Diabetic cardiomyopathy refers to myocardial disease in diabetic subjects that cannot be ascribed to hypertension, coronary artery disease (CAD), or any other known cardiac disease. Key aspects discussed include the high prevalence of heart failure in diabetic patients, pathophysiological changes such as hypertrophy and fibrosis, and risk factors like hyperglycemia and hypertension. Management involves tight control of blood pressure and blood glucose, as well as medications like angiotensin-converting enzyme inhibitors, beta blockers, and aldosterone receptor antagonists which have been shown to improve outcomes. Aggressive modification of cardiovascular risk factors is important in the management of diabetic cardiomyopathy.
diabetes is most prevalent disease in asia, incidence of heart failure is also increasing in diabetic population, understanding the pathophysiology is very important to deal with these cases.
SGLT2 inhibitors in Heart failure: A prized addition to HF treatment optionsahvc0858
Early Diabetes and Dyslipidaemia Treatment Optimisation.
Presentation by Dr Chan Wan Xian
Cardiologist, Echocardiologist
Heart Failure Intensivist
Asian Heart & Vascular Centre
www.ahvc.com.sg
DIABETES AND CARDIOVASCULAR DISEASE - THE CONTINUUMPraveen Nagula
DIABETES IS ONE OF THE MOST COMMON NONCOMMUNICABLE DISEASES WORLD WIDE.
EVERY 6 SECONDS ONE PERSON IS AFFECTED BY DIABETES..
THEME FOR 2014-2016
LETS UNITE FOR DIABETES
diabetes is most prevalent disease in asia, incidence of heart failure is also increasing in diabetic population, understanding the pathophysiology is very important to deal with these cases.
SGLT2 inhibitors in Heart failure: A prized addition to HF treatment optionsahvc0858
Early Diabetes and Dyslipidaemia Treatment Optimisation.
Presentation by Dr Chan Wan Xian
Cardiologist, Echocardiologist
Heart Failure Intensivist
Asian Heart & Vascular Centre
www.ahvc.com.sg
DIABETES AND CARDIOVASCULAR DISEASE - THE CONTINUUMPraveen Nagula
DIABETES IS ONE OF THE MOST COMMON NONCOMMUNICABLE DISEASES WORLD WIDE.
EVERY 6 SECONDS ONE PERSON IS AFFECTED BY DIABETES..
THEME FOR 2014-2016
LETS UNITE FOR DIABETES
Diabetes mellitus (DM) refers to a group of common metabolic disorders that share the phenotype of hyperglycemia.
Several distinct types of DM are caused by a complex interaction of genetics and environmental factors.
Depending on the etiology of the DM, factors contributing to hyperglycemia include reduced insulin secretion, decreased glucose utilization, and increased glucose production.
The metabolic dysregulation associated with DM causes secondary pathophysiologic changes in multiple organ systems that impose a tremendous burden on the individual with diabetes and on the health care system.
#flozins
🫀DAPA 🆚placebo in HFpEF
Now we have a positive trial!
⬇️18% in CV☠️ death or
worsening HF among LVEF>40%
⬇️ 21%heart failure
💥Results same for LVEF> 60% 🆚LVEF<60%
La Dra. Ainara Lozano Bahamonde repasa las novedades incluidas en las últimas guías europeas en insuficiencia cardiaca presentadas en ESC Congress 2021.
Presentation given to our fellowship program about diabetic kidney disease.
2022 update discussing SGLT2i, MRA (e.g. finerenone), health economics and beyond
WHAT IS DIURETIC RESISTANCE?How to Tackle Congestion in Heart Failure?Renal handling of sodium and water.Adverse effects of major diuretics.There are two forms diuretic tolerance
Pathophysiology and mechanisms of loop diuretic resistance.Combination Diuretic Therapy. IV Diuretic .
Isolated ultrafiltration
Heart failure Update as per, 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the
Management of Heart Failure and 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure
1. A Case report of Heart Failure
2. Discussion on Heart Failure
3. Role of Peptides in Heart Failure
4. Importance of 30 days in heart failure
5. Role of ENTRESTO in Stable Heart Failure patient (PARADIGM-HF study)(HFrEF)
6. Biomarkers in Heart Failure
7. Role of ARNI in Hospitalized Heart Failure patient (PIONEER-HF study)
8. Role of ARNI in HFpEF (PARAMOUNT Trial)
9. Safety and usefulness of ACEI/ARB/ARNI
10. Role of SGPL2 inhibitors in HF with/without DM
Diabetes mellitus (DM) refers to a group of common metabolic disorders that share the phenotype of hyperglycemia.
Several distinct types of DM are caused by a complex interaction of genetics and environmental factors.
