This document discusses ventricular septal defect (VSD), a type of acyanotic congenital heart disease where there is a hole in the wall separating the two ventricles of the heart. It describes the types, symptoms, complications, investigations, and management of VSD. VSDs can range from small and asymptomatic to large defects that cause heart failure. Treatment may involve medical management or surgical closure of the defect depending on the size of the shunt and presence of complications like congestive cardiac failure.
TAPVC defines the anomaly in which the pulmonary veins have no connection with the left atrium. Rather, the pulmonary veins connect directly to one of the systemic veins (TAPVC) or drain in to right atrium.
A PFO or ASD is present essentially in those who survive after birth
When pulmonary veins drain anomalously into the right atrium either because of complete absence of the interatrial septum or malattachment of the septum primum , then it is known as total anomalous pulmonary venous drainage.
When some or all of the pulmonary veins drain anomalously in to RA or its tributaries without being abnormally connected, the terms partially anomalous pulmonary venous drainage (PAPVD) or totally anomalous pulmonary venous drainage (TAPVD) with normal pulmonary venous connections are used.
Patent Ductus Arteroisus, PDA, Cardiology, Paediatrics, Pedicatrics, Critical Care, Emergency medicine, Medicine, Internal Medicine, MBBD, MD, India, CMC Vellore, Christian Medical College
The jugular venous pressure (JVP, sometimes referred to as jugular venous pulse) is the indirectly observed pressure over the venous system via visualization of the internal jugular vein. It can be useful in the differentiation of different forms of heart and lung disease.
TAPVC defines the anomaly in which the pulmonary veins have no connection with the left atrium. Rather, the pulmonary veins connect directly to one of the systemic veins (TAPVC) or drain in to right atrium.
A PFO or ASD is present essentially in those who survive after birth
When pulmonary veins drain anomalously into the right atrium either because of complete absence of the interatrial septum or malattachment of the septum primum , then it is known as total anomalous pulmonary venous drainage.
When some or all of the pulmonary veins drain anomalously in to RA or its tributaries without being abnormally connected, the terms partially anomalous pulmonary venous drainage (PAPVD) or totally anomalous pulmonary venous drainage (TAPVD) with normal pulmonary venous connections are used.
Patent Ductus Arteroisus, PDA, Cardiology, Paediatrics, Pedicatrics, Critical Care, Emergency medicine, Medicine, Internal Medicine, MBBD, MD, India, CMC Vellore, Christian Medical College
The jugular venous pressure (JVP, sometimes referred to as jugular venous pulse) is the indirectly observed pressure over the venous system via visualization of the internal jugular vein. It can be useful in the differentiation of different forms of heart and lung disease.
Ventricular septal defects a brief and easy understanding of embryogenesis, pathophysiology, clinical features, types, diagnosis and management of various types of Ventricular septal defects
Acyanotic heart defects are a class of congenital malformation of the heart. It provides knowledge in detail regarding acyanotic heart defects(VSD &ASD) for B.Sc(N) students.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Pharynx and Clinical Correlations BY Dr.Rabia Inam Gandapore.pptx
Acyanotic Congenital Heart Disease - VSD - Dr. Gunasekaran
1. Dr. D. Gunasekaran D, MD., Dept., of Paediatrics, MGMCRI.
Acyanotic Congenital Heart Disease - VSD
DISEASES OF THE CARDIOVASCULAR SYSTEM
2. Dr. D. Gunasekaran D, MD., Dept., of Paediatrics, MGMCRI.
Acyanotic Congenital Heart Disease - VSD
3. Dr. D. Gunasekaran D, MD., Dept., of Paediatrics, MGMCRI.
Acyanotic Congenital Heart Disease - VSD
Outlet (infundibular)(Supra cristal)
Membranous (80%)
Muscular(5-20%)
Inlet
4. Dr. D. Gunasekaran D, MD., Dept., of Paediatrics, MGMCRI.
Acyanotic Congenital Heart Disease - VSD
Based on size:
Mild, Moderate, Severe:
0.5 cm, 0.5 -1 cm, >1 cm
5. Dr. D. Gunasekaran D, MD., Dept., of Paediatrics, MGMCRI.
Acyanotic Congenital Heart Disease - VSD
6. Dr. D. Gunasekaran D, MD., Dept., of Paediatrics, MGMCRI.
Acyanotic Congenital Heart Disease - VSD
RARVPV PALungsPVLAMV LVAorta
Other parts of the body
What organic murmur? Why?
