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Edwin Austin Abbey biography

When used, ARBs should be initiated with the starting doses shown in Table Many of the considerations with initiation of an ARB are similar to those with initiation of an ACE inhibitor, as discussed previously. Blood pressure including postural blood pressure changes , renal function, and potassium should be reassessed within 1 to 2 weeks after initiation and followed closely after changes in dose. Titration is generally achieved by doubling doses. For stable patients, it is reasonable to add therapy with beta-blocking agents before full target doses of either ACE inhibitors or ARBs are reached.

The risks of ARBs are attributed to suppression of angiotensin stimulation. These risks of hypotension, renal dysfunction, and hyperkalemia are greater when combined with another inhibitor of this neurohormonal axis, such as ACE inhibitors or aldosterone antagonists. Use of 1 of the 3 beta blockers proven to reduce mortality eg, bisoprolol, carvedilol, and sustained-release metoprolol succinate is recommended for all patients with current or prior symptoms of HF r EF, unless contraindicated, to reduce morbidity and mortality.

The favorable effects of beta blockers were also observed in patients already taking ACE inhibitors. Three beta blockers have been shown to be effective in reducing the risk of death in patients with chronic HF r EF: bisoprolol and sustained-release metoprolol succinate , which selectively block beta-1—receptors; and carvedilol, which blocks alpha-1—, beta-1—, and beta-2—receptors.

Positive findings with these 3 agents, however, should not be considered a beta-blocker class effect. Bucindolol lacked uniform effectiveness across different populations, and short-acting metoprolol tartrate was less effective in HF clinical trials. Beta-1 selective blocker nebivolol demonstrated a modest reduction in the primary endpoint of all-cause mortality or cardiovascular hospitalization but did not affect mortality alone in an elderly population that included patients with HF p EF.

Beta blockers should be prescribed to all patients with stable HF r EF unless they have a contraindication to their use or are intolerant of these drugs. Because of its favorable effects on survival and disease progression, a clinical trial—proven beta blocker should be initiated as soon as HF r EF is diagnosed. Even when symptoms are mild or improve with other therapies, beta-blocker therapy is important and should not be delayed until symptoms return or disease progression is documented.

Therefore, even if patients have little disability and experience seemingly minimal symptomatic benefit, they should still be treated with a beta blocker to reduce the risks of disease progression, clinical deterioration, and sudden death. Patients need not take high doses of ACE inhibitors before initiation of beta-blocker therapy. In patients taking a low dose of an ACE inhibitor, the addition of a beta blocker produces a greater improvement in symptoms and reduction in the risk of death than does an increase in the dose of the ACE inhibitor, even to the target doses used in clinical trials.

Treatment with a beta blocker should be initiated at very low doses Table 15 , followed by gradual increments in dose if lower doses have been well tolerated. Patients should be monitored closely for changes in vital signs and symptoms during this uptitration period. Planned increments in the dose of a beta blocker should be delayed until any adverse effects observed with lower doses have disappeared.

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Even if symptoms do not improve, long-term treatment should be maintained to reduce the risk of major clinical events. Abrupt withdrawal of treatment with a beta blocker can lead to clinical deterioration and should be avoided. Initiation of treatment with a beta blocker may produce 4 types of adverse reactions that require attention and management: fluid retention and worsening HF; fatigue; bradycardia or heart block; and hypotension. The occurrence of fluid retention or worsening HF is not generally a reason for the permanent withdrawal of treatment.

Such patients generally respond favorably to intensification of conventional therapy, and once treated, they remain excellent candidates for long-term treatment with a beta blocker. The slowing of heart rate and cardiac conduction produced by beta blockers is generally asymptomatic and thus requires no treatment; however, if the bradycardia is accompanied by dizziness or lightheadedness or if second- or third-degree heart block occurs, clinicians should decrease the dose of the beta blocker.

Clinicians may minimize the risk of hypotension by administering the beta blocker and ACE inhibitor at different times during the day. Hypotensive symptoms may also resolve after a decrease in the dose of diuretics in patients who are volume depleted. If hypotension is accompanied by other clinical evidence of hypoperfusion, beta-blocker therapy should be decreased or discontinued pending further patient evaluation.

The symptom of fatigue is multifactorial and is perhaps the hardest symptom to address with confidence. Although fatigue may be related to beta blockers, other causes of fatigue should be considered, including sleep apnea, overdiuresis, or depression. See Online Data Supplement 20 for additional data on beta blockers. Patients with NYHA class II HF should have a history of prior cardiovascular hospitalization or elevated plasma natriuretic peptide levels to be considered for aldosterone receptor antagonists.

Creatinine should be 2. Careful monitoring of potassium, renal function, and diuretic dosing should be performed at initiation and closely followed thereafter to minimize risk of hyperkalemia and renal insufficiency. Inappropriate use of aldosterone receptor antagonists is potentially harmful because of life-threatening hyperkalemia or renal insufficiency when serum creatinine is greater than 2.

Eplerenone has been shown to reduce all-cause deaths, cardiovascular deaths, or HF hospitalizations in a wider range of patients with HF r EF. Clinicians should strongly consider the addition of the aldosterone receptor antagonists spironolactone or eplerenone for all patients with HF r EF who are already on ACE inhibitors or ARBs and beta blockers. Careful patient selection and risk assessment with availability of close monitoring is essential in initiating the use of aldosterone receptor antagonists. Spironolactone should be initiated at a dose of After initiation of aldosterone receptor antagonists, potassium supplementation should be discontinued or reduced and carefully monitored in those with a history of hypokalemia; Table 17 , and patients should be counseled to avoid foods high in potassium and NSAIDs.

Potassium levels and renal function should be rechecked within 2 to 3 days and again at 7 days after initiation of an aldosterone receptor antagonist. Subsequent monitoring should be dictated by the general clinical stability of renal function and fluid status but should occur at least monthly for the first 3 months and every 3 months thereafter. Drug Dosing for Aldosterone Receptor Antagonists. Adapted from Butler et al. ACE indicates angiotensin-converting enzyme. There are limited data to support or refute that spironolactone and eplerenone are interchangeable.

The perceived difference between eplerenone and spironolactone is the selectivity of aldosterone receptor antagonism and not the effectiveness of blocking mineralocorticoid activity. The development of worsening renal function should lead to careful evaluation of the entire medical regimen and consideration for stopping the aldosterone receptor antagonist.

Patients should be instructed specifically to stop the aldosterone receptor antagonist during an episode of diarrhea or dehydration or while loop diuretic therapy is interrupted. A combination of hydralazine and isosorbide dinitrate can be useful to reduce morbidity or mortality in patients with current or prior symptomatic HF r EF who cannot be given an ACE inhibitor or ARB because of drug intolerance, hypotension, or renal insufficiency, unless contraindicated.

In a large-scale trial that compared the vasodilator combination with placebo, the use of hydralazine and isosorbide dinitrate reduced mortality but not hospitalizations in patients with HF treated with digoxin and diuretics but not an ACE inhibitor or beta blocker. The combination of hydralazine and isosorbide dinitrate is recommended for African Americans with HF r EF who remain symptomatic despite concomitant use of ACE inhibitors, beta blockers, and aldosterone antagonists. The combination of hydralazine and isosorbide dinitrate should not be used for the treatment of HF r EF in patients who have no prior use of standard neurohumoral antagonist therapy and should not be substituted for ACE inhibitor or ARB therapy in patients who are tolerating therapy without difficulty.

