1) This document provides an approach to managing patients presenting with chest pain and ST elevation on ECG with the aim of expediting diagnosis and treatment of acute myocardial infarction (AMI).
2) It outlines how to assess for AMI in ECGs with confounding patterns like left bundle branch block, ventricular paced rhythm, and left ventricular hypertrophy by applying Sgarbossa criteria to rule in AMI. Serial ECGs are used to look for dynamic changes if criteria are not met.
3) For uncomplicated ECGs, specific ECG features are examined to rule in AMI and serial ECGs are used to look for dynamic changes if initial features are not suspicious for AMI. The goal is
HIV/AIDS data Hub Asia Pacific -Malaysia 2014Dr. Rubz
This document provides a summary of HIV/AIDS data for Malaysia across multiple indicators:
- HIV prevalence is highest among key populations like people who inject drugs, female sex workers, and men who have sex with men. Condom use and safe injection practices have increased over time but remain below optimal levels.
- The number of reported HIV infections and AIDS-related deaths has declined in recent years. Most HIV transmissions are through heterosexual contact and injecting drug use.
- Vulnerability remains high as many key populations lack comprehensive HIV knowledge and access to prevention programs, testing, and treatment.
- Government spending on HIV has increased but more funding needs to be directed towards programs for key populations at higher
Chronic renal failure concise long case approach & crf with fluid overload m...Dr. Rubz
This document provides a concise long case approach for chronic renal failure. It outlines the key presenting complaints, history, physical exam findings, investigations, complications, and management strategies for chronic renal failure. The management involves addressing issues related to calcium/phosphate metabolism, anemia, osteodystrophy, fluid overload, and nutritional management. Treatment plans include diuresis, dialysis/filtration, erythropoietin therapy, calcium supplementation, and dietary restrictions. Referrals to other specialists are recommended based on the severity of renal failure and patient needs.
Chronic liver disease ( concise long case approach )Dr. Rubz
This document discusses the identification, diagnosis, and management of chronic liver disease (CLD). It identifies the main etiologies and risk factors for CLD, including infections like hepatitis B and C, alcohol, drugs, and metabolic disorders. It outlines the approach to diagnosing CLD based on symptoms, signs, laboratory tests, and imaging. Factors are assessed to determine if the CLD is compensated or decompensated. Management involves treating complications like ascites, bacterial peritonitis, variceal bleeding, and hepatic encephalopathy. Treatment may also include procedures like paracentesis or transplantation.
The document discusses the second stage of labor and normal childbirth procedures. It describes:
1) The second stage of labor involves full dilation of the cervix over 1 hour followed by birth of the fetus. The fetus is born through a series of movements including extension, restitution, and external rotation of the head.
2) Proper techniques for assisting a normal vaginal delivery include encouraging the woman to push in her preferred position, suctioning the baby's mouth and nose after crowning, and gently guiding the shoulders and rest of the baby out one at a time to avoid tears.
3) Standard steps after birth include promptly placing the baby skin to skin on the mother, clamping and
This document appears to be a set of slides for a lecture or teaching session on rapidly interpreting electrocardiograms (ECGs) given by Dr. James Smitt of Monash University on July 25, 2013 for third year medical students. The slides provide instruction on efficiently analyzing ECG readings to identify potential cardiac issues or abnormalities.
The document announces an e-mail auction to raise funds for the United Learning Centre, which provides education and meals to 140 refugee children in Malaysia. The auction includes donations of a Rado watch, porcelain vases, paintings, a lamp, and other items. Proceeds will help the learning center continue offering refugee children education, nutrition, and boarding for those whose parents work far away. The auction encourages supporting this charity auction to help children in need.
Epilepsy is a chronic neurological condition characterized by recurrent seizures. The majority of childhood epilepsy is idiopathic or genetic in origin. Seizures can be generalized, arising from both hemispheres, or focal, arising from one hemisphere. Common generalized seizures include tonic-clonic, absence, and myoclonic seizures. Diagnosis involves a clinical history and may include EEG and imaging. Treatment primarily involves antiepileptic drug therapy to control seizures.
Alcoholism has genetic, personality, and environmental risk factors. It is characterized by impaired control over alcohol use and dependence. Signs include tolerance, withdrawal, neglecting responsibilities, and continued use despite harm. Complications involve the liver, brain, heart, pancreas, and mental health. Treatment focuses on detoxification, counseling, support groups, and preventing relapse. The long-term prognosis remains guarded as 30% relapse within a year of stopping heavy drinking.
HIV/AIDS data Hub Asia Pacific -Malaysia 2014Dr. Rubz
This document provides a summary of HIV/AIDS data for Malaysia across multiple indicators:
- HIV prevalence is highest among key populations like people who inject drugs, female sex workers, and men who have sex with men. Condom use and safe injection practices have increased over time but remain below optimal levels.
- The number of reported HIV infections and AIDS-related deaths has declined in recent years. Most HIV transmissions are through heterosexual contact and injecting drug use.
- Vulnerability remains high as many key populations lack comprehensive HIV knowledge and access to prevention programs, testing, and treatment.
