprofen, indomethacin, dipyridamole, hydroxychloroquine and others that interfere with platelet-aggregation reactions the main hemostatic defense of Heparinized patients may induce bleeding and should be used with caution in patients receiving Heparin sodium. After hemostasis was established, treatment was initiated 12 to 24 hours after surgery and was continued for 10 to 14 days after surgery. The hypotensive effects of beta blockers may be diminished by the concomitant administration of aspirin due to inhibition of renal prostaglandins, leading to decreased renal blood flow and salt and fluid retention. Gallstones removal. ERCP can remove gallstones from the bile duct, but not from the gallbladder itself.

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WPW: WPW is a pathway that makes a form of supraventricular tachycardia fast heart rate originating above the ventricles. People with WPW have more than one electrical conduction pathway in their hearts accessory pathways. March 5, 2016. Kidney International - Dipyridamole and low-dose warfarin. If you are taking this medication "as needed" not on a regular schedule remember that pain work best if they are used as the first occur. If you wait until the pain has worsened, the medicine may not work as well. First International Low Molecular Weight Heparin Reference Standard. While this dose of Cilostazol produced pharmacologic effects in monkeys, plasma Cilostazol levels were less than those seen in humans given the MRHD, and those seen in dogs given doses associated with cardiovascular lesions. Ganji V, Kies CV. Psyllium husk fibre supplementation to soybean and coconut oil diets of humans: effect on fat digestibility and faecal fatty acid excretion. Most commonly, it is kept intact at its origin and sewn to the coronary artery beyond the site of blockage. If the surgeon removes the mammary artery from its origin to use as a bypass graft, it is then called a "free" mammary artery bypass graft. Metabolic Exercise Stress Test also called metabolic stress test: A test used to measure the performance of the heart and lungs while they are under physical stress. The test involves walking on a treadmill or pedaling a stationary bike at increasing levels of difficulty, while being closely monitored. Dipyridamole prevents diabetes-induced alterations of kidney. Overdose symptoms may include flushing warmth, redness, or tingly feeling restless feeling, sweating, weakness, or fainting. What should I avoid while taking Persantine dipyridamole? Infusion of undiluted Dipyridamole Injection may cause local irritation. If your condition persists or worsens, or if you think you may have a serious medical problem, seek immediate medical attention. Heparin resulted in increased resorptions. If you miss a dose, skip the missed dose. Take your next dose at the regular time. Monagle P, Chan AK, Goldenberg NA et al. Antithrombotic therapy in neonates and children: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. Table 24: Efficacy of Enoxaparin Sodium Injection in the Prophylaxis of Ischemic Complications in Unstable Angina and Non-Q-Wave Myocardial Infarction Combined Endpoint of Death or Myocardial Infarction All patients were also treated with aspirin 100 to 325 mg per day. Evaluation timepoints are after initiation of treatment. buy amaryl in germany

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Category B: Conventional tablets and injection. Who should not take Cilostazol tablets, USP? After hemostasis was established, treatment was initiated 12 to 24 hours after surgery and was continued up to 15 days after surgery. The incidence of proximal and total DVT after surgery was significantly lower for Enoxaparin Sodium Injection compared to placebo. Ethylene glycol poisoning is caused by the ingestion of ethylene glycol, the primary ingredient in automotive antifreeze. Ethylene glycol is a toxic, colorless. cytoxan

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Take pentoxifylline by mouth with a meal. April 12, 2017. Hypophosphatemia Clinical Presentation: History, Physical. Batista Procedure: During this surgical procedure, to treat heart failure, the surgeon cuts out a piece of the patient's enlarged left ventricular muscle. Mortality Rate: The percentage of deaths associated with a disease or medical treatment. If you have any questions about dipyridamole tablets, please talk with your doctor, pharmacist, or other health care provider.

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Taking Cilostazol tablets, USP and drinking grapefruit juice can increase the amount of Cilostazol tablets, USP causing side effects. Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention. Cilostazol is a quinolinone derivative that inhibits cellular phosphodiesterase more specific for phosphodiesterase III. The empirical formula of Cilostazol is C 20H 27N 5O 2, and its molecular weight is 369. May 13, 2017. Dipyridamole attenuates ischemia reperfusion induced acute. Patients taking aspirin in combination with anagrelide are at an increased risk of bleeding. gefitinib

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Augmentation of peritoneal clearance by dipyridamole. Kidney Int. 1982. Tell your doctor if your condition persists or worsens. Carry an identification card at all times that says you are taking this medication.

Anemia reduces the amount of oxygen available to the body. Cilostazol is an antiplatelet drug and a vasodilator. It works by stopping called platelets from sticking together and prevents them from forming harmful clots. It also widens blood vessels in the legs. Cilostazol helps the blood to move more easily and keeps blood flowing smoothly in your body. Collateral Blood Vessels: Small capillary-like branches of an artery that form over time in response to narrowed coronary arteries. The collaterals "bypass" the area of narrowing and help to restore blood flow. However, during times of increased exertion, the collaterals may not be able to supply enough oxygen-rich blood to the heart muscle.

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