Despite the lack of data with the vasodilator combination in patients who are intolerant of ACE inhibitors or ARBs, the combined use of hydralazine and isosorbide dinitrate may be considered as a therapeutic option in such patients. If the fixed-dose combination is available, the initial dose should be 1 tablet containing The dose can be increased to 2 tablets 3 times daily for a total daily dose of mg of hydralazine hydrochloride and mg of isosorbide dinitrate. When the 2 drugs are used separately, both pills should be administered at least 3 times daily.

Initial low doses of the drugs given separately may be progressively increased to a goal similar to that achieved in the fixed-dose combination trial. Adherence to this combination has generally been poor because of the large number of tablets required, frequency of administration, and the high incidence of adverse reactions. Nevertheless, the benefit of these drugs can be substantial and warrant a slower titration of the drugs to enhance tolerance of the therapy. Adapted with permission from Fonarow et al. Several placebo-controlled trials have shown that treatment with digoxin for 1 to 3 months can improve symptoms, HRQOL, and exercise tolerance in patients with mild to moderate HF.

In a long-term trial that primarily enrolled patients with NYHA class II or III HF, treatment with digoxin for 2 to 5 years had no effect on mortality but modestly reduced the combined risk of death and hospitalization. Digoxin may also be added to the initial regimen in patients with severe symptoms who have not yet responded symptomatically during GDMT.

If a patient is taking digoxin but not an ACE inhibitor or a beta blocker, treatment with digoxin should not be withdrawn, but appropriate therapy with the neurohormonal antagonists should be instituted. Digoxin is prescribed occasionally in patients with HF and AF, but beta blockers are usually more effective when added to digoxin in controlling the ventricular response, particularly during exercise. Patients should not be given digoxin if they have significant sinus or atrioventricular block unless the block has been addressed with a permanent pacemaker.

The drug should be used cautiously in patients taking other drugs that can depress sinus or atrioventricular nodal function or affect digoxin levels eg, amiodarone or a beta blocker , even though such patients usually tolerate digoxin without difficulty. Therapy with digoxin is commonly initiated and maintained at a dose of 0. Low doses 0. There is no reason to use loading doses of digoxin to initiate therapy in patients with HF. Doses of digoxin that achieve a plasma concentration of drug in the range of 0.

There has been no prospective, randomized evaluation of the relative efficacy or safety of different plasma concentrations of digoxin. Retrospective analysis of 2 studies of digoxin withdrawal found that prevention of worsening HF by digoxin at lower concentrations in plasma 0. When administered with attention to dose and factors that alter its metabolism, digoxin is well tolerated by most patients with HF.

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However, toxicity may also occur with lower digoxin levels, especially if hypokalemia, hypomagnesemia, or hypothyroidism coexists. In addition, a low lean body mass and impaired renal function can also elevate serum digoxin levels, which may explain the increased risk of digoxin toxicity in elderly patients. Anticoagulation is not recommended in patients with chronic HF r EF without AF, a prior thromboembolic event, or a cardioembolic source.

Patients with chronic HF r EF are at an increased risk of thromboembolic events due to stasis of blood in dilated hypokinetic cardiac chambers and in peripheral blood vessels , and perhaps due to increased activity of procoagulant factors. In several retrospective analyses, the risk of thromboembolic events was not lower in patients with HF taking warfarin than in patients not treated with antithrombotic drugs. Another trial compared aspirin with warfarin in patients with reduced LVEF, sinus rhythm, and no cardioembolic source and demonstrated no difference in either the primary outcome of death, stroke, or intracerebral hemorrhage.

There was a significant increase in major bleeding with warfarin. Given that there is no overall benefit of warfarin and an increased risk of bleeding, there is no compelling evidence to use warfarin or aspirin in patients with HF r EF in the absence of a specific indication. The efficacy of long-term warfarin for the prevention of stroke in patients with AF is well established. More recently, a revised score, CHADS2-VASc, has been suggested as more applicable to a wider range of patients, but this revised score has not yet been fully studied in patients with HF.

Regardless of whether patients receive rhythm or rate control, anticoagulation is recommended for patients with HF and AF for stroke prevention in the presence of at least 1 additional risk factor. For patients with HF and AF in the absence of another cardioembolic risk factor, anticoagulation is reasonable. Trials of newer oral anticoagulants have compared efficacy and safety with warfarin therapy rather than placebo. Several new oral anticoagulants are now available, including the factor Xa inhibitors apixaban and rivaroxaban and the direct thrombin inhibitor dabigatran. The fixed dosing together with fewer interactions may simplify patient management, particularly with the polypharmacy commonly seen in HF.

These drugs have a potential for an improved benefit—risk profile compared with warfarin, which may increase their use in practice, especially in those at increased bleeding risk. However, important adverse effects have been noted with these new anticoagulants, including gastrointestinal distress, which may limit compliance. At present, there is no commercially available agent to reverse the effect of these newer drugs.

As more detailed evaluations of the comparative benefits and risks of these newer agents in patients with HF are still pending, the writing committee considered their use in patients with HF and nonvalvular AF as an alternative to warfarin to be reasonable.

A Cochrane review failed to find sufficient evidence to support its use. Currently, data are insufficient to recommend aspirin for empiric primary prevention in HF patients known to be free of atherosclerotic disease and without additional risk factors. See Online Data Supplement 21 for additional data on anticoagulants. Statins are not beneficial as adjunctive therapy when prescribed solely for the diagnosis of HF in the absence of other indications for their use. Statin therapy has been broadly implicated in prevention of adverse cardiovascular events, including new-onset HF.

Originally designed to lower cholesterol in patients with cardiovascular disease, statins are increasingly recognized for their favorable effects on inflammation, oxidative stress, and vascular performance. Several observational and post hoc analyses from large clinical trials have implied that statin therapy may provide clinical benefit to patients with HF. See Online Data Supplement 22 for additional data on statin therapy.

In reported studies, this therapy has been safe and very well tolerated. See Online Data Supplement 23 for additional data on omega-3 fatty acids. Nutritional supplements as treatment for HF are not recommended in patients with current or prior symptoms of HF r EF. Hormonal therapies other than to correct deficiencies are not recommended for patients with current or prior symptoms of HF r EF.

Drugs known to adversely affect the clinical status of patients with current or prior symptoms of HF r EF are potentially harmful and should be avoided or withdrawn whenever possible eg, most antiarrhythmic drugs, most calcium channel—blocking drugs [except amlodipine], NSAIDs, or thiazolidinediones.

Long-term use of infused positive inotropic drugs is potentially harmful for patients with HF r EF, except as palliation for patients with end-stage disease who cannot be stabilized with standard medical treatment see recommendations for stage D. Patients with HF, particularly those treated with diuretics, may become deficient in vitamins and micronutrients. Several nutritional supplements eg, coenzyme Q10, carnitine, taurine, and antioxidants and hormonal therapies eg, growth hormone or thyroid hormone have been proposed for the treatment of HF. No clinical trials have demonstrated improved survival rates with use of nutritional or hormonal therapy, with the exception of omega-3 fatty acid supplementation as previously noted.