What flow murmurs? Why?
Which chamber gets enlarged? Position of AI? Type of AI?
Why recurrent RTI?
7. Dr. D. Gunasekaran D, MD., Dept., of Paediatrics, MGMCRI.
Acyanotic Congenital Heart Disease - VSD
Symptoms in VSD
Small VSD:
Asymptomatic; growth is normal;
Murmur - routine clinical examination.
Moderate to Large VSD:
Breathlessness on exertion
Exercise intolerance
Feeding difficulties
Failure to thrive
Frequent RTI
Forehead sweating
Chest pain, palpitation, syncope ???
8. Dr. D. Gunasekaran D, MD., Dept., of Paediatrics, MGMCRI.
Acyanotic Congenital Heart Disease - VSD
Vitals in VSD
Pulse: Volume? Rate? Character? Rhythm?
Blood pressure?
If there is CCF:
9. Dr. D. Gunasekaran D, MD., Dept., of Paediatrics, MGMCRI.
Acyanotic Congenital Heart Disease - VSD
General examination
Undernourished, pallor +/-
Pedal edema, Pre sacral edema
Signs of I.E
10. Dr. D. Gunasekaran D, MD., Dept., of Paediatrics, MGMCRI.
Acyanotic Congenital Heart Disease - VSD
Examination of heart
Inspection:
Precordial bulge (Cardiomegaly – Pliable chest)
Harrison sulcus +/-
Respiratory distress (CCF, LRTI)
11. Dr. D. Gunasekaran D, MD., Dept., of Paediatrics, MGMCRI.
Acyanotic Congenital Heart Disease - VSD
Examination of heart
Palpation:
Position of apical impulse
Shifted down & out (LV enlarge)
Type of apical impulse
Hyper dynamic
Palpate in the lower sternal area:
Thrill in 3, 4, & 5th LICS – Parasternal area
Palpate in the PA for the presence of PHT:
Palpable P2 ; also Systolic thrill
12. Dr. D. Gunasekaran D, MD., Dept., of Paediatrics, MGMCRI.
Acyanotic Congenital Heart Disease - VSD
Examination of heart -Auscultation
Heart sounds:
Usually normal
S1: loud (the cusps of MV are kept wide apart till the end of LV diastole)
S2 : may be widely split; but, varies with respiration.
Murmurs:
PSM – left lower parasternal area - grade 3,4 or 5
(heard throughout the systole, as the pressure in the LV>RV)
Other possible murmurs: Flow murmurs –
ESM at PA,MDM at MA – often drowned by the loud PSM
13. Dr. D. Gunasekaran D, MD., Dept., of Paediatrics, MGMCRI.
Acyanotic Congenital Heart Disease - VSD
Complications
Congestive Cardiac Failure
Pulmonary Hypertension
Failure to thrive
Infective Endocarditis
Recurrent LRTI (for any LR shunt)
Eisenmenger’s syndrome
14. Dr. D. Gunasekaran D, MD., Dept., of Paediatrics, MGMCRI.
Acyanotic Congenital Heart Disease - VSD
Complications
Congestive Cardiac Failure:
Symptoms:
Gen Exam:
Vitals: Pulse:
BP:
Auscultation of Heart:
RS:
Abdomen examination:
15. Dr. D. Gunasekaran D, MD., Dept., of Paediatrics, MGMCRI.
Acyanotic Congenital Heart Disease - VSD
Complications
Congestive Cardiac Failure:
Symptoms: Breathlessness, PND or Orthopnoea, cough
Gen Exam: Pedal edema
Vitals: Pulse:
BP:
Auscultation of Heart: Gallop
RS: Basal creps
Abdomen examination: Tender hepatomegaly
16. Dr. D. Gunasekaran D, MD., Dept., of Paediatrics, MGMCRI.
Acyanotic Congenital Heart Disease - VSD
Complications
Pulmonary Hypertension:
Palpable P2
P2 loud
Narrow S2
Ejection click + after S1 (dilated PA)
Soft & short systolic murmur (occassionally, followed by
EDM + due to Pulmonary regurgitation)
17. Dr. D. Gunasekaran D, MD., Dept., of Paediatrics, MGMCRI.
Acyanotic Congenital Heart Disease - VSD
Complications
Eisenmenger’s syndrome
In LR shunt; shunt reversal severe PHT & cyanosis
Can occur in all LR (VSD, ASD & PDA or Aortopulmonray shunts)
Usually occurs in non-restrictive lesions, in late teens age
If it occurs in VSD, then it is called as Eisenmenger Complex
If it occurs in VSD:
PSM Murmur intensity decrease
P2 becomes loud; Early Diastolic murmur +
18. Dr. D. Gunasekaran D, MD., Dept., of Paediatrics, MGMCRI.
Acyanotic Congenital Heart Disease - VSD
Differential diagnosis
Tricuspid Regurgitation:
19. Dr. D. Gunasekaran D, MD., Dept., of Paediatrics, MGMCRI.
Acyanotic Congenital Heart Disease - VSD
Natural History – What is the fate of VSD?
Spontaneous closure :
Possible-small sized membranous, muscular (even large) and inlet
Outlet (of any size), large membranous with CCF: do not close
In smaller VSD: Risk of IE is more
In larger VSDs: Risk of CCF is more (8 weeks of age)
(Infundibular stenosis may develop: decrease in L R shunt: acyanotic TOF)
20. Dr. D. Gunasekaran D, MD., Dept., of Paediatrics, MGMCRI.
Acyanotic Congenital Heart Disease - VSD
Investigations
Chest X Ray: Cardiomegaly, Increased PBF, Lung Infection
ECG: Chamber enlargement
ECHO:
21. Dr. D. Gunasekaran D, MD., Dept., of Paediatrics, MGMCRI.
Acyanotic Congenital Heart Disease - VSD
Management
Medical:
Anemia correction
Proper nutrition (feed frequently)
Dental Hygiene
Infective Endocarditis Prophylaxis
Treatment for Cardiac failure
22. Dr. D. Gunasekaran D, MD., Dept., of Paediatrics, MGMCRI.
Acyanotic Congenital Heart Disease - VSD
Management - Surgical
Closure: Patch of woven dacron or PTFE
Decision based on
Size of defect
Size of shunt (LR)
CCF
PVR
23. Dr. D. Gunasekaran D, MD., Dept., of Paediatrics, MGMCRI.
Acyanotic Congenital Heart Disease - VSD
Management - Surgical
Decision based on
Size of defect - Small
Size of shunt (LR)- Small (PBF:SBF <1.5:1)
CCF-Absent
PVR Normal
No need for Surgery; Only life-long IE Prophylaxis
24. Dr. D. Gunasekaran D, MD., Dept., of Paediatrics, MGMCRI.
Acyanotic Congenital Heart Disease - VSD
Management - Surgical
Decision based on
Size of defect - large
Size of shunt (LR)- large (PBF:SBF >2:1)
CCF+ not responding to medical management
PVR slightly increased
Outlet defects- associated with aortic cusp prolapse
Surgery is indicated
25. Dr. D. Gunasekaran D, MD., Dept., of Paediatrics, MGMCRI.
Acyanotic Congenital Heart Disease - VSD
Management - Surgical
Contraindications for surgery: severe PHT
PVR > 8 wood units/m2 BSA not responding to isoproterenol infusion
> 12 wood units / m2 BSA