constrict

* WISDOM TROVE *

1:Thoughts can increase our understanding of a subject, or they can just as easily constrict or block our understanding of a subject. It very much depends upon the language we are thinking in. ~ frederick-lenz, @wisdomtrove

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1:My wish for you is that you feel no need to constrict yourself to make other people comfortable. ~ Ta Nehisi Coates,

2:In a fallen world there is a powerful pressure to constrict your life to the shape and size of your life. ~ Paul David Tripp,

3:In a fallen world there is a powerful pressure to constrict your life to the shape and size of your life. There ~ Paul David Tripp,

4:He felt his throat constrict. and was overcome with an emotion that he could not name. because it was a mixture of so many. ~ Louis de Berni res,

5:You are growing into consciousness, and my wish for you is that you feel no need to constrict yourself to make other people comfortable. ~ Ta Nehisi Coates,

6:Lilac won’t talk to me again. There’s a tremor. Lilac won’t kiss me again. I won’t hear her laugh. My lungs constrict. Why am I doing this to myself ? ~ Amie Kaufman,

7:Meg felt her heart constrict. There was so much she wanted to say to him. Things any normal mother would say, like that a one-handed backhand is more versatile. ~ Nell Zink,

8:Thoughts can increase our understanding of a subject, or they can just as easily constrict or block our understanding of a subject. It very much depends upon the language we are thinking in. ~ Frederick Lenz,

9:I don't like clothes that constrict. The idea is that they should accompany and help you. There's nothing superficial about getting dressed. Clothes can give you self-confidence and help you be yourself. ~ Christophe Lemaitre,

10:So often we think of a wound or a loss as making a person feel more deeply, become a better person. But I don't think that always happens. I think it can constrict people's lives, especially if they don't push beyond it. ~ Leni Zumas,

11:We are more willing to offend someone with whom we have weak ties, and a willingness to offend is an important part of creativity. Strong ties make us feel good, make us feel that we belong, but they also constrict our worldview. ~ Eric Weiner,

12:For Jefferson and his contemporaries—and, thankfully, for most of their successors in positions of ultimate authority—one of the main points of public life was to enable human creativity and ingenuity and possibility, not to constrict it. ~ Jon Meacham,

13:If I were doing the Security Council today, I'd have one permanent member, the United States, because that's the real reflection of the distribution of power in the world. All international laws are invalid, meaningless attempts to constrict American power. ~ John Bolton,

14:Angels light the way. Angels do not begrudge anyone anything, angels do not tear down, angels do not compete, angels do not constrict their hearts, angels do not fear. That's why they sing and that's how they fly. We, of course, are only angels in disguise. ~ Marianne Williamson,

15:Fear..." I uncrossed her arms and linked my fingers with hers. "Is what makes us feel alive. Fear causes our blood vessels to constrict, and then the amygdala, a tiny almond shaped part of our brain, sends signals to our nervous system. The signal says run or fight. ~ Rachel Van Dyken,

16:Either way, the thought of entire lives lost—family celebrations, Christmases and birthdays, love affairs and bedtime stories, weddings and high school graduations—because of a misfire or unexplained chaos inside a person’s brain, made her chest constrict. It wasn’t fair. ~ Ellen Marie Wiseman,

17:One thing that stress does is make us ungenerous, so we constrict, we look after our own. We get solipsistic and go into our own narcissistic spiral. What this taught me is that there is a way of dealing with stress that is much more welcoming and open and hospitable to the world. ~ Kyo Maclear,

18:Obviously, there are people who constrict themselves and build walls around themselves, whether it's from a moral standpoint or a patriotic standpoint, or just plain old conformity, and who therefore live in those little prisons, and when things breach those walls, it's shocking for them. ~ George Carlin,

19:She said when a boy and a girl dog copulate, the head of the boy's penis swells and the vaginal muscles of the girl constrict. Even after sex, both dogs remain locked together, helpless and miserable for a brief period of time.
The Mommy said this same scenario described most marriages. ~ Chuck Palahniuk,

20:I should have acted sooner. Saved him. It was in my power.” Her throat closed painfully. Then Crash did something unexpected. He sat down on the bed, his hand landing close to her face, gazing down at her intently. For reasons unknown, Sora felt her breath catch, her chest constrict peculiarly. ~ T L Shreffler,

21:The singing grew louder as they approached the church. It made Harry’s throat constrict, it reminded him so forcefully of Hogwarts, of Peeves bellowing rude versions of carols from inside suits of armour, of the Great Hall’s twelve Christmas trees, of Dumbledore wearing a bonnet he had won in a cracker, of Ron in a hand-knitted sweater… ~ J K Rowling,

22:Minds don't rest; they reel and wander and fixate and roll back and reconsider because it's like this, having a mind. Hearts don't idle; they swell and constrict and break and forgive and behold because it's like this, having a heart. Lives don't last; they thrill and confound and circle and overflow and disappear because it's like this, having a life. ~ Kelly Corrigan,

23:Minds don’t rest; they reel and wander and fixate and roll back and reconsider because it’s like this, having a mind. Hearts don’t idle; they swell and constrict and break and forgive and behold because it’s like this, having a heart. Lives don’t last; they thrill and confound and circle and overflow and disappear because it’s like this, having a life. ~ Kelly Corrigan,

24:The smile he gave her was slow in forming, and when it came, she felt pain constrict her chest. Memories came at her in waves, surging over the breakwater she’d built in the isolated years. Him sweeping her into his arms, twirling her around; picking her up from a fall, dusting her off, whispering, Not so loud, my little terror, you’ll wake your maman … ~ Kristin Hannah,

25:Constriction alters a person’s breathing, muscle tone, and posture in order to promote efficiency and strength. Blood vessels in the skin, extremities, and internal organs constrict so that more blood is available to the muscles, which are tensed and prepared to take defensive action. At the same time, the digestive system is inhibited. We may also feel numb and shut down. ~ Peter A Levine,

26:It is easy to see the beginnings of things, and harder to see the ends. I can remember now, with a clarity that makes the nerves in the back of my neck constrict, when New York began for me, but I cannot lay my finger upon the moment it ended, can never cut through the ambiguities and second starts and broken resolves to the exact place on the page where the heroine is no longer as optimistic as she once was. ~ Joan Didion,

27:Johnson’s research suggests that elevated levels of uric acid (at least in laboratory animals) leads to mild kidney damage and accelerates the process of kidney disease that’s already established. The uric acid appears to cause the blood vessels in the kidneys to constrict and increases the blood pressure in the small capillaries (known as glomeruli) through which the kidneys filter waste products from the blood. ~ Gary Taubes,

28:He chose not to work through the limited official channels that the Army and the OSRD had devised to constrict the flow of information. “I wanted to let Oppenheimer know what we were doing. Someone in the Bureau of Ships knew one of the people in the [Navy] Bureau of Ordnance who was going out to Los Alamos. I remember that I met the man at the old Warner Theater here in Washington, up in the balcony—real cloak and dagger stuff. ~ Richard Rhodes,

29:In a fallen world there is a powerful pressure to constrict your life to the shape and size of your life. There is a compelling tendency to forget who you are and what you were made for. There is a tendency to be shortsighted, myopic, and easily distracted. There is a tendency to settle for less when you have been created for more. There is something expansive, glorious, and eternal that is meant to give direction to everything you do. ~ Paul David Tripp,

30:The odd thing was, Dickie longed to experience that feeling. It wasn't any kind of death wish: there was not a suicidal cell in his body. rather, it seemed that the very sensation, the inner force that made Dickie's scrotum tighten, his throat constrict, and his eyeballs swim in dizziness also made him want to tumble into the precipitous void. And ultimately, his fear of longing to fall was greater, more disturbing, than his fear of falling. ~ Tom Robbins,