- Government spending on HIV has increased but more funding needs to be directed towards programs for key populations at higher
Chronic renal failure concise long case approach & crf with fluid overload m...Dr. Rubz
This document provides a concise long case approach for chronic renal failure. It outlines the key presenting complaints, history, physical exam findings, investigations, complications, and management strategies for chronic renal failure. The management involves addressing issues related to calcium/phosphate metabolism, anemia, osteodystrophy, fluid overload, and nutritional management. Treatment plans include diuresis, dialysis/filtration, erythropoietin therapy, calcium supplementation, and dietary restrictions. Referrals to other specialists are recommended based on the severity of renal failure and patient needs.
Chronic liver disease ( concise long case approach )Dr. Rubz
This document discusses the identification, diagnosis, and management of chronic liver disease (CLD). It identifies the main etiologies and risk factors for CLD, including infections like hepatitis B and C, alcohol, drugs, and metabolic disorders. It outlines the approach to diagnosing CLD based on symptoms, signs, laboratory tests, and imaging. Factors are assessed to determine if the CLD is compensated or decompensated. Management involves treating complications like ascites, bacterial peritonitis, variceal bleeding, and hepatic encephalopathy. Treatment may also include procedures like paracentesis or transplantation.
The document discusses the second stage of labor and normal childbirth procedures. It describes:
1) The second stage of labor involves full dilation of the cervix over 1 hour followed by birth of the fetus. The fetus is born through a series of movements including extension, restitution, and external rotation of the head.
2) Proper techniques for assisting a normal vaginal delivery include encouraging the woman to push in her preferred position, suctioning the baby's mouth and nose after crowning, and gently guiding the shoulders and rest of the baby out one at a time to avoid tears.
3) Standard steps after birth include promptly placing the baby skin to skin on the mother, clamping and
This document appears to be a set of slides for a lecture or teaching session on rapidly interpreting electrocardiograms (ECGs) given by Dr. James Smitt of Monash University on July 25, 2013 for third year medical students. The slides provide instruction on efficiently analyzing ECG readings to identify potential cardiac issues or abnormalities.
The document announces an e-mail auction to raise funds for the United Learning Centre, which provides education and meals to 140 refugee children in Malaysia. The auction includes donations of a Rado watch, porcelain vases, paintings, a lamp, and other items. Proceeds will help the learning center continue offering refugee children education, nutrition, and boarding for those whose parents work far away. The auction encourages supporting this charity auction to help children in need.
Epilepsy is a chronic neurological condition characterized by recurrent seizures. The majority of childhood epilepsy is idiopathic or genetic in origin. Seizures can be generalized, arising from both hemispheres, or focal, arising from one hemisphere. Common generalized seizures include tonic-clonic, absence, and myoclonic seizures. Diagnosis involves a clinical history and may include EEG and imaging. Treatment primarily involves antiepileptic drug therapy to control seizures.
Alcoholism has genetic, personality, and environmental risk factors. It is characterized by impaired control over alcohol use and dependence. Signs include tolerance, withdrawal, neglecting responsibilities, and continued use despite harm. Complications involve the liver, brain, heart, pancreas, and mental health. Treatment focuses on detoxification, counseling, support groups, and preventing relapse. The long-term prognosis remains guarded as 30% relapse within a year of stopping heavy drinking.
The document discusses the stages of normal labor, including:
- The first stage of labor involves cervical dilation from 0-10 cm over 8-12 hours and has latent and active phases.
- The second stage involves pushing and lasts up to 1 hour.
- The third stage involves delivery of the placenta within 30 minutes.
- Labor is diagnosed based on cervical effacement and dilation which are assessed through vaginal examinations every 4 hours in the first stage and hourly in the second stage.
This document provides information on the diagnosis, symptoms, signs, screening, and treatment of diabetes mellitus. It defines the main types of diabetes as type 1, type 2, gestational diabetes, and prediabetes conditions. It outlines the diagnostic criteria and recommendations for screening asymptomatic individuals. Signs and symptoms of diabetes as well as potential complications are described. Treatment aims and options including lifestyle modifications, oral hypoglycemic agents, and insulin therapy are summarized. The document also discusses prevention and management of diabetes complications focused on cardiovascular, renal, foot, and eye health.
Hyperthyroidism can be caused by Graves' disease, multinodular goiter, toxic adenoma, or thyroiditis. It presents with symptoms affecting the goiter, gastrointestinal tract, cardiovascular system, neuromuscular and dermatological systems, and reproduction. Investigations include thyroid function tests, thyroid receptor antibodies, and thyroid ultrasound. Management involves antithyroid medications, radioactive iodine therapy, surgery, beta blockers, and treatment of complications like thyrotoxic crisis or ophthalmopathy. Special considerations include hyperthyroidism in pregnancy and periodic paralysis.
This document presents a long case presentation of a 13-year-old female patient from Charsadda. She has a history of excessive weeping, not eating, repetitive behaviors such as touching people's faces and picking things, and intellectual impairment. Her symptoms have been present since early childhood. A psychiatric evaluation found mood and speech abnormalities, intellectual impairment, and obsessive-compulsive-like behaviors. Differential diagnoses include autism spectrum disorder, obsessive-compulsive disorder with intellectual impairment, or schizophrenia. She is being treated with fluoxetine and olanzapine, along with behavioral management, educational support, and family counseling.
Nephrotic syndrome is defined by hypoalbuminemia, proteinuria, and edema. It is caused by primary glomerular diseases like minimal change nephropathy or secondary diseases like diabetes. Complications include infections due to immunosuppression, thrombosis due to hypercoagulability, decreased blood volume, hyperlipidemia, hypocalcemia, and negative nitrogen balance. Investigations include blood tests to check for causes and urine tests to measure proteinuria. Management involves diet, diuretics, treating infections, hyperlipidemia, and hypertension, with corticosteroids often used for minimal change disease.
