7. When Block Become Dangerous.pdf
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The document discusses various types of arrhythmias including sinus node dysfunction, atrioventricular blocks, bifascicular and trifascicular blocks. It notes that patients with serious signs or symptoms of arrhythmias should receive treatment. For sinus node dysfunction, the document indicates that pacing may be considered if the patient has symptoms related to a slow heart rate, drug therapy is not possible, or the heart rate is less than 40 beats per minute with symptoms or pause over 3 seconds on electrophysiology study. The document stresses that heart blocks can become dangerous if accompanied by symptoms, and reversible causes of slow heart rate should be ruled out.
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Co-Chairs, Val J. Lowe, MD, and Cyrus A. Raji, MD, PhD, prepared useful Practice Aids pertaining to Alzheimer’s disease for this CME/AAPA activity titled “Alzheimer’s Disease Case Conference: Gearing Up for the Expanding Role of Neuroradiology in Diagnosis and Treatment.” For the full presentation, downloadable Practice Aids, and complete CME/AAPA information, and to apply for credit, please visit us at https://bit.ly/3PvVY25. CME/AAPA credit will be available until June 28, 2025.Breast cancer: Post menopausal endocrine therapy
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
Travel Clinic Cardiff: Health Advice for International Travelers
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
How to Control Your Asthma Tips by gokuldas hospital.
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
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7. When Block Become Dangerous.pdf
- 1. Haryadi
- 2. Impulse Formation Impulse conduction
- 3. Sinus node dysfunction : Sinus pause/arrest, bradycardia, Sick Sinus Syndrome : tachy-brady arrhytmia Atrioventricular block - First degree - Second degree ◦ Mobitz I (Wenckebach) ◦ Mobitz II ◦ Third degree Bifasicular block Trifasicular block
- 7. If the patient has serious signs or symptoms, make sure they are related to the slow rate Look for symptoms and signs related to the slow heart rate
- 10. Sinus Node dysfunction Spontaneous, related with symptom, drug induced but no other choice or lacking drug alternative, no symptom related documented but with HR at rest < 40x/minute, syncope with no other explanation but from EP study : CSNRT > 800 ms Yes : Pacing No : Observe, re-evaluate
- 17. Heart block become dangerous if there is sign and symptom related Avoid reversible causes of slow heart rate HR < 40x/minute usually related with symptom Pause > 3 second, usually related with symptom
- 18. Terimakasih