This document provides guidance on evaluating patients presenting with cardiovascular complaints such as chest pain, shortness of breath, palpitations, syncope, and edema. It emphasizes taking a thorough history as the key to diagnosis, as initial investigations may be normal. Common life-threatening causes of these symptoms include myocardial infarction, aortic dissection, pulmonary embolism, and tension pneumothorax. The document outlines approaches to categorizing different types of chest pain, dyspnea, palpitations, syncope, and edema. It provides diagnostic criteria and recommends focused physical exams and initial tests such as ECG, CXR, and cardiac enzymes.
The lecture is for medical student. It is from Dr RUSINGIZA Emmanuel, MD, senior lecture at UR( UNIVERSITY OF RWANDA) .
It will help to understand heart diseases in newborn, infants and children.
palpitation is one of the most presentations in outpatients, about 16% of patients presenting to ER complaining from palpitation , for the juniors , my presentation aiming to help them to how to approach with a case complaining of palpitation
The lecture is for medical student. It is from Dr RUSINGIZA Emmanuel, MD, senior lecture at UR( UNIVERSITY OF RWANDA) .
It will help to understand heart diseases in newborn, infants and children.
palpitation is one of the most presentations in outpatients, about 16% of patients presenting to ER complaining from palpitation , for the juniors , my presentation aiming to help them to how to approach with a case complaining of palpitation
Acute Shortness of Breath at 36 weeks of PregnancySujoy Dasgupta
lecture delivered by Dr Sujoy Dasgupta at BOGSCON 42, the Annual Conference of Bengal Obstetric and Gynaecological Society, where he was invited as Faculty in a session on "Difficult Clinical Scenario in Pregnancy"
Similar to Approach to a patient with cardiovascular disease (20)
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.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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
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.
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
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The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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.
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.
- 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
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
Triangles of Neck and Clinical Correlation by Dr. RIG.pptx
Approach to a patient with cardiovascular disease
1. APPROACH TO A PATIENT WITH
CARDIOVASCULAR DISEASE
PROF FARHAT BASHIR
DEPARTMENT OF MEDICINE
2. Objectives
• To be able to diagnose a patient complaining
of chest pain, shortness of breath,
palpitations, syncope, edema and intermittent
claudication.
• To be able to formulate an accurate
differential diagnosis for them.
3.
4. CHEST PAIN
• Common presentation.
• Trivial to life-threatening causes.
• Key to diagnosis is history NOT
INVESTIGATIONS.
Negative baseline investigations DO NOT rule
out serious conditions
5. Initial Approach
• Triage
– Chest pain
– Significant abnormal pulse
– Abnormal blood pressure
– Dyspnoea
– These patients need IV, O2, Monitor, ECG
10. • there are a lot of importment data of the pain:
– localisation
– radiation
– onset of the pain
– the type (press, smart,cutting)
– dinamic of the pain (continouosly, ongoing, undulaiting)
– answer to the medical therapy
CHEST PAIN
14. Investigations
• ECG most important But history is more
important.
• 20% of patients having an MI will have a
normal ECG initially.
• Negative cardiac enzymes in A&E are not
helpful.
• CXR useful to rule out other causes like
pneumonia.
15. 26 yr old thin man with sudden onset of severe, right sided
sharp, chest pain ,dyspnoeic.
19. .
65 year old man(H/O DM,HTN) presented with a 1 hour
history of severe central crushing chest pain. He is
sweaty, clammy and has vomited twice
20.
21. 65 year old man(H/O DM,HTN) presented with a 1 hour history of severe
central crushing chest pain. He is sweaty, clammy and has vomited twice .
• Anterior (extensive) Myocardial infarction.
Why ?
Male 65 years.
H/O DM+HTN
Crushing chest pain.
Associated sweating, clammy, vomiting.
