ADRIAMYCIN INDUCED CARDIOTOXICITY.pptx
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Doxorubicin is an effective anticancer drug that can cause cardiotoxicity. The risk of acute cardiotoxicity during or shortly after administration is approximately 11%, while chronic cardiotoxicity occurring later has a risk of 1.7%. Chronic cardiotoxicity once established has a poor prognosis and high mortality. Early detection of subclinical cardiotoxicity through risk assessment, monitoring, and cardiac imaging may allow for intervention to prevent progression to heart failure and improve outcomes.
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- CIN is defined as a 25% rise in serum creatinine within 3 days of a contrast procedure. It occurs most often in patients with pre-existing renal insufficiency or diabetes and can be prevented using hydration protocols, acetylcysteine, and sodium bicarbonate administration.
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3. The diagnosis is an acute ST elevation myocardial infarction (STEMI) requiring timely reperfusion therapy such as thrombolytics or percutaneous coronary intervention to restore blood flow and limit damage from the heart attack.
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The document discusses the biological basis of cardiac repair after myocardial infarction. It notes that massive cardiomyocyte loss due to infarction overwhelms the heart's limited regenerative capacity, resulting in scar formation. Necrotic cells trigger an intense inflammatory response through danger signals and toll-like receptor signaling that recruits leukocytes. As inflammation subsides, fibroblasts proliferate and deposit collagen, maintaining ventricular integrity. Dysregulated inflammation, impaired resolution, or excessive fibrosis can cause adverse remodeling and heart failure. Modulating the inflammatory and reparative response may prevent post-infarction heart failure.
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This document discusses anesthesia considerations for renal transplantation. It begins by outlining the history of anesthesia used in kidney transplantation, noting the early use of spinal anesthesia and limited monitoring. It then discusses:
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- Indications and contraindications for transplantation.
- Outcomes being greatly improved compared to remaining on dialysis.
- Types of donors including living and cadaveric.
- Anesthesia goals for living donors focusing on safety.
- Evaluation, induction, maintenance and monitoring for recipients.
- Positioning, fluid management and hemodynamic goals.
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Myocardial Infarction
Drugs for primary prevention of MI
Drugs for secondary prevention of MI
Recent advances
Cardiac rehabilitation
Prevention is easier than solving the problem
Contrast-induced nephropathy (CIN) is acute kidney injury caused by iodinated contrast media used in medical imaging. [1] It is a significant problem, the third most common cause of hospital-acquired renal dysfunction. [2] While CIN is usually reversible, it increases mortality and the risk of progressing to chronic kidney disease. [3] CIN can be prevented through measures such as intravenous hydration, using low-dose iso-osmolar contrast, and managing risk factors. [4] Once occurred, CIN is typically not difficult to treat as renal function usually recovers within 1-3 weeks, but it may require short-term dialysis in severe cases. [5
Anaesthesia for cancer patients
1) Chemotherapeutic agents can cause toxicities affecting the heart, lungs, kidneys, liver, and bone marrow. Careful preoperative assessment is important, and certain agents increase risks during anesthesia.
2) Patients receiving chemotherapy like bleomycin are at high risk for pulmonary complications and require conservative fluid management. Those with prior anthracycline treatment are also at risk of cardiac issues.
3) Neuraxial techniques may be preferable for some cancer surgeries as they decrease the stress response compared to general anesthesia, which has been linked to increased metastasis in animal studies. Regional approaches can lower opioid requirements as well.
Myocardial Infarction
Myocardial infarction, also known as a heart attack, results from prolonged lack of oxygen supply to heart muscle, causing cell death. It is usually caused by a blockage of a coronary artery from an atherosclerotic plaque rupture. Symptoms include chest pain and shortness of breath. Diagnosis involves evaluating symptoms, electrocardiogram changes, and cardiac enzyme levels. Treatment focuses on restoring blood flow, reducing workload and complications through medications like antiplatelets, anticoagulants, beta blockers, and ACE inhibitors.
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The document summarizes several key trials comparing outcomes of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) for revascularization of multivessel coronary artery disease and left main coronary artery disease. The FREEDOM trial found CABG superior to PCI for reducing mortality, myocardial infarction, and stroke at 5 years in patients with diabetes and multivessel disease. The NOBLE trial also found CABG superior to PCI for reducing major adverse cardiac events at 5 years in patients with left main disease. Subsequent EXCEL and PRECOMBAT trials found no difference in longer term outcomes between PCI and CABG for left main disease depending on syntax score and lesion location. Guidelines now support consideration of PCI
Presentation 4123.pptx
The document summarizes findings from the SYNTAX trial which compared percutaneous coronary intervention (PCI) with drug-eluting stents to coronary artery bypass grafting (CABG) in patients with complex coronary artery disease involving three vessels or the left main coronary artery. The trial found that rates of death, stroke, or heart attack were similar between PCI and CABG at 12 months. However, CABG was superior to PCI in reducing the risk of major adverse cardiac or cerebrovascular events. The rate of repeat revascularization was significantly higher in the PCI group. Among patients with the most complex disease, as indicated by high SYNTAX scores, the event rate at 12 months was significantly higher in the PCI group compared to CAB
BACKGROUND 1234.pptx
The trial used an "all-comers" design and excluded patients with previous interventions or acute myocardial infarction without consulting local doctors. Patients assigned to one treatment but receiving another or neither were analyzed based on their assigned treatment. The study also included registries of patients not eligible for randomization due to clinical characteristics, including those not suitable for CABG due to comorbidities or no graft material or for PCI due to complex anatomy or untreated chronic total occlusions. The primary endpoint was a composite of death, stroke, heart attack, or revascularization over 12 months as adjudicated by an independent committee.