Depending on the etiology of the DM, factors contributing to hyperglycemia include reduced insulin secretion, decreased glucose utilization, and increased glucose production.
The metabolic dysregulation associated with DM causes secondary pathophysiologic changes in multiple organ systems that impose a tremendous burden on the individual with diabetes and on the health care system.
#flozins
🫀DAPA 🆚placebo in HFpEF
Now we have a positive trial!
⬇️18% in CV☠️ death or
worsening HF among LVEF>40%
⬇️ 21%heart failure
💥Results same for LVEF> 60% 🆚LVEF<60%
La Dra. Ainara Lozano Bahamonde repasa las novedades incluidas en las últimas guías europeas en insuficiencia cardiaca presentadas en ESC Congress 2021.
Presentation given to our fellowship program about diabetic kidney disease.
2022 update discussing SGLT2i, MRA (e.g. finerenone), health economics and beyond
WHAT IS DIURETIC RESISTANCE?How to Tackle Congestion in Heart Failure?Renal handling of sodium and water.Adverse effects of major diuretics.There are two forms diuretic tolerance
Pathophysiology and mechanisms of loop diuretic resistance.Combination Diuretic Therapy. IV Diuretic .
Isolated ultrafiltration
Heart failure Update as per, 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the
Management of Heart Failure and 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure
1. A Case report of Heart Failure
2. Discussion on Heart Failure
3. Role of Peptides in Heart Failure
4. Importance of 30 days in heart failure
5. Role of ENTRESTO in Stable Heart Failure patient (PARADIGM-HF study)(HFrEF)
6. Biomarkers in Heart Failure
7. Role of ARNI in Hospitalized Heart Failure patient (PIONEER-HF study)
8. Role of ARNI in HFpEF (PARAMOUNT Trial)
9. Safety and usefulness of ACEI/ARB/ARNI
10. Role of SGPL2 inhibitors in HF with/without DM
For more Info visit www.healthlibrary.com "Management of PCOS in Unani System of Medicine" by Dr. Shaikh Nikhat held on 11th June 2016.
Management of PCOS in Unani System of Medicine - Unani system have the holistic approach to treat the condition like PCOD / PCOS.
Cardiomyopathy (KAR-de-o-mi-OP-ah-thee) refers to diseases of the heart muscle. These diseases have many causes, signs and symptoms, and treatments.
In cardiomyopathy, the heart muscle becomes enlarged, thick, or rigid. In rare cases, the muscle tissue in the heart is replaced with scar tissue.
As cardiomyopathy worsens, the heart becomes weaker. It's less able to pump blood through the body and maintain a normal electrical rhythm. This can lead toheart failure or irregular heartbeats called arrhythmias (ah-RITH-me-ahs). In turn, heart failure can cause fluid to build up in the lungs, ankles, feet, legs, or abdomen.
The weakening of the heart also can cause other complications, such as heart valve problems.
OverviewThe main types of cardiomyopathy are:
Dilated cardiomyopathy
Hypertrophic (hi-per-TROF-ik) cardiomyopathy
Restrictive cardiomyopathy
Arrhythmogenic (ah-rith-mo-JEN-ik) right ventricular dysplasia
(dis-PLA-ze-ah)
Other types of cardiomyopathy sometimes are referred to as "unclassified cardiomyopathy."
Cardiomyopathy can be acquired or inherited. "Acquired" means you aren't born with the disease, but you develop it due to another disease, condition, or factor. "Inherited" means your parents passed the gene for the disease on to you. Many times, the cause of cardiomyopathy isn't known.
Cardiomyopathy can affect people of all ages. However, people in certain age groups are more likely to have certain types of cardiomyopathy. This article focuses on cardiomyopathy in adults.
OutlookSome people who have cardiomyopathy have no signs or symptoms and need no treatment. For other people, the disease develops quickly, symptoms are severe, and serious complications occur.
Treatments for cardiomyopathy include lifestyle changes, medicines, surgery, implanted devices to correct arrhythmias, and a nonsurgical procedure. These treatments can control symptoms, reduce complications, and stop the disease from getting worse.
