Dabigatran for Atrial Fibrillation: Cardioversion and Ablationlarriva
The presentation covers background information regarding atrial fibrillation (A-fib) and the use of oral anticoagulant dabigatran surrounding cardioversion and ablation for A-fib. The information surrounds a patient case in which the patient prefers dabigatran over warfarin. Available literature on the topic is analyzed to make a patient specific recommendation.
http://www.theheart.org/web_slides/1425587.do
A randomized to placebo or ivabradine study on Systolic Heart Failure Treatment with the If Inhibitor Ivabradine (SHIFT) with patients on standard HF medications according to guidelines
Dabigatran for Atrial Fibrillation: Cardioversion and Ablationlarriva
The presentation covers background information regarding atrial fibrillation (A-fib) and the use of oral anticoagulant dabigatran surrounding cardioversion and ablation for A-fib. The information surrounds a patient case in which the patient prefers dabigatran over warfarin. Available literature on the topic is analyzed to make a patient specific recommendation.
http://www.theheart.org/web_slides/1425587.do
A randomized to placebo or ivabradine study on Systolic Heart Failure Treatment with the If Inhibitor Ivabradine (SHIFT) with patients on standard HF medications according to guidelines
The natriuretic peptide system works antagonistically to the RAAS and has favorable effects on the pathogenesis of heart failure
Natriuretic peptides are broken down by an enzyme called neprilysin
Neprilysin is also responsible for the breakdown of other substances, including bradykinin and angiotensin II
Sacubitril/valsartan is a combination product
Sacubitril is a pro-drug that, upon activation, acts as a neprilysin inhibitor
It works by blocking the action of neprilysin, thus preventing the breakdown of natriuretic peptides
This leads to a prolonged duration of the favorable effects of these peptides
Heart failure: From Evidence To Clinical CarePavanAchaya
It includes pathophysiology, classification and treatment of heart failure according to landmark clinical trials for established medications as well as for novel treatment molecules like ARNI
Recent Advancements in the treatment of Hypertension.Akshata Darandale
Uncontrolled blood pressure had become most common cause of death accounting for more than 7 million deaths per year worldwide. Despite the availability of potent lifestyle and pharmacologic approaches, rates of control of blood pressure are unsatisfactory and additional strategies to curb the burden of hypertension are warranted. Several novel pharmacological and device-based approaches have recently been tested and may prove helpful to achieve better blood pressure control rates and thereby improve cardiovascular outcomes in patients with hypertension.
Vymada Tablet (ARNI: Angiotensin Receptor Neprilysin Inhibitor) is an anti-hypertensive drug used in combination with Sacubitril & Valsartan to reduce the risk of cardiovascular events in patients with chronic heart failure (NYHA Class II-IV) and reduced ejection fraction.
In this ppt, I am going to discuss the role of ICD in the patient with Non-ischemic cardiomyopathy. I am going to discuss all the major trials done in the patient with non-ischemic cardiomyopathy.
2015 Jones criteria for the diagnosis of rheumatic feverPRAVEEN GUPTA
In this ppt, I am going to discuss 2015 Jones criteria for the diagnosis of rheumatic fever and various modification made into it and basis for those modifications
Hierarchical Digital Twin of a Naval Power SystemKerry Sado
A hierarchical digital twin of a Naval DC power system has been developed and experimentally verified. Similar to other state-of-the-art digital twins, this technology creates a digital replica of the physical system executed in real-time or faster, which can modify hardware controls. However, its advantage stems from distributing computational efforts by utilizing a hierarchical structure composed of lower-level digital twin blocks and a higher-level system digital twin. Each digital twin block is associated with a physical subsystem of the hardware and communicates with a singular system digital twin, which creates a system-level response. By extracting information from each level of the hierarchy, power system controls of the hardware were reconfigured autonomously. This hierarchical digital twin development offers several advantages over other digital twins, particularly in the field of naval power systems. The hierarchical structure allows for greater computational efficiency and scalability while the ability to autonomously reconfigure hardware controls offers increased flexibility and responsiveness. The hierarchical decomposition and models utilized were well aligned with the physical twin, as indicated by the maximum deviations between the developed digital twin hierarchy and the hardware.
