This document summarizes a study of 50 patients with cardiomyopathy who visited a teaching hospital over 2 years. The most common type of cardiomyopathy was dilated cardiomyopathy (36% of cases), followed by ischemic cardiomyopathy (34% of cases). The mean age of presentation was 57 years, with most patients in their 7th decade of life. The most common symptoms were breathlessness (100% of patients) and cough (50% of patients). Echocardiography revealed hypokinesia in 78% of patients and mitral regurgitation in 76% of patients. The study documented various types of cardiomyopathies and their characteristics.
This document discusses Takayasu arteritis, a rare inflammatory disease of large arteries. It begins by defining the disease and describing the anatomy of the aorta and its branches that are commonly affected. It then discusses the classification of the disease based on angiography and lists the criteria used for diagnosis. The document concludes by describing the typical symptoms, physical exam findings, and stages of the disease.
takayasu arteritis is inflammatory disorder of medium sized arteries of unknown etiology, prevent in young female. lead to life threatening complication and long lasting morbidity. early diagnosis and treatment prevent complication and improve quality of life
This study prospectively examined cardiac arrhythmias in 90 patients undergoing cardiac surgery at a hospital in Romania between January and June 2017. The study found that postoperative atrial fibrillation was more common in older patients (above 60 years old) with enlarged left atriums. Patients who developed arrhythmias tended to have lower ejection fractions, higher creatinine levels, and more postoperative hemodynamic and renal complications compared to patients without arrhythmias. Risk factors for developing arrhythmias after cardiac surgery included older age, enlarged left atrium, lower arterial oxygen saturation, lower potassium levels, and need for higher doses of inotropic drugs.
Echocardiography plays an essential role in diagnosing hypertrophic cardiomyopathy (HCM) by demonstrating left ventricular hypertrophy of 15mm or greater that is asymmetric and cannot be attributed to another cause. Echocardiography can also identify the characteristic patterns of hypertrophy such as sigmoid septum, reverse curvature of the septum, and apical hypertrophy. It is used to detect complications of HCM such as left ventricular outflow tract obstruction, mitral regurgitation, and apical aneurysms. Risk stratification for sudden cardiac death utilizes echocardiography to identify features such as massive hypertrophy, abnormal blood pressure response to exercise, and nonsustained ventricular tachycard
Diagnosis, management, workup in a case of Takayasu's arteritis. Definition, synonyms, history, epidimiology, pathophysiology, etiology of Takayasu's arteritis.
Diagnosis of Early Risks, Management of Risks, and Reduction of Vascular Dise...asclepiuspdfs
In a recent issue of the Journal of Circulation, American Heart Association has published a scientific statement, related to the excess heart disease and acute vascular events in South Asians living in the USA. The same group of experts, also have published a complementary article in Circulation titled, “call to action: Cardiovascular disease (CVD) in Asian Americans.”I being a South Asian immigrant living in the USA, have always wondered as to why we do not have the same benefits as the other resident Americans in terms of the advantages of living in a highly advanced country? According to a study done in 2013, cardiovascular mortality has declined and diabetes mortality has increased in high-income countries. The study done in 26 industrialized nations, estimated the potential role of trends in population, for body mass index, systolic blood pressure, serum total cholesterol, and smoking, the modifiable risk factors identified as the promoters of CVD, and acute vascular events, by the Framingham Heart Study (FHS) group.
Takayasu arteritis is a chronic inflammatory disease that primarily affects large arteries like the aorta and its branches. Accurate early diagnosis is important to improve outcomes for patients. Imaging like CT angiography and MR angiography are essential non-invasive tools to detect luminal narrowing, wall thickening, and other vascular abnormalities associated with Takayasu arteritis. Differential diagnosis includes other diseases like atherosclerosis and giant cell arteritis that can present similarly on imaging. Characteristic findings on CT and MR imaging can help establish the diagnosis of Takayasu arteritis.
Takayasu's arteritis is a rare inflammatory disease that affects large blood vessels. It most commonly involves the aorta and its major branches. It predominantly affects young women of Asian descent. Symptoms can include headaches, fatigue, joint pains, and abnormalities in blood pressure between limbs. Diagnosis involves imaging tests like angiograms to detect vessel narrowing, blockages, or aneurysms. Treatment focuses on controlling inflammation with corticosteroids and immunosuppressants, and managing hypertension through cardiovascular procedures or surgery if needed. Strict control of risk factors is also important to prevent complications like heart disease.
This document discusses Takayasu arteritis, a rare inflammatory disease of large arteries. It begins by defining the disease and describing the anatomy of the aorta and its branches that are commonly affected. It then discusses the classification of the disease based on angiography and lists the criteria used for diagnosis. The document concludes by describing the typical symptoms, physical exam findings, and stages of the disease.
takayasu arteritis is inflammatory disorder of medium sized arteries of unknown etiology, prevent in young female. lead to life threatening complication and long lasting morbidity. early diagnosis and treatment prevent complication and improve quality of life
This study prospectively examined cardiac arrhythmias in 90 patients undergoing cardiac surgery at a hospital in Romania between January and June 2017. The study found that postoperative atrial fibrillation was more common in older patients (above 60 years old) with enlarged left atriums. Patients who developed arrhythmias tended to have lower ejection fractions, higher creatinine levels, and more postoperative hemodynamic and renal complications compared to patients without arrhythmias. Risk factors for developing arrhythmias after cardiac surgery included older age, enlarged left atrium, lower arterial oxygen saturation, lower potassium levels, and need for higher doses of inotropic drugs.
Echocardiography plays an essential role in diagnosing hypertrophic cardiomyopathy (HCM) by demonstrating left ventricular hypertrophy of 15mm or greater that is asymmetric and cannot be attributed to another cause. Echocardiography can also identify the characteristic patterns of hypertrophy such as sigmoid septum, reverse curvature of the septum, and apical hypertrophy. It is used to detect complications of HCM such as left ventricular outflow tract obstruction, mitral regurgitation, and apical aneurysms. Risk stratification for sudden cardiac death utilizes echocardiography to identify features such as massive hypertrophy, abnormal blood pressure response to exercise, and nonsustained ventricular tachycard
Diagnosis, management, workup in a case of Takayasu's arteritis. Definition, synonyms, history, epidimiology, pathophysiology, etiology of Takayasu's arteritis.
Diagnosis of Early Risks, Management of Risks, and Reduction of Vascular Dise...asclepiuspdfs
In a recent issue of the Journal of Circulation, American Heart Association has published a scientific statement, related to the excess heart disease and acute vascular events in South Asians living in the USA. The same group of experts, also have published a complementary article in Circulation titled, “call to action: Cardiovascular disease (CVD) in Asian Americans.”I being a South Asian immigrant living in the USA, have always wondered as to why we do not have the same benefits as the other resident Americans in terms of the advantages of living in a highly advanced country? According to a study done in 2013, cardiovascular mortality has declined and diabetes mortality has increased in high-income countries. The study done in 26 industrialized nations, estimated the potential role of trends in population, for body mass index, systolic blood pressure, serum total cholesterol, and smoking, the modifiable risk factors identified as the promoters of CVD, and acute vascular events, by the Framingham Heart Study (FHS) group.
Takayasu arteritis is a chronic inflammatory disease that primarily affects large arteries like the aorta and its branches. Accurate early diagnosis is important to improve outcomes for patients. Imaging like CT angiography and MR angiography are essential non-invasive tools to detect luminal narrowing, wall thickening, and other vascular abnormalities associated with Takayasu arteritis. Differential diagnosis includes other diseases like atherosclerosis and giant cell arteritis that can present similarly on imaging. Characteristic findings on CT and MR imaging can help establish the diagnosis of Takayasu arteritis.
Takayasu's arteritis is a rare inflammatory disease that affects large blood vessels. It most commonly involves the aorta and its major branches. It predominantly affects young women of Asian descent. Symptoms can include headaches, fatigue, joint pains, and abnormalities in blood pressure between limbs. Diagnosis involves imaging tests like angiograms to detect vessel narrowing, blockages, or aneurysms. Treatment focuses on controlling inflammation with corticosteroids and immunosuppressants, and managing hypertension through cardiovascular procedures or surgery if needed. Strict control of risk factors is also important to prevent complications like heart disease.
This document provides an overview of hypertrophic cardiomyopathy (HCM). It defines HCM as an increased left ventricular wall thickness of 15 mm or more that is not due to abnormal loading conditions. HCM is caused by mutations in sarcomere genes. Symptoms can include left ventricular outflow tract obstruction and complications such as heart failure, atrial fibrillation, and sudden cardiac death. The document discusses the diagnosis of HCM using echocardiography, cardiac MRI and other imaging tools. It also reviews treatments such as medications, surgical myectomy to relieve outflow tract obstruction, alcohol septal ablation, implantable cardioverter-defibrillators and heart transplantation.
This document presents the case of a 16-year-old female patient with Takayasu's arteritis. She presented with symptoms of breathlessness, swelling in the lower limbs, decreased urine output, and fever. Investigations revealed coarctation of the aorta, renal artery stenosis, dissection of the aorta, and renovascular hypertension. Angiography showed involvement of multiple arteries. She was diagnosed with Takayasu's arteritis based on clinical criteria and imaging findings.
he diseased aorta in Takayasu’s arteritis features areas of ectasia and stenosis; the aorta is left with very little elastic tissue due to diffuse fibrosis of the intima, media, and externa. Stent-supported endovascular aortoplasty and surgical revascularization are associated with higher complication and recurrence rates, even with regular immunomodulation follow-up. Unlike atheromatous disease, the inflexible artery is vulnerable to dissection, and is as “brittle as glass” during balloon angioplasty. Therefore, some authors suggest self-expanding stent or stent-graft supported angioplasty for this condition, with high-pressure dilation,to overcome fibrosis caused by panarteritis. However, the incidence of dissection in this situation appears to be under-reported.