Background 123.pptx
The SYNTAX trial compared percutaneous coronary intervention (PCI) using drug-eluting stents to coronary-artery bypass grafting (CABG) for treating patients with previously untreated three-vessel or left main coronary artery disease. It was a prospective, international clinical trial involving over 1,800 patients across 85 sites. The primary outcome was a composite of death, stroke, or myocardial infarction within 5 years. Patients were assessed using the SYNTAX score to evaluate disease complexity. The trial found CABG resulted in better long-term outcomes than PCI for patients with more complex multi-vessel coronary artery disease.
Presentation334545.pptx
A CT pulmonary angiogram was ordered due to elevated creatinine and potassium levels. The lung perfusion scan found multiple perfusion defects. A follow up normal lung perfusion scan showed resolution of the previously detected defects.
CARDIOLOGY SPOTTER 1111111.pptx
A 70-year-old man presented with right sided chest pain and dyspnea for 2 weeks. An ECG showed no significant ST or T wave changes. He was found to have significant right ventricular dysfunction and pulmonary oligemia.
answer.pptx
This document discusses acute pulmonary embolism, including its clinical features, diagnosis, and management. It presents pulmonary embolism as a blockage in the lungs caused by blood clots that can be life-threatening. Diagnosis involves tests like a CT scan or lung scan to detect clots, while treatment focuses on anticoagulant drugs to prevent further clotting as well as other procedures in severe cases. Managing the condition requires identifying risk factors, diagnosing properly, and providing appropriate treatment to resolve symptoms and reduce long-term complications.
qqq.pptx
Heart failure with preserved ejection fraction (HFpEF) is a condition where the heart muscle stiffens, making it difficult to fill and pump blood efficiently. While medications like candesartan and empagliflozin can help reduce hospitalizations for HFpEF by improving symptoms, other drugs like irbesartan and spironolactone have not shown benefits. Management of HFpEF focuses on controlling blood pressure, reducing fluid retention, and treating the underlying causes.
SYNTAX TRIAL.pptx
- The SYNTAX trial compared outcomes of percutaneous coronary intervention (PCI) using drug-eluting stents versus coronary artery bypass grafting (CABG) for treating three-vessel or left main coronary artery disease.
- For the primary endpoint of major adverse cardiac and cerebrovascular events at 12 months, CABG was superior to PCI. However, outcomes were similar between treatments for patients with less complex disease as measured by low or intermediate SYNTAX scores.
- For patients with more complex disease and high SYNTAX scores, CABG had significantly fewer primary events than PCI at 12 months.
JVP AND WAVEFORMS.ppt
This document provides an overview of jugular venous pressure and waveforms. It discusses the anatomy of the jugular veins and the technique for measuring jugular venous pressure at the bedside. Normal jugular venous waveform patterns are described including the a, x, c, x', v, and y waves. Abnormal waveform patterns are also outlined that may indicate conditions like tricuspid regurgitation, constrictive pericarditis, pulmonary hypertension, and cardiac tamponade. The document concludes with how jugular venous waveforms can help identify various cardiac arrhythmias.
SUDDEN CARDIAC DEATH.pptx
This document provides an overview of sudden cardiac death, including its definition, epidemiology, risk factors, etiologies, clinical features, management, and prevention. Some key points include:
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- Risk factors include increasing age, male sex, coronary heart disease, smoking, elevated cholesterol, emotional stress, depression, low socioeconomic status, and left ventricular dysfunction.
- Transient factors like ischemia, electrolyte abnormalities, drugs, and autonomic influences can trigger lethal arrhythmias in those with underlying structural heart issues. Antiarrhythmic drugs in particular carry
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- 2. Introduction Mechanisms Risk factors Clinical manifestations Diagnosis Management Prevention
- 3. INTRODUCTION • DOXORUBICIN is an Anthracycline derivative anticancer drug. • Effective and more frequently used agent . • Its major adverse effect is cardiotoxicity ---> which limits its use. • Incidence of acute cardiotoxicity is approximately 11%. • Chronic cardiotocxicity is around 1.7% . • Doxorubicin cardiomyopathy once developed carries a poor prognosis and is frequently fatal.
- 4. • ~50% mortality in 1year who develop congestive heart failure • Many preventive measures have been proposed. • Presently available treatment of established cardiomyopathy does not appear to improve prognosis.
- 5. MECHANISMS MOA • Topoisomerase II inhibitor • Intercalates between DNA base pairs • Inhibits Replication and Transcription • Reactive Oxygen Species Formation • DNA damage through Topoisomerase II • induction of APOPTOSIS • Protein synthesis inhibition
- 6. RISK FACTORS • Age < 4 Yr, > 65 yr • Females • Raised Cardiac biomarkers • Previous HF/ Cardiomyopathy/ CTRCD • Severe VHD • MI/ PCI / CABG • Stable Angina • LVEF < 50% • HTN • DM • Smoking • Hyperlipidemia • Obesity
- 7. CLINICAL MANIFESTATIONS Acute • Occurs during and within 2-3 days of administration • Incidence is 11% • Chest pain • Sinus tachycardia • Paroxysmal non sustained SVT • Premature atrial and ventricular beats Chronic • Incidence 1.7% • Dose related Incidence 4% 500-550mg/m2 18% 551-600mg/m2 36% >600 mg/m2 • Usually seen within 30 days of administration of its last dose • Can occur even after 6-10 years after its administration
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- 9. DIAGNOSIS • New CV symptoms • New abnormalities in Cardiac functionon CV imaging • New increase in Cardiac bio-markers
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- 20. THANK YOU