This document provides a regional overview of HIV/AIDS trends in Asia and the Pacific from 1990-2013. It summarizes that there are currently 4.8 million people living with HIV in the region, with new infections declining significantly since 2001 but remaining largely unchanged in the past 5 years. Treatment coverage has increased substantially, with 1.56 million people now on ART, however this is still only about one-third of those in need. The challenges ahead include addressing gaps in prevention for key populations and along the treatment cascade.
1) Hypertension is a major risk factor for cardiovascular disease. The risk increases continuously with higher blood pressure levels.
2) Hypertension is classified based on systolic and diastolic blood pressure levels according to JNC VII guidelines. It is further classified as stage 1 or 2 based on drug treatment needs.
3) Evaluation of hypertension involves assessing lifestyle risk factors, identifying secondary causes, evaluating for target organ damage, and measuring other cardiovascular risk factors. Treatment aims to reduce blood pressure levels and cardiovascular risk.
The document discusses cancer (neoplasia) including definitions, classifications, staging, diagnostic methods, hereditary factors, symptoms, and treatments. It provides an overview of the history and development of cancer research from Hippocrates to modern classifications and therapies. Key topics covered include the TNM staging system, common cancer types and locations, diagnostic imaging techniques, hereditary cancer syndromes, and approaches to chemotherapy and combined modality treatment.
This document summarizes different types of shock including hypovolemic, cardiogenic, neurogenic, septic, anaphylactic, and obstructive shock. It provides details on definitions, signs and symptoms, investigations, and management for each type of shock. General management includes maintaining the airway, providing oxygen, establishing intravenous access, monitoring vital signs, and administering fluids with or without vasopressors depending on the type and severity of shock. Specific investigations and treatments are outlined for each shock type.
1. The document summarizes Malaysia's HIV/AIDS situation and recommendations for interventions. It reports that while HIV transmission is declining overall, sexual transmission now accounts for over 50% of new cases, especially among heterosexuals and men who have sex with men. 2. Key recommendations include expanding access to antiretroviral treatment, strengthening prevention services for at-risk groups, and implementing proven interventions like condom promotion and harm reduction programs. 3. Achieving the UNAIDS 90-90-90 targets of diagnosing 90% of HIV cases, treating 90% of those diagnosed, and virally suppressing 90% of those treated is an important goal.
Acromegaly is caused by excessive growth hormone (GH) secretion from the pituitary gland, usually presenting in adults aged 30-50 years old. Signs and symptoms include enlarged features of the face, hands, and feet; joint pain; headaches; and increased sweating. Treatment options include trans-sphenoidal surgery to remove the pituitary tumor, radiation therapy, and medication like somatostatin analogues to control GH levels. Complications can develop if acromegaly goes untreated and includes heart failure, arthritis, sleep apnea, and visual impairments.
The document discusses pyogenic meningitis, including the pathophysiology of convulsions which can result from meningitis due to imbalances in excitatory and inhibitory neurotransmitters. It also outlines the clinical features, investigations, treatment including antibiotics and dexamethasone, and complications of acute bacterial meningitis, with a focus on different age groups. Prevention methods like vaccination and prophylactic antibiotics for contacts are also covered.
Pneumonia is an inflammation of the lungs that can be caused by bacteria, viruses, or other pathogens. It is a major cause of illness and death in children worldwide, especially in those under 5 years old. Common symptoms include fever, cough, difficulty breathing, and fatigue. Diagnosis involves examination for signs of respiratory distress, chest x-ray, and tests of blood and sputum samples. Treatment depends on the identified cause but generally involves antibiotics, oxygen, fluids, and fever control. Complications can include pleural effusions, lung abscesses, or respiratory failure.
1) This document provides guidelines for the management of atrial fibrillation (AF), including evaluating the underlying causes, classifying the type of AF, assessing risk of complications, and approaches to rate control and rhythm control.
2) Rate control is recommended for most stable patients and involves pharmacological therapies like beta-blockers, calcium channel blockers, or digoxin, while assessing risk of thromboembolism and anticoagulating appropriately.
3) Rhythm control includes pharmacological or electrical cardioversion along with anticoagulation and maintenance medications to prevent AF recurrence, or non-pharmacological options like pacing or ablation for selected patients.
1. Orchitis and epididymo-orchitis are usually caused by blood-borne infections like Chlamydia, gonorrhea, or E. coli. They present with acute pain and swelling of the testes or epididymis.
2. Undescended testes occur in 1% of boys after 1 year of age and can lead to infertility if not treated. Risk factors include prematurity and family history. Treatment is orchidopexy to bring the testes into the scrotum.
3. Testicular torsion occurs when the spermatic cord twists, cutting off blood supply to the testes. It requires urgent surgery to untwist the cord or
The document discusses various conditions that can affect the male genital tract including hydrocele, hematocele, spermatocele, varicocele, testicular tumors, testicular torsion, epididymo-orchitis, and undescended testis. It provides information on the presentation, risk factors, investigations, management, and complications of each condition. The document is a reference for doctors on evaluating and treating various scrotal and testicular issues.