National Heart Lung and Blood Institute
diabetes was associated with insulin resistant state which affects liver cells.Also fatty liver may be called NAFLA OR NASH may lead to liver cirrhosis and sometimes to hepatocelular carcinoma
Cardiology: Treatment of Heart FailureVedica Sethi
Abstract Heart Failure (HF) is the most widely recognized cardiovascular disorder behind medical clinic affirmation for individuals more established than 60 years old. Hardly any regions in medication have advanced as surprisingly as HF treatment in the course of recent decades. Be that as it may, progress has been reliable just for ceaseless HF with diminished discharge part. In intensely decompensated HF and HF with safeguarded discharge part, none of the medications tried to date have been conclusively demonstrated to improve endurance. Deferring or forestalling HF has gotten progressively significant in patients who are inclined to HF. The anticipation of declining interminable HF and hospitalisations for intense decompensation is likewise critical. The target of this paper is to give a compact and down to earth rundown of the accessible medication medicines for HF. The most ideal proof based medication treatment (counting inhibitors of the renin–angiotensin– aldosterone framework and β blockers) is helpful just when ideally actualized. Notwithstanding, usage may be testing. To accept that ailment the executives projects can be useful in giving a multidisciplinary, comprehensive way to deal with the conveyance of ideal clinical consideration. Keywords; heart failure, multidisciplinary approach, Beat-blocker, RAAS framework
Management of HTN according to gender. This slides will answer some questions such as
1. Why there is BP variability difference between male and female?
2. What's the regulatory mechanism of HTN in gender?
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
2. AgendaAgenda
Magnitude of the problemMagnitude of the problem
Definition , pathophysiology and riskDefinition , pathophysiology and risk
factors of diabetic cardiomyopathyfactors of diabetic cardiomyopathy
ManagementManagement
Role of RAAS inhibitors and B.BRole of RAAS inhibitors and B.B
SummarySummary
3. FACTSFACTS
The percentage of patients with DM and heart failure in different
studies ranged between 20-26%.
DM is 2-5 times more common patients with HF.DM is 2-5 times more common patients with HF.
Every 1% increase in HA1c translates into 15 % increase the riskEvery 1% increase in HA1c translates into 15 % increase the risk
of developing HF.of developing HF.
The frequency of risk factors for HF ( IHD , HT , dyslipidemia , LVHThe frequency of risk factors for HF ( IHD , HT , dyslipidemia , LVH
) is increased in diabetics .) is increased in diabetics .
DM is an independent risk factor for death in patients with systolicDM is an independent risk factor for death in patients with systolic
dysfunction.dysfunction.
4.
5.
6. Risk of Different Outcomes Associated
with Diabetes in HF. LEF and HF.PEF
MacDonald M R et al. EHJ 2008;29:1377-85
7.
8.
9. Diabetic CardiomyopathyDiabetic Cardiomyopathy
DCMDCM
Some diabetic patients do not have obviousSome diabetic patients do not have obvious
ischemic insults that lead to progressive HF.ischemic insults that lead to progressive HF.
The entity of diabetic cardiomyopathy was
originally described in 1972 on the basis of
observations in four diabetic patients who
presented with HF without evidence of
hypertension, CAD, valvular or congenital
heart disease.
Anatomical dissection of the myocardium
revealed LVH and myocardial fibrosis.
10. DefinitionDefinition
Diabetic cardiomyopathy refersDiabetic cardiomyopathy refers
to myocardial disease into myocardial disease in
diabetic subjects that cannotdiabetic subjects that cannot
be ascribed to hypertension,be ascribed to hypertension,
CAD, or any other knownCAD, or any other known
cardiac diseasecardiac disease
19. MANAGEMENT OF CARDIOMYOPATHYMANAGEMENT OF CARDIOMYOPATHY
AND HEART FAILURE IN DIABETESAND HEART FAILURE IN DIABETES
Control of risk factorsControl of risk factors
Tight BP and glycemic controlTight BP and glycemic control
Treat etiologic / aggravatingTreat etiologic / aggravating
factorsfactors
LifestyleLifestyle
Team workTeam work
20. Can glucose control improveCan glucose control improve
diastolic functiondiastolic function??
The UKPDS evaluated the relationship
between exposure to glycemia over time and
the development of diabetic cardiomyopathy
in patients with type 2 diabetes :
For each 1% reduction in mean HbA1c, there
was a 14% associated decrease in risk for
myocardial infarction and a 16% decrease in
risk for heart failure.
21. Can glucose control improveCan glucose control improve
diastolic functiondiastolic function??
Epidemiological analysis of a prospective,
multicenter, population-based study of
patients with newly diagnosed type 2 DM:
Good glycemic control was associated with a
lower incidence of diabetic cardiomyopathy
(27% vs 9%), whereas postprandial blood
glucose levels were among the independent
predictors for cardiovascular morbidity and
mortality.
Vasc Health Risk Manag. 2009;5:859–871.
22.
23.