31:She hesitated. “I’m not sure I understand.”
“Don’t you?” he asked. “You changed my heart, Rachel.”
She felt her throat constrict, making any reply impossible.
“Rachel?” Her silence rarely made him uncomfortable, but this time he had no clear view of her features and no way to gauge her reaction. He wondered if he should have made a more straightforward declaration. “Did you hear me say I love you?”
She turned her cheek into his shoulder. “I heard you. ~ Jo Goodman,

32:This forgetting, this slide into smallness, this irritability and shame, this disorienting grief: It’s like this. Minds don’t rest; they reel and wander and fixate and roll back and reconsider because it’s like this, having a mind. Hearts don’t idle; they swell and constrict and break and forgive and behold because it’s like this, having a heart. Lives don’t last; they thrill and confound and circle and overflow and disappear because it’s like this, having a life. ~ Kelly Corrigan,

33:Dependency may appear to be love because it is a force that causes people to fiercely attach themselves to one another. But in actuality it is not love; it is a form of antilove. It has its genesis in a parental failure to love and it perpetuates the failure. It seeks to receive rather than to give. It nourishes infantilism rather than growth. It works to trap and constrict rather than to liberate. Ultimately it destroys rather than builds relationships, and it destroys rather than builds people. ~ M Scott Peck,

34:In a fallen world there is a powerful pressure to constrict your life to the shape and size of your life. There is a compelling tendency to forget who you are and what you were made for. There is a tendency to be shortsighted, myopic, and easily distracted. There is a tendency to settle for less when you have been created for more. There is something expansive, glorious, and eternal that is meant to give direction to everything you do. And when you lose sight of it, you have effectively denied your own humanity. ~ Paul David Tripp,

35:You are growing into consciousness, and my wish for you is that you feel no need to constrict yourself to make other people comfortable. None of that can change the math anyway. I never wanted you to be twice as good as them, so much as I have always wanted you to attack every day of your brief bright life in struggle. The people who must believe they are white can never be your measuring stick. I would not have you descend into your own dream. I would have you be a conscious citizen of this terrible and beautiful world. — ~ Ta Nehisi Coates,

36:Struggling transforms her captor into a Chinese finger trap. She’s suffocating. Sucking in air without relief. Her lungs expand. Contract. Expand. They fill with lies and broken promises. With despair and lost hope. Each inhale is empty. Invisible hands reach into her body and constrict around her windpipe. She watches her friends collapse like supernovae, their cognizance disappearing into a black hole. A black hole she’s quickly cascading into. The dark consumes, bleeds into her vision. She blinks. Catches icy blue eyes peeking out from the shadows. ~ Laura Kreitzer,

37:Generally speaking, we call neurotic any life style that begins to constrict too much, that prevents free forward momentum, new choices, and growth that a person may want and need. For example, a person who is trying to find his salvation only in a love relationship but who is being defeated by this too narrow focus is neurotic. He can become overly passive and dependent, fearful of venturing out on his own, of making his life without his partner, no matter how that partner treats him. The object has become his “All,” his whole world; and he is reduced to the status of a simple reflex of another human being. ~ Ernest Becker,

38:music stopped, and I felt my heart constrict, like I’d lost something precious. I took another step, and another, until I could see through the leaves. That’s when I realized the singer was a person. A little girl. She was plain, with brown hair the same color as mine. But hers was ratted around her face like she’d never seen a brush, and she had dirt smeared across her cheeks and nose. Too thin, I thought, as she climbed over the edge of the bundled mess of sticks and out onto a branch to see me better. She was awfully close to the slender branches that I knew wouldn’t hold the weight of a kid, even a skinny little girl. I had to get her to come down before ~ Nikki Loftin,