Legislative and Ethical Framework of Organ Donation and Transplantation in Ma...Dr Hirman Ismail
The document provides an overview of the legislative and ethical framework for organ donation and transplantation in Malaysia. It discusses the current laws and policies governing transplantation, including the Human Tissues Act 1974, Anti-Trafficking in Persons Act 2007, and proposed new Organ and Tissue Transplantation Bill. It also addresses the gap between organ supply and demand, ethical issues around organ trading, and efforts to increase rates of deceased and living donation in Malaysia.
Gout is a mono or oligoarticular crystal arthropathy caused by uric acid crystals in the joints. It is associated with hyperuricemia and inflammation occurs when white blood cells phagocytose the urate crystals. It typically affects middle aged men or postmenopausal women. Clinically, it presents as acute arthritis, chronic tophaceous gout, urate urolithiasis or urate nephropathy. Diagnosis is confirmed by identifying needle-shaped urate crystals in joint fluid aspirate. Treatment involves bed rest, NSAIDs for acute attacks, and allopurinol or uricosurics for chronic management and prevention of further attacks and complications.
This document discusses different types of hernias, including ventral, incisional, and Spigelian hernias. It defines a hernia as an abnormal protrusion of an organ outside its normal cavity. It classifies hernias based on their location, such as inguinal or femoral. Incisional hernias occur through a previous surgical wound. Signs and symptoms vary from a painless lump to a painful, swollen protrusion. Management typically involves surgical repair to excise the hernia sac and close the defect.
The document discusses various aspects of human sexuality including:
1) The normal sexual response cycle of desire, excitement and orgasm in men and women.
2) Several types of sexual dysfunctions that can occur including decreased libido, erectile dysfunction, delayed ejaculation and anorgasmia.
3) Paraphilias or abnormal sexual interests involving non-consenting partners or objects. Examples given include fetishism, voyeurism and pedophilia.
4) Gender identity disorders where one's identity does not match their biological sex.
1) The document defines wide complex tachycardia as a rhythm with a QRS duration ≥120ms and heart rate >100 bpm.
2) The main causes listed are ventricular tachycardia (80% of cases) and supraventricular tachycardia with aberrancy.
3) Key features that can help differentiate the underlying rhythm include QRS duration, axis, morphology, and the presence or absence of AV dissociation on electrocardiogram.
A 22-year-old male presented with acute onset breathlessness, palpitations, profuse sweating, and vague chest discomfort for 1 hour. His ECG showed tachycardia at 200 bpm with a regular rhythm, right bundle branch block pattern, and extreme northwest axis. This case report discusses the differential diagnosis and criteria used to differentiate ventricular tachycardia from supraventricular tachycardia with aberrancy based on the ECG findings. Key criteria evaluated include Brugada criteria, AVR criteria, morphology, axis, and presence of fusion or capture beats. The conclusion is that while no single criteria is definitive, if there is any doubt the rhythm should be treated as ventricular tachycard
The document discusses the stages of normal labor, including:
- The first stage of labor involves cervical dilation from 0-10 cm over 8-12 hours and has latent and active phases.
- The second stage involves pushing and lasts up to 1 hour.
- The third stage involves delivery of the placenta within 30 minutes.
- Labor is diagnosed based on cervical effacement and dilation which are assessed through vaginal examinations every 4 hours in the first stage and hourly in the second stage.
This document provides information on the diagnosis, symptoms, signs, screening, and treatment of diabetes mellitus. It defines the main types of diabetes as type 1, type 2, gestational diabetes, and prediabetes conditions. It outlines the diagnostic criteria and recommendations for screening asymptomatic individuals. Signs and symptoms of diabetes as well as potential complications are described. Treatment aims and options including lifestyle modifications, oral hypoglycemic agents, and insulin therapy are summarized. The document also discusses prevention and management of diabetes complications focused on cardiovascular, renal, foot, and eye health.
Hyperthyroidism can be caused by Graves' disease, multinodular goiter, toxic adenoma, or thyroiditis. It presents with symptoms affecting the goiter, gastrointestinal tract, cardiovascular system, neuromuscular and dermatological systems, and reproduction. Investigations include thyroid function tests, thyroid receptor antibodies, and thyroid ultrasound. Management involves antithyroid medications, radioactive iodine therapy, surgery, beta blockers, and treatment of complications like thyrotoxic crisis or ophthalmopathy. Special considerations include hyperthyroidism in pregnancy and periodic paralysis.
This document presents a long case presentation of a 13-year-old female patient from Charsadda. She has a history of excessive weeping, not eating, repetitive behaviors such as touching people's faces and picking things, and intellectual impairment. Her symptoms have been present since early childhood. A psychiatric evaluation found mood and speech abnormalities, intellectual impairment, and obsessive-compulsive-like behaviors. Differential diagnoses include autism spectrum disorder, obsessive-compulsive disorder with intellectual impairment, or schizophrenia. She is being treated with fluoxetine and olanzapine, along with behavioral management, educational support, and family counseling.
Nephrotic syndrome is defined by hypoalbuminemia, proteinuria, and edema. It is caused by primary glomerular diseases like minimal change nephropathy or secondary diseases like diabetes. Complications include infections due to immunosuppression, thrombosis due to hypercoagulability, decreased blood volume, hyperlipidemia, hypocalcemia, and negative nitrogen balance. Investigations include blood tests to check for causes and urine tests to measure proteinuria. Management involves diet, diuretics, treating infections, hyperlipidemia, and hypertension, with corticosteroids often used for minimal change disease.