Cosmetic shop management system project report.pdfKamal Acharya
Buying new cosmetic products is difficult. It can even be scary for those who have sensitive skin and are prone to skin trouble. The information needed to alleviate this problem is on the back of each product, but it's thought to interpret those ingredient lists unless you have a background in chemistry.
Instead of buying and hoping for the best, we can use data science to help us predict which products may be good fits for us. It includes various function programs to do the above mentioned tasks.
Data file handling has been effectively used in the program.
The automated cosmetic shop management system should deal with the automation of general workflow and administration process of the shop. The main processes of the system focus on customer's request where the system is able to search the most appropriate products and deliver it to the customers. It should help the employees to quickly identify the list of cosmetic product that have reached the minimum quantity and also keep a track of expired date for each cosmetic product. It should help the employees to find the rack number in which the product is placed.It is also Faster and more efficient way.
Industrial Training at Shahjalal Fertilizer Company Limited (SFCL)MdTanvirMahtab2
This presentation is about the working procedure of Shahjalal Fertilizer Company Limited (SFCL). A Govt. owned Company of Bangladesh Chemical Industries Corporation under Ministry of Industries.
Sachpazis:Terzaghi Bearing Capacity Estimation in simple terms with Calculati...Dr.Costas Sachpazis
Terzaghi's soil bearing capacity theory, developed by Karl Terzaghi, is a fundamental principle in geotechnical engineering used to determine the bearing capacity of shallow foundations. This theory provides a method to calculate the ultimate bearing capacity of soil, which is the maximum load per unit area that the soil can support without undergoing shear failure. The Calculation HTML Code included.
2016 acc focused update on new pharmacological therapy for heart failure
1. 2016 ACC/AHA Focused Update on New
Pharmacological Therapy for Heart
Failure
Presenter
Dr PRAVEEN GUPTA
Moderator
Dr. Ajith Ananthakrishna Pillai
Date
20/08/2016
Departement of Cardiology,
JIPMER,
Pondicherry (India)
2. Introduction
• New therapies that affect a large number of patients presents both
opportunities and challenges.
Agiotensin receptor–neprilysin inhibitor (ARNI)
(valsartan/sacubitril)
Sinoatrial node modulator (ivabradine)
• Writing committees of the “2016 ACC/AHA/HFSA Focused Update
on New Pharmacological Therapy for Heart Failure” and the “2016
ESC Guideline on the Diagnosis and Treatment of Acute and
Chronic Heart Failure” concurrently developed recommendations
for the incorporation of these therapies into clinical practice.
3. Angiotensin-converting enzyme (ACE)
• Reduce morbidity and mortality in HFrEF
• Benefits in patients with mild, moderate, or severe symptoms
of HF and in patients with or without coronary artery disease
• Can produce angioedema, cough
• Given with caution to patients with low systemic blood
pressures, renal insufficiency, or elevated serum potassium
(>5.0 mEq/L).
4. Angiotensin-converting enzyme (ACE)
• No differences among available ACE inhibitors in their effects
on symptoms or survival.
• Start at low doses and titrated upward
5. Angiotensin receptor blockers (ARBs)
• Were developed with the rationale that angiotensin II
production continues in the presence of ACE inhibition
• lower incidence of cough and angioedema
• Given with caution to patients with low systemic blood
pressure, renal insufficiency, or elevated serum potassium.
• Reduce morbidity and mortality, especially in ACE inhibitor–
intolerant patient
• Patients intolerant to ACE inhibitors because of cough or
angioedema should be started on ARBs;
6. Angiotensin receptor blockers (ARBs)
• Patients already tolerating ARBs for other indications may be
continued on ARBs if they subsequently develop HF.
• ARBs should be started at low doses and titrated upward, with
an attempt to use doses shown to reduce the risk of
cardiovascular events in clinical trials.
7. Angiotensin receptor blockers (ARBs)
• Some patients developed angioedema .
• For those patients for whom an ACE inhibitor or ARNI is
inappropriate, use of an ARB remains advised.
8. ARNI
• An ARB is combined with an inhibitor of neprilysin, an
enzyme that degrades natriuretic peptides, bradykinin,
adrenomedullin, and other vasoactive peptides.
• ARNI reduced the composite endpoint of cardiovascular
death or HF hospitalization significantly, by 20%
• The benefit was consistent across subgroups.
