This document summarizes the evaluation of aortic valve stenosis using echocardiography. It describes the normal aortic valve anatomy and various types of aortic valve stenosis including calcific, bicuspid, rheumatic, and supravalvular or subvalvular stenosis. Doppler echocardiography is used to evaluate aortic valve stenosis severity based on valve area, mean gradient, and peak jet velocity. Stress echocardiography with dobutamine can help distinguish true severe from pseudo-severe low-flow, low-gradient aortic stenosis.
A lecture on the echocardiographic evaluation of hypertrophic cardiomyopathy. Starts with an overview of the topic then a systematic approach to diagnosis and then a differential diagnosis followed by take-home messages and conclusion.
preop TEE assessment of atrial septal defect is very important for making decision for device closure, properly assessed adequate rims of ASD will reduce risk of device embolization to almost nil.
ECHOCARDIOGRAPHIC EVALUATION OF MITRAL VALVE DISEASEPraveen Nagula
MITRAL VALVE ANATOMY , M MODE FINDINGS IN MITRAL STENOSIS,EVALUATION OF THE SEVERITY OF LESION,CALCIFIC MS,CCMA,CONGENITAL LESIONS,GUIDELINES ALL IN DETAIL....
A lecture on the echocardiographic evaluation of hypertrophic cardiomyopathy. Starts with an overview of the topic then a systematic approach to diagnosis and then a differential diagnosis followed by take-home messages and conclusion.
preop TEE assessment of atrial septal defect is very important for making decision for device closure, properly assessed adequate rims of ASD will reduce risk of device embolization to almost nil.
ECHOCARDIOGRAPHIC EVALUATION OF MITRAL VALVE DISEASEPraveen Nagula
MITRAL VALVE ANATOMY , M MODE FINDINGS IN MITRAL STENOSIS,EVALUATION OF THE SEVERITY OF LESION,CALCIFIC MS,CCMA,CONGENITAL LESIONS,GUIDELINES ALL IN DETAIL....
Echo assesment of Aortic Stenosis and Regurgitationdrpraveen1986
A simple ppt presentation on echo assesment of AS and AR. Don forget to leave a comment if u find this ppt useful. - Dr. Praveen Babu, Vijaya HOspital, Chennai
A PowerPoint presentation on the basic of Aortic Reguritation evaluation by TEE.
Dr Terry Bejot is a cardiovascualr anesthesiologist who is also the creator and publisher of E-echocardiography.com, the online course and resource for learning TEE.
Coronary Calcium and other CVD Risk Biomarkers: From Epidemiology to Comparat...CTSI at UCSF
Presented by Philip Greenland, MD, at UCSF's symposium "The Role of Risk Stratification and Biomarkers in Prevention of Cardiovascular Disease" in Jan 2012.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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
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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
10. ACC/AHA Valvular Guidelines 2006:
AS is a disease of continuum, without a single value defining its
severity.
AS description Area
(cm2)
Mean Gradient
(mm Hg)
Jet velocity
(m/s)
Mild > 1.5 < 25 < 3.0
Moderate 1.0-1.5 25-40 3.0-4.0
Severe < 1.0 > 40 > 4.0
11. Causes
Age < 70 years (n=324) Age >70 years (n=322)
1. Bicuspid AV (50%)
2. Rheumatic (25%)
3. Degenerative (18%)
4. Unicommissural (3%)
5. Hypoplastic (2%)
6. Indeterminate (2%)
Degenerative (48%)
Bicuspid (27%)
Rheumatic (23%)
Hypoplastic (2%)
12.
13. Anatomic evaluation
Combination of short and long axis images to identify
Number of leaflets
Describe leaf mobility, thickness, calcification
Combination of imaging and doppler allows the determination of the
level of obstruction: subvalvular, valvular, or supravalvular.
Transesophageal echocardiography may be helpful when image quality
is suboptimal.
14. Calcific Aortic Stenosis
Nodular calcific masses on aortic side of cusps.
No commissural fusion.
Free edges of cusps are not involved.
Stellate-shaped systolic orifice.
15. Parasternal long axis view showing echogenic and immobile aortic
valve.
16. Parasternal short-axis view showing calcified aortic valve leaflets.
Immobility of the cusps results in only a slit like aortic valve orifice in
systole
17. Bicuspid Aortic valve
Fusion of the right and left coronary cusps (80%).
Fusion of the right and non-coronary cusps(20%).
18. Two cusps are seen in systole with only two commissures framing an
elliptical systolic orifice.
Diastolic images may mimic a tricuspid valve when a raphe is present.
19.
20. Parasternal long-axis echo may show
an asymmetric closure line
systolic doming
diastolic prolapse of the cusps
In children, valve may be stenotic
without extensive calcification.
In adults, stenosis typically is due to
calcific changes, which often
obscures the number of cusps,
making determination of bicuspid
vs. tricuspid valve difficult.
22. Parasternal short axis view showing commissural fusion, leaflet thickening
and calcification, small triangular systolic orifice
23. Subvalvularaortic stenosis
Thin discrete membrane consisting of endocardial fold and fibrous
tissue.
A fibromuscular ridge.
Diffuse tunnel-like narrowing of the LVOT.
Accessory or anomalous mitral valve tissue.
24. Supravalvular Aortic stenosis
Type I -Thick, fibrous ring above the aortic valve with less mobility and
has the easily identifiable 'hourglass' appearance of the aorta.
25. Type II - Thin, discrete fibrous membrane located above the aortic
valve.
The membrane usually mobile and may demonstrate doming during
systole.
Type III - Diffuse narrowing.
26.
27. ACC/AHA Valvular Guidelines 2006:
AS is a disease of continuum, without a single value defining its
severity.
AS description Area
(cm2)
Mean Gradient
(mm Hg)
Jet velocity
(m/s)
Mild > 1.5 < 25 < 3.0
Moderate 1.0-1.5 25-40 3.0-4.0
Severe < 1.0 > 40 > 4.0
29. Peak transvalvular velocity
Continuous-wave Doppler ultrasound.
Multiple acoustic windows
Apical and suprasternal or right parasternal almost frequently yield
the highest velocity.
Rarely subcostal or supraclavicular windows may be required.
Three or more beats are averaged in sinus rhythm, with irregular
rhythms at least 5 consecutive beats.
AS jet velocity: Highest velocity signal obtained.
A smooth velocity curve with a dense outer edge and clear maximum
velocity should be recorded.
30. The shape of the CW Doppler velocity curve is helpful in
distinguishing the level and severity of obstruction.
Severe obstruction: maximum velocity occurs later in systole and the
curve is more rounded in shape.
31. Mild obstruction: The peak is in early systole with a triangular shape of
the velocity curve.
32. The shape of the CWD velocity curve also can be helpful in
determining whether the obstruction is fixed or dynamic.
Dynamic sub aortic obstruction: Characteristic late-peaking velocity
curve, often with a concave upward curve in early systole.
33. Mean transvalvular gradient
The difference in pressure between the left ventricle and aorta in
systole.
Gradients are calculated from velocity information.
The relationship between peak and mean gradient depends on the
shape of the velocity curve.
Bernoulli equations
ΔP =4v²
The maximum gradient is calculated from maximum velocity
ΔP max =4v² max
34. The mean gradient is calculated by averaging the instantaneous
gradients over the ejection period.
The accuracy of the Bernoulli equation to quantify AS pressure
gradients is well established.
35. Sources of error for pressure gradient
calculations
Malalignment of jet and ultrasound beam.
Recording of MR jet.
Neglect of an elevated proximal velocity.
Any underestimation of aortic velocity results in an even greater
underestimation in gradients, due to the squared relationship between
velocity and pressure difference.
36. Aortic valve area by Continuity equation
Well validated - clinical & experimental studies.
Measures the effective valve area - the primary predictor of clinical
outcome (and not the anatomic orifice area).
Continuity equation concept: SV ejected through the LV outflow tract
all passes through the stenotic orifice.
Calculation of continuity-equation valve area requires three
measurements
AS jet velocity by CWD.
LVOT diameter for calculation of a circular CSA.
LVOT velocity recorded with pulsed Doppler.
AVA = CSALVOT × VTILVOT / VTIAV
37. LVOT diameter and velocity should be measured at the same distance
from the aortic valve.
When the PW sample volume is optimally positioned, the recording
shows a smooth velocity curve with a well-defined peak.
38. The VTI is measured by tracing the dense modal velocity throughout
systole.
LVOT diameter is measured from the inner edge to inner edge of the
septal endocardium, and the anterior mitral leaflet in mid-systole.
39.
40. Limitations of continuity-equation valve area
Intra-and inter observer variability
AS jet and LVOT velocity 3 to4%.
LVOT diameter 5% to 8%.
When sub aortic flow velocities are abnormal SV calculation at this site
are not accurate.
Sample volume placement near to septum or anterior mitral leaflet.
Observed changes in valve area with changes in flow rate.
AS and normal LV function, the effects of flow rate are minimal.
This effect may be significant in presence concurrent LV dysfunction.
41.
42.
43. Three different subgroups of Severe AS:
1. High gradient, high velocity, normal LVEF.
2. Low gradient, low velocity, and low EF.
3. Low flow, low gradient but preserved LVEF (paradoxical low flow,
low gradient AS).