- Takayasu Arteritis is an idiopathic inflammatory disease that causes inflammation and narrowing of the large arteries, mainly the aorta and its branches.
- Early diagnosis is difficult due to nonspecific initial symptoms. Management is challenging due to the lack of reliable disease activity markers and low levels of evidence regarding treatment.
- High-dose corticosteroids are effective for inducing remission but relapses often occur upon tapering. Additional immunosuppressants are usually needed to sustain remission and prevent disease progression and damage.
Contemporary Perspectives on the Diagnosis and Management of Hypertrophic Car...asclepiuspdfs
Hypertrophic cardiomyopathy (HCM) is a cardiovascular disorder with genetic predisposition. The number of treatment modalities has grown in the contemporary era, with use of pharmacotherapy, device therapy, and surgical intervention, though with the relative paucity of data derived from randomized trials. Its clinical course and prognosis are relatively good. The ongoing quest is to establish the optimal treatment strategy in patients with HCM. This is of direct relevance in reducing the mortality burden associated with sudden cardiac death primarily secondary to dysrhythmias. This review summarizes the clinical features, course, and management of HCM. In particular, we highlight advances in cardiac magnetic resonance imaging assessment of HCM and how risk stratification criteria for suitability of implantable cardioverter defibrillators differ between continents.
Left Ventricular Apical Ballooning, Catecholamine Toxicity, and Cardiomyopathyasclepiuspdfs
Case reports and clinical experiences have implicated catecholamine. Excess likely contributes to the pathophysiologic process as a cause of cardiac dysfunction, impaired hemodynamic function, and poor outcomes. Cardiac dysfunction has also been described in many other diseases; there is likely a common underlying pathophysiology. In this review, we will examine the pathophysiology of cardiac dysfunction after catecholamine surge and discuss the evidence surrounding cardiac dysfunction.
Takayasu arteritis is a chronic inflammatory disease that causes stenosis, occlusion, dilation or aneurysm of the aorta and its branches. It most commonly affects adolescent girls and young women. Symptoms include limb claudication, decreased brachial pulse, hypertension, bruits, and vascular ischemia. Diagnosis is based on meeting criteria such as age of onset under 40, decreased pulse, blood pressure difference between arms, and angiographic evidence of vascular involvement. Treatment involves glucocorticoids which can control inflammation and symptoms, though relapses may occur. Additional immunosuppressants may be needed, and management of hypertension is important, especially during pregnancy which carries higher risks but fertility is not affected.
This document provides an overview of Takayasu Arteritis (TA), including:
- The definition, epidemiology, pathology, and clinical features of TA. Key symptoms include fever, weight loss, and ischemia of the extremities.
- Diagnostic criteria including the Ishikawa, ACR, and Suri criteria, which rely on angiographic and clinical findings.
- Challenges in assessing disease activity, as inflammatory markers may be normal despite active vasculitis.
- The role of non-invasive imaging methods like MRI, CT, and ultrasound in evaluating vessel wall changes and inflammation as markers of active disease.
This document presents the fourth universal definition of myocardial infarction. Key changes include differentiating myocardial infarction from myocardial injury, highlighting peri-procedural myocardial injury after procedures as distinct from infarction, and considering electrical remodeling in assessing repolarization abnormalities. The definition aims to standardize the diagnosis of infarction for improved patient management and research.
Takayasu arteritis is an idiopathic inflammatory disease that primarily affects large elastic arteries, especially the aorta and its branches. It most commonly occurs in young females. The disease involves occlusive or ectatic changes in the arteries and can present with nonspecific early symptoms or later with signs of ischemia due to arterial occlusion. Diagnosis is based on criteria that consider clinical features, imaging findings, and laboratory tests showing inflammation. Treatment involves management of symptoms and immunosuppression.
Fourth universal definition of myocardial infarction (2018)hospital
This document outlines the 2018 universal definition of myocardial infarction and describes its various types. It defines Type 1 MI as detected cardiac troponin rise with symptoms of ischemia. Type 3 MI occurs in patients who experience cardiac death before biomarkers can be obtained. Type 4a MI is elevation of troponin levels more than 5 times the cutoff 48 hours after percutaneous coronary intervention. Type 5 MI involves troponin elevation more than 10 times the cutoff 48 hours after coronary artery bypass grafting. It also describes myocardial infarction with non-obstructive coronary arteries.
Carotid revascularization in cad patientsDIPAK PATADE
Carotid artery disease is common in patients with coronary artery disease undergoing coronary artery bypass grafting (CABG). The incidence of perioperative stroke after CABG is around 1.6-3.1%, with risks increased by factors like aortic atherosclerosis, atrial fibrillation, prior stroke, and carotid stenosis. Strokes are often embolic and occur during or soon after surgery. Asymptomatic carotid stenosis alone may not increase stroke risks significantly, but bilateral or recently symptomatic stenosis does. Careful screening and management of atherosclerotic risk factors can help reduce perioperative stroke risks in patients with coexisting carotid and coronary artery disease.
ST-segment Depression: All are Not Created Equal!asclepiuspdfs
ST depression on an electrocardiography can be from various causes including ischemia, acute coronary syndrome, electrolyte imbalance, posterior myocardial infarction, pulmonary embolism and others. Making the right diagnosis and therefore the right treatment is of paramount importance. This article goes into depth explaining why all ST-segment depressions are not created equal.
Universal Definition of Myocardial Infarct Han Naung Tun
1) The document summarizes the 4th Universal Definition of Myocardial Infarction from 2018, outlining 5 types of MI (myocardial infarction).
2) It describes the criteria for each type of MI, including Type 1 due to plaque rupture, Type 2 due to oxygen supply/demand imbalance, and Type 3 where the patient dies before biomarkers can be obtained.
3) It also discusses MI associated with procedures like PCI (Type 4) and CABG (Type 5), and conditions like MINOCA where the coronary arteries are non-obstructive.
Radiological evaluation of takayasu arteritis Dr. muhammad Bin Zulfiqar Servi...Dr. Muhammad Bin Zulfiqar
Radiological evaluation of takayasu arteritis Dr. muhammad Bin Zulfiqar Services Institute of Medical Sciences Services Hospital Lahore
In this presentation we will discuss the role of imaging in TA.
SCAD is a rare, sometimes fatal, traumatic condition with approximately eighty percent of cases affecting women. The coronary artery can suddenly develop a tear, causing blood to flow between the layers which forces them apart, potentially causing a blockage of blood flow through the artery and a resulting heart attack. The condition may be related to female hormone levels, as it is often seen in post-partum women, or in women during or very near menstruation, but not always. It is not uncommon for SCAD to occur in people in good physical shape and with no known prior history of heart related illness. It is also not uncommon for SCAD to occur in people in their 20's, 30's, and 40's, as well as older.
Aortic Dissection with Hemopericardium and Thrombosed Left Common Iliac Arter...Vinod Namana
#aortic dissection #tamponade #hemopericardium #pericardial effusion #leg ischemia #type a dissection #shock #cardiogenic shock.
An aortic dissection is an uncommon serious condition, which usually presents with chest pain or upper back pain. Symptoms of aortic dissection may mimic those of other diseases, often leading to delay in diagnosis. We report an unusual case of aortic dissection with hemopericardium and thrombosed left common iliac artery presenting as acute limb ischemia. Maintaining a high index of clinical suspicion for aortic pathology could possibly lead to identification and timely management of a greater number of patients who have atypical presentations. This would be especially true for patients who have catastrophic presentations with unexplained symptoms.
Cardiomyopathy refers to diseases of the heart muscle. There are several types including dilated cardiomyopathy, hypertrophic cardiomyopathy, and restrictive cardiomyopathy. Dilated cardiomyopathy is characterized by enlarged heart chambers and poor systolic function, while hypertrophic cardiomyopathy involves thickened heart muscle walls, often asymmetrically involving the septum. Restrictive cardiomyopathy causes stiffening of the heart muscle resulting in diastolic dysfunction. Echocardiography and cardiac MRI are important diagnostic tools to classify and characterize cardiomyopathies. Treatment involves managing symptoms, reducing risk of complications like arrhythmias, and potentially treating underlying causes.
This document provides an overview of cardiomyopathy, specifically focusing on dilated cardiomyopathy and hypertrophic cardiomyopathy. It defines cardiomyopathy as a myocardial disorder resulting in structural and functional heart muscle abnormalities without other known cardiac causes. Cardiomyopathies are classified based on anatomy and physiology into dilated, hypertrophic, restrictive, and arrhythmogenic right ventricular types. Dilated cardiomyopathy is characterized by enlarged, poorly contracting ventricles, while hypertrophic cardiomyopathy involves thickened ventricular walls but a non-dilated chamber size. The causes, pathophysiology, clinical presentation, investigations, and management of dilated and hypertrophic cardiomyopathy are described in detail.
Cardiomyopathies are diseases of the heart muscle that weaken and enlarge the heart. There are three main types: dilated cardiomyopathy where the heart chambers enlarge, hypertrophic cardiomyopathy where the heart muscle thickens, and restrictive cardiomyopathy where the heart muscle stiffens. Dilated cardiomyopathy is the most common type and causes the heart to dilate and weaken over time from various genetic, toxic, or inflammatory causes ultimately leading to heart failure.