Some studies have suggested a possible effect for coenzyme Q10 in reduced hospitalization rates, dyspnea, and edema in patients with HF, but these benefits have not been seen uniformly. Until more data are available, nutritional supplements or hormonal therapies are not recommended for the treatment of HF. With atrial and ventricular arrhythmias contributing to the morbidity and mortality of HF, various classes of antiarrhythmic agents have been repeatedly studied in large RCTs.

Instead of conferring survival benefit, however, nearly all antiarrhythmic agents increase mortality in the HF population. Hence, class I sodium channel antagonists and the class III potassium channel blockers d-sotalol and dronedarone should be avoided in patients with HF. Amiodarone and dofetilide are the only antiarrhythmic agents to have neutral effects on mortality in clinical trials of patients with HF and thus are the preferred drugs for treating arrhythmias in this patient group.

See Online Data Supplement 24 for additional data on antiarrhythmic agents. Calcium channel—blocking drugs are not recommended as routine treatment for patients with HF r EF. By reducing peripheral vasoconstriction and LV afterload, calcium channel blockers were thought to have a potential role in the management of chronic HF.

However, first-generation dihydropyridine and nondihydropyridine calcium channel blockers also have myocardial depressant activity. Several clinical trials have demonstrated either no clinical benefit or even worse outcomes in patients with HF treated with these drugs. In general, calcium channel blockers should be avoided in patients with HF r EF. See Online Data Supplement 25 for additional data on calcium channel blockers. NSAIDs inhibit the synthesis of renal prostaglandins, which mediate vasodilation in the kidneys and directly inhibit sodium resorption in the thick ascending loop of Henle and collecting tubule.

Several observational cohort studies have revealed increased morbidity and mortality in patients with HF using either nonselective or selective NSAIDs. Thiazolidinediones increase insulin sensitivity by activating nuclear peroxisome proliferator-activated receptor gamma. Expressed in virtually all tissues, peroxisome proliferator-activated receptor gamma also regulates sodium reabsorption in the collecting ducts of the kidney. In clinical trials, thiazolidinediones have been associated with increased incidence of HF events, even in those without any prior history of clinical HF.

See Table 19 for a summary of recommendations from this section and Table 20 for strategies for achieving optimal GDMT; see Online Data Supplement 27 for additional data on thiazolidinediones. See Table 21 for a summary of recommendations from this section. Systolic and diastolic blood pressure should be controlled in patients with HF p EF in accordance with published clinical practice guidelines to prevent morbidity. Diuretics should be used for relief of symptoms due to volume overload in patients with HF p EF.

Routine use of nutritional supplements is not recommended for patients with HF p EF. Blood pressure control concordant with existing hypertension guidelines remains the most important recommendation in patients with HF p EF. Evidence from an RCT has shown that improved blood pressure control reduces hospitalization for HF, decreases cardiovascular events, and reduces HF mortality in patients without prevalent HF.

Specific blood pressure targets in HF p EF have not been firmly established; thus, the recommended targets are those used for general hypertensive populations. Specific to this population, it might be reasonable to consider revascularization in patients for whom ischemia appears to contribute to HF symptoms, although this determination can be difficult.

Theoretical mechanisms for the worsening of HF symptoms by AF among patients with HF p EF include shortened diastolic filling time with tachycardia and the loss of atrial contribution to LV diastolic filling. Conversely, chronotropic incompetence is also a concern. Slowing the heart rate is useful in tachycardia but not in normal resting heart rate; a slow heart rate prolongs diastasis and worsens chronotropic incompetence. Currently, there are no specific trials of rate versus rhythm control in HF p EF. See Table 22 for a summary of recommendations from this section.

The usefulness of implantation of an ICD is of uncertain benefit to prolong meaningful survival in patients with a high risk of nonsudden death as predicted by frequent hospitalizations, advanced frailty, or comorbidities such as systemic malignancy or severe renal dysfunction. See Figure 2 , indications for CRT therapy algorithm. Figure 2. Indications for CRT therapy algorithm.

Sudden death in HF r EF has been substantially decreased by neurohormonal antagonists that alter disease progression and also protect against arrhythmias. Nonetheless, patients with systolic dysfunction remain at increased risk for SCD due to ventricular tachyarrhythmias. Patients who have had sustained ventricular tachycardia, ventricular fibrillation, unexplained syncope, or cardiac arrest are at highest risk for recurrence.

ICD therapy for primary prevention was demonstrated to reduce all-cause mortality. Other smaller trials were consistent with this degree of benefit, except for patients within the first 40 days after acute MI, in whom SCD was decreased but there was an increase in other events such that there was no net benefit for survival.

A repeat assessment of ventricular function is appropriate to assess any recovery of ventricular function on GDMT that would be above the threshold where an ICD is indicated. This therapy will often improve ventricular function to a range for which the risk of sudden death is too low to warrant placement of an ICD. ICDs are highly effective in preventing death from ventricular arrhythmias, but frequent shocks can decrease HRQOL and lead to posttraumatic stress syndrome. Refined device programming can optimize pacing therapies to avert the need for shocks, minimize inappropriate shocks, and avoid aggravation of HF by frequent ventricular pacing.

Although there have been occasional recalls of device generators, these are exceedingly rare in comparison to complications related to intracardiac device leads, such as fracture and infection. ICDs are indicated only in patients with a reasonable expectation of survival with good functional status beyond a year, but the range of uncertainty remains wide. The complex decision about the relative risks and benefits of ICDs for primary prevention of SCD must be individualized for each patient.

Patients with multiple comorbidities have a higher rate of implant complications and higher competing risks of death from noncardiac causes. Similar considerations apply to the decision to replace the device generator. Consideration of ICD implantation is highly appropriate for shared decision making. Discussion should include the potential for SCD and nonsudden death from HF or noncardiac conditions. Information should be provided in a format that patients can understand about the estimated efficacy, safety, and potential complications of an ICD and the ease with which defibrillation can be inactivated if no longer desired.

In approximately one third of patients, HF progression is accompanied by substantial prolongation of the QRS interval, which is associated with worse outcome. Increased blood pressure with CRT can allow increased titration of neurohormonal antagonist medications that may further contribute to improvement. Improvement in survival is evident as early as the first 3 months of therapy. These results include patients with a wide range of QRS duration and, in most cases, sinus rhythm. Although it is still not possible to predict with confidence which patients will improve with CRT, further experiences have provided some clarification.

In general, most data derive from patients with class III symptoms. Patients labeled as having class IV symptoms account for a small minority of patients enrolled. In addition, patients with significant noncardiac limitations are unlikely to derive major benefit from CRT. Since publication of the HF guideline, 38 new evidence supports extension of CRT to patients with milder symptoms. LV remodeling was consistently reversed or halted, with benefit also in reduction of HF hospitalizations.

Although the weight of evidence is substantial for patients with class II symptoms, these CRT trials have included only patients with class I symptoms, most with concomitant ICD for the postinfarction indication. In addition, regular monitoring is required after device implantation because adjustment of HF therapies and reprogramming of device intervals may be required. The trials establishing the benefit of these interventions were conducted in centers offering expertise in both implantation and follow-up.

Recommendations for CRT are made with the expectation that they will be performed in centers with expertise and outcome comparable to that of the trials that provide the bases of evidence. The benefit—risk ratio for this intervention would be anticipated to be diminished for patients who do not have access to these specialized care settings or who are nonadherent. A subset of patients with chronic HF will continue to progress and develop persistently severe symptoms despite maximum GDMT. There are clinical clues that may assist clinicians in identifying patients who are progressing toward advanced HF Table Adapted from Metra et al.

Adapted from Russell et al. Profile 3 can be modified in this fashion if the patient is usually at home. If a Profile 7 patient meets the definition of frequent flyer, the patient should be moved to Profile 6 or worse. Other modifier options include arrhythmia, which should be used in the presence of recurrent ventricular tachyarrhythmias contributing to the overall clinical course eg, frequent implantable cardioverter-defibrillator shocks or requirement of external defibrillation, usually more than twice weekly ; or temporary circulatory support for hospitalized patients profiles 1—3.

Adapted from Stevenson et al. Patients considered to have stage D HF should be thoroughly evaluated to ascertain that the diagnosis is correct and that there are no remediable etiologies or alternative explanations for advanced symptoms. For example, it is important to determine that HF and not a concomitant pulmonary disorder is the basis of dyspnea. Similarly, in those with presumed cardiac cachexia, other causes of weight loss should be ruled out. Likewise, other reversible factors such as thyroid disorders should be treated. Severely symptomatic patients presenting with a new diagnosis of HF can often improve substantially if they are initially stabilized.

See Online Data Supplements 30 and 31 for additional data on therapies—important considerations and sildenafil. Fluid restriction 1. Recommendations for fluid restriction in HF are largely driven by clinical experience. Sodium and fluid balance recommendations are best implemented in the context of weight and symptom monitoring programs.

Routine strict fluid restriction in all patients with HF regardless of symptoms or other considerations does not appear to result in significant benefit. In 1 study, patients on a similar sodium and diuretic regimen showed higher readmission rates with higher fluid intake, suggesting that fluid intake affects HF outcomes. Fluid restriction, especially in conjunction with sodium restriction, enhances volume management with diuretics. Fluid restriction is important to manage hyponatremia, which is relatively common with advanced HF and portends a poor prognosis.

In hot or low-humidity climates, excessive fluid restriction predisposes patients with advanced HF to the risk of heat stroke. Hyponatremia in HF is primarily due to an inability to excrete free water. Norepinephrine and angiotensin II activation result in decreased sodium delivery to the distal tubule, whereas arginine vasopressin increases water absorption from the distal tubule. In addition, angiotensin II also promotes thirst. Thus, sodium and fluid restriction in advanced patients with HF is important. Until definitive therapy eg, coronary revascularization, MCS, heart transplantation or resolution of the acute precipitating problem, patients with cardiogenic shock should receive temporary intravenous inotropic support to maintain systemic perfusion and preserve end-organ performance.

Short-term, continuous intravenous inotropic support may be reasonable in those hospitalized patients presenting with documented severe systolic dysfunction who present with low blood pressure and significantly depressed cardiac output to maintain systemic perfusion and preserve end-organ performance. Long-term, continuous intravenous inotropic support may be considered as palliative therapy for symptom control in select patients with stage D HF despite optimal GDMT and device therapy who are not eligible for either MCS or cardiac transplantation. Long-term use of either continuous or intermittent, intravenous parenteral positive inotropic agents, in the absence of specific indications or for reasons other than palliative care, is potentially harmful in the patient with HF.

Use of parenteral inotropic agents in hospitalized patients without documented severe systolic dysfunction, low blood pressure, or impaired perfusion and evidence of significantly depressed cardiac output, with or without congestion, is potentially harmful. Despite improving hemodynamic compromise, positive inotropic agents have not demonstrated improved outcomes in patients with HF in either the hospital or outpatient setting.

Parenteral inotropes, however, remain as an option to help the subset of patients with HF who are refractory to other therapies and are suffering consequences from end-organ hypoperfusion. To minimize adverse effects, lower doses are preferred. Similarly, the ongoing need for inotropic support and the possibility of discontinuation should be regularly assessed. See Online Data Supplements 32 and 33 for additional data on inotropes. Since its initial use 50 years ago for postcardiotomy shock, the implantable VAD continues to evolve.

Designed to assist the native heart, VADs are differentiated by the implant location intracorporeal versus extracorporeal , approach percutaneous versus surgical , flow characteristic pulsatile versus continuous , pump mechanism volume displacement, axial, centrifugal , and the ventricle s supported left, right, biventricular. VADs are effective in both the short-term hours to days management of acute decompensated, hemodynamically unstable HF r EF that is refractory to inotropic support, and the long-term months to years management of stage D chronic HF r EF.

Nondurable or temporary, MCS provides an opportunity for decisions about the appropriateness of transition to definitive management such as cardiac surgery or durable, that is, permanent, MCS or, in the case of improvement and recovery, suitability for device removal. Nondurable MCS thereby may be helpful as either a bridge to decision or a bridge to recovery. More common scenarios for MCS, however, are long-term strategies, including 1 bridge to transplantation, 2 bridge to candidacy, and 3 destination therapy.

Bridge to transplant and destination therapy have the strongest evidence base with respect to survival, functional capacity, and HRQOL benefits. The greatest risk factors for death among patients undergoing bridge to transplant include acuity and severity of clinical condition and evidence of right ventricular failure. Other bridge-to-candidacy indications may include obesity and tobacco use in patients who are otherwise candidates for cardiac transplantation.

Current scientific and translational research in the area aims to identify clinical, cellular, molecular, and genomic markers of cardiac recovery in the patient with VAD. Evaluation for cardiac transplantation is indicated for carefully selected patients with stage D HF despite GDMT, device, and surgical management. Cardiac transplantation is considered the gold standard for the treatment of refractory end-stage HF. Since the first successful cardiac transplantation in , advances in immunosuppressive therapy have vastly improved the long-term survival of transplant recipients with a 1-, 3-, and 5-year posttransplant survival rate of Determination of HF prognosis is addressed in Sections 6.

The listing criteria and evaluation and management of patients undergoing cardiac transplantation are described in detail by the International Society for Heart and Lung Transplantation. See Table 27 for a summary of recommendations from this section, Figure 3 for the stages of HF development; and Online Data Supplement 36 for additional data on transplantation.

Figure 3.

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Stages in the development of HF and recommended therapy by stage. Adapted from Hunt et al. Hospitalization for HF is a growing and major public health issue. There is no widely accepted nomenclature for HF syndromes requiring hospitalization. Data from HF registries have clarified the profile of patients with HF requiring hospitalization. The overall morbidity and mortality for both groups is high. Hospitalized patients with HF can be classified into important subgroups. These include patients with acute coronary ischemia, accelerated hypertension and acutely decompensated HF, shock, and acutely worsening right HF.

Patients who develop HF decompensation after surgical procedures also bear mention. Each of these various categories of HF has specific etiologic factors leading to decompensation, presentation, management, and outcomes. Noninvasive modalities can be used to classify the patient with hospitalized HF.

Chest x-ray is variably sensitive for the presence of interstitial or alveolar edema, even in the presence of elevated filling pressures. Thus, a normal chest x-ray does not exclude acutely decompensated HF. Both BNP and NT-proBNP are useful for the identification or exclusion of acutely decompensated HF in dyspneic patients, , , , , particularly in the context of uncertain diagnosis. Figure 4. Classification of patients presenting with acutely decompensated heart failure. Adapted with permission from Nohria et al.

ACS precipitating acute HF decompensation should be promptly identified by ECG and serum biomarkers, including cardiac troponin testing, and treated optimally as appropriate to the overall condition and prognosis of the patient. Common precipitating factors for acute HF should be considered during initial evaluation, as recognition of these conditions is critical to guide appropriate therapy.

ACS is an important cause of worsening or new-onset HF. Complicating the clinical scenario is that many patients with acute HF, with or without CAD, have serum troponin levels that are elevated. The artist files document details about the recording process and interactions between the record company and the artists, while the ephemera, printing proofs, and sketches provide insight to the planning and execution of album artwork.

The information regarding these bands will be of particular interest to both fans and researchers, providing a first-hand, inside look at their lives and careers. The Modern Music Records document the publishing side of the music industry. The records span from the company's earliest days in the late s, when it was founded by Jules Bihari, to a few documents from the s through The bulk of the collection dates from the early s, and the contents only document select parts of the business.

Of particular note are materials related to the subject of copyright, and the records demonstrate how Bihari and his two brothers, Joe and Saul, added their names or pseudonyms to a song in order to receive shares of the royalties. The collection also contains information about many of Modern Music's subsidiary record labels, including Flair and Kent Records.

The collection is arranged alphabetically by file title. The Lenny Kaye Collection spans the years to and , with the bulk of the material dating between and The collection consists of business documents from Elektra Records and notes for a speech Kaye gave to the Association of Midwest Museums annual conference in The Elektra materials include catalogs, clippings, correspondence, press releases, and records, illustrating Elektra's influence and importance within the music industry. The David Russell Collection spans the years to and includes undated material, with the bulk of the collection dating between and The collection provides unique insight to the intricate process of producing individual concerts and world tours for major artists.

It consists of tour production materials, including detailed documents about production, personnel, stage design, and travel itineraries; as well as personal files with information about Russell's life while on tour; and graphic materials that add a visual landscape to the collection. The stage blueprints are of particular note. M, Pink Floyd, and Tina Turner. ARC Bomp! Records Collection, , undated, The Bomp! Records Collection spans the years to and includes undated material.

It consists of audiovisual materials, periodicals, the personal and business papers of Greg Shaw, Shaw's "Scene" files, and manuscript drafts, as well as promotional material and ephemera. The audiovisual materials consist mainly of bootleg concert and album recordings on audiocassette, but there are also several audiotape reels. The periodicals contain zines and single issues of commercial magazines. The papers consist of correspondence, clippings, and other personal- and business-related files collected by Greg Shaw. Records Collection will be useful to researchers interested in the indie underground culture of the s and s in the United States and the origins and evolution of punk rock.

The zines are of particular note as a record of fan documentation and general counterculture from the s to the s. The newspapers will be of interest to researchers studying s youth culture. The Jeff Gold Collection contains of a wide array of items that document various artists and people in the music industry, specifically from the late s through There are six series that organize the items by format or source, including artist files, subject files, posters, 16 Magazine , and audiovisual materials, as well as materials from the collections of Art Collins and Ralph Gleason.

Please note that files may contain only one item about the artist or subject, such as a press release or photograph. The Anita Gelman Collection spans and the s, with the bulk of the materials dating between and The collection provides rich visual evidence in the form of 35mm color slides, black-and-white photographs, and color Polaroids of Gelman's role as the a professional cosmetologist for MTV including VH1 and the Movie Channel and Epic Records. The Anita Gelman Collection provides a glimpse into the visual history of s rock and pop music and culture, specifically through the hair styles, makeup, and costumes for which the era is best known.

The Continental Club Collection spans the years to and includes undated material. The collection documents the history of the popular New York City night club, located in the East Village and open from to The bulk of the collection consists of photographs from shows performed at the club. Other materials include clippings, correspondence, flyers, and publications. The collection highlights the history of the New York City punk rock music scene and the community that formed around the Continental Club.

The records include the original blue prints, modification specifications, notes, operation manuals, and photographs; as well as information on the Custom Coach company itself. The records provide insight into the lifestyle of a touring musician and its effects on the creation of a custom-made tour bus. This is a setlist, handwritten by Elvis Presley, from a concert in Memphis on March 20, This is the original contract, signed on July 28, , for Raitt's first concert, performed on August 13, at Pennypacker Park in Philadelphia, Pennsylvania. This is Jimi Hendrix's original, handwritten lyrics to the song "Purple Haze.

The Rick Dees Papers span the years , to , and include undated material. The various materials included here chronicle Dees' career as a popular radio personality and a late night talk show host. The photographic materials, which include photographs, slides, and negatives, comprise the largest portion of the collection and include images of Dees' late night talk show Into the Night and showcase television personalities of the era and musicians, including James Brown.

This collection gives researchers a look into Dees' career as well as his private life.

Filmography

His awards, certificates of recognition, and the magazine clippings showcase his level of success, while the photographs and correspondence give insight to his personal life. Seen in a broader context, the collection provides a look at the career of disc jockeys from the mids to the early s and the recognition and career opportunities that were afforded them.

The James Brawley Collection spans the years to and includes undated material, with the bulk of the material dating between and The collection primarily consists of bootleg audiocassette tapes Brawley recorded at various rock concerts, mostly in New York City. Each audiocassette has a corresponding note card. Brawley's collection provides rich insight to the punk rock music scene of the late s and s.

The collection provides evidence of the evolution of punk through raw bootleg audio recordings. The collection includes press kits; press releases; articles about AAP as well as the individuals, legal cases, companies, and organizations involved; and correspondence directed to AAP. The collection offers an overview of the music piracy problem as it was viewed in the early s, as well as its perceived effects on artists and their intellectual property rights. The Four Tops Collection spans the years to , with the bulk of the material dating between The majority of the collection is business records.

These records include invoices, tour information, contracts, song information, and bank records. The Collection provides rich insight to the daily life of a popular recording and touring musical group; the financial aspects in particular. The Four Tops Collection is organized by format, with business records first, listed alphabetically by file title. The business records include invoices, bank statements, tour information, contracts, song information, original sheet music, receipts, and insurance documents.

Other formats of material follow, arranged alphabetically by file title. The Specialty Records Collection spans the years to and includes undated material. The collection consists of album flats and an album cover, black-and-white promotional photographs, correspondence, deejay tip sheets, flyers, record labels, record sleeves, publications, record review cards, and juke box title strips--all created by Specialty Records to promote their artists and their work.

Specialty Record's role in the development of rock and roll is also highlighted through collection materials related to Little Richard. The Scotty Moore Papers span the years to and include undated materials. The papers contain Moore's personal files, photographic material, clippings, and publications.

His personal files provide an in-depth look at the career and life of Moore; the correspondence and contracts are of particular note. Moore's photographic materials consist of photographs and slides spanning Moore's career and personal life. Moore's relationship with Elvis Presley and their work together is documented through the clippings in the collection. Overall, the papers showcase Moore's career from his early days at Sun records to the present, providing rich insight to the life of a rock and roll guitarist and legend.

Hollywood Knitting Factory Posters spans the years to The collection consists of 35 different concert posters for performances held at the venue. Ten of the posters are available here only in digital form. Artists include Darren Grealish and Jim Mazza. The collection provides a glimpse into the types of acts that appeared at the Hollywood Knitting Factory, and how the shows were promoted. Seen in a broader context, the collection provides insights to how national venues promoted alternative rock from , the bands that played during that era, and the artists that created the posters.