39:He looked at his monitor. A hundred and seventy-five. A hundred and seventy-two. A welcome little gust of wind carried the sound of distant cheering up from the town. It must have been from Ullevål Stadium—there was an important international match this evening. Slovakia or Slovenia. Erlend Vennesla imagined for a few seconds that they had been applauding for him. It was a while since anyone had done that. The last time would have been the farewell ceremony at Kripos up at Bryn. Layer cake, speech by the boss, Mikael Bellman, who since then had continued his steady rise to take the top police job. And Erlend had received the applause, met their eyes, thanked them and even felt his throat constrict as he was about to deliver his simple, brief speech. ~ Jo Nesb,

40:I am speaking to you as I always have—as the sober and serious man I have always wanted you to be, who does not apologize for his human feelings, who does not make excuses for his height, his long arms, his beautiful smile. You are growing into consciousness, and my wish for you is that you feel no need to constrict yourself to make other people comfortable. None of that can change the math anyway. I never wanted you to be twice as good as them, so much as I have always wanted you to attack every day of your brief bright life in struggle. The people who must believe they are white can never be your measuring stick. I would not have you descend into your own dream. I would have you be a conscious citizen of this terrible and beautiful world. ~ Ta Nehisi Coates,

41:I am speaking to you as I always have - as the sober and serious man I have always wanted you to be, who does not apologize for his human feelings, who does not make excuses for his height, his long arms, his beautiful smile. You are growing into consciousness, and my wish for you is that you feel no need to constrict yourself to make other people comfortable. None of that can change the math anyway. I never wanted you to be twice as good as them, so much as I have always wanted you to attack every day of your brief bright life in struggle. The people who must believe they are white can never be your measuring stick. I would not have you descend into your won dream. I would have you be a conscious citizen of this terrible and beautiful world. ~ Ta Nehisi Coates,

42:Gradually it was disclosed to me that the line separating good and evil passes not through states, nor between classes, nor between political parties either -- but right through every human heart -- and through all human hearts. This line shifts. Inside us, it oscillates with the years. And even within hearts overwhelmed by evil, one small bridgehead of good is retained. And even in the best of all hearts, there remains ... an unuprooted small corner of evil.

Since then I have come to understand the truth of all the religions of the world: They struggle with the evil inside a human being (inside every human being). It is impossible to expel evil from the world in its entirety, but it is possible to constrict it within each person. ~ Aleksandr Solzhenitsyn,

43:You know, one of the things that made me come here, was that I am frightfully afraid of being alone. The fear of the dark is only part of it. I wanted to break that fear in the middle, because I am afraid much of my existance is going to be more or less alone, and I might as well go into training for it. It comes on me at night mostly, in little waves of panic, that constrict something in my stomach. But don;t you think it is good to fight these things? Last night, some quite large animal came and sniffed under the door. I presume it was a coyote, though I do not know. The moon had not come up, and when I run outside there was nothing to be seen. But the main thing was that I was frightened, even though I knew it could be nothing but a coyote. Don't tell anyone I am afraid. I do not like to be suspected of being afraid. ~ John Steinbeck,

44:You know, one of the things that made me come here, was that I am frightfully afraid of being alone. The fear of the dark is only a part of it. I wanted to break that fear in the middle, because I am afraid much of my existance is going to be more or less alone, and I might as well go into training for it. It comes on me at night mostly, in little waves of panic, that constrict something in my stomach. But don;t you think it is good to fight these things? Last night, some quite large animal came and sniffed under the door. I presume it was a coyote, though I do not know. The moon had not come up, and when I run outside there was nothing to be seen. But the main thing was that I was frightened, even though I knew it could be nothing but a coyote. Don't tell anyone I am afraid. I do not like to be suspected of being afraid. ~ John Steinbeck,

45:You know, one of the things that made me come here, was that I am frightfully afraid of being alone. The fear of the dark is only a part of it. I wanted to break that fear in the middle, because I am afraid much of my existence is going to be more or less alone, and I might as well go into training for it. It comes on me at night mostly, in little waves of panic, that constrict something in my stomach. But don't you think it is good to fight these things? Last night, some quite large animal came and sniffed under the door. I presume it was a coyote, though I do not know. The moon had not come up, and when I run outside there was nothing to be seen. But the main thing was that I was frightened, even though I knew it could be nothing but a coyote. Don't tell anyone I am afraid. I do not like to be suspected of being afraid. ~ John Steinbeck,

46:Tick's strategy for dealing with lying adults is to say nothing and watch thee lies swell and constrict in their throats. when this happens, the lie takes on a physical life of its own and must be either expelled or swallowed. Most adults prefer to expel untruths with little burplike coughs behind their hands, while others chuckle or snort or make barking sounds. When Mr. Meyer's Adam's apple bobs once, Tick sees that he's a swallower, and that this particular lie has gone south down his esophagus and into his stomach. According to her father, the man suffers from bleeding ulcers. Tick can see why. She imagines all the lies a man in his position would have to tell, how they must just churn away down there in his intestines like chunks of indigestible food awaiting elimination. By the Tick suspects, lies seek open air. they don't like being confined in dark, cramped places. ~ Richard Russo,

47:And what about things from your own childhood? Do you still keep your report cards or graduation certificates? When my client pulled out a school uniform from forty years ago, even I felt my heart constrict with emotion. But it still should be disposed of. Let all those letters you received years ago from a girlfriend or boyfriend go. The purpose of a letter is fulfilled the moment it is received. By now, the person who wrote it has long forgotten what he or she wrote and even the letter’s very existence. As for accessories you received as gifts, keep them only if they bring you pure joy. If you are keeping them because you can’t forget a former boyfriend, it’s better to discard or donate them. Hanging on to them makes it more likely that you will miss opportunities for new relationships. It is not our memories but the person we have become because of those past experiences that we should treasure. ~ Marie Kond,

48:Sustainability is today’s freedom crusade, because the next generation will not live free—will not have the freedom to pursue its economic dreams or to delight in all that nature has to offer—if our approach to the financial world and the natural are not grounded in sustainable values. That lack of sustainability will constrict everything in our lives. It will limit everything we might want to do. Unless we become less dependent on hydrocarbons, and unless we find a balance between the need for markets to be free enough to reward innovation and risk-taking but not so free as to reward recklessness that can destabilize the whole global economy, our lives will be reduced, redacted, and restricted. We will be overwhelmed by all the toxic assets we will produce in the Market and in Mother Nature. It will feel worse than had the Soviet Union won the Cold War, because we and our children will be enslaved by our financial debts and constricted by our ecological debts. ~ Thomas L Friedman,

49:Anything perceived as a threat trips the amygdala—the brain’s hand-wringing sentry—to set in motion the biochemical cascade known as the fight-or-flight response. Bruce Siddle, who consults in this area and sits on the board of Strategic Operations, prefers the term “survival stress response.” Whatever you wish to call it, here is a nice, concise summary, courtesy of Siddle: “You become fast, strong, and dumb.” Our hardwired survival strategy evolved back when threats took the form of man-eating mammals, when hurling a rock superhumanly hard or climbing a tree superhumanly fast gave you the edge that might keep you alive. A burst of adrenaline prompts a cortisol dump to the bloodstream. The cortisol sends the lungs into overdrive to bring in more oxygen, and the heart rate doubles or triples to deliver it more swiftly. Meanwhile the liver spews glucose, more fuel for the feats at hand. To get the goods where the body assumes they’re needed, blood vessels in the large muscles of the arms and legs dilate, while vessels serving lower-priority organs (the gut, for example, and the skin) constrict. The prefrontal cortex, a major blood guzzler, also gets rationed. Good-bye, reasoning and analysis. See you later, fine motor skills. None of that mattered much to early man. You don’t need to weigh your options in the face of a snarling predator, and you don’t have time. ~ Mary Roach,

