1) Arrhythmia is any deviation from the normal rhythm of the heart and can be caused by abnormalities in impulse generation or conduction.
2) There are several types of cardiac tissue with different electrophysiological properties, including pacemaker and contractile tissues.
3) Mechanisms of arrhythmia include enhanced automaticity, triggered activity, and reentry.
4) Antiarrhythmic drugs are classified based on their effects on ion channels and are used to treat various arrhythmias depending on their properties and side effect profiles.
This presentation consists of various approaches to treat hypertension depending on severity. It also include treatment according to international guidelines. Classification and brief description of each antihypertensive agent has been mentioned.
Reversal of Anticoagulation in Intracerebral Hemorrhageperezjohnangelo
A lecture fellow medical students and neurology residents on reversing anticoagulation in the setting of intracerebral hemorrhage. This lecture focuses on the reversal of warfarin and heparin and shares a recent case of intraventricular hemorrhage with warfarin use.
This presentation consists of various approaches to treat hypertension depending on severity. It also include treatment according to international guidelines. Classification and brief description of each antihypertensive agent has been mentioned.
Reversal of Anticoagulation in Intracerebral Hemorrhageperezjohnangelo
A lecture fellow medical students and neurology residents on reversing anticoagulation in the setting of intracerebral hemorrhage. This lecture focuses on the reversal of warfarin and heparin and shares a recent case of intraventricular hemorrhage with warfarin use.
S1 antiarrhythmicdrugs 000 /certified fixed orthodontic courses by Indian den...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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
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
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
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2. A-RHYTHM
Def- Arrhythmia is deviation of heart from normal RHYTHM
RHYTHM
1) HR- 60-100
2) Should origin from SA Node
3) Cardiac impulse should propagate through normal conduction
pathway with normal velocity
4. Types of cardiac tissue
AUTOMATIC/ PACEMAKER/ CONDUCTING FIBRES (Ca++ driven tissues)
• Includes SA node, AV node
• Capable of generating their own impulse
• Normally SA node acts as Pacemaker of heart
NON-AUTOMATIC MYOCARDIAL CONTRACTILE FIBRES (Na+ driven
tissues)
• Can not generate own impulse
• Includes atria and ventricles
7. Action potential in Pacemaker Cells Action potential in Myocardium
•Prepotential :
Slow Na⁺(funny channels)
Ca²⁺ influx (through T-type Ca²⁺
channels)
Decrease in K⁺ efflux
•Action potential :
Depolarization(phase 0): increase
in Ca²⁺ influx through L type Ca²⁺
channel
Repolarization(phase 3): increase
in K⁺ efflux
Phase Name Cause
0 Initial rapid
depolarization
and overshoot
Opening of Na⁺
Channels
1 Initial rapid
repolarization
Efflux of K⁺
Closure of Na⁺
channels
2 Plateau Ca²⁺ influx (L
type)
and K⁺ efflux .
3 Repolarization Closure of Ca²⁺
channels
K⁺ efflux through
various type of K⁺
channels
4 Resting
membrane
potential
9. 1. Abnormal impulse generation:
• Enhanced automaticity
2. Triggered activity (after depolarization):
• Early after depolarization
• Delayed after depolarization
3. Re-entry phenomenon
10. Enhanced Automaticity
• Cell other than SA node take control as pacemaker
• Results due to pathological increase in phase 4 slope -
accelerated pacemaker rate
• May result from current of Injury
• Ischemia, high sympathetic tone, electrolyte imbalance
• Example: ectopic atrial tachycardia, ventricle tachycardia
following MI
11. Triggered Activity (After Depolarization)
• A normal AP interrupted/followed by
a abnormal depolarization
• Delayed After Depolarization: – due
to Ca++ overload
• After attaining RMP
• Caused by Digoxin toxicity,
Myocardial Ischaemia or Adrenergic
stress or Heart failure
Source: Goodman Gilman 13th edition
12. Early Afterdepolarization
• Interrupting phase 3 repolarization
• Multiple ion channels and transporters can
contribute to EADs
• Membrane potential oscillates
• Frequently associated with long Q-T
interval
Source: Goodman Gilman 13th edition
13. Reentry
• Primarily due to abnormality of conduction
• Impulse may recirculate in the heart
• Repetitive activation without the need for any new impulse
Circus movement reentry (anatomically defined circuit): WPW
syndrome, PSVT
• Permanently cured by radiofrequency catheter ablation
23. Supraventricular Tachycardia
Aim: prevent propagation to
ventricle
1. Blocking AV node
i. CCB: as depolarization occur
due to calcium
ii. Block sympathetic system
iii. Adenosine
iv. Parasympathomimetic drug:
digoxin
2. Control rhythm
i. Na+ blocker
ii. K+ blocker
24. Treatment of SVT/PSVT
1. Acute attack: short acting drug
• DOC: adenosine(I.V)