The John Platt Collection spans the years to , with the bulk of the materials dating between and The collection contains VHS tapes, audiocassettes, and personal files. The materials are primarily centered around the ss San Francisco era of psychedelic rock. Platt's files also contain research and correspondence for many of his professional projects, including the creation of video installations and short films for the opening of the Rock and Roll Hall of Fame and Museum in The Platt Collection provides extensive insight to the professional life of a lifelong rock and roll fan and historian.

Of particular interest are original concert recordings and video footage of interviews with prominent artists of the era. Many of the video recordings are of European television broadcasts. There are over audiocassettes of Grateful Dead concert recordings in this collection. The collection consists of ten black-and-white photographs taken by Mayes at the festival. The collection provides visual evidence of the performers who appeared at the Monterey Pop Festival, on and off stage. Seen in a broader context, the collection provides insight to the types of performers that appeared at festivals in the late s, as well as the clothing and hairstyles of the period.

Kid Rock Posters span the years to The collection consists of nine different promotional and commercial posters related to Kid Rock's albums, tours, and television appearances. The collection provides a glimpse into how Kid Rock, his albums, and tours were promoted during the s. Seen in a broader context, the collection provides insights into the promotion of high profile artists and the styles of period.

The Rick Miller Papers span the years to The papers document the featured tours rather than the artists themselves and include riders, blueprints, stage plans, venue information and photographs, and lighting cues, as well as itineraries for the artists and crew, correspondence, contracts, artist requests, and carnets merchandise passports.

Miller's papers provide insight into the process of producing rock and roll concerts, specifically the aspects of administration and design. The Ralph Bass Papers, circa the s to , consist of an interview transcript of Bass, one copy of the Chicago Reader featuring an interview with Bass, and eight photographs of Bass and various performers, including the Vashonettes and James Brown. All photographs are 8" x 10" black-and-whites, unless otherwise noted. The collection will be most useful to researchers looking for images of Bass. The Richard Smith Andridge Collection spans to and consists of a black-and-white photograph and a magazine advertisement for The Seeds.

The collection provides visual evidence of The Seeds and how they were promoted. Seen in the broader context, the collection provides insights into southern California garage bands and the advertising used by smaller record labels. The James Bernard Papers span the years to and include undated material. The collection consists of audiovisual material, magazines, and papers, including correspondence, clippings, financial documents, and other materials related to The Source magazine, promotional materials from the National Hip Hop Political Convention, interview transcripts, press kits from various magazines, and other miscellaneous items.

Notable items in the correspondence include letters from readers of The Source , with both critical and supportive messages to the magazine; invitations for Bernard to speak at various functions; a letter from Carol Moseley Braun regarding an appearance before Congress to discuss rap lyrics Bernard's remarks accompany the letter ; a faxed letter from Bernard to David Mays, demanding Mays' resignation as publisher of The Source ; and a letter from Bernard and Reginald Dennis to Mumia Abu-Jamal, negotiating terms for an article to be written for XXL.

The financial documents include auditor's reports, consolidated financial statements, and supplementary information. Audiovisual materials in the collection include VHS videocassettes, two CD-Rs, and audiocassette recordings of interviews. The magazines include single issues of non-music magazines related to African American culture. The James Bernard Papers will be useful to researchers interested in rap and hip hop music in the s and early s. The collection should not be interpreted as an exhaustive business history of The Source.

The Bitter End Records span the years to , with the bulk of the records dating between and The collection provides insight into the management of The Bitter End nightclub, located in the Greenwich Village neighborhood of New York. It does not, however, represent an exhaustive documentation of the business or financial operations of the nightclub.

Of most use to researchers will be the artist files, which provide a record of engagements played by numerous high profile artists and entertainers--many of which began their careers at The Bitter End. The artist files include contracts, photographs, clippings, press releases, press kits, and other promotional items. The collection also contains artist contracts, clippings, photographs, press releases, and information about The Bitter End's near-closure in The Bitter End Records also include a sizeable collection of posters advertising performances played at the venue.

The Martha Radosevich Posters span the years to and include undated material. The collection consists of 32 concert posters for various performers, bands, and venues in the Southern California area. The collection provides a sampling of the kinds of concert posters that would have been posted around the Southern California area in the early- to mids.

Seen in a broader context, the collection provides insight to how performers and venues promoted their shows in the earlys and the acts that were performing during that period. The Anastasia Pantsios Collection spans the years to The collection consists of photographs and radio station playlists. The photographs provide visual evidence of performers who have appeared in Cleveland, Ohio over the course of nearly two decades, on and off stage.

Comparatively, the playlists represent what was being played on the radio in Cleveland during that same time. Seen in a broader context, the collection provides documentation of performers who have appeared in Cleveland over the years, as well as their public persona and dress. The collection also provides insight into the performers who allowed themselves and their performances to be photographed by female rock photographers, as women were finally gaining a foothold in the ranks, led by Rolling Stone's Annie Leibovitz.

As women became more numerous and prominent on rock and roll stages in the s and beyond, Pantsios developed a special interest in the visual study of the changing and diverse ways rock musicians presented themselves while making music. These original illustrations appeared in The Plain Dealer prior to the induction ceremony, and glossy and matte prints were made available for purchase by the newspaper. The collection is made up of the original paintings by Crow, as well as glossy prints of the paintings.

The collection provides a look at the artwork of Ted Crow and the artists and performers who were inducted into the Rock and Roll Hall of Fame in Seen in a broader context, the collection provides insight into the graphic art of the period and the ways in which newspapers were attempting to find new revenue streams. The collection also includes the film's press kit, promotional materials, and copies of the DVD.

The film chronicles the history of the rock concert poster, from its origins in s San Francisco to its re-emergence in the 21st century. American Artifact was released in and directed by Merle Becker. The collection provides a look at the majority of the posters created for the film's release in , press materials, and the film itself. Seen in a broader context, the collection provides insight to fringe and underground artists of the past fifty years and how art is influenced by music, culture, and society, and how music, culture, and society, in return, influence art.

The John Seabury Flyers and Posters collection spans the years to The collection consists of 26 concert posters for various bands and venues, one poster for the Jean-Luc Godard film Sympathy for the Devil, and 19 concert flyers, mostly from shows at Slim's in San Francisco--all created by John Seabury. The collection provides a sampling of Seabury's artistic work for various bands and concerts in the United States and Europe. Seen in a broader context, the collection highlights how mainstream and alternative rock bands and venues promoted their shows during the s to s and provides a reference point for the artists that played during that era.

The Jason Andrew Goad Collection spans the years to and includes undated material. The collection consists of 14 concert posters for various bands and venues created by Jason Andrew Goad, and five concert posters Goad created with Jeff Wood of Drowning Creek Studio. Also included in the collection is some of the original art that Goad created in for The Offspring's Rise and Fall, Rage and Grace. The collection provides a sampling of Goad's artistic work for various performers and rock concerts in the United States. Seen in a broader context, the collection provides insight into how rock and alternative rock bands and venues promoted their shows during the s and the bands that were actively performing during that era.

The Curtis Mayfield Collection spans the years to The Collection consists of a typed manuscript for the posthumously-published book, Poetic License: In Poem and Song ; three negatives and ten original photographs from various stages of Mayfield's solo career and his time with The Impressions; three oversize photographic reproductions; a concert poster; and two concert programs.

