LECTURE ON ATRIAL FIBRILLATION TO 9TH TERM MEDICAL STUDENTS REFERENCES: DAVIDSON(2018) HARRISON 20TH ED OF MEDICINE AND 2020 EUROPEAN HEART GUIDELINES ON AF
A comprehensive approach to Atrial Fibrillation. Everything you need to know about Atrial fibrillation. Including recent 2014 AHA guidelines of management.
Wolff–Parkinson–White syndrome (WPW) is one of several disorders of the conduction system of the heart that are commonly referred to as pre-excitation syndromes. WPW is caused by the presence of an abnormal accessory electrical conduction pathway between the atria and the ventricles. Electrical signals traveling down this abnormal pathway (known as the bundle of Kent) may stimulate the ventricles to contract prematurely, resulting in a unique type of supra-ventricular tachycardia referred to as an atrio-ventricular reciprocating tachycardia.
Wolff–Parkinson–White syndrome (WPW) is one of several disorders of the conduction system of the heart that are commonly referred to as pre-excitation syndromes. WPW is caused by the presence of an abnormal accessory electrical conduction pathway between the atria and the ventricles. Electrical signals travelling down this abnormal pathway (known as the bundle of Kent) may stimulate the ventricles to contract prematurely, resulting in a unique type of supraventricular tachycardia referred to as an atrioventricular reciprocating tachycardia.The incidence of WPW is between 0.1% and 0.3% in the general population.Sudden cardiac death in people with WPW is rare (incidence of less than 0.6%), and is usually caused by the propagation of an atrial tachydysrhythmia (rapid and abnormal heart rate) to the ventricles by the abnormal accessory pathway.
A comprehensive approach to Atrial Fibrillation. Everything you need to know about Atrial fibrillation. Including recent 2014 AHA guidelines of management.
Wolff–Parkinson–White syndrome (WPW) is one of several disorders of the conduction system of the heart that are commonly referred to as pre-excitation syndromes. WPW is caused by the presence of an abnormal accessory electrical conduction pathway between the atria and the ventricles. Electrical signals traveling down this abnormal pathway (known as the bundle of Kent) may stimulate the ventricles to contract prematurely, resulting in a unique type of supra-ventricular tachycardia referred to as an atrio-ventricular reciprocating tachycardia.
Wolff–Parkinson–White syndrome (WPW) is one of several disorders of the conduction system of the heart that are commonly referred to as pre-excitation syndromes. WPW is caused by the presence of an abnormal accessory electrical conduction pathway between the atria and the ventricles. Electrical signals travelling down this abnormal pathway (known as the bundle of Kent) may stimulate the ventricles to contract prematurely, resulting in a unique type of supraventricular tachycardia referred to as an atrioventricular reciprocating tachycardia.The incidence of WPW is between 0.1% and 0.3% in the general population.Sudden cardiac death in people with WPW is rare (incidence of less than 0.6%), and is usually caused by the propagation of an atrial tachydysrhythmia (rapid and abnormal heart rate) to the ventricles by the abnormal accessory pathway.
Atrial Fibrillation is the most common arrhythmia encountered by a physician. The global prevalence is increasing because of aging population and better detection methods. Prediction of new onset AF is possible. AF is also a lifestyle disease. Lifestyle therapy, rate or rhythm control and stroke risk stratification are are four main pillars of AF management.
Approach to evaluating and treating Chronic Heart Failure and Acute Heart Failure
Reference: Harrison’s Principles of internal medicine Harrison's 21st Ed (2022)
download notes of the presentation and study with its print out
Approach to evaluating and treating Chronic Heart Failure and Acute Heart Failure
Reference: Harrison’s Principles of internal medicine Harrison's 21st Ed (2022)
surviving sepsis guidelines - Notes are made from surviving sepsis guidelines 2016 article to assist medical students and residents to grasp subject in a easy to read format in a step wise manner. Resources: surviving sepsis guidelines 2016 (free access article)
Pulmonary embolism - Notes are made from textbook of Internal medicine to assist medical students and residents to grasp subject in totality. Resources: Harrison's 20thEd, ESC 2019 guidelines on PE
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
- 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
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.
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
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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.
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ATRIAL FIBRILLATION
1. Col Bharat Malhotra
Senior Advisor (Medicine)
REFERENCE
Harrison’s Principles of internal medicine Harrisons 20th Ed
Davidson’s Principles and practice of Medicine (2018)
2020 European Cardiology guidelines on Atrial Fibrillation 2019 American Heart Association Guidelines on AF
9. • Supraventricular Tachyarrhythmia
• Disorganized, uncoordinated atrial activation
• Consequently ineffective atrial contraction
• With irregular ventricular rate that is determined by
AV conduction
10. American Heart Association Cardiology Guidelines 2019
• Terminates < 7 DAYS
• Spontaneous or by Intervention. AF may recur
PAROXYSMAL
AF
• Sustained > 7 DAYS
PERSISTENT AF
• Sustained > 12 MONTHS
LONGLASTING
PERSISTENT AF
• Joint decision by patient and clinician to
cease further attempts to restore sinus
rhythm.
PERMANENT
AF
17. Risk of Stroke
CHA2DS2-VASc
Score
Asymptomatic,
Mild, Mod,
Severe
QoL
Questionnaires
Temporal
Pattern
• Paroxysmal
• Persistent
• Long standing
persistent
• Permanent
Comorbidities
Comorbidities &
Risk factors
Assessment
Imaging
18. The diagnosis of AF requires rhythm documentation
with an (ECG) tracing showing AF
• No P Wave
• Irregularly Irregular QRS interval
• Fibrillatory wave
19. Inferior Wall MI with
Atrial Fibrillation with fast ventricular rate
22. ALL AF PATIENTS
CHA2DS2-VASc Score
AF related symptoms
AF burden
Comorbidity & risk factors
12 Lead ECG
CXR- PA view
ECHO
T3 T4 TSH
CBC
Kidney functions, Liver functions
Electrolytes, PT INR
Cognitive function assessment
TREATMENT – AF
Rhythm control
Rate Control
Treat
comorbidities
Intervention in
selected cases by
Catheter ablation
SELECTED AF PATIENTS
Ambulatory ECG Monitoring
Transesophageal ECHO
CRP, Troponin T, Pro BNP
Biomarkers for angina, HF
Coronary Angiography
Suspected CAD/ACS
Brain CT/MRI
Suspected stroke
CMRI, EP Mapping
for LA assessment - Evaluation
for catheter ablation
23. • CHA2DS2-VASC SCORE, HAS-BLED SCORE
• ANTICOAGULANTS
Optimized stroke prevention
• DC CARDIOVERSION
• IV AMIODARONE / other antiarrhythmic agents
• CATHETER ABLATION
Rhythm control
• B BLOCKER
• CALCIUM CHANNEL BLOCKER
• DIGOXIN
• EXCEPTIONAL CASES – IV AMIODARONE
Rate Control
• TREAT UNDERLYING CAUSE AND RISK FACTORS
Rx Comorbidities & Risk
• Life style modification
• Psychosocial support
• Structured follow-up
Supportive care
24. Valvular disease – MS
HCM
Prior stroke
Score > 2
THE RISK OF STROKE BY
CHA2DS2-VASC SCORE
0 NIL
2+ Oral
Anticoagulant
INDICATION
25. THE RISK OF BLEEDING
HAS-BLED Score
0 NIL
3+ Close
Monitoring
Contraindication To Oral Anticoagulants
Active Bleed/ High Risk of bleed
Platelet Count < 50k, INR > 3
Creatinine Clearance < 30 ml/min
26. THROMBOPROPHYLAXIS
Loss of atrial contraction
&
Left atrial dilatation
Cause stasis of blood in
the LA & thrombus
formation in the left atrial
appendage.
This predisposes
patients to stroke Antiplatelet therapy should not
be used for stroke prevention in
Vitamin K
Antagonist
WARFARIN
New Oral
Anticoagulants
Factor Xa Inhibitors
RIVOROXABAN
APIXABAN
ENDOXABAN
Direct Thrombin
Inhibitor
DABIGATRAN
No INR monitoring
Fixed Dose
Less drug interactions
INR: 2 to 3
Monitor INR
Drug Interactions
Use especially for
Mitral valve disease
Prosthetic Valve
27. Attempt to restore rhythm + achieve rate control
• If troublesome symptoms to improve QoL
• Symptomatic paroxysmal AF, Recurrent symptomatic persistent AF
• Modifiable or correctable cause in young with short history &
fewer comorbidities are candidates for rhythm control
Hemodynamically unstable:
Emergency - synchronized DC cardioversion
Hemodynamically stable
Elective - synchronized DC cardioversion (<48h) ECHO
Elective - synchronized DC cardioversion (>48h) ECHO , OAC 4 weeks
till 4 weeks after
Pharmacological – Sick, HF, IHD – IV Amiodarone
Resistant Cases – Catheter ablation
Surgical therapy – MAZE
28. Sedate
Press Sync button
Apply jelly over pads and place over chest as demonstrated
Select Charge 200 J
Do synchronized DC cardioversion
Monitor patient
29. IV AMIODARONE
150 mg over 10 mins infusion then 360 mg (1mg/min) over 6 hours infusion
Then 540 mg (0.5 mg/min) over 18 hours infusion
Class III
Anti arrhythmic Drug
Increase refractoriness
of myocardium
30. Prepare – TEE, ECG, CT Angio of Heart
Ablation Cath Lab
Electrical mapping
Ablate around pulmonary veins
31.
32. Attempt to restore rhythm + achieve rate control
Accept presence of AF but achieve rate control
B Blocker (IV Metoprolol, IV Esmolol)
(Metoprolol, Bisoprolol, Nebivolol, Carvedilol)
Calcium Channel Blocker – