This document provides guidance on diagnosing cyanotic congenital heart disease through a practical clinical approach. It emphasizes the importance of suspecting heart disease in any child who does not clearly fit the initial diagnosis or has significant desaturation. Key signs to look for include cyanosis, differential pulse oximetry readings, and clues from chest X-ray and ECG. The approach involves classifying heart defects based on hemodynamics like pulmonary blood flow and systemic saturation. For neonates, focus is on duct-dependent lesions presenting with cyanosis or shock. Beyond the neonatal period, diagnosis involves assessing cyanosis and pulmonary congestion to identify lesions like left-to-right shunts, tetralogy of Fallot physiology,
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.
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 Arteriosus: Clinical manifestation and DiagnosisNinia Kabir
Descriptive and informative facts about Patent Ductus Arteriosus focusing on its clinical features, physical findings, natural course and diagnostic work up. The diagnostic work up does not include Echocardiography in this presentation.
Educative power-point presentation for students in paediatrics, paediatric critical care, neonatology, And trainees or fellows in paediatric critical care
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"
Cardiology 1.4. Palpitations - by Dr. Farjad IkramFarjad Ikram
Introduction to one of the more common symptoms of cardiac, psychiatric and metabolic disease. Palpitation is the uncomfortable awareness of heart beat and can often be the only symptom of underlying fatal arrhythmias.
Template design credits - http://www.slidescarnival.com
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
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
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
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.
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
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
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
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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
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!
2. Diagnosing Heart Disease
• Suspecting it
• If you are waiting for the child to
present to you with cyanosis, you are
likely to miss majority of the cases
• History and clinical clues
• Role of Chest X Ray, ECG,
Echocardiography
4. CHD: Diagnostic approach
• Age oriented approach
– Neonates
– Early and mid infancy
– Late infancy and older children
• ‘Physiological’ diagnosis rather than
anatomical diagnosis
– Functional effects of the heart disease: Cyanosis,
Pulmonary blood flow, CCF, Shock
– Assessing the need for early intervention
5. Hemodynamic Classification
• Duct dependent lesions
– Duct dependent pulmonary circulation
– Duct dependent systemic circulation
• Left to right shunts (Pre and Post tricuspid)
• Tetralogy of Fallot physiology
• Admixture physiology
• Miscellaneous
– Valvular diseases
– Obstructive lesions
– Cardiomyopathies
6. Neonates
• Duct dependent lesions
– Duct dependent pulmonary circulation
– Duct dependent systemic circulation
• Transposition of great arteries
• Total anomalous PV drainage (Obstructed)
• Admixture lesions
• Large PDA (Preterms), AP Window, Trucus
arteriosus
7. Duct Dependent Pulmonary Circulation
• Discontinuity between pulmonary ventricle and pulmonary artery
• Typical presentation: 24-72 hours .
10. Clinical features
• Development of cyanosis, rapid
worsening
• Single S2
• Unremarkable otherwise (no murmur)
• Sick looking and acidotic
• Misdiagnosed as sepsis commonly
11. Detection of cyanosis
• Cyanosis indicates presence of R-L shunt
• Can be easily missed: Poor lighting, dark skin
and anemia
• Absence of h/o cyanosis does not r/o cyanotic
heart disease
• At times cyanosis is evident only during
activity or crying
12. Detection of cyanosis
• Clinical cyanosis is apparent
only if the SO2 is <85%
• Any value <95% is abnormal
after 48 hours of birth
• Pulse oximetry: invaluable tool
to aid clinical diagnosis (detects
subclinical cyanosis)
13. Work up of the Cyanotic Newborn:
The Hyperoxia Test
100% O2 via hood
~10 min..
PO2
< 150 mmHg
CHD likely
PO2
>200mmHg,
CHD
unlikely
150 to
200
< 70
mmHg
CHD very
likely
14. Duct dependent systemic circulation
• Obstruction to left
heart outflow:
– Aortic atresia,
– Severe coarctation
– Hypoplastic left heart
syndrome
• Circulation maintained
by flow through the
PDA (R-L shunt)
• When PDA constricts,
systemic perfusion is
compromised
15. • Present with shock like state
• Pulse disparity, SO2 disparity (Difference of >5%)
• Single S2, no murmur
16. Signs of Low Cardiac Output
• Poor perfusion, bradycardia, hypotension
• Acidosis
• Cyanosis
• Arrhythmias
• Altered sensorium
• Temperature instability
• Renal and Liver dysfunction
17. Clinical clue
• Femoral pulsations: often the only
clue to the presence of coarctation;
Careful palpation and comparison with
brachials
• Ideally four limb BP measurement
should be made (automated NIBP
preferred )
SHOCK WITH DIFFERENTIAL CYANOSIS: EXCLUDE CHD
18. Mode of presentation
A relatively well child presenting dramatically
between 2 days to 1 week of life strongly
suggests duct dependent lesion
20. Transposition of Great Arteries
• Two parallel
circuits
• Early presentation
with intact IVS
• Large ASD or VSD
will delay the
presentation
• Single S2
• Short ESM
21. Obstructed TAPVC
• Pathway from PVs to LA
obstructed
• Results in Severe PVH
and PAH
• Variable presentation
depending of severity of
obstruction
• S2 variable
• ESM at PA
RA
RV
LV
LA
PA
Ao
Inn
Obstructed
TAPVC
22. • If there is a murmur
• It there is cardiomegaly in the CXR
• If there is pulse discrepancy
– We all know that ….
– We already knew that …..
So… when to suspect heart disease?
23. So… when to suspect heart disease?
• Any child who does not fit clearly to
your initial clinical diagnosis
– Think if this could be heart disease and
look out for some more clues
– Read the CXR again, take an ECG
– When in doubt, do a simple echo: A4CV
24. • Any child with significant desaturation
(assuming that we are doing pulse oxymetry in every child. If
we have not started this practice, we should start it today)
– Think if this could be heart disease and
look out for some more clues
– Read the CXR again, take an ECG
– Don’t hesitate to ask for an echo
So… when to suspect heart disease?
25. Screening
Clinical Examination and Pulse oximetry
Pre-discharge
Repeat 6-8 weeks
Any one
abnormal
Refer for echo and pediatric cardiology
evaluation
27. Role of Chest x Ray
Situs
Cardiac position
Chamber enlargement
Arch sidedness
Lung vasculature
Lung parenchyma
Bony cage and diaphragm
41. Role of ECG
• It is normal in many of the serious CHD.
Hence, a normal ECG does not rule out a
heart disease
• An abnormal ECG, almost always points
towards a serious heart disease
• Answer three questions:
– Is the QRS axis rightward
– Is there RV dominance
– Are there q waves in II, III and aVF
42. QRS axis… simplified
• Look at lead I and aVF
• Calculate the mean QRS voltage
I
aVF
+
+
-
-
46. 3 weeks to 3 months
‘Physiological / Functional’ approach
Answer two questions
• Is there cyanosis / systemic
desaturation?
• Is the pulmonary blood flow is
normal/decreased or increased?
47. Large ASD vs large VSD
• Volume overload
• RV vs LV
• Pressure overload
48. Assessment of PBF
History
• Excessive precordial activity noted by parents
• Poor feeding and interrupted feeding
• Excessive forehead sweating
• Orthopnea equivalent
• Respiratory infections that are frequent,
prolonged and difficult to treat
• Failure to thrive
49. Assessment of PBF
Clinical features
• Intercostal and sub-costal retractions
• Cardiomegaly
• Visible precordial activity
• Ejection murmur in the pulmonary area
• Diastolic flow murmur in the apical area
Absence of these findings mean that the PBF is
normal or decreased
56. TOF physiology
Tetralogy of Fallot
• PBF reduced
• Significant
cyanosis
Single ventricle with PS
DORV with PS
Tricuspid atresia with
restrictive VSD
57. To simplify…
• Acyanotic + active chest = simple L-R shunt
• Cyanotic + active chest = admixture
physiology
• Cyanotic + quite chest = TOF Physiology
58. ‘Physiological / Functional’ approach
Significant cyanosisMild CyanosisNo Cyanosis
No h/o CCF
Quiet precordium
TOF physiology
Heart failure
Hyperactive precordium
Murmur
Admixture
physiology
L – R shunts
(usually
post tricuspid)
59. ‘Physiological / Functional’ approach
No cyanosis
No CCF
No active precordium
+
Prominent murmur
Small L-R shunts
Valvular HD
AS, PS, MR
No cyanosis
H/o CCF
Active precordium
+
No/short murmur
Cardiomyopathies
60. Infants (after 3 months)
• Ventricular Septal Defects (Moderate to large)
• PDA / AP window
• Tetralogy of Fallot physiology
• Admixture physiology
• Outflow tract obstructions, esp PS
• Congenital AV valve regurgitation
• Cardiomyopathies, ALCAPA
61. Older children
• Moderate to small VSD (can be large)
• Small PDA (can be mod to large)
• Fallot and its variants
• PS, AS
• RHD
62. Summary
• Hemodynamic understanding of CHD is very
important
• Clinical, CXR and ECG clues
• Neonatal period: Duct dependent lesions,
cyanosis or shock like status
• Infancy: approach based on systemic
desaturation and pulmonary blood flow
• To have a low threshold for ordering an
echocardiography if clinically indicated