The Collection provides a glimpse into the career of Curtis Mayfield through images, lyrics, and poetry. Elliot, copyright May 27, Paul, Minnesota on June 26, The show was set to last from 12 noon until P. The collection provides a look at Elliot's work and a part of the promotion for the Open Air Celebration. Seen in a broader context, the collection provides insight to the promotion of festivals in America's Midwest during the late s and early s, and the artists that performed at these types of festivals.

This particular issue is volume 50, number 60 from December 3, The collection provides a look at Jim Morrison during his time at Florida State and gives the researcher insight into other happenings at the school in December Seen in a broader context, the collection provides insight into southern college newspapers during the early s, the types of articles they were running, and the advertising they were accepting.

The photo was subsequently published in Rolling Stone. The Ed Chalpin Papers span the years to , with the bulk of the materials dating between and The collection consists of business records, clippings, correspondence, photographs, and sound recordings. Also included is material related to the dispute between Chalpin former producer of Jimi Hendrix prior to the Jimi Hendrix Experience years and various parties over Hendrix's "exclusive artist productions writing contract" from October through October Of particular note are an acetate pressing of six tracks featuring Jimi Hendrix and Curtis Knight and several photographs of Hendrix during his time with The Squires.

The collection consists of 91 concert posters for various bands, primarily at venues and shows in Cleveland, Ohio; all designed and created by Sean Carroll,. The collection provides a sampling of Carroll's artistic work for various concert venues and performers. Seen in a broader context, the collection provides insight to how rock bands of varying popularity and diverse venues promoted their shows in the early s.

The collection also acts as a reference point for bands that played during that era. The collection consists mainly of correspondence, flyers, radio show playlists, stickers, zines, and other miscellaneous materials related to the Riot Grrrl movement. The collection provides a unique look into the Riot Grrrl movement from the inside--from the perspectives of the performers and record labels to the fans and critics. The Gabor Kovats Negatives collection consists of images of live concert performances from to in the Austin and Dallas, Texas areas.

The images were taken by Gabor Kovats, a member of the camera club at his high school, during his late teens and early 20s. The collection highlights a strong cross section of performers, musical genres, and concert venues that were popular during the s. ARC Dr. Rosario Cambria Collection, , 0.

The intellectual content of the Rosario Cambria Collection spans the year The collection consists of 48 black-and-white photographic reproductions, printed in , of candid shots from what appears to be at least two different events held at the Brooklyn Paramount Theater in New York: Alan Freed's Easter Jubilee from April and his Summer Festival from July. The collection provides visual evidence of the groundbreaking mixed race concerts Freed hosted in the s. The Len DeLessio Photographs consist of 21 images of various rock musicians from the s.

The collection provides visual evidence of the diversity of rock music that was being performed during the s and the musicians who were performing it. As a whole, the collection highlights the career of one of the first racially integrated rock and roll bands and a hit group on Cleveland's airwaves during the lates to early s. The Eric Caidin Collectin of Photographs span the years of the s to and include undated material. The collection consists of black-and-white as well as color photographs of artists, mostly promotional in nature.

The collection provides visual evidence of how record labels marketed artists over the course of six decades and across a diverse range of musical genres, from country to psychedelic rock; pop to punk. Of particular note is an image of Cannibal and The Headhunters, known as one of the first Mexican-American groups to have a national hit record, "Land of a Thousand Dances.

Newsletter Terry Stewart Collection , , 0. The T. Newsletter was the first of its kind published in the music industry, describing the weekly events at WERE-AM, Cleveland, Ohio, including what artists had been at the station and which records looked promising. The newsletter was distributed to over two hundred agency men, music publishers, columnists, and disc jockeys from coast to coast. The Peter Hujar Photographs consist of 11 vintage gelatin silver prints by the artist that are part of a portrait series for Scenes Magazine in called "Rock Couples. The Gary Owens Papers span the years to and include undated material.

The papers contain photographs of Owens, a handwritten biography, a membership card, and ephemera from radio stations. Owen's papers provide evidence of his career as a radio disc jockey and highlight the importance and role of disc jockeys in the music industry. The Tom Donahue Papers span the years to and contain some undated material.

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The collection consists of business papers, correspondence, interview transcripts, photographs, and printed materials documenting Donahue's career as a popular radio station disc jockey. Of particular note is information about the Wild West Festival and film, a San Francisco Bay Area high profile music festival that was cancelled a week before it was scheduled to begin; a John Lennon interview transcript; and a dissertation written by Susan Krieger on the history of underground radio. Donahue's papers provide rich documentation of the importance and role of radio disc jockeys in the development and dissemination of rock and roll music and culture.

The Bluefield Auditorium Posters span the years to The collection consists of seven concert posters for performances held at the auditorium in Bluefield, West Virginia. The collection provides a glimpse into the types of acts that appeared at the Bluefield Auditorium and, most importantly, how the shows were promoted to a segregated audience. Seen in a broader context, the collection provides insights into African American musicians of the period and the types of venues at which they performed. The James Fortune Photographs consists of 30 prints that document the rock and roll scene of the late s and s.

The scrapbooks contain concert reviews published in Michigan newspapers, and copies of autographed photographs sent to fan Julie Anderson by Stewart and the Rolling Stones. ARC B. The B. King Track List is a handwritten track listing of instrumental songs. The Randy and Kathy Minck Photographs collection consists of 34 snapshots, in black-and-white and color that were taken from audience seats at the Veterans Memorial Building in Columbus, Ohio. ARC Genesis Collection, , undated, 0.

The Genesis Collection is comprised of items surrounding the announcement and subsequent "Turn It On Again" concert tour in Items included are photographs from the tour press conference, tour booklets, and concert stage schematics. The collection provides insight into the process of creating and marketing a highly anticipated concert tour.

The Christopher McLallen Photographs consist of six portraits of musicians and rock groups. The R. Included here are two oversize lithographs, two 8" x 10" matted prints, and a set of postcards. There are also two 8" x 10" prints from a Metallica concert: one of Robert Trujillo and the other of James Hetfield. The collection provides visual evidence of band marketing techniques. The Sue Cassidy Clark Collection spans the years to and includes undated material. The collection focuses on artists in the San Francisco psychedelic rock scene as well as prominent rock bands of that era.

The collection is mainly comprised of interviews Clark conducted on audiocassettes, along with the associated transcripts. Also included is biographical research and clippings on the artists Clark interviewed and wrote about, and flyers and pamphlets for bands and artists performing in and around the San Francisco bay area. Clark's collection provides a behind-the-scenes look at rock music journalism and the research and primary source material necessary to the writing process.

The concert was sponsored by the school's booster club in hopes of raising money to build a sign to promote upcoming events in front of the school. The Viking's Booster Club received a list of bands that would be in the area from a locate promoter, and the students were allowed to vote for which band they would like to see. The winner, Kiss, was touring with Rush and Rockandy at the time. The reproduction is signed on the back by the donor, Michael R. Powers, and numbered 19 of denoting a limited print run.

The collection showcases the marketing of two groups Kiss and Rush , who were both on the verge of becoming mainstream rock and roll success stories. Seen in a broader context, the collection provides insights into the touring circuit of the mids, how those shows were promoted, and the performers of that era.

The Bobbi Cowan Public Relations Artist Files consist of photographs, clippings, press kits, and correspondence related to Bobbi Cowan, an artist manager. The business files are made up of tour schematics, tour contracts, stage design, and personnel information. Fisher's papers provide insight to the process of producing a rock and roll concert, specifically the special effects and stage design. Accompanying correspondence from James A. Dorskind, Special Assistant to the President, outlines the purposes for which the presidential letter may and may not be used.