This document discusses different types of cardiomyopathy, including dilated cardiomyopathy (DCM), hypertrophic cardiomyopathy (HCM), and restrictive cardiomyopathy. DCM is characterized by enlarged heart chambers and reduced systolic function. HCM involves thickened heart muscle and potential outflow tract obstruction. Restrictive cardiomyopathy restricts heart filling due to stiff heart muscles. The causes, clinical presentations, diagnostic evaluations, and management strategies are described for each type of cardiomyopathy.
1. Systemic diseases like autoimmune disorders can involve the cardiovascular system and cause manifestations such as pericarditis, coronary artery disease, cardiomyopathy, and congestive heart failure.
2. Diseases such as rheumatoid arthritis, systemic lupus erythematosus, and inflammatory myopathies commonly affect the heart.
3. Many systemic diseases are associated with accelerated atherosclerosis and premature cardiovascular disease due to chronic inflammation.
This document provides an overview of hypertrophic cardiomyopathy (HCM). It defines HCM as an increased left ventricular wall thickness of 15 mm or more that is not due to abnormal loading conditions. HCM is caused by mutations in sarcomere genes. Symptoms can include left ventricular outflow tract obstruction and complications such as heart failure, atrial fibrillation, and sudden cardiac death. The document discusses the diagnosis of HCM using echocardiography, cardiac MRI and other imaging tools. It also reviews treatments such as medications, surgical myectomy to relieve outflow tract obstruction, alcohol septal ablation, implantable cardioverter-defibrillators and heart transplantation.
This document presents the case of a 16-year-old female patient with Takayasu's arteritis. She presented with symptoms of breathlessness, swelling in the lower limbs, decreased urine output, and fever. Investigations revealed coarctation of the aorta, renal artery stenosis, dissection of the aorta, and renovascular hypertension. Angiography showed involvement of multiple arteries. She was diagnosed with Takayasu's arteritis based on clinical criteria and imaging findings.
he diseased aorta in Takayasu’s arteritis features areas of ectasia and stenosis; the aorta is left with very little elastic tissue due to diffuse fibrosis of the intima, media, and externa. Stent-supported endovascular aortoplasty and surgical revascularization are associated with higher complication and recurrence rates, even with regular immunomodulation follow-up. Unlike atheromatous disease, the inflexible artery is vulnerable to dissection, and is as “brittle as glass” during balloon angioplasty. Therefore, some authors suggest self-expanding stent or stent-graft supported angioplasty for this condition, with high-pressure dilation,to overcome fibrosis caused by panarteritis. However, the incidence of dissection in this situation appears to be under-reported.
- Takayasu Arteritis is an idiopathic inflammatory disease that causes inflammation and narrowing of the large arteries, mainly the aorta and its branches.
- Early diagnosis is difficult due to nonspecific initial symptoms. Management is challenging due to the lack of reliable disease activity markers and low levels of evidence regarding treatment.
- High-dose corticosteroids are effective for inducing remission but relapses often occur upon tapering. Additional immunosuppressants are usually needed to sustain remission and prevent disease progression and damage.
Contemporary Perspectives on the Diagnosis and Management of Hypertrophic Car...asclepiuspdfs
Hypertrophic cardiomyopathy (HCM) is a cardiovascular disorder with genetic predisposition. The number of treatment modalities has grown in the contemporary era, with use of pharmacotherapy, device therapy, and surgical intervention, though with the relative paucity of data derived from randomized trials. Its clinical course and prognosis are relatively good. The ongoing quest is to establish the optimal treatment strategy in patients with HCM. This is of direct relevance in reducing the mortality burden associated with sudden cardiac death primarily secondary to dysrhythmias. This review summarizes the clinical features, course, and management of HCM. In particular, we highlight advances in cardiac magnetic resonance imaging assessment of HCM and how risk stratification criteria for suitability of implantable cardioverter defibrillators differ between continents.
Left Ventricular Apical Ballooning, Catecholamine Toxicity, and Cardiomyopathyasclepiuspdfs
Case reports and clinical experiences have implicated catecholamine. Excess likely contributes to the pathophysiologic process as a cause of cardiac dysfunction, impaired hemodynamic function, and poor outcomes. Cardiac dysfunction has also been described in many other diseases; there is likely a common underlying pathophysiology. In this review, we will examine the pathophysiology of cardiac dysfunction after catecholamine surge and discuss the evidence surrounding cardiac dysfunction.
Takayasu arteritis is a chronic inflammatory disease that causes stenosis, occlusion, dilation or aneurysm of the aorta and its branches. It most commonly affects adolescent girls and young women. Symptoms include limb claudication, decreased brachial pulse, hypertension, bruits, and vascular ischemia. Diagnosis is based on meeting criteria such as age of onset under 40, decreased pulse, blood pressure difference between arms, and angiographic evidence of vascular involvement. Treatment involves glucocorticoids which can control inflammation and symptoms, though relapses may occur. Additional immunosuppressants may be needed, and management of hypertension is important, especially during pregnancy which carries higher risks but fertility is not affected.
This document provides an overview of Takayasu Arteritis (TA), including:
- The definition, epidemiology, pathology, and clinical features of TA. Key symptoms include fever, weight loss, and ischemia of the extremities.
- Diagnostic criteria including the Ishikawa, ACR, and Suri criteria, which rely on angiographic and clinical findings.
- Challenges in assessing disease activity, as inflammatory markers may be normal despite active vasculitis.
- The role of non-invasive imaging methods like MRI, CT, and ultrasound in evaluating vessel wall changes and inflammation as markers of active disease.
This document presents the fourth universal definition of myocardial infarction. Key changes include differentiating myocardial infarction from myocardial injury, highlighting peri-procedural myocardial injury after procedures as distinct from infarction, and considering electrical remodeling in assessing repolarization abnormalities. The definition aims to standardize the diagnosis of infarction for improved patient management and research.
Takayasu arteritis is an idiopathic inflammatory disease that primarily affects large elastic arteries, especially the aorta and its branches. It most commonly occurs in young females. The disease involves occlusive or ectatic changes in the arteries and can present with nonspecific early symptoms or later with signs of ischemia due to arterial occlusion. Diagnosis is based on criteria that consider clinical features, imaging findings, and laboratory tests showing inflammation. Treatment involves management of symptoms and immunosuppression.
Fourth universal definition of myocardial infarction (2018)hospital
This document outlines the 2018 universal definition of myocardial infarction and describes its various types. It defines Type 1 MI as detected cardiac troponin rise with symptoms of ischemia. Type 3 MI occurs in patients who experience cardiac death before biomarkers can be obtained. Type 4a MI is elevation of troponin levels more than 5 times the cutoff 48 hours after percutaneous coronary intervention. Type 5 MI involves troponin elevation more than 10 times the cutoff 48 hours after coronary artery bypass grafting. It also describes myocardial infarction with non-obstructive coronary arteries.
Carotid revascularization in cad patientsDIPAK PATADE
Carotid artery disease is common in patients with coronary artery disease undergoing coronary artery bypass grafting (CABG). The incidence of perioperative stroke after CABG is around 1.6-3.1%, with risks increased by factors like aortic atherosclerosis, atrial fibrillation, prior stroke, and carotid stenosis. Strokes are often embolic and occur during or soon after surgery. Asymptomatic carotid stenosis alone may not increase stroke risks significantly, but bilateral or recently symptomatic stenosis does. Careful screening and management of atherosclerotic risk factors can help reduce perioperative stroke risks in patients with coexisting carotid and coronary artery disease.
ST-segment Depression: All are Not Created Equal!asclepiuspdfs
ST depression on an electrocardiography can be from various causes including ischemia, acute coronary syndrome, electrolyte imbalance, posterior myocardial infarction, pulmonary embolism and others. Making the right diagnosis and therefore the right treatment is of paramount importance. This article goes into depth explaining why all ST-segment depressions are not created equal.
Universal Definition of Myocardial Infarct Han Naung Tun
1) The document summarizes the 4th Universal Definition of Myocardial Infarction from 2018, outlining 5 types of MI (myocardial infarction).
2) It describes the criteria for each type of MI, including Type 1 due to plaque rupture, Type 2 due to oxygen supply/demand imbalance, and Type 3 where the patient dies before biomarkers can be obtained.
3) It also discusses MI associated with procedures like PCI (Type 4) and CABG (Type 5), and conditions like MINOCA where the coronary arteries are non-obstructive.
Radiological evaluation of takayasu arteritis Dr. muhammad Bin Zulfiqar Servi...Dr. Muhammad Bin Zulfiqar
Radiological evaluation of takayasu arteritis Dr. muhammad Bin Zulfiqar Services Institute of Medical Sciences Services Hospital Lahore
In this presentation we will discuss the role of imaging in TA.
SCAD is a rare, sometimes fatal, traumatic condition with approximately eighty percent of cases affecting women. The coronary artery can suddenly develop a tear, causing blood to flow between the layers which forces them apart, potentially causing a blockage of blood flow through the artery and a resulting heart attack. The condition may be related to female hormone levels, as it is often seen in post-partum women, or in women during or very near menstruation, but not always. It is not uncommon for SCAD to occur in people in good physical shape and with no known prior history of heart related illness. It is also not uncommon for SCAD to occur in people in their 20's, 30's, and 40's, as well as older.
Aortic Dissection with Hemopericardium and Thrombosed Left Common Iliac Arter...Vinod Namana
#aortic dissection #tamponade #hemopericardium #pericardial effusion #leg ischemia #type a dissection #shock #cardiogenic shock.
An aortic dissection is an uncommon serious condition, which usually presents with chest pain or upper back pain. Symptoms of aortic dissection may mimic those of other diseases, often leading to delay in diagnosis. We report an unusual case of aortic dissection with hemopericardium and thrombosed left common iliac artery presenting as acute limb ischemia. Maintaining a high index of clinical suspicion for aortic pathology could possibly lead to identification and timely management of a greater number of patients who have atypical presentations. This would be especially true for patients who have catastrophic presentations with unexplained symptoms.
Cardiomyopathy refers to diseases of the heart muscle. There are several types including dilated cardiomyopathy, hypertrophic cardiomyopathy, and restrictive cardiomyopathy. Dilated cardiomyopathy is characterized by enlarged heart chambers and poor systolic function, while hypertrophic cardiomyopathy involves thickened heart muscle walls, often asymmetrically involving the septum. Restrictive cardiomyopathy causes stiffening of the heart muscle resulting in diastolic dysfunction. Echocardiography and cardiac MRI are important diagnostic tools to classify and characterize cardiomyopathies. Treatment involves managing symptoms, reducing risk of complications like arrhythmias, and potentially treating underlying causes.
This document provides an overview of cardiomyopathy, specifically focusing on dilated cardiomyopathy and hypertrophic cardiomyopathy. It defines cardiomyopathy as a myocardial disorder resulting in structural and functional heart muscle abnormalities without other known cardiac causes. Cardiomyopathies are classified based on anatomy and physiology into dilated, hypertrophic, restrictive, and arrhythmogenic right ventricular types. Dilated cardiomyopathy is characterized by enlarged, poorly contracting ventricles, while hypertrophic cardiomyopathy involves thickened ventricular walls but a non-dilated chamber size. The causes, pathophysiology, clinical presentation, investigations, and management of dilated and hypertrophic cardiomyopathy are described in detail.
Cardiomyopathies are diseases of the heart muscle that weaken and enlarge the heart. There are three main types: dilated cardiomyopathy where the heart chambers enlarge, hypertrophic cardiomyopathy where the heart muscle thickens, and restrictive cardiomyopathy where the heart muscle stiffens. Dilated cardiomyopathy is the most common type and causes the heart to dilate and weaken over time from various genetic, toxic, or inflammatory causes ultimately leading to heart failure.
This document discusses different types of cardiomyopathy, including dilated cardiomyopathy (DCM), hypertrophic cardiomyopathy (HCM), and restrictive cardiomyopathy. DCM is characterized by enlarged heart chambers and reduced systolic function. HCM involves thickened heart muscle and potential outflow tract obstruction. Restrictive cardiomyopathy restricts heart filling due to stiff heart muscles. The causes, clinical presentations, diagnostic evaluations, and management strategies are described for each type of cardiomyopathy.
1. Systemic diseases like autoimmune disorders can involve the cardiovascular system and cause manifestations such as pericarditis, coronary artery disease, cardiomyopathy, and congestive heart failure.
2. Diseases such as rheumatoid arthritis, systemic lupus erythematosus, and inflammatory myopathies commonly affect the heart.
3. Many systemic diseases are associated with accelerated atherosclerosis and premature cardiovascular disease due to chronic inflammation.
Cardiomyopathy, Myocarditis and Pericarditis_C I lecture_Oct.pptMesfinShifara
The document provides an overview of cardiomyopathy, myocarditis, and pericardial diseases for nursing students. It defines cardiomyopathy as a heterogeneous group of diseases affecting the heart muscle and lists the main types as dilated, hypertrophic, and restrictive cardiomyopathy. Myocarditis is defined as inflammation of the heart muscle and pericarditis as inflammation of the pericardium. The document describes the causes, clinical presentations, diagnoses, and treatments of these conditions.
Role of Left Ventricular Mass Index Versus Left Ventricular Relative Wall Thi...Premier Publishers
This study examined left ventricular geometry in 100 patients with non-cardioembolic ischemic stroke using echocardiography. The study found that concentric remodeling was the most common left ventricular pattern at 43%, followed by normal geometry at 27%, concentric hypertrophy at 22%, and eccentric hypertrophy at 8%. Abnormal left ventricular relative wall thickness was more common than abnormal left ventricular mass index, occurring in 61.4% versus 38.6% of patients. The results suggest that assessing relative wall thickness in addition to mass index can help identify more patients with left ventricular remodeling who may be at increased risk of stroke.
Hypertrophic cardiomyopathy (HCM) is a genetic heart condition characterized by thickened heart muscle. It is defined as thickening of the left ventricle in the absence of another cause like hypertension. The thickening can occur in any part of the left ventricle but commonly involves the septum. HCM is diagnosed based on echocardiogram findings showing thickened heart muscle of 15mm or more. Management involves preventing sudden cardiac death through ICD implantation in high risk patients and treating heart failure symptoms with medications like beta blockers.
EMGuideWire's Radiology Reading Room: Hypertrophic CardiomyopathySean M. Fox
The Department of Emergency Medicine at Carolinas Medical Center is passionate about education! Dr. Michael Gibbs is a world-renowned clinician and educator and has helped guide numerous young clinicians on the long path of Mastery of Emergency Medical Care. With his oversight, the EMGuideWire team aim to help augment our understanding of emergent imaging. You can follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides or you can also use this section to learn more in-depth about specific conditions and diseases. This Radiology Reading Room pertains to Hypertrophic Cardiomyopathy and is brought to you by Ashley Moore-Gibbs, DNP, Claire Lawson, NP, Laszlo Littmann, MD, and John Symanski, MD.
This document discusses aortic aneurysms and dissections. It covers risk factors, clinical presentations, diagnostic imaging and treatment. Key points include: thoracic aortic dissections have high mortality if undiagnosed; imaging modalities like CT, MRI and TEE are useful for diagnosis but presentations can be atypical; hypertension is a major risk factor; pain is the most common symptom but neurological symptoms, syncope or abdominal pain may occur instead.
This document provides an overview of cardiomyopathy, including definitions, classifications, pathophysiology, clinical manifestations, diagnostic studies, and treatment approaches for various subtypes. It defines cardiomyopathy and classifies the main subtypes as dilated, hypertrophic, restrictive, and arrhythmogenic right ventricular cardiomyopathy. For each subtype, the document discusses epidemiology, causes, characteristics, symptoms, diagnostic findings, and general management principles. It also covers unclassified cardiomyopathies, screening of family members, and population health approaches.
Cardiomyopathies are diseases of the heart muscle that result from various causes such as genetic defects, injury to heart muscle cells, or infiltration of heart tissue. There are several classifications of cardiomyopathies including dilated, hypertrophic, restrictive, and arrhythmogenic right ventricular cardiomyopathy. Dilated cardiomyopathy is the most common type and results in enlarged heart chambers and impaired contraction. Hypertrophic cardiomyopathy is characterized by abnormal thickening of the heart muscle and can lead to obstruction of blood flow. Restrictive cardiomyopathy involves scarring or infiltration of the heart muscle which restricts the filling of the heart chambers. The document provides details on the definitions, causes, clinical presentations, diagnostic evaluations, and management of these
Restrictive cardiomyopathy-VALSALVA, KUSSUMAL ITS IMPORTANCE IN DDpptxlakshminivasPingali
Most important basic myopathy on which definitely, clinical assessment well as DM. Entrance NEETSS CARDIOLOGY candidates benefit by learning 3aspects, 1) clinical presentation 2) Kussumal sign and RM,Tampo,ccmyopathy.MOST IMPORTANT TO DIFFERENTIATE BETWEEN CCMYOPATHY AND RESTRICTIVE CARDIOMYOPATHY.
This document provides an overview of hypertrophic cardiomyopathy (HCM). It begins with definitions of cardiomyopathy and HCM. It then discusses the historical perspective, genetic basis, morphology, pathophysiology, clinical features, diagnosis, and management of HCM. Some key points include:
- HCM is a genetic heart condition characterized by unexplained thickening of the heart muscle. It is the most common cause of sudden cardiac death in young people.
- The genetic basis involves mutations in genes encoding sarcomere proteins. This leads to impaired relaxation and increased calcium sensitivity of the heart muscle.
- Morphologically, HCM involves asymmetric left ventricular hypertrophy and abnormalities of the mitral valve apparatus. Hist
Tachycardia induced cardiomyopathy is a type of dilated cardiomyopathy caused by chronic or frequent tachycardia that leads to impaired left ventricular function. This impairment is partially or fully reversible by controlling the heart rate. The document discusses the criteria, types, pathophysiology, diagnosis, and treatment of tachycardia induced cardiomyopathy. Treatment focuses on heart rate control through medications, ablation, or devices, which can improve ejection fraction and heart failure symptoms over time.
Cardiomyopathy refers to diseases of the heart muscle that are not caused by coronary artery disease, hypertension, or congenital heart defects. The main types are dilated cardiomyopathy, hypertrophic cardiomyopathy, restrictive cardiomyopathy, and arrhythmogenic right ventricular cardiomyopathy. Dilated cardiomyopathy is characterized by decreased contractility and ventricular dilation, while hypertrophic cardiomyopathy involves ventricular hypertrophy with impaired diastolic function. Restrictive cardiomyopathy restricts diastolic filling. Management involves medications to reduce symptoms and progression such as ACE inhibitors, beta blockers, diuretics, and device therapy for refractory cases.
Cardiogenic shock is caused by severe impairment of myocardial performance resulting in diminished cardiac output and end-organ hypoperfusion. It presents clinically as hypotension refractory to fluids with signs of poor tissue perfusion. Acute myocardial infarction accounts for most cases of cardiogenic shock. Rapid diagnosis and treatment is needed to prevent end-organ damage. Management involves hemodynamic support, revascularization when possible, and mechanical circulatory support for refractory cases.
Reverse Takotsubo Cardiomyopathy Following General AnaesthesiaPremier Publishers
Reverse takotsubo cardiomyopathy(r-TTC) is a rare condition in which regional wall motion abnormalities affect the basal segments of left ventricle in absence of significant coronary artery disease. The Diagnosis is established by characteristic echocardiographic findings, clinical manifestations, and laboratory features. In this report we demonstrate a case of general anaesthesia induced cardiomyopathy in 21 years old female.
This document outlines and defines various types of cardiomyopathies:
- Dilated cardiomyopathy is the most common type and is characterized by dilation and impaired contraction of one or both ventricles.
- Hypertrophic cardiomyopathy is characterized by left ventricular hypertrophy in the absence of another cause. It is often genetic and can cause sudden death.
- Restrictive cardiomyopathy features a rigid ventricle causing severe diastolic dysfunction. It can be idiopathic or caused by conditions like amyloidosis.
- Arrhythmogenic right ventricular cardiomyopathy causes replacement of the right ventricle with fat or fibrosis which can lead to arrhythmias.
Cardiomyopathies are a group of diseases that affect the myocardium of the heart. They can be classified into different types including dilated, hypertrophic, restrictive, and arrhythmogenic right ventricular cardiomyopathy. Hypertrophic cardiomyopathy is a familial condition characterized by unexplained thickening of the left ventricular wall and septum without an identifiable cause. It is one of the leading causes of sudden cardiac death.
Similar to A diverse spectrum of cardiomyopathies including atypical variants ijar november 2016 (20)
This document discusses the importance of ophthalmoscopy examination in patients presenting to the emergency department with headache or neurologic complaints. It notes that fundus examination is often not performed due to barriers like time, training, and equipment. Studies found high rates of undiagnosed conditions when fundus was not examined. The document recommends using portable non-mydriatic cameras and tele-ophthalmology to make fundus imaging easier and more accessible. A trial found emergency department providers had better results examining digital fundus photos compared to traditional ophthalmoscopy. Wider use of fundus photography may help improve diagnosis and management of neurologic conditions.
CMB and ICH on oral anticoagulation in strokes due to non valvular AFSachin Adukia
The study assessed the association between cerebral microbleeds (CMBs) and future spontaneous intracerebral hemorrhage (ICH) risk in ischemic stroke patients with atrial fibrillation (AF) taking oral anticoagulants (OACs). A meta-analysis of 1552 patients from studies measuring CMBs on MRI found that the presence of 5 or more CMBs, regardless of location, was associated with a higher risk of future ICH. The risk of ICH in patients with 5 or more CMBs may be too high to continue OAC treatment.
This document provides guidelines for assessing and managing mild cognitive impairment (MCI). It defines MCI as a state between normal cognition and dementia, involving measurable deficits in at least one cognitive domain with no impairment in daily living. There are two main types: amnestic MCI, which is often a precursor to Alzheimer's disease, and non-amnestic MCI affecting other domains. The guidelines recommend using validated cognitive assessment tools in addition to patient/informant reports to diagnose MCI, and assessing for functional impairment before diagnosing dementia. They also suggest monitoring patients over time, treating modifiable risk factors, and discussing uncertainties around prognosis and long-term planning with patients and families.
Electrodiagnostic approach to peripheral neuropathySachin Adukia
This document discusses electrodiagnostic approaches to peripheral neuropathy. It begins with the anatomy and physiology of peripheral nerves and clinical clues in diagnosis. It then covers electrodiagnostic principles in nerve conduction studies and their use in evaluating various pathologies. Specific examples discussed include mononeuropathy, polyneuropathy, mononeuritis multiplex, and demyelinating vs axonal neuropathies. Case examples are also provided of common conditions like carpal tunnel syndrome, Guillain-Barré syndrome, and chronic inflammatory demyelinating polyneuropathy.
The document discusses various epileptic encephalopathies that typically begin early in life and are characterized by seizures, abnormal EEG patterns, and cognitive and neurological deterioration. It defines epileptic encephalopathies and provides details on specific syndromes including early myoclonic encephalopathy, Ohtahara syndrome, West syndrome, Dravet syndrome, and Lennox-Gastaut syndrome. For each syndrome, it discusses age of onset, causes, clinical features, EEG findings, treatment approaches, and prognosis.
neurodegeneration due to braiin iron accumulationSachin Adukia
This document provides an overview of neurodegeneration due to brain iron accumulation (NBIA). It defines NBIA as a heterogeneous group of inherited neurodegenerative disorders characterized by extrapyramidal movement disorders and abnormal iron accumulation in the basal ganglia. It then describes several specific disorders that fall under the NBIA classification, including their typical clinical presentations, imaging features, pathology findings, and treatment approaches. Key disorders discussed include PKAN, PLAN, MPAN, and BPAN. The document provides detailed information on the genetic causes and characteristic signs of each condition.
This document provides guidelines for the comprehensive management of patients with amyotrophic lateral sclerosis (ALS). It discusses presenting the diagnosis, specific pharmacotherapies including riluzole and edaravone, symptomatic treatments, multi-disciplinary care, physical and speech rehabilitation, nutritional management, respiratory care, and end-of-life care. Key recommendations include using riluzole to prolong survival, considering non-invasive ventilation to prolong survival and slow respiratory decline, and providing home or hospice care for terminally ill patients to maintain dignity.
This document provides an overview of normal EEG patterns in adults. It begins with a brief history of EEG and then describes the basic electrical activity generated by the brain and how EEG recordings work. It outlines the normal frequency bands seen in EEG - delta, theta, alpha, beta and gamma. Specific normal EEG patterns like the alpha rhythm, vertex waves, sleep spindles and K-complexes are described. It also discusses benign variants and activation procedures. In summary, the document serves as a reference for the typical EEG patterns seen in healthy, awake and sleeping adults.
This document discusses progressive myoclonic epilepsy (PME), a group of rare genetic neurological disorders characterized by myoclonus and epileptic seizures with progressive neurological decline. It describes several specific forms of PME, including neuronal ceroid lipofuscinoses (NCLs), Lafora body disease, Unverricht-Lundborg disease, and myoclonic epilepsy with ragged-red fibers. For each, it covers clinical features, genetics, investigations such as EEG and MRI findings, pathology, treatment approaches, and prognosis. The document provides a detailed review and comparison of these progressive myoclonic epilepsy syndromes.
1. PLEDs (Periodic Lateralized Epileptiform Discharges) are a pattern seen on EEG characterized by periodic discharges that are lateralized to one hemisphere.
2. They are commonly seen in conditions involving acute brain injury or inflammation such as stroke, encephalitis, tumors, or hypoxic ischemic encephalopathy.
3. PLEDs are associated with a risk of seizures but generally indicate an unstable brain state that will improve over time as the underlying condition resolves. Prognosis depends on the specific cause.
The document discusses parasomnias, which are abnormal behaviors or movements that occur during sleep or sleep transitions. It describes the different stages of sleep based on EEG patterns. It then discusses various parasomnias like sleepwalking, sleep terrors, confusional arousals, REM sleep behavior disorder, nightmares, and sleep paralysis. It provides details on characteristics, typical age of onset, precipitating factors, treatment options. It also discusses disorders like sleep talking, catathrenia, hypnic jerks, and excessive fragmentary myoclonus that are common and clinically insignificant. The document outlines investigations like polysomnography and neurological imaging that can help evaluate parasomnias.
The document summarizes several newer antiepileptic drugs including levetiracetam, lacosamide, zonisamide, vigabatrin, rufinamide, and topiramate. It discusses their mechanisms of action, indications, dosages, advantages, side effects, drug interactions, and considerations for use in women. The newer AEDs have fewer drug interactions than older AEDs, unique mechanisms of action, and broader spectrum of activity against different seizure types.
This document provides information about nerve conduction studies (NCS). It discusses the basic components of a NCS including compound muscle action potentials, sensory nerve action potentials, F-waves, and H-reflexes. It describes the procedure, techniques, and applications of NCS in evaluating conditions like neuropathies, radiculopathies, and neuromuscular junction disorders. Limitations include NCS only assessing the largest nerve fibers and conditions proximal to the dorsal root ganglia potentially showing normal results.
Imaging based selection of patients for acute stroke treatmentSachin Adukia
1) Several positive randomized controlled trials from 2015 established endovascular therapy (EVT) as effective for recanalization in patients with acute proximal anterior circulation artery occlusion.
2) Non-invasive neuroimaging is needed to exclude intracranial hemorrhage, confirm and localize treatable vessel occlusions, detect irreversible ischemic damage, and characterize salvageable tissue.
3) Recent studies have demonstrated that imaging-based selection of patients for EVT, including analysis of infarct core size, penumbra, and collateral flow, can effectively identify patients likely to benefit from the procedure beyond the 6 hour time window established in earlier trials.
This document summarizes information about primary headaches. It discusses how headaches arise from activation of pain-sensitive intracranial structures identified in the 1930s. It then describes migraines, including diagnostic criteria and prevalence statistics. Symptoms and diagnostic scales for migraine aura are outlined. Common terms formerly used to describe tension headaches are listed. Treatment options for migraines and other primary headaches include triptans, corticosteroids, antiemetics, narcotic analgesics, and preventative medications like beta-blockers, calcium channel blockers, lithium, topiramate, and valproate. Refractory cases may require combination therapies. References are provided.