1. Prophylaxis: long acting AV node blocking drugs
• β blocker: decrease sympathetic system
• CCB: verapamil/diltiazem
• Digoxin (parasympathomimetic activity)
25. Atrial fibrillation/flutter
1. Acute attack:
• TOC: Cardioversion
• DOC: Ibutelide
2. Long term
1. Rate control
• Block AV node
• DOC: β blocker
2. Rhythm control
• Na+ channel blocker
• K+ channel blocker
Source: Google Images
26. Ventricular tachycardia/ fibrillation
Aim : suppress myocardial tissue
i. Na+ channel blocker (lignocaine)
ii. K+ channel blocker (amiodarone)
iii. β blocker (propranolol)
Source: Google Images
28. Classification
Class Actions Drugs
I Membrane stabilizing agents
(Na+ channel blockers)
A. Moderately decrease dv/dt of 0 phase Quinidine, Procainamide
B. Little decrease in dv/dt of 0 phase Lidocaine, Mexiletine
C. Marked decrease in dv/dt of 0 phase Propafenone, Flecainide
II Antiadrenergic agents (β blockers) Propranolol, Esmolol
III Agents widening AP (prolong repolarization and
ERP)
Amiodarone, Dronedarone,
Dofetilide, Ibutilide, Sotalol
IV Calcium channel blockers Verapamil, Diltiazem
29. Class 1a Class 1b Class 1c
Na+ channel Block Block Block
Duration of block 1-10 sec < 1 sec >10 sec
State of Na+
channel
Open Inactivated Open
K+ channel Blocker Opener Blocker (negligible
effect)
Effect on QT
interval
Increased Decreased No effect
Additional property AV Node blocker
Anticholinergic
effects
AV Node blocker
34. • Derivative of procaine
• No anticholinergic action
• No α-blocking action unlike quinidine
• Action similar to quinidine
Adverse effects:
• SLE
• Higher doses can cause hypotension (due to ganglion block)
• Heart block and QT prolongation
Procainamide
35. • Block Na+ channel in open state
• Most potent sodium channel blocking effects
• Marked delay channel recovery
• Markedly block A-V conduction
• Prolong refractoriness (normal as well as accessory pathways)
• Negligible effect on K+ channels
SUBCLASS I C
36. • Maximum proarrhythmic property
• Drugs: Flecainide, Propafenone
Used: only for refractory and life threating condition
• Atrial flutter & fibrillation
• Ventricular tachycardia & fibrillation
• Flecainide: DOC for acute therapy of WPW syndrome
SUBCLASS I C
37. • Block Na+ channels
• More in the inactivated than in the open state
• Do not delay channel recovery (channel recovery time < 1S)
• K+ channel opener (↓ QT)
• No effect on AV node
• Lidocaine (Lignocaine) and Mexiletine
• Mexiletine is an orally active lignocaine derivative with all the
properties of lignocaine
SUBCLASS IB
38. • Most prominent action is suppression of automaticity in ectopic foci
• Useful in acute ischemic ventricular arrhythmias
• Depolarized/damaged fibers are significantly depressed
• Lidocaine is inactive orally
• High first pass metabolism (so loading dose given)
• Main toxicity is dose related neurological effects
lignocaine
39. Dose and preparation
• Lidocaine is given only by i.v. route
• 50–100 mg bolus followed by 20–40 mg every 10– 20 min or 1–3
mg/min infusion
• XYLOCARD, GESICARD 20 mg/ml inj
40. • Local anaesthetic
• Inactive orally
• Given IV for antiarrhythmic action
• Na+ channel blockade which occurs
• Only in inactive state of Na+ channels
• CNS side effects in high doses
• Action lasts only for 15 min
• Inhibits purkinje fibres and ventricles but
• No action on AVN and SAN
• Effective in Ventricular arrhythmias only
41. CLASS II
• Suppress adrenergic mediated ectopic activity
• Impedes A-V conduction
• Increase PR interval
• Prolong AV refractoriness
• Marked decrease in the slope of phase-4 depolarization
• Decrease automaticity occurs in SA node
• Propranolol, Esmolol, Metoprolol
42. Uses
• Idiopathic ventricular tachycardia
• Ventricular premature beats
• Congenital long QT syndrome(long term management)
• Cathecholamine induce arrhythmia
• Pheochromocytoma
• Exercise
• Emotional
• Rate control in atrial flutter and atrial fibrillation
• Termination of acute attack PSVT: Esmolol IV
43. Dose
Propranolol
• For rapid action, propranolol may be injected i.v. 1 mg/min
(max. 5 mg) under close monitoring
• Maintenance dose is 40–80 mg 2–4 times a day
Esmolol (for acute attack only)
0.5 mg/kg in 1 min followed by 0.05–0.2 mg/kg/min i.v. infusion
44. Class III drugs
• K+ channel blocker
• Delay in repolarization
• ERP increases
• Increase QT interval
• Causes torsade de pointes
• Maximum: ibutilide
• Minimum: amiodarone
• No effect: vernakalant
Source: Katzung & trevors 11th edition
46. Amiodarone
• Widest spectrum anti arrhythmic drug
• Block: K+, Na+, Ca++, alpha and β receptor
• Least risk of QT prolongation
• High volume of distribution(loading dose given)
• Long duration of action: t1/2: 3-8 weeks
• Uses: VT, VF, AF, Atrial flutter
47. Dose
• Amiodarone is mainly used orally 400–600 mg/day for few
weeks, followed by 100–200 mg OD for maintenance therapy
• 100–300 mg (5 mg/kg) slow i.v. injection over 30–60 min
• Preparation: CORDARONE, ALDARONE, EURYTHMIC 100, 200
mg tabs, 150 mg/3 ml inj.