44. High gradient, High flow, Normal LVEF AS
AVA by 2D Echo – Continuity equation:
Volume flow (or stroke volume) proximal to the valve = volume flow
through the narrowed valve.
AVA = CSALVOT × VTILVOT / VTIAV
Severe AS:
Area < 1 cm2
Systolic LV-Ao gradient > 40 mm Hg
Jet velocity > 4 m/s.
Standard and most common subgroup of severe AS.
45. Low flow, Low gradient, Low LVEF AS
Low EF low SV and low gradient.
Effective orifice area < 1.0 cm2
LV ejection fraction < 40%
Mean pressure gradient < 40 mm Hg
Severe AS and severely reduced LVEF represent 5% of AS patients.
Difficult to distinguish between:
1. Severe AS with diminished contractility.
2. Mild or moderate AS with myocardial disorders (such as
cardiomyopathy, infarction or ischemia).
Inotropic challenge test: Dobutamine stress echo (DSE).
46. Dobutamine stress Echo
Provides information on the changes in aortic velocity, mean gradient,
valve area, SV and EF as flow rate increases.
Measure of the contractile response to dobutamine.
LV dysfuction with severe AS has two diagnostic possibilities:
True anatomically severe aortic stenosis.
Functionally severe aortic stenosis (pseudosevere - aortic valve with
mild or moderately severe stenosis may not open fully if the stroke
volume is low).
47. Dobutamine (up to a maximum 20 μg/kg/min):
Increase stroke volume.
Helpful in differentiating morphologically severe AS from a
decreased effective stenotic orifice area caused by low cardiac
output (pseudosevere aortic stenosis).
Dobutamine infused gradually from 5 µg/kg/minute in 5 µg increments
every 5 minutes until the LVOT velocity or VTI reaches a normal value
i.e., 0.8 to 1.2 m/s or 20 to 25 cm, respectively.
True AS:
Increase in the peak velocity and VTI of both the LVOT and aortic valve
proportionally.
Hence, the LVOTVTI : AoV VTI remains constant.
48. Pseudo severe AS:
Higher SV Aortic leaflets increase their excursion
Increase in calculated valve area.
Increase in LVOTVTI far greater than that of the AV VTI.
LVOTVTI : AoVVTI increases.
Increase in AVA ≥ 1.2 cm2 confirmatory of pseudosevere stenosis.
51. LV systolic dysfunction and cardiac output is reduced, aortic stenosis is
probably severe if:
Aortic valve area by the continuity equation is ≤ 1.0 cm2
LVOTVTI : AoVVTI is ≤ 0.25
Another most important role of dobutamine infusion in patients who
have severe aortic stenosis and a low gradient is to assess inotropic
reserve:
Defined as an increase in stroke volume of more than 20% with
dobutamine.
Failure of ventricle to augment with dobutamine portends poor
perioperative mortality (50% vs. 7%) if aortic valve replacement is
attempted.
Prognosis is improved with aortic valve replacement in patients with
contractile reserve and true AS.
52. Lack of contractile reserve: SV does not increase by at least 20% or
more with dobutamine.
Measured as 20% increase in LVOTVTI by PW doppler as CSA of
LVOT should not change between dobutamine stages.
Suggests etiology other than high afterload for low EF.
53. AV Gradient Stroke Volume AVA
Severe AS
Mild – moderate AS
No contractile
reserve
Response to dobutamine stress echo:
54.
55.
56. Low flow, Low gradient, Normal EF AS
Low transaortic gradient < 40 mm Hg.
Severe AS.
Normal EF ≥ 50%.
Low stroke volume ≤ 35 mL/m2.
Elderly (predominantly females).
AVA < 1 cm2.
Concentric LVH Small ventricular cavity and reduced LV compliance
Reduced SV.
Hypertension also add to the afterload burden of LV.
These patients if treated medically had markedly lower survival as
compared to those who had AVR.
57. Summary
Normal Flow,
High
Gradient
Low Flow,
Low Gradient,
Normal EF
Low flow,
Low Gradient,
Low EF
AVA, cm2 ≤ 1.0 ≤ 1.0 ≤ 1.0
Mean gradient, mm Hg > 40 < 40 < 40
LVIDd, mm 45-55 < 47 > 50
LVEF, % > 50 > 50 < 50
Stroke volume index,
mL/m2
> 35 < 35 < 35
Myocardial fibrosis + ++ +++
Plasma NT-proBNP,
pg/mL
< 1500 > 1500 > 1500
Typical Characteristics of Three Main Entities of Severe AS