This document provides a regional overview of HIV/AIDS trends in Asia and the Pacific from 1990-2013. It summarizes that there are currently 4.8 million people living with HIV in the region, with new infections declining significantly since 2001 but remaining largely unchanged in the past 5 years. Treatment coverage has increased substantially, with 1.56 million people now on ART, however this is still only about one-third of those in need. The challenges ahead include addressing gaps in prevention for key populations and along the treatment cascade.
1) Hypertension is a major risk factor for cardiovascular disease. The risk increases continuously with higher blood pressure levels.
2) Hypertension is classified based on systolic and diastolic blood pressure levels according to JNC VII guidelines. It is further classified as stage 1 or 2 based on drug treatment needs.
3) Evaluation of hypertension involves assessing lifestyle risk factors, identifying secondary causes, evaluating for target organ damage, and measuring other cardiovascular risk factors. Treatment aims to reduce blood pressure levels and cardiovascular risk.
The document discusses cancer (neoplasia) including definitions, classifications, staging, diagnostic methods, hereditary factors, symptoms, and treatments. It provides an overview of the history and development of cancer research from Hippocrates to modern classifications and therapies. Key topics covered include the TNM staging system, common cancer types and locations, diagnostic imaging techniques, hereditary cancer syndromes, and approaches to chemotherapy and combined modality treatment.
This document summarizes different types of shock including hypovolemic, cardiogenic, neurogenic, septic, anaphylactic, and obstructive shock. It provides details on definitions, signs and symptoms, investigations, and management for each type of shock. General management includes maintaining the airway, providing oxygen, establishing intravenous access, monitoring vital signs, and administering fluids with or without vasopressors depending on the type and severity of shock. Specific investigations and treatments are outlined for each shock type.
1. The document summarizes Malaysia's HIV/AIDS situation and recommendations for interventions. It reports that while HIV transmission is declining overall, sexual transmission now accounts for over 50% of new cases, especially among heterosexuals and men who have sex with men. 2. Key recommendations include expanding access to antiretroviral treatment, strengthening prevention services for at-risk groups, and implementing proven interventions like condom promotion and harm reduction programs. 3. Achieving the UNAIDS 90-90-90 targets of diagnosing 90% of HIV cases, treating 90% of those diagnosed, and virally suppressing 90% of those treated is an important goal.
Acromegaly is caused by excessive growth hormone (GH) secretion from the pituitary gland, usually presenting in adults aged 30-50 years old. Signs and symptoms include enlarged features of the face, hands, and feet; joint pain; headaches; and increased sweating. Treatment options include trans-sphenoidal surgery to remove the pituitary tumor, radiation therapy, and medication like somatostatin analogues to control GH levels. Complications can develop if acromegaly goes untreated and includes heart failure, arthritis, sleep apnea, and visual impairments.
The document discusses pyogenic meningitis, including the pathophysiology of convulsions which can result from meningitis due to imbalances in excitatory and inhibitory neurotransmitters. It also outlines the clinical features, investigations, treatment including antibiotics and dexamethasone, and complications of acute bacterial meningitis, with a focus on different age groups. Prevention methods like vaccination and prophylactic antibiotics for contacts are also covered.
Pneumonia is an inflammation of the lungs that can be caused by bacteria, viruses, or other pathogens. It is a major cause of illness and death in children worldwide, especially in those under 5 years old. Common symptoms include fever, cough, difficulty breathing, and fatigue. Diagnosis involves examination for signs of respiratory distress, chest x-ray, and tests of blood and sputum samples. Treatment depends on the identified cause but generally involves antibiotics, oxygen, fluids, and fever control. Complications can include pleural effusions, lung abscesses, or respiratory failure.
1) This document provides guidelines for the management of atrial fibrillation (AF), including evaluating the underlying causes, classifying the type of AF, assessing risk of complications, and approaches to rate control and rhythm control.
2) Rate control is recommended for most stable patients and involves pharmacological therapies like beta-blockers, calcium channel blockers, or digoxin, while assessing risk of thromboembolism and anticoagulating appropriately.
3) Rhythm control includes pharmacological or electrical cardioversion along with anticoagulation and maintenance medications to prevent AF recurrence, or non-pharmacological options like pacing or ablation for selected patients.
1. Orchitis and epididymo-orchitis are usually caused by blood-borne infections like Chlamydia, gonorrhea, or E. coli. They present with acute pain and swelling of the testes or epididymis.
2. Undescended testes occur in 1% of boys after 1 year of age and can lead to infertility if not treated. Risk factors include prematurity and family history. Treatment is orchidopexy to bring the testes into the scrotum.
3. Testicular torsion occurs when the spermatic cord twists, cutting off blood supply to the testes. It requires urgent surgery to untwist the cord or
The document discusses various conditions that can affect the male genital tract including hydrocele, hematocele, spermatocele, varicocele, testicular tumors, testicular torsion, epididymo-orchitis, and undescended testis. It provides information on the presentation, risk factors, investigations, management, and complications of each condition. The document is a reference for doctors on evaluating and treating various scrotal and testicular issues.
Legislative and Ethical Framework of Organ Donation and Transplantation in Ma...Dr Hirman Ismail
The document provides an overview of the legislative and ethical framework for organ donation and transplantation in Malaysia. It discusses the current laws and policies governing transplantation, including the Human Tissues Act 1974, Anti-Trafficking in Persons Act 2007, and proposed new Organ and Tissue Transplantation Bill. It also addresses the gap between organ supply and demand, ethical issues around organ trading, and efforts to increase rates of deceased and living donation in Malaysia.
Gout is a mono or oligoarticular crystal arthropathy caused by uric acid crystals in the joints. It is associated with hyperuricemia and inflammation occurs when white blood cells phagocytose the urate crystals. It typically affects middle aged men or postmenopausal women. Clinically, it presents as acute arthritis, chronic tophaceous gout, urate urolithiasis or urate nephropathy. Diagnosis is confirmed by identifying needle-shaped urate crystals in joint fluid aspirate. Treatment involves bed rest, NSAIDs for acute attacks, and allopurinol or uricosurics for chronic management and prevention of further attacks and complications.
This document discusses different types of hernias, including ventral, incisional, and Spigelian hernias. It defines a hernia as an abnormal protrusion of an organ outside its normal cavity. It classifies hernias based on their location, such as inguinal or femoral. Incisional hernias occur through a previous surgical wound. Signs and symptoms vary from a painless lump to a painful, swollen protrusion. Management typically involves surgical repair to excise the hernia sac and close the defect.
The document discusses various aspects of human sexuality including:
1) The normal sexual response cycle of desire, excitement and orgasm in men and women.
2) Several types of sexual dysfunctions that can occur including decreased libido, erectile dysfunction, delayed ejaculation and anorgasmia.
3) Paraphilias or abnormal sexual interests involving non-consenting partners or objects. Examples given include fetishism, voyeurism and pedophilia.
4) Gender identity disorders where one's identity does not match their biological sex.
1) The document defines wide complex tachycardia as a rhythm with a QRS duration ≥120ms and heart rate >100 bpm.
2) The main causes listed are ventricular tachycardia (80% of cases) and supraventricular tachycardia with aberrancy.
3) Key features that can help differentiate the underlying rhythm include QRS duration, axis, morphology, and the presence or absence of AV dissociation on electrocardiogram.
A 22-year-old male presented with acute onset breathlessness, palpitations, profuse sweating, and vague chest discomfort for 1 hour. His ECG showed tachycardia at 200 bpm with a regular rhythm, right bundle branch block pattern, and extreme northwest axis. This case report discusses the differential diagnosis and criteria used to differentiate ventricular tachycardia from supraventricular tachycardia with aberrancy based on the ECG findings. Key criteria evaluated include Brugada criteria, AVR criteria, morphology, axis, and presence of fusion or capture beats. The conclusion is that while no single criteria is definitive, if there is any doubt the rhythm should be treated as ventricular tachycard
The document provides information about electrocardiograms (ECGs), including what an ECG is, the types of pathology that can be identified from ECGs, ECG paper specifications, heart anatomy and the normal ECG signal, ECG leads, determining heart rate from ECGs, common rhythms, P waves, the PR interval, the QRS complex, identifying left and right bundle branch block, identifying left and right ventricular hypertrophy, Q waves, the ST segment and T waves. Key details are provided about normal ECG measurements and the signs of various cardiac conditions.
This document provides a basic guide to interpreting electrocardiograms (ECGs). It outlines the key aspects of ECG interpretation including heart rate, rhythm, axis, P waves, PR interval, QRS complex, ST segments, QT interval, and T waves. A systematic approach is recommended over just pattern recognition. The guide defines normal and abnormal findings for each ECG feature and provides example tracings.
This document provides a basic guide to interpreting electrocardiograms (ECGs). It outlines the key aspects of ECG interpretation including heart rate, rhythm, axis, P waves, PR interval, QRS complex, ST segments, QT interval, and T waves. A systematic approach is recommended over just pattern recognition. The guide defines normal and abnormal findings for each ECG feature and provides example tracings.
This document provides a basic guide to interpreting electrocardiograms (ECGs). It outlines the key steps in ECG interpretation, including evaluating heart rate, rhythm, axis, waves, intervals, segments, and potential arrhythmias. While ECG interpretation may seem daunting, the document emphasizes that a systematic approach is better than relying solely on pattern recognition. It also stresses the importance of considering the patient's clinical condition when evaluating any arrhythmias.
This ECG shows signs of Wolff-Parkinson-White syndrome with a likely accessory right posteroseptal pathway. Key features include a frontal QRS axis around -30 degrees, frontal delta wave axis between -30 to -60 degrees, and dominant negative QRS deflection in lead V1 with isoelectric or negative delta wave. The patient presented with palpitations since childhood and exam was unremarkable other than tachycardia.
An electrocardiogram (ECG or EKG) records the electrical signal from your heart to check for different heart conditions. Electrodes are placed on your chest to record your heart's electrical signals, which cause your heart to beat. The signals are shown as waves on an attached computer monitor or printer
1. Left bundle branch block (LBBB) is a conduction abnormality caused by impaired conduction in the left bundle branch or its fascicles.
2. LBBB can be chronic or intermittent and is often caused by coronary artery disease or hypertension.
3. On ECG, LBBB is characterized by a QRS duration ≥120ms and other abnormalities including broad R waves and abnormal ST-T wave patterns.
4. LBBB can make ECG diagnosis of myocardial infarction difficult and criteria like Sgarbossa scores are used to help identify MI in the setting of LBBB.
A 22-year-old male presented with acute onset breathlessness, palpitations, and profuse sweating. His ECG showed tachycardia at a rate of 200 bpm with a right bundle branch block pattern. This wide complex tachycardia was determined to be ventricular tachycardia based on Brugada criteria and AVR criteria, including the absence of an RS complex in leads V1-V6, a QRS duration greater than 100 ms, and a ventricular activation-velocity ratio greater than 1. The patient was diagnosed with ventricular tachycardia based on the ECG findings and treated accordingly.
Vt in normal and abnormal hearts my ppt copyRahul Chalwade
This document discusses ventricular tachycardia (VT) in normal and abnormal hearts. It begins by defining VT and describing its classification based on ECG morphology, duration, mechanism, and etiology. In normal hearts, VT can be due to reentry, automaticity, or triggered activity. Common types of idiopathic VT in normal hearts include outflow tract VT, fascicular VT, and automatic VT. Outflow tract VT often originates from the right ventricular outflow tract and has a good prognosis. Fascicular VT originates from the left posterior fascicle. In abnormal hearts post-myocardial infarction, VT is commonly due to reentry within scar tissue. The 12-lead ECG can provide
This document provides guidance on electrocardiogram (ECG) interpretation. It begins with descriptions of normal ECG appearances and measurements. It then discusses approaches to reading an ECG, including evaluating heart rate, rhythm, axis, and abnormalities. Common conduction abnormalities and what parts of the heart different abnormalities indicate are defined. The document concludes with descriptions of abnormalities in various ECG components like ST segments, T waves, and Q waves as well as the typical evolution of a myocardial infarction on ECG.
This document provides guidance on electrocardiogram (ECG) interpretation. It begins with descriptions of normal ECG appearances and measurements. It then discusses approaches to reading an ECG, including evaluating the patient details, heart rate, rhythm, axis, and conduction abnormalities. Various abnormalities are described such as arrhythmias, conduction blocks, abnormal P waves, QRS complexes, ST segments, and T waves. Causes and indications of different abnormalities are provided. The document concludes with descriptions of myocardial infarction patterns on ECG over time.
This document discusses various non-coronary causes of ST-elevation on electrocardiograms (ECGs) including ventricular aneurysms, pericarditis, early repolarization patterns, left ventricular hypertrophy, left bundle branch block, hypothermia, cardioversion, intraventricular hemorrhage, hyperkalemia, Brugada pattern, type 1C antiarrhythmic drugs, hypercalcemia, pulmonary embolism, hypothermia, myocarditis, and tumor invasion of the left ventricle. It then discusses left ventricular aneurysms, early repolarization, acute pericarditis, hyperkalemia, hypothermia, increased intracranial pressure, Brugada syndrome, Tak
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1. Approach to ST elevation in ECGs Features in ECG with STE to examine
1) Magnitude of ST changes
Population: Patients presenting with chest pain and STE on ECG - STE greater in MI PTs
Aim: Approach to managing patients presenting with chest pain and STE on ECG with the aim - Sum of ST deviations (ie elevation and depression) is greated in MI patients
of expediting diagnosis and treatment of AMI 2) Anatomical distribution of ST changes
- ST elevation: widespread STE more likely to be due to non-AMI causes, localised
DDx of STE: STE more likely to be due to aCS
1. STEMI - ST depression: not helpful in dx of ACS except in confounding ECG patterns (LVH,
2. LV aneurysm LBBB, VPR) thru application of the Rule of Discordance
3. LBBB 3) ST segment contour
4. RBBB - Concave upwards – likely non-MI cause
5. Ventricular Paced Rhythm (VPR) - Convex upwards – likely AMI
6. LVH - Very specific but not sensitive, therefore used to rule in, but not rule out ACS
7. Benign Early Repolarisation (BER) 4) QRS width and amplitude
8. Acute Pericarditis - widened or increased amplitude of QRS usually seen in BBB, VPR and LVH, making
9. NSIVCD dx of ACS difficult
a) LBBB
Approach to Patient presenting with CP - Negative QRS complex in V1 (either QS or rS complex)
- Positive monophasic R waves in leads I, aVL, V5 & V6
Stabilise if necessary (ABC) - May see QS complexes in III & aVF
ECG b) RBBB
- Broad R wave in V1 – either monophasic R, biphasic rSR’ or qR morphologies
- Wide S or RS wave in V6
- QS complexes in inferior leads
Non-diagnostic ECG Obvious
STEMI c) VPR
- Negative QRS in precordial leads
Low Risk Group High Risk Group PCI /
- Monophasic R wave in leads I & aVL +/- V5 & V6, usually a/w T inversion
NSR No change NSSTTW Abnormal ECG Confounding Thrombolysis
- +/- QS complexes in II, III & AVF
from old ECG pattern
ECG
Rely on clinical hx for dx • Q waves • LBBB
• ST changes • VPR - T waves in Rt to mid precordial and inferior leads have convex upwards shape
• T wave • LVH mimicking hyperacute T waves of early MI
changes
Serial ECG & CE if indicated Dx Clinical Pathway in STE Rule of Appropriate Discordance ( in BBB or VPR)
ST Leads with mainly negative QRS complexes (ie QS or rS complexes)
1) NSR – normal sinus rhythm segment should have STE
2) NSSTW (Non-specific ST segment/T wave abnormalities) Leads with mainly positive QRS complexes (ie large monophasic R waves)
- ST elevation/depression of <1mm should have ST depression
- Blunted/flattened/biphasic T waves w/o inversion or hyperacuity T wave T waves in leads with mainly negative QRS complexes have convex
- Low risk of AMI upward or tall vaulting shapes similar to hyperacute T waves in early MI
- but high risk of non-AMI ACS T waves in leads with mainly positive QRS complexes are frequently
3) Abnormal ECG inverted
- ST changes, T inversion, Q waves Loss of this normal QRS complex-T wave axes discordance imply an acute
4) Confounding ECGs (LBBB, VPR, LVH) process eg AMI
- ability to detect ACS is limited due to the abnormal repolarisation that accompany
these patterns of abnormal intraventricular conductions d) LVH
- Definition: voltage criteria V1 S wave + V5/6 R wave ≥35mm
- Poor R wave progression
2. - V1 & V2: loss of septal R wave in Rt to mid precordial leads, usually resulting in
QS pattern (ie mostly negative); usually a/w concave pattern STE and prominent
T waves
- Leads I, aVL, V5 & V6: ST depression with downsloping ST segment; prominent
R waves; assymetrical (gradual downsloping initial limb with abrupt return to
baseline), biphasic or inverted T waves
Diagnostic Clinical Pathway in STE
Overview
1) Identify chest pain patients with STE
2) For STE in LVH, BBB & VPR (ie confounding ECG patterns)
- Use highly specific criterias to rule in AMI
- If negative, use serial ECG to f/u the patient for dynamic changes suggestive of
AMI
3) For STE in uncomplicated ECGs
- Look for specific features to rule in AMI
- If negative, use serial ECG to f/u the patient for dynamic changes suggestive of
AMI
Use of specific criterias aims to diagnose AMI quickly based on a single ECG so as to
allow for rapid diagnosis and institution of thrombolysis/PCI.
Digitally signed by DR WANA HLA SHWE
DN: cn=DR WANA HLA SHWE, c=MY, o=UCSI
University, School of Medicine, KT-Campus, Terengganu,
ou=Internal Medicine Group, email=wunna.
hlashwe@gmail.com
Reason: This document is for UCSI University, School of
Medicine students.
Date: 2009.03.05 08:55:25 +08'00'
Based on Clinical Decision-making in Adult Chest Pain Patients with
Electrocardiographic ST-segment Elevation: STEMI vs Non-AMI Causes of ST-
Segment Abnormality. William J Brady, Andrew Homer. Emergency Medicine
3. CP patient
- Perform ECG
STE
≥ 1mm in ≥2 contiguous leads
a) VPR Sgarbossa Criteria – to rule in AMI in VPR
Aim: Predict AMI in ECGs with confounding patterns (ie LVH, BBB, VPR)
1) Widened QRS (any one of 3)
Yes
STE ≥5mm with negative QRS
complex? Likely MI – initiate Rx
STE ≥1mm with positive QRS Positive
ST depression ≥1mm with negative QRS Negative Serial ECG to look for dynamic changes
No b) LBBB Sgarbossa Criteria – to rule in AMI in LBBB ≥0.2mm change in STE in single lead OR Positive Likely MI
(any one of 3) ≥0.1mm change in STE in 2 leads Negative No ECG
STE ≥1mm with positive QRS evidence of
ST depression ≥1mm in V1,2 or 3 MI
STE ≥5mm with negative QRS
Sgarbossa Criteria is based on principle of appropriate discordance to look for abnormal ST segment changes
It has low sensitivity & specificity, hence it is used to rule in PTs with MI in VPR/LBBB so as to allow for early initiation of Rx
Does not rule out MI in VPR/LBBB, hence the need for serial ECG monitoring in PTs who do not meet Sgarbossa criteria. Aim is to look for dynamic changes
that indicates ischaemic induced changes of an evolving AMI, as ST & T wave abnormalities are assumed to be temporally static in VPR/LBBB
2) Large amplitude LVH STE Concave up Serial ECG q4hr to look for dynamic changes
0.05mm change in STE or depression
Yes
QRS SV1 + RV 5/6 ≥ 35mm morphology Q wave devt
High specificity Positive Likely MI
T inversion in ≥2 anatomically continuous Negative No ECG
but low sensitivity
No leads evidence of
- used to rule in
Loss of ST segment concavity MI
AMI, not to rule
Convex up or Suspicious for MI
out AMI
obliquely flat
ST segment morphology Convex upwards or obliquely flat
3) STE in Exclude AMI - specific but not sensitive, hence
Yes
used to rule in AMI Suspicious for AMI
uncomplicated ECGs
Aim: Predict AMI in uncomplicated ECGs
Reciprocal ST depression Positive
(in absence of LVH, BBB, - specific but not sensitive, hence
VPR) used to rule in AMI
Exclude Benign Early Repolarisation J point notching present Suspicious for AMI
Exclude Acute Pericarditis PR depression OR Suspicious for AMI
Ratio of ST height at J point in V6 to T wave
apex height in V6 ≥0.25
Exclude AMI Ratio of sum off T wave apex heights in V1-4 Suspicious for AMI
to sum of QRS apex heights in V1-4 >0.22
Serial ECG Positive Likely MI
≥0.05mm change in ST elevation or depression Negative No ECG
Q wave devt evidence of MI
T inversion in ≥2 anatomically continuous leads
Loss of ST segment concavity