ARC Norm N. Nite Papers, , undated, 0. The Norm N. The papers consists of biographical information, correspondence, photographs, printed materials, sound recordings, and general Rock and Roll Fall of Fame information. Researchers interested in the formation of the Rock and Roll Hall of Fame Foundation and Museum will find the correspondence series and Rock and Roll Hall of Fame information series of use. The Bob Hamilton collection spans the years , and includes some undated material. The collection provides insight to the history of radio programming. The Hyde Street Studios Records span the years to and provide insight to the activities of the San Francisco recording studio during the s and s.

Founded on the site of a recording destination for artists of note since the late s, the studio was purchased and renamed by current owner Michael Ward in The collection contains handwritten and typewritten press releases, invoices of services rendered, master schedules from to , and correspondence. Also included is a folder of documents from Ward's earlier recording venture, Rancho Rivera Recording.

The Hyde Street Studios Records document the inner-workings of a prominent recording studio and provide a behind-the-scenes look at an integral part of the music business. The collection provides a glimpse into the creative process of Jorma Kaukonen and his relationships with manager Bill Graham and Janis Joplin. Seen in a broader context, the collection highlights the late s psychedelic scene in San Francisco, California and its folk beginnings. These items range from newspaper clippings about his brother Mike McCartney, to concert programs in both English and Japanese, to unique publications, and are from the years The collection as a whole offers a glimpse into rock fandom.

The Ocean Way Recording Scheduling Book is a ledger displaying the comprehensive master schedule for the studio between and The ledger represents the beginning years of the company when founder Allen Sides first operated his studio from a garage in Santa Monica, California. Ocean Way continues to function today as an award winning studio hosting a wide variety of celebrity musicians. This collection contains memorabilia related to the career of pop singers Paul and Paula.

The Collection will be of most use to researchers interested in images of Crosby, Stills, Nash and Young or rock concert photography in general. The Women in Music Artist Files span the years to and contain biographical information and clippings featuring prominent women in the music industry. The collection provides rich documentation of the impact of women in rock and pop music, specifically in the s. The Datwon Thomas Collection spans the years to and consists of clippings, correspondence, photographs, flyers, and a calendar documenting Thomas' career as a music journalist and includes information on hip-hop and rap artists from the late s to early s.

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The hip-hop and rap cultures of the time are also documented. The collection showcases the impact of journalism and mass media on the rap and hip-hop music culture. The Spooner Oldham Papers span the years to and provide documentation of Oldham's successful career as a musician and songwriter. The materials in the collection include business papers, photographs, printed materials, handwritten songs, and tour schedule booklets. Commander Hoo Ha voice. Raj voice. Jake's Father voice. Huntsmaster voice. Show all 37 episodes. Clancy voice. The Meteor voice.

Auctioneer Hero voice. Foo English version, voice. Hachiro English version, voice. News Anchor voice, uncredited. Ragdoll voice. Frankie voice. Frankie - Train Conductor voice. Jones voice. TV Movie Mr. Jacques von Hamsterviel voice. Clay Bailey voice. Bud Buddiovitch English version, voice. Show all 95 episodes. Arturo Ocdof voice. Three voice. Tapir Leafrider voice. Fernando voice.

Fidel Chroniker voice. Professor Zane voice. Ring Announcer voice. Loki voice. Jody Viking voice. Cop voice. Barbarino voice. Moist voice. Travoltron voice. Mahmood voice. Count Muerte voice, as Jeff Glen Bennett. Principal Pestrip voice. Puddington - Return of the Tracker Narrator voice. Video Dr. Skalgar voice, as Jeff Glen Bennett. Zarek voice. Robo-Ape Alfa voice. Johnny Bravo voice.

Show all 67 episodes. Show all 28 episodes. Drix voice. Bruno Bullnerd voice. Mason voice. Mama's Boy Wrestling Announcer 1 voice. Director voice. Joseph voice. Crows voice. The Movie Video Dr. Windbear voice, as Jeff Glen Bennett. Show all 69 episodes. Fadil voice. Guy on TV uncredited. Turkey voice. Shelby voice. Reluctant Dragon voice. Mad Dog voice, uncredited. Shopkeeper English version, voice, uncredited. Announcer voice, as Jeff Glen Bennet.

Archimedes Q. Porter voice. Jeremiah Tuddrussel voice. Townsperson Leader voice. Spies Edison voice. Porter - Tarzan and the Flying Ace Show all 36 episodes. Wesley Rank voice. Technor voice. Jollyland voice. Cody Koala voice, as Jeff Glen Bennett. TV Short Vex voice. British customer voice. Hassenfeld voice. Katsufrakis voice. Igor voice. Lucky Bob voice. Ralph of Cornwallis voice.


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Show all 49 episodes. Anchor Jim voice, as Jeff Glen Bennett. Announcer in Parody Sequence voice, uncredited. Howell Hoser voice, as Jeff Glen Bennett. Cat Leader voice, as Jeff Glen Bennett. British Gent voice, as Jeff Glen Bennett. Crush voice, as Jeff Glen Bennett. Official 1 voice, as Jeff Glen Bennett. Zookeeper voice, as Jeff Glen Bennett.

Dave voice. Buzzsaw voice, as Jeff Glen Bennett. Guard voice, as Jeff Glen Bennett. Young Doctor voice. Show all 22 episodes. Pigeon Boss voice. Baloney voice. Jimmy voice. Environmentalist 1. Leonard Shelton voice. Scientist 2 voice. Mordough voice. Irving Thyroid voice. Dog Catcher voice. Officer voice, as Jeff Glen Bennett. Weasel: The Hole Announcer voice. Ernest Hemingway voice, as Jeff Glen Bennett. Show all 34 episodes. Show all 65 episodes. Ben voice, as Jeff Glen Bennett. Clubtail voice, as Jeff Glen Bennett. Conrad voice. Innkeeper voice.

Mystico Cave Guy voice, as Jeff Glen Bennett.

Attendant voice. Manager voice. Orbitron voice. Aronus voice. Orbitron voice, as Jeff Glen Bennett. Additional Voices English version, voice. Blitz voice. Curiosity Killed the Cat Al voice. Chief voice. Duke L'Orange voice. Voices voice. Gaff voice.

Cody and the Big Fat Rat! (97 Flash Cards at the end of story! Book 1) Cody and the Big Fat Rat! (97 Flash Cards at the end of story! Book 1)
Cody and the Big Fat Rat! (97 Flash Cards at the end of story! Book 1) Cody and the Big Fat Rat! (97 Flash Cards at the end of story! Book 1)
Cody and the Big Fat Rat! (97 Flash Cards at the end of story! Book 1) Cody and the Big Fat Rat! (97 Flash Cards at the end of story! Book 1)
Cody and the Big Fat Rat! (97 Flash Cards at the end of story! Book 1) Cody and the Big Fat Rat! (97 Flash Cards at the end of story! Book 1)
Cody and the Big Fat Rat! (97 Flash Cards at the end of story! Book 1) Cody and the Big Fat Rat! (97 Flash Cards at the end of story! Book 1)
Cody and the Big Fat Rat! (97 Flash Cards at the end of story! Book 1) Cody and the Big Fat Rat! (97 Flash Cards at the end of story! Book 1)

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