22. • A 70 years old male with long history of
untreated HTN, nonsmoker came complaining of
chest pain migrated to interscapular region &
became severe(tearing),SBP 200,ECG mild inferior
changes
• Most likely diagnosis is
• ? AMI
• ?PE
• ?Esophageal Rupture
• ?Aortic Dissection
26. Aortic Dissection
• Severe, sharp, “tearing” posterior chest
pain or back pain (occurs in 74-90% of
patients)
• Pain may be associated with syncope, CVA, MI, or CHF
– Painless dissection relatively uncommon 15%
27. • Physical Examination
• Pulse deficit
– Weak or absent carotid, brachial, or femoral
pulses
– these patients have a higher rate of mortality
• Acute Aortic Insufficiency
– Diastolic decrescendo murmur
– Best heard along the right sternal border
29. • 40 years old male finished cardiac evaluation last week
for insurance (every thing is normal), ate a heavy meal
with friends (celebrating), followed by severe vomiting
then chest pain. Last vomitus contains streaks of fresh
blood.
• Likely diagnosis
• ?ACS
• ?PE
• ?Aortic Dissection
• Esophageal submucosal tear(Mallory Weiss syndrome).
30. Oesophageal rupture: Diagnosis
• CXR: early shows
mediastinal or free
peritoneal air
–Hours to days
later: widening of
mediastinum,
pleural effusion
31. Oesophageal rupture:
• CT scan: Oesophageal
oedema, extra
oesophageal air,
perioesophageal fluid
• Oesophagram:
Extravasation of
contrast
• NO role for endoscopy
which introduces more
air into mediastinum
32. A 26 year old woman presented 1 week post delivery of
her first baby. She has sharp L sided chest pain and she
is short of breath.
33. • Pulmonary Embolism
• Why ?
• Young female
• Pregnancy hypercoagulable state
• Occurrence one week post partum
34.
35.
36. A 26 year old army officer had flu last week, felt chest
pain while driving his car, pain increased by deep
breathing, he has no history of DM or HTN,
nonsmoker, lipid profile LDL 94mg/dl
41. Diagnostic limitations
History:
25% have ‘atypical’ histories
ECG:
20% of patients with Acute Myocardial
Infarction have a normal first 12-lead ECG
Conventional Cardiac Markers:
Normal for the first 3- 4 hours
42. Take home points
•History 90%
•ECG: if ST elevated act fast
•Risk factor reduction
•Never ignore chest pain
43.
44.
45. Dyspnea
• Awareness of his own breathing.
– Hyperventilation
– Sighing breath
– Inability to take deep breath
• Orthopnea dyspnea on lying down
• Dyspnea of exertion (DOE)
– Exertion-induced SOB
– Grades of dyspnea
• Paroxysmal nocturnal dyspnea (PND)
– Sudden SOB after recumbent
46. 1. 73 year old female with HO IHD presents to the ED
with complaints of SOB for the last 2 days.
2. 28 year male presented with high grade fever,
cough and SOB for 5 days. On examination of chest
there is bronchial breathing.
a) Diagnosis
b) Investigation & Management
49. Dyspnea
History
• Prolonged questioning can be counterproductive
– Yes/No questions if significantly dyspneic
– Unlike pain, severity of dyspnea = severity of disease
• What does patient mean by SOB?
• How long has SOB been present?
– Is it sudden or gradual
• Does anything make it better or worse?
50. Dyspnea
History
• Has there been similar episodes?
• Are there associated symptoms?
• What is the past medical Hx?
– Smoking Hx?
– Medications?
53. • GRADE 1 –Dyspnoea only with unusual
exertion.
• GRADE 2 –Dyspnoea on doing ordinary
activity
• GRADE 3 –Dyspnoea on doing less than
ordinary activity.
• GRADE 4 –Dyspnoea at rest.
NYHA SCALE
55. Dyspnea
Physical Examination: Vital Signs
• BP
• Pulse
– Usually
– Bradycardia - severe hypoxemia
• Respiratory rate
– Sensitive indicator of respiratory distress
– DANGER = > 35-40 bpm or < 8-10 bpm
56. Dyspnea
Physical Examination: Observation
• Ability to speak
• Patient position
• Cyanosis
– Central vs. peripheral (acrocyanosis)
• Mental status
– Altered MS - hypoxemia/hypercapnia
57. Cardiovascular examination
• JVP , extra heart sound (S3 gallop rhythm), and
fluid retention - congestive heart failure.