This document discusses different types of autoimmune encephalitis. It categorizes autoimmune encephalitis as either paraneoplastic, non-paraneoplastic, or associated with vasculitis. Within non-paraneoplastic autoimmune encephalitis, several specific types are described that are associated with antibodies against receptors like NMDA, GABA, AMPA, and LGI1. Clinical features, pathogenesis, diagnosis and treatment approaches are summarized for some of the major types like anti-NMDA receptor encephalitis. Long term management involves immunosuppression with steroids and other agents to prevent relapse, though neurologic sequelae may still occur in some patients.
1) Stupor and coma are states of decreased or absent responsiveness that require evaluation to identify potentially reversible causes and provide emergency treatment.
2) The initial approach involves stabilizing vital functions, treating potentially reversible causes, obtaining history, and performing a full neurological examination.
3) Emergency treatment may include supplemental oxygen, IV thiamine, glucose, and antibiotics depending on suspected causes identified from history and examination.
This case report describes an unusual case of a 31-year-old male who presented with symptoms of Wallenberg syndrome due to simultaneous bilateral infarction of the anterolateral medulla. Extensive evaluation did not reveal a clear cause of the stroke. MRI showed subacute infarcts in the anterolateral aspect of the medulla bilaterally. CT angiogram showed a hypoplastic left vertebral artery but no significant stenosis. Investigations ruled out conditions like vasculitis, vascular malformations, and cardiac abnormalities. The patient was diagnosed with cryptogenic stroke and made a near complete recovery with treatment. This case highlights the importance of thorough evaluation for young patients presenting with stroke to identify potentially treatable causes.
multiple level spondylodiscitis in neurobrucllosis: int jr of medicineSachin Adukia
Multiple level spondylodiscitis with presacral abscess in spinal brucellosis: a rare presentation
A 56-year-old male farmer in India presented with lower back pain and weakness in his legs for 9 weeks. MRI revealed multi-level infective spondylodiscitis and a prevertebral sacral abscess. Blood culture grew Brucella melitensis after 8 days. Treatment was modified to a 12-month triple antibiotic therapy. Spinal brucellosis should be considered for those with back pain in endemic areas, as timely diagnosis and appropriate treatment is important.
This letter discusses the case of a young male patient who presented with right-sided abducens and facial nerve palsies. MRI showed pachymeningeal thickening and the patient was initially diagnosed with idiopathic hypertrophic pachymeningitis (HPM). However, the patient's condition deteriorated and he developed anisocoria and delirium. Further investigations revealed acute leukemic changes in the bone marrow. This case highlights how HPM can be disguised by other conditions like leukemia, and emphasizes considering alternative diagnoses when patients do not respond as expected to initial treatments.
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
Dr. Tan's Balance Method.pdf (From Academy of Oriental Medicine at Austin)GeorgeKieling1
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Organization
Academy of Oriental Medicine at Austin
Academy of Oriental Medicine at Austin
Academy of Oriental Medicine at Austin
About AOMA: The Academy of Oriental Medicine at Austin offers a masters-level graduate program in acupuncture and Oriental medicine, preparing its students for careers as skilled, professional practitioners. AOMA is known for its internationally recognized faculty, award-winning student clinical internship program, and herbal medicine program. Since its founding in 1993, AOMA has grown rapidly in size and reputation, drawing students from around the nation and faculty from around the world. AOMA also conducts more than 20,000 patient visits annually in its student and professional clinics. AOMA collaborates with Western healthcare institutions including the Seton Family of Hospitals, and gives back to the community through partnerships with nonprofit organizations and by providing free and reduced price treatments to people who cannot afford them. The Academy of Oriental Medicine at Austin is located at 2700 West Anderson Lane. AOMA also serves patients and retail customers at its south Austin location, 4701 West Gate Blvd. For more information see www.aoma.edu or call 512-492-303434.
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
Congestive Heart failure is caused by low cardiac output and high sympathetic discharge. Diuretics reduce preload, ACE inhibitors lower afterload, beta blockers reduce sympathetic activity, and digitalis has inotropic effects. Newer medications target vasodilation and myosin activation to improve heart efficiency while lowering energy requirements. Combination therapy, following an assessment of cardiac function and volume status, is the most effective strategy to heart failure care.
PGx Analysis in VarSeq: A User’s PerspectiveGolden Helix
Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...Université de Montréal
“Psychiatry and the Humanities”: An Innovative Course at the University of Montreal Expanding the medical model to embrace the humanities. Link: https://www.psychiatrictimes.com/view/-psychiatry-and-the-humanities-an-innovative-course-at-the-university-of-montreal
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14...Donc Test
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
Gene therapy can be broadly defined as the transfer of genetic material to cure a disease or at least to improve the clinical status of a patient.
One of the basic concepts of gene therapy is to transform viruses into genetic shuttles, which will deliver the gene of interest into the target cells.
Safe methods have been devised to do this, using several viral and non-viral vectors.
In the future, this technique may allow doctors to treat a disorder by inserting a gene into a patient's cells instead of using drugs or surgery.
The biggest hurdle faced by medical research in gene therapy is the availability of effective gene-carrying vectors that meet all of the following criteria:
Protection of transgene or genetic cargo from degradative action of systemic and endonucleases,
Delivery of genetic material to the target site, i.e., either cell cytoplasm or nucleus,
Low potential of triggering unwanted immune responses or genotoxicity,
Economical and feasible availability for patients .
Viruses are naturally evolved vehicles that efficiently transfer their genes into host cells.
Choice of viral vector is dependent on gene transfer efficiency, capacity to carry foreign genes, toxicity, stability, immune responses towards viral antigens and potential viral recombination.
There are a wide variety of vectors used to deliver DNA or oligo nucleotides into mammalian cells, either in vitro or in vivo.
The most common vector system based on retroviruses, adenoviruses, herpes simplex viruses, adeno associated viruses.
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A diverse spectrum of cardiomyopathies including atypical variants ijar november 2016
1. A diverse spectrum of cardiomyopathies including atypical
variants
KEYWORDS Poor ejection fraction, peripartum cardiomyopathy, systolic anterior motion
Introduction
Cardiomyopathies are diseases of heart muscle resulting
genetic defects, cardiac myocyte injury, or in ltration of
myocardial tissues, insults to both cellular elements of the heart
(notably the cardiac myocyte) and processes that are external to
cells (such as deposition of abnormal substances into the
extracellular matrix).[1] Cardiomyopathies are traditionally
categorized into dilated cardiomyopathy (DCM), restrictive
cardiomyopathy (RCM) and hypertrophic cardiomyopathy
(HCM) variants. Predominant remodeling of the left ventricle
(LV) distinguishes these categories.
Disorders associated with systemic or certain cardiac diseases
are called speci c heart muscle diseases. These include
ischemic cardiomyopathy (ICM), valvular, hypertensive,
in ammatory, metabolic, peripartum, general systemic disease,
muscular dystrophies, neuromuscular disorders and toxic and
hypersensitivity reactions.[2] Morphological changes of
cardiomyopathy (CM) precede clinical manifestations of heart
failure by months to years. Heart failure due to congestive
cardiac failure (CCF), hypertension (HTN), diabetes mellitus
(DM), rheumatic heart disease and obesity in the year 2000
ranged from 1.3 million to 4.6 million. These estimates however
exclude causes such as alcoholic, familial, hypertrophic,
idiopathic, dilated and other cardiomyopathies.[3] A clinical
pro le of cardiomyopathies is therefore needed as
epidemiological data on cardiomyopathy in India is lacking.
Material and Methods
Approval from the Ethics committee for material and methods
to be used, was procured before commencing data collection.
50 patients (age > 18 years) with echocardiographic ndings of
cardiomyopathy, visiting a teaching hospital over 2 years, were
included after written informed consent in this descriptive
analytical study.
Inclusion Criteria
Ÿ Patients presenting with 2D-Echo showing evidence of
cardiomyopathy
Exclusion Criteria
Ÿ Valvular Heart Disease
Ÿ Congenital Heart Disease
Ÿ Pericardial Disease
Ÿ History of Acute Myocardial Infarction [Patients with
ischemic heart disease (IHD) were included as IHD is a
recognized cause of cardiomyopathy].[4]
Echocardiographic diagnostic criteria in Dilated
Cardiomyopathy included:
Ÿ a dilated, poorly contractile left ventricle
Ÿ left atrial dilatation
Ÿ mitral valve motion consistent with reduced cardiac output
Echocardiographic diagnostic criteria in Hypertrophic
Cardiomyopathy included:
Ÿ Asymmetrical septal hypertrophy (ASH):- LV thickness was
considered abnormal when ≥ 15 mm, and de ned
asymmetrical septal hypertrophy in presence of a septal to
free wall thickness ratio between 1.3 and 1.5
Ÿ Systolic anterior motion of the mitral valve (SAM):-
characterized by an abrupt anterior movement of the mitral
valve reaching its peak before maximum movement of the
posterior wall
Ÿ a small LV cavity
Ÿ septal immobility
Ÿ premature closure of the aortic valve[4,5]
The data was compiled and analyzed using Statistical Package
for Social Sciences (SPSS v/s 18) and employing descriptive
statistics such as frequencies and percentages.
Volume : 6 | Issue : 11 | November 2016 | ISSN - 2249-555X | IF : 3.919 | IC Value : 74.50ORIGINAL RESEARCH PAPER Medical Science
Dr. Sachin A Adukia Dr. Arundhati G Diwan
Senior Resident, MD (Medicine). MD (Medicine), Professor and Head, Department
Of Medicine.