24. UKPDS Blood Pressure Study:UKPDS Blood Pressure Study:
Tight vs. Less Tight ControlTight vs. Less Tight Control
1148 type 2 patients1148 type 2 patients
BP lowered to avg. 144/82 (controls-154/87); 9 yr follow-upBP lowered to avg. 144/82 (controls-154/87); 9 yr follow-up
EndpointEndpoint Risk Reduction(%) P ValueRisk Reduction(%) P Value
Any diabetes related endpointAny diabetes related endpoint 2424 0.00460.0046
Diabetes related deathsDiabetes related deaths 3232 0.0190.019
Heart failureHeart failure 5656 0.00430.0043
StrokeStroke 4444 0.0130.013
Myocardial infarctionMyocardial infarction 2121 NSNS
Microvascular diseaseMicrovascular disease 3737 0.00920.0092
UKPDS. BMJ. 317: 703-713. 1998.
25. DRUG THERAPY OF HEART FAILUREDRUG THERAPY OF HEART FAILURE
IN DIABETESIN DIABETES
Treating heart failure and diabetes separatelyTreating heart failure and diabetes separately
Drug therapy :Drug therapy :
• ACEI (ARBs )ACEI (ARBs )
• BBBB
• Aldosterone blocadeAldosterone blocade
• CCBCCB
• DiureticsDiuretics
• StatinsStatins
26. Disease Progression
Hypertrophy, apoptosis, ischemia,
arrhythmias, remodeling, fibrosis
Angiotensin II Norepinephrine
Neurohormonal ActivationNeurohormonal Activation
inin HF and DMHF and DM
RAAS inhibitors
Beta blockers
27. ACEI and ARBsACEI and ARBs
HOPE ,SOLVD, RESOLVD , andHOPE ,SOLVD, RESOLVD , and
Assessment of Treatment withAssessment of Treatment with
Lisinopril and Survival trialsLisinopril and Survival trials
Greater benefits with ACEI inGreater benefits with ACEI in
diabetic subgroups with HF.diabetic subgroups with HF.
Increase responsiveness to insulin.Increase responsiveness to insulin.
Reduction in Hb A1cReduction in Hb A1c..
30. BB in HFBB in HF
20102010
BB are recommended for all patients with HFBB are recommended for all patients with HF
due to left ventricular systolic dysfunction,due to left ventricular systolic dysfunction,
including :including :
Older adultsOlder adults
Patients with :Patients with :
1)1) Diabetes mellitusDiabetes mellitus
2)2) Peripheral vascular diseasePeripheral vascular disease
3)3) Erectile dysfunctionErectile dysfunction
4)4) Interstitial pulmonary diseaseInterstitial pulmonary disease
5)5) COPD without reversibilityCOPD without reversibility
NICE GUIDELINES (2010)NICE GUIDELINES (2010)
33. Drugs effect and Insulin sensitivity (ISDrugs effect and Insulin sensitivity (IS((
Decreased ISDecreased IS
High-dose thiazideHigh-dose thiazide
Diuretics are perhaps bestDiuretics are perhaps best
avoided in DM patient .avoided in DM patient .
Loop diureticsLoop diuretics
have ahave a lesser effect onlesser effect on
glucose metabolism andglucose metabolism and
are preferred to thiazideare preferred to thiazide
agents.agents.
Improve ISImprove IS
Angiotensin-convertingAngiotensin-converting
enzyme inhibitorsenzyme inhibitors
Angiotensin-II receptorAngiotensin-II receptor
blockersblockers
Vasodilators.Vasodilators.
34.
35. Special considrationSpecial considration
Reduce polypharmacyReduce polypharmacy
Adverse drug reactions :Adverse drug reactions :
Glitazones , NSAID , DiuriticsGlitazones , NSAID , Diuritics
Electrolyte abnormalitiesElectrolyte abnormalities
Renal and hepatic functionsRenal and hepatic functions
36.
37. SUMMARYSUMMARY
Patients with DM have a high risk for LVD and a poor prognosis oncePatients with DM have a high risk for LVD and a poor prognosis once
they develop HF.they develop HF.
Diabetic cardiomyopathy refers to LVD in diabetic patients with noDiabetic cardiomyopathy refers to LVD in diabetic patients with no
evidence of CAD or any other known cardiac disease .evidence of CAD or any other known cardiac disease .
The pathophysiology of diabetic cardiomopathy includes : functional ,The pathophysiology of diabetic cardiomopathy includes : functional ,
anatomical and metabolic abnormalities .anatomical and metabolic abnormalities .
Choice of drugs for the management of HF in diabetic patients shouldChoice of drugs for the management of HF in diabetic patients should
be directed at changing the natural history of the disease.be directed at changing the natural history of the disease.
ACEI and BB should be given as first-line therapy in diabeticACEI and BB should be given as first-line therapy in diabetic
cardiomyopathy .cardiomyopathy .
Aggressive risk-factor modification in addition to tight BP andAggressive risk-factor modification in addition to tight BP and
glycemic control are crucial in the management diabeticglycemic control are crucial in the management diabetic
cardiomyopathy .cardiomyopathy .