• Elevated neck veins, pulsus paradoxus, a
pericardial knock, pericardial rub, and the
Kussmaul's sign - Constrictive pericarditis and
effussion
• An irregular or fast heart beat - a tachyarrhythmia
or atrial fibrillation.
• A loud S2 -PAH
• A systolic heart murmur- acute valvular
insufficiency, mechanical valve malfunction.
58.
59. Case 1
History
• Symptoms started 2 days ago
• Onset gradual and progressive
• Exertion makes it worse
• New onset
• (+) chest pain, cough, DOE, PND
• No past medical Hx
• No medications or smoking Hx
60. Case 1
Physical Examination
• Moderate respiratory distress, talks in partial
sentences, prefers to sit in ED wheel-chair
• BP = 190/110 mmHg; HR = 118 /min; RR = 36
bpm; afebrile; SpO2 = 85%
• HEENT: no angioedema
• Lungs: rales & wheezing bilaterally
• Cardiac: (+) JVP; (+) S3
• Skin: no rashes
• Extremities: no edema
61. Case 1
• What are likely etiologies for this patient’s
dyspnea?
– Heart failure
– ? ACS
62. Dyspnea
Diagnostic Adjuncts
• What study will most patient’s with dyspnea
get?
– CXR
• Indicated in most cases of dyspnea, especially new-
onset
66. Dyspnea
Diagnostic Adjuncts
• What lab tests might be useful in dyspnea
workup?
– ABG
• If any question about ventilatory or acid-base status
• Beware of interpretation of (A–a)O2
– Troponin
• How would it be helpful in our patient?
– B-type natriuretic protein (BNP)
– Laboratory studies based on suspected etiology of
dyspnea
67. PALPITATION
• Abnormal subjective awareness of the heart beat.
• Thumping, pounding, fluttering, jumping, racing,
skipping)
• But patient may describe palpitation as a feeling
of breathlessness, excitement, fright etc.
• Palpitation is not always = arrythmias
68. B. Causes.
• Palpitation may be due to Rapid heart beat or
Slow heart beat or
Irregular heart beat.
• Palpitation may be due to
Primary cardiac disease (Acute or Chronic) or
Secondary effect on the heart (Systemic disease or
Drugs)
71. C. Diagnosis
• Careful and thorough history is important.
• Definitive diagnosis may be obtained by doing ECG
during attacks or ambulatory ECG monitoring.
72. The evaluation of patient with palpitation.
• Continuous or intermittent?
• Regular or irregular heartbeat?
• Approximate heart rate?
• Discrete attacks or not? If yes, is the onset abrupt?
Or how do attacks terminate?
• Any associated symptoms? Eg. Chest pain,
lightheadedness, polyuria.
• Any precipitating factors? Eg. Exercise, alcohol.
• Evidence of structural heart disease? Eg. Coronary
heart disease, valvular heart disease.
74. SYNCOPE/ PRESYNCOPE
• Sudden loss of consciousness
• May be due to reduced cerebral perfusion.
• Presyncope is lightheadedness in which the
patient thinks he may black out.
75. • Cardiac syncope- arrythmia, structural heart
disease
• Neurocardiogenic syncope- situational,
vasovagal, hypersensitive carotid sinus
syndrome
• Postural hypotension
• CNS: Loss of consciousness due to seizure,
CVA, hypoglycemia.
76. Questions to be asked for syncope
• Did you lose consciousness completely? If yes for how long?
• Do you blackout or feel dizzy when you stand up quickly?
• How often have episodes occurred?
• Was the sensation more one of spinning?
• Did the episode occur during heavy exercise? Or when you got up to pass
urine during the night?
• Have you injured yourself?
• Do you get any warning?
• 9feeling of nausea while in a stuffy room suggests----; a strange smell or
feeling of deja-vu suggests an aura and therefore----)
• Have you become incontinent during an episode?
• Have you bitten your tongue?
• Has anyone witnessed an episode and seen tonic clonic jerking?
• Do you wake up feeling normal or drowsy?
• What medications are you taking?