538 X INDIAN JOURNAL OF APPLIED RESEARCH
Aim and Objectives: To document the clinical pro le of cardiomyopathy including age distribution, symptoms,
clinical signs, electrocardiographic and echocardiographic changes. Material and methods: A descriptive analytical study was
conducted at a teaching hospital over 2 years including 50 adults (age 18 years) with echocardiographic evidence of
cardiomyopathy. Patients with valvular heart disease, pericardial disease, history of myocardial infarction and congenital heart
disease were excluded. The echocardiographic criteria were as per 'American Society of Echocardiography' and 'American Heart
Association'. Results: Mean age of presentation was 57 years (range 22 to 80 years); more in males (52%) with peak prevalence in
7th decade (26%). Commonest type was dilated cardiomyopathy (36%) due to primary causes and secondary causes (other than
ischemia). Commonest presentation was breathlessness (100%) with one-third showing dyspnoea NYHA grade 4, cough (50%)
and fatiguability (42%). Basal crepitations were the commonest clinical nding (72%). Electrocardiography commonly revealed left
ventricular hypertrophy (72%), ST-T segment abnormalities (56%), ventricular premature complexes (32%), left bundle branch
block (26%) and rst degree AV block (14%). Echocardiography showed hypokinesia (segmental or global) in 78% and mitral
regurgitation (isolated or as part of multivalvular involvement) in 76%. Subjects with dilated cardiomyopathy showed a dilated left
ventricular cavity and severely reduced left ventricular ejection fraction on echocardiography. Hypertrophic cardiomyopathy and
restrictive cardiomyopathy were also documented alongwith atypical variants like arrhythmogenic right ventricular dysplasia,
takotsubo cardiomyopathy, peripartum cardiomyopathy, hypothyroid cardiomyopathy and takayasu arteritis related
cardiomyopathy.
ABSTRACT
2. 539 X INDIAN JOURNAL OF APPLIED RESEARCH
Volume : 6 | Issue : 11 | November 2016 | ISSN - 2249-555X | IF : 3.919 | IC Value : 74.50ORIGINAL RESEARCH PAPER
Results
50 cases were studied in all. DCM (other than ischemic etiology)
was the commonest cardiomyopathy (36%). Causes of DCM
included idiopathic, alcohol and diabetes. ICM was the second
commonest cardiomyopathy (34%). Commonest age group to
be affected was 7th decade (13 patients, 26%) followed closely
by the 4th and 5th decade (24% each). Maximal occurrence for
DCM was between 40 to 70 yrs of age (20 patients out of 27,
74%), with a similar occurrence for ICM (14 out of 17, 82%).
Atypical cardiomyopathies like takotsubo cardiomyopathy,
hypothyroidism related cardiomyopathy, Parkinson associated
cardiomyopathy, peripartum cardiomyopathy and Takayasu
arteritis related cardiomyopathy were included as part of DCM
because their eventual phenotype was similar to DCM. Table 1
shows various types of atypical cardiomyopathies documented
by us.
Table 1: Types of Atypical of Cardiomyopathy in the present
study
*CM- Cardiomyopathy
Females were commonly affected by DCM (15 out of 27, 56%),
while males were more affected by ICM (11 out if 17; 65%). In
HCM (obstructive and non-obstructive) males were
predominantly affected (3 out of 4; 75%). Overall males were
marginally more affected in the entire study than females (52%
versus 48%).
Dyspnoea was found in all 50 patients (100%). Cough was seen
50% (more in patients of ICM- 11 of 17 patients; 65%).
Fatiguability (42%), swelling of feet (40%), chest pain (38%),
palpitations (20%) and syncope (10%) were other notable
presenting features. New York Heart Asoociation (NYHA) Grade
IV dyspnoea was overall seen in 17 patients (34%) on initial
history recording with an equal number in ICM patients and
DCM (8 patients each). On examination, signs of cardiac failure
were more common in DCM and ICM group. Basal crepitations
(72%), pedal edema (48%), heart murmur (44%), raised jugular
venous pressure (JVP; 36%) and hepatomegaly (18%) were
frequently appreciated.
On ECG analysis left ventricular hypertrophy (LVH) was the
commonest nding (72%). ST-T changes like ST segment
elevation, ST segment attening and ST segment depression
was seen in all types of cardiomyopathy (28 patients, 56%). T
wave changes like T wave inversion (32%), left bundle branch
block (LBBB; 26%) and 1o AV block (14%) were also seen. Other
arrhythmias including atrial brillation (AF; 12%),
supraventricular tachycardia (SVT; 12%), atrial utter (2%) and
ventricular brillation (VF; 2%) were recorded. Tachyarrhythmias
more frequent than bradyarrhytmias.
In the DCM group (including atypical cardiomyopathy) and ICM
group, chest x-ray suggestive of cardiomegaly was seen in 33 of
44 patients (75%), while pulmonary congestion is seen in 24 of
these 44 patients (55%). HCM group showed no signi cant x-
ray ndings.
Echocardiography study revealed that dilated LV cavity, poor LV
contractility, decreased left ventricular ejection fraction (LVEF),
hypokinesia, diastolic dysfunction and valvular regurgitation
were common ndings in DCM and ICM group. Mitral valve
(alone and isolated) was most commonly affected. Valvular
regurgitation was seen in 26 (96.29%) of patients of DCM. There
was isolated MR in 4 (14.81%) of patients, while MR associated
with TR in 11 (40.74%), MR with AR in 2 (7.40%) of patients.
There was isolated TR in 3 (11.11%) of patients. In patients of
ICM valvular regurgitation was seen in 17 (100%) patients.
There was isolated MR in 2 patients (11.76%), while associated
MR with TR in 4 (23.52%) and isolated AR in 2 patients (11.76%).
All our 4 patients of HCM showed increased thickness of inter-
ventricular septum (IVS). The average septal thickness of 20.33
± 4.04 mm in obstructive HCM was signi cantly higher than 17
mm recorded in our only case of non obstructive HCM.
Asymmetrical septal hypertrophy (ASH) and systolic anterior
motion of mitral valve (SAM) was observed in obstructive group.
MR and LV out ow tract (LVOT) gradient was also observed in
obstructive group. LVOT gradient was found in obstructive
HCM and was more than 20mm Hg. SAM was seen in 2 of 3
patients of obstructive HCM only. Ratio of IVS: LVPW (LV
posterior wall; LVPW) in obstructive group was 1.32:1 while in
non obstructive HCM it is 1.7:1. LA enlargement was found
signi cantly more in patients with obstructive HCM, while
normal in non obstructive HCM. It was taken as indicator of
presence of dynamic obstruction. Ejection fraction (EF) was
normal in both groups, obstructive and non-obstructive.
Our only patient with RCM was 45 years female presenting with
cough, breathlessness, fatigability and swelling of feet. On
physical examination pulse rate was 70/min, irregular, low
volume pulse. Blood pressure was 110/70 mmHg, minimal
pedal edema and elevated JVP. Cardio-respiratory examination
revealed apical systolic murmur with bilateral scattered
crepitations. The ECG showed an axis of +10o with AF and T-
inversion in V3- V6. Chest x-ray revealed mild cardiomegaly
with bilateral pulmonary congestion. Echocardiography
showed extraneous echodensities in LV apex with evidence of
decreased EF (50%), diastolic dysfunction, LA enlargement (47
mm).
Data on peripartum cardiomyopathy showed that it affected
multigravida and primigravida equally. Patients presented with
higher grades of dyspnoea (NYHA grade III or IV). Symptoms
began within 1 month after delivery (vaginal or
Caesarean).Chest X-ray showed moderate cardiomegaly and
pulmonary congestion. Echocardiography showed features of
DCM with poor EF. However, the number of cases was too small
(only 4 cases) to make accurate conclusions. Table 2 shows
echocardiographic ndings of our study. None of our patients
of any group had pericardial effusion or intra-cavitatory clots.
Types of
atypical
CM*
Parkinso
n's CM
Takotsu
bo CM
Peripart
um CM
Hypothy
roid CM
Takayasu
Arteritis
realated
Total
No. of
Cases
1 2 4 2 1 10
Table 2: Echocardiographic features in Cardiomyopathy in present study
Radiological
ndings
TYPES OF CARDIOMYOPATHY Total
DCM ICM HOCM HCM RCM ARVD**
LVID(d)* mm
57.29 ± 3.82
58.11 ±
3.85
42 ± 9.64 57 47 48 -
LVID (S) † mm 42.03 ± 4.68 42.7 ± 5.27 26 ± 10.39 38 33 30 -
3. *LVID (d)- LV diameter in diastole, † LVID (s)- LV diameter in
systole , ‡LVPW- LV posterior wall thickness, § ASH- Asymmetric
septal hypertrophy, || SAM- Systolic anterior motion of mitral
valve,¶ DD- Diastolic dysfunction, ** ARVD- Arrhythmogenic
right ventricular dysplasia.
Discussion
Hollister R.M and Goodwin J.F[6] (1963) studied 52 patients
with cardiomyopathy, 25 patients had DCM, 18 patients had
HCM and 9 patients had RCM. This was concordant with our
study. In our study, age range of HCM (obstructive and non-
obstructive) was between 31-70 years with an overall mean age
of 60.75 yrs and male predominance. Braunwald et al[7] (1964)
found that average age of presentation for HCM among
Western population was 26 years with a strong male
preponderance; similar to that recorded in the apical variant of
HCM by Panja[8] (1988). In our study, no patient of HCM had a
positive family history. However, Marron et al [9] (1984) while
studying 70 families of HCM patients, found that other
members showed evidence of HCM in 39 families. Of these, 30
families had autosomal dominant transmission.