50:WHY FAST: Brain function. A neuroscientist Mark Mattson found that intermittent fasting increases levels of a protein called brain-derived neurotrophic factor, or BDNF. This, in turn, stimulates new brain cells in the hippocampus, the region of the brain that is responsible for memory. (Shrinking of the hippocampus has been linked to dementia and Alzheimer’s disease.) Increases mood. The protein called BDNF that helps improve memory also suppresses anxiety and elevates mood. Mattson showed this to be true in a study of rats. He injected BDNF into their brains, and it had the same effect as a regular antidepressant. Increases the effectiveness of insulin, the hormone that affects our ability to process sugar and break down fat. Reduces blood pressure. As your insulin level increases, so does your blood pressure. Insulin stores magnesium, but if your insulin receptors are blunted and your cells grow resistant to insulin, you can’t store magnesium; it ends up passing out of your body through urination. Magnesium in your cells relaxes muscles. If your magnesium level is too low, your blood vessels will constrict rather than relax, which will raise your blood pressure and decrease your energy level. Reduces triglycerides. Insulin upregulates LPL on fat tissue and inhibits activation on muscle cells. On the other hand, glucagon upregulates LPL on muscle and cardiac tissue, while inhibiting the activation of fat. Weight loss. You burn fat, rather than sugar, in a fasted state. ~ Maria Emmerich,

51:I am sorry that I cannot make it okay. I am sorry that I cannot save you -- but not that sorry. Part of me thinks that your very vulnerability brings you closer to the meaning of life, just as for others, the quest to believe oneself white divides them from it. The fact is that despite their dreams, their lives are also not inviolable. When their own vulnerability becomes real -- when the police decide that tactics for the ghetto should enjoy wider usage, when their armed society shoots down their children, when nature sends hurricanes against their cities -- they are shocked in a way that those of us who were born and bred to understand cause and effect can never be. And I would not have you like them. You have been cast into a race in which the wind is always at your face and the hounds are always at your heels. And to varying degrees this is true of all life. The difference is that you do not have the privilege of living in ignorance of this essential fact. I am speaking to you as I always have -- as the sober and serious man I have always wanted you to be, who does not apologize for his human feelings, who does not make excuses for his height, his long arms, his beautiful smile. You are growing into consciousness, and my wish for you is that you feel no need to constrict yourself to make other people comfortable. None of that can change the math anyway. I never wanted you to be twice as good as them, so much as I have always wanted you to attack every day of your brief bright life in struggle. The people who must believe they are white can never be your measuring stick. I would not have you descend into your own dream. I would have you be a conscious citizen of this terrible and beautiful world. ~ Ta Nehisi Coates,

52:Y-You love me?”
Gazing down at her pert nose and the freckles that made him think of an adorable pixie, he felt his throat constrict. “I want you every hour of the day. I can’t imagine a future without you in it. The idea of returning to my empty house alone is so hellish that I’d rather wander the world at your heels than be without you. Tell me, is that love?”
She cast him a blazing smile. “It sounds like it.”
“Then I love you, my wonderful, sword-wielding, tart-tongued angel. I want you to be my wife. I want you to preside over my table and accompany me to balls and share my bed.” A most uncharacteristic happiness surged through him. “And I want to have children with you, lots of them, filling every room in Halstead Hall.”
A sudden understanding lit her face. His clever love didn’t miss the fact that he was offering her not just himself, but everything else he’d neglected, as well. Everything that he wanted to put to rights. That he needed to put to rights.
“Not filling every room, I hope,” she teased, even as tears shone in her eyes. “There are three hundred, after all.”
“Then I suppose we’ll have to get started right away,” he said, matching her light tone. His heart near to bursting, he reached again for the buttons on the back of her gown. “These things should never be left until the last minute.”
As a laugh of pure joy bubbled out of her, she began to untie his cravat. “I can see you’re going to be quite the lusty husband, aren’t you?”
He stripped her gown from her, then turned her around to undo her stays. “You have no idea,” he murmured, and filled his hands with the breasts he’d freed.
Moaning, she pressed her bottom against him. “I have some idea. ~ Sabrina Jeffries,