9. ARNI
• ARNI approved for patients with symptomatic
HFrEF intended to be substituted for ACE inhibitors
or ARBs.
10. Side effect of ARNI
• A medication that represented both a neprilysin inhibitor
and an ACE inhibitor, omapatrilat, was terminated because
of an unacceptable incidence of angioedema and associated
significant morbidity.
• This adverse effect was thought to occur because both ACE
and neprilysin break down bradykinin, which directly or
indirectly can cause angioedema.
• 3-fold increased risk of angioedema as compared with
enalapril .
• Blacks and smokers at risk.
• The high incidence of angioedema ultimately led to cessation of
the clinical development of omapatrilat
11. Side effect of ARNI
• An ARNI should not be administered within 36 hours of
switching from or to an ACE inhibitor.
• Oral neprilysin inhibitors, used in combination with ACE
inhibitors can lead to angioedema and concomitant use is
contraindicated and should be avoided.
12. Side effect of ARNI
• ARNI therapy should not be administered in patients with a
history of angioedema because of the concern that it will increase
the risk of a recurrence of angioedema.
• ARNI is associated with the risk of hypotension and renal
insufficiency
13. Stage C
Pharmacological Treatment for Stage C HF With Reduced
Ejection Fraction:
Recommendations
• Renin-Angiotensin System Inhibition With Angiotensin-
Converting Enzyme Inhibitor or Angiotensin Receptor
Blocker or ARNI: Recommendations
• The clinical strategy of inhibition of the renin-angiotensin
system with ACE inhibitors (Level of Evidence: A) , OR
ARBs (Level of Evidence: A) , OR ARNI (Level of Evidence:
B-R) in conjunction with evidence-based beta blockers ,
and aldosterone antagonists in selected patients , is
recommended for patients with chronic HFrEF to reduce
morbidity and mortality.
14. Renin-Angiotensin System Inhibition With Angiotensin-
Converting Enzyme Inhibitor or Angiotensin Receptor
Blocker or ARNI: Recommendations
The use of ACE inhibitors is beneficial for patients
with prior or current symptoms of chronic HFrEF to
reduce morbidity and mortality .
15. Renin-Angiotensin System Inhibition With Angiotensin-
Converting Enzyme Inhibitor or Angiotensin Receptor Blocker
or ARNI: Recommendations
• The use of ARBs to reduce morbidity and mortality is
recommended in patients with prior or current symptoms
of chronic HFrEF who are intolerant to ACE inhibitors
because of cough or angioedema .
16. Renin-Angiotensin System Inhibition With Angiotensin-Converting
Enzyme Inhibitor or Angiotensin Receptor Blocker or ARNI:
Recommendations
• In patients with chronic symptomatic HFrEF NYHA class
II or III who tolerate an ACE inhibitor or ARB,
replacement by an ARNI is recommended to further
reduce morbidity and mortality.
17. Renin-Angiotensin System Inhibition With Angiotensin-
Converting Enzyme Inhibitor or Angiotensin Receptor Blocker
or ARNI: Recommendations
• ARNI should not be administered concomitantly with ACE
inhibitors or within 36 hours of the last dose of an ACE
inhibitor .
18. Renin-Angiotensin System Inhibition With Angiotensin-Converting
Enzyme Inhibitor or Angiotensin Receptor Blocker or ARNI:
Recommendations
• ARNI should not be administered to patients with
a history of angioedema.
19. Ivabradine
• Inhibits the If current in the sinoatrial node, providing heart
rate reduction.
• Efficacy of ivabradine in reducing the composite endpoint of
cardiovascular death or HF hospitalization
• Given the well-proven mortality benefits of beta-blocker
therapy, it is important to initiate and up titrate these agents to
target doses, as tolerated, before assessing the resting heart rate
for consideration of ivabradine initiation
20. Ivabradine: Recommendation
• Ivabradine can be beneficial to reduce HF hospitalization
for patients with symptomatic (NYHA class II-III) stable
chronic HFrEF (LVEF ≤35%) who are receiving GDEM,
including a beta blocker at maximum tolerated dose, and
who are in sinus rhythm with a heart rate of 70 bpm or
greater at rest.