Fuster et al [10] (1981) found that symptoms of CCF were
present in 73% patients of DCM and symptoms of systemic
emboli were present in only 4% of patients. Schoeller et al [11]
(1993) found dyspnoea NYHA grade II-40%, grade III-36% and
grade IV-24%. Rihal et al[12] (1994) have found that out of 102
patients 30 patients had NYHA dyspnoea grade 1, 28 grade II,
35 grade III and 9 grade IV. Anderson et al [13] (1995) studied 83
patients of idiopathic DCM and found higher NYHA grade of
dyspnoea (III or IV). In India, Parale et al [14] (2001) have
reported breathlessness in 100% patients; consistent with our
study. However, we recorded an overall higher NYHA grade of
dyspnoea in majority patients with DCM or ICM (30 patients out
of 44; 68%) compared to other studies. In the present study 5
patients and 3 patients of DCM and ICM group respectively,
had syncope. Viable comparative data for syncope was not
available.
Breathlessness was invariable and present in all 4 patients
(100%) of HCM. 2 patients had NYHA grade 1 dyspnoea, while
grade II dyspnoea and grade III dyspnoea was seen in 1 patient
each. History of syncope was present in all 3 patients of HCM –
obstructive type. Braunwald et al [7] (1964) have found that out
of 64 patients of HCM (obstructive and non-obstructive type),
breathlessness was present in 83% cases, chest pain 39%,
palpitation 17% giddiness 34% and syncope in 26% cases.
Godwin et al [15] (1964) found that out of 29 patients of HCM,
breathlessness was present in 69%, chest pain 38%, palpitation
13.8% and syncope in 41% cases. Shapiro et al [16] (1983)
studied 39 patients of HCM and reported breathlessness in
59%, chest pain 47%, palpitation 31% and syncope in 23%
cases.
In the present study, signs of right heart failure like raised JVP,
congestive hepatomegaly, ascites and pedal oedema were
observed in less than half the patients of DCM and ICM both.
On cardio-respiratory examination in patients of DCM, systolic
murmur was appreciated in 13 (48%), gallop rhythm in 3 (11%),
precordial thrill in 2 (7.40%) and 19 (70%) patients had
respiratory crepitations. Likoff et al [17] (1987) found that 86%
patients had S3 and 73% had evidence of right sided failure.
Dec et al [1] (1994) found right heart failure in fewer than 50% of
patients. Parale et al [14] (2001) observed similar ndings as
ours.
In our study, systolic murmur and precordial thrill was present in
1 patient of obstructive HCM while the only patient of non-
obstructive HCM had no physical ndings.
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IVS (mm) 10.48 ± 2.22
10.41 ±
1.62
20.33 ±
4.04
17 16 9 -
LVPW ‡ (mm) 9.96± 1.74
10.79 ±
1.30
15.33 ±
3.51
10 16 9 -
LA 33.85 ± 3.76
38.29 ±
4.90
45.33 ±
10.11
18 47 24 -
Ejection
Fraction (%)
29.81 ± 8.26
27.35 ±
9.20
61.66 ±
2.88
75 50 60 -
Hypokinesia 24 16 0 0 0 0 40
ASH § 0 0 3 0 0 0 3
SAM || 0 0 2 0 0 0 2
DD ¶ 11 4 2 1 2 0 20
LVOT
Obstruction
0 0 3 0 0 0 3
Valvular regurgitation
AR 3 2 0 0 0 0 5
MR 4 2 2 0 0 0 8
MR,AR 2 2 0 0 0 0 4
MR,TR 11 4 0 0 1 0 16
TR 3 1 0 0 0 0 4
MR (combined
+ isolated)
20 14 2 0 1 0 37
4. Godwin et al [15] (1964) found that out of 29 cases of HCM, 26
(90%) had murmur, 23 (79%) had LV apex, 10 (34%) had thrill and
20 (69%) had third or fourth heart sound. Braunwald et al [7]
(1964) reported that out of 64 cases of HCM, all had murmur
(100%), 33(51%) had LV apex, 45(73%) had thrill and 38(59%)
had third or fourth heart sound.
ECG pro ling of DCM patients by Wilensky et al [18] (1988)
revealed a range of QRS axis from -130o to + 130o; mean QRS
axis was -21o. Parale et al [14] (2001) reported left axis deviation
(LAD) in 59% patients of DCM. Techuan Chou mentions LAD in
42% patients of DCM. Findings in the present study were
comparable with above studies. Out of 27 patients of DCM in
our study, normal axis was seen in 19 (70%), left axis deviation 8
(27%). None of our DCM patients had RAD. Wilensky et al [18]
(1988) found mean PR interval 0.20 sec. Schoeller et al [11]
(1993) found rst degree AV block in 18% and second degree
AV block in 11% patients. These compared with our recordings
of 1st degree AV block in 2 (7%) of DCM and 5 (29%) in ICM. We
recorded LVH without strain in 44% (12/27) of DCM and 47%
(8/17) of ICM patients. Momiyama et al (19) (1994) reported
69% LVH on ECG.
In our study, LBBB was seen in 9 (33%) DCM patients; ICM
subjects showed LBBB in 3 (18%) and RBBB in 1 patient (6%).
Likoff et al [17] (1987) found LBBB in 22% patients, Barbosa et al
[20] (1989) reported LBBB in 25% and RBBB in 4.4%, Schoeller
et al [11] (1993) found LBBB in 41% and RBBB in 3.5%. This data
was concordant with our data. –we observed that 'P' waves
were absent in 6 patients with AF and 1 with VF. Various
investigators including Likoff (1987), Barbosa (1989), Wilensky
(1988), Schoeller (1993), Anderson (1995) and Parale (2001) all
had AF and ventricular premature complexes (VPCs) as the
commonest arrhythmias.(11,13,14,17,18,20)
Our study included 4 HCM patients, and QRS axis was normal
seen in all 4 with ST- T and T wave changes in 1 patient each
(25%) and LVH in 1 (25%). No conduction abnormalities were
seen in any of them. Savage et al [21] (1978) found ST changes
in 81%, LVH in 64%, LA enlargement in 48% and abnormal Q
wave in 33% patients on ECG. Shapiro et al [16] (1983) found ST
changes in 54% and LVH in 87% patients.
In our study, out of 27 patients of DCM, 16 patients (59.25%)
showed evidence of cardiomegaly with cardio thoracic ratio (CT
ratio) more than 0.5. Out of 17 patients of ICM, 12 patients
(70.58%) had evidence of cardiomegaly. Fuster et al [10] (1981)
studied 104 patients of DCM; only 24 of these survived at the
end of follow up (6-20 years). They found that 86% of the
patients died had a CT ratio 0.55, where only 14% of those
alive had a CT ratio 0.55. Cardiomegaly and pulmonary
congestion was absent in all our 4 patients of HCM. In contrast,
Godwin et al [15] (1964) found cardiomegaly in chest x-ray
15/29 patients with obstructive HCM. Table 3 and table 4
compare our echocardiographic ndings with 2 earlier studies.
According to table 3, LV dimensions were lesser, but all patients
had hypokinesia and poor LVEF which is comparable to other
studies.
Table 3: Comparison of echocardiography parameters
between previous studies and present study including LV
diastolic and systolic dimensions, and LVEF.
As per table 4, compared with other studies LVPW and IVS were
within normal limits. Abbasi et al [22] (1972) had concluded that
posterior left ventricular wall motion was markedly reduced in
dilated cardiomyopathy.
Table 4: Comparison of echocardiography parameters
between previous studies and present study including LV
posterior wall thickness and IV septal thickness.
In a study done by Karl et al [23] (1998) mean left atrial diameter
was 47+/-7mm which is more than the mean LA dimension in
this study.
Karl et al [23] (1998) found that MR was present in 89% of the
patients of cardiomyopathy. Kono et al [24] (1991) concluded
that increased LV sphericity was an important factor in evolution
heart failure. In the present study, 11 (41%) of the DCM group
and 4 (15%) of the ICM group showed diastolic dysfunction.
Anderson et al [13] (1995) observed presence of diastolic
dysfunction even in patients without LV dilatation.
Gilbert et al [25] reported septal thickness in HCM patients
(20.7mm) which was signi cantly higher than normal (8.7mm).
He found mean septal size (mm) in patients with various groups:
obstruction at rest-24.8 mm, latent obstruction-20.2 mm and no
obstruction-17.1 mm. He also noted higher incidence of ASH
and higher ratio of IVS: LVPW in obstructive group as compared
with non obstructive group. He found LA enlargement
signi cantly more often in patients with obstruction. He also
documented severe SAM in all patients with obstruction at rest
and in no patients without obstruction. All these parameters
compared to our ndings.
Since we had only one patient of restrictive cardiomyopathy, we
found it inadequate for comparative studies. 4 cases of
peripartum cardiomyopathy were recorded by us, all of whom
showed favorable outcome on serial follow up.
To conclude, commoner types of cardiomyopathies can be
diagnosed by basic investigations like echocardiography and
clinical suspicion index. Potential for pharmacological response
and maintenance justi es further research into this entity.
Limitations of our study were that the sample was too small to
generalize the results. Cardiac investigations including
electrophysiological studies would have added value to the
study. Also, prognosis could not be ascertained as this study
was cross sectional.
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541 X INDIAN JOURNAL OF APPLIED RESEARCH
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542 X INDIAN JOURNAL OF APPLIED RESEARCH