53:All right there, mate?’ Clark jumped and turned round. He straightened up and looked at Billy, recognition taking a few seconds. Billy’s hair was shorter now, and his face was tanned. ‘Christ, you startled me,’ he said. ‘What have you got there?’ Clark held up the jar by a piece of tatty string. ‘Sticklebacks!’ For a moment his blue eyes shone with excitement, then they clouded over. He ran a wet hand through his red hair and swept it off his face. His freckles were more pronounced than usual, and for a moment Billy saw him as an eleven-year-old again. He felt his throat constrict, which made his next sentence a strangled croak. ‘We had fun, didn’t we, Clark?’ Clark snorted and set the jar of fish down on a large stone. He waded out of the water and sat down heavily on the bank. Billy edged closer and then tentatively sat down next to him. ‘Don’t get too comfortable,’ said Clark. ‘Look, Clark. Can’t we be friends again?’ ‘Can’t we be friends again?’ mimicked Clark. ‘We’re not in the school playground now, Billy.’ ‘Why did you come here?’ asked Billy. Clark thought for a moment. ‘To reflect.’ He reached inside his jacket and pulled out a brown envelope. ‘Here,’ he said, thrusting it into Billy’s hands. Billy opened the envelope and stared at the contents. ‘You’ve been called up?’ ‘Military training,’ explained Clark. Billy knew it was only a matter of time. Since Parliament had passed the Act in April, all men aged twenty and twenty-one were required to undertake six months’ military training. He didn’t know what to say. ‘Clark, look …’ He passed the envelope back. ‘How’s Chrissie?’ asked Clark, looking Billy directly in the eye. Billy was taken by surprise at the sudden mention of her name and picked at a blade of grass. ‘She’s fine, thanks. In fact she’s with me now, over there.’ Clark looked in the direction of Billy’s finger and Chrissie slid out sheepishly from behind a tree. ~ Kathryn Hughes,

54:constrict cutaneous muscle and splanchnic vasculature and promote salt and water retention. h e synthesis of vasodilating prostaglandins (prostacyclin and PGE 2 ) and nitric oxide in the kidneys and the intrarenal action of angiotensin II recurrent angina signals the need for angiography, if it has not already been performed. Intraaortic balloon counterpulsation is usually reserved for hemodynamically compromised patients with refractory ischemia. Temporary pacing following AMI is indicated for Mobitz type II and complete heart block, a new bifascicular block, and bradycardia with hypotension. Emergency treatment of arrhythmias constantly evolves and we recommend that the guidelines for Advanced Cardiac Life Support be followed. In general, ventricular tachycardia, if treated medically is best managed with amiodarone (150 mg intravenous bolus over 10 min). Synchronized cardioversion may be used in patients with ventricular tachycardia and with a pulse. Patients with a stable narrow-complex supraventricular tachycardia should be treated with amiodarone. Patients with paroxysmal supraventricular tachycardia, whose ejection fraction is preserved, should be treated with a calcium channel blocker, a β blocker, or DC cardioversion. Medically unstable hypotensive patients should receive cardioversion. Patients with ectopic or multifocal atrial tachycardia should not receive DC cardioversion; instead they should be treated with calcium channel blockers, a β blocker, or amiodarone. Acute Kidney Injury & Failure Acute kidney injury (AKI) is a rapid deterioration in renal function that is not immediately reversible by altering factors such as blood pressure, intravascular volume, cardiac output, or urinary l ow. h e hallmark of AKI is azotemia and frequently oliguria. Azotemia may be classii ed as prerenal, renal, and postrenal.Moreover, the diagnosis of renal azotemia is one of exclusion; thus, prerenal and postrenal causes must always be excluded.However, not all patients with acute azotemia have kidney failure.Likewise, urine output of more than 500 mL/d does not imply that renal function is normal. Basing the diagnosis of AKI on creatinine levels or an increase in blood urea nitrogen (BUN) is also problematic because creatinine clearance is not always a good measure of glomerular i ltration 12 r a t e . h e criteria developed by the Acute Kidney Injury Network are now most ot en used ~ Anonymous,

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