48. Side effects of amiodarone:
• Dose-related and increase with duration of therapy
• Pulmonary fibrosis
• Goitre, hypothyroidism and rarely hyperthyroidism
• Fall in BP, bradycardia
• Myocardial depression
• Liver damage
• Photosensitivity
• Corneal microdeposits
49. Dronedarone
• Noniodinated congener of amiodarone
• Less toxic
• Also less effective
• Used only as a substitute to amiodarone
• T1/2= around 24 hours
• Food increases absorption
50. Sotalol
• Nonselective β blocker having prominent Class III action
• It is a racemic mixture; the d-isomer has pure class III property,
while the I-isomer is a β blocker
• Used:
• Polymorphic VT
• WPW arrhythmias
• Maintaining sinus rhythm in AF/AFI
51. Ibutilide
• Structural analog of sotalol (but no β blocking property)
• Shortest acting K+ blocker
• Used for acute treatment of atrial fibrillation or atrial flutter
• I.V. route
• Only antiarrhythmic agent currently approved by FDA for acute
conversion of atrial fibrillation to sinus rhythm
• Other drugs used in atrial fibrillation are for controlling ventricular
rate
52. Dofetilide
• Pure class III antiarrhythmic
• A potential K+ channel blocker
• Uses: Atrial flutter & fibrillation
Vernakalant
• Multiple ion channel (Na+, K+, Ca++ blocker)
• Does not cause QT prolongation
• Use: Atrial fibrillation
53. Class IV drugs
• Calcium channel blocker
• Major effect on nodal tissue
• Verapamil and diltiazem is used
• No reflex tachycardia(as in Dihydropyridines)
• Cause AV nodal delay
• Suppresses automaticity and re-entry dependent on slow
channel response
• Suppress both early & delayed afterdepolarizations
54. • Effects in a calcium-dependent
cardiac cell in the AV node
• Reduce inward calcium current
during the AP and during phase 4
• Conduction velocity is slowed in
the AV node
• Refractoriness is prolonged
Source: Katzung & trevors 11th edition
55. Uses:
• Terminate PSVT
• Acute attack: verapamil 5 mg i.v. over 2–3 min is effective
• For preventing recurrences of PSVT, verapamil 60 to 120 mg
TDS may be given orally
• Control ventricular rate in atrial flutter or fibrillation
57. Route: IV rapid infusion/ close to heart(jugular vein)
• Rapidly taken by cellular adenosine uptake protein
• Shortest action
Side effect:
• Vasodilation: flushing
• Bronchoconstriction: dyspnea
• So contraindicated in asthma and COPD
58. Drug interaction
1. Theophylline cause failure (adenosine receptor antagonist)
2. Dipyramidole causes toxicity (blocking cellular uptake)
Uses
• PSVT: Administered by rapid i.v. injection (over 1–3 sec) either as
the free base (6–12 mg) or as ATP (10–20 mg)
• Diagnosis of tachycardias dependent on A-V node
59. Magnesium
Mechanism of action is unknown but calcium channel blocking
property is possible mechanism
Use
• Acute treatment of long QT syndrome(both congenital and
acquired)
• As Calcium channel block trigger K+ opening which cause
repolarization
60. Atropine
• Stimulate heart
• SA node: increase heart rate
• AV node: increase conduction
Uses
• Sinus arrest
• Sinus bradycardia
• Inferior wall MI (vagal irritation Parasympathetic activity)
• AV nodal block reversal (digoxin toxicity)
61. Digoxin
• M.O.A: parasympathomimetic activity
• Block AV node
• Slow onset of action(not for acute condition)
Use
• Controlling ventricular rate in atrial flutter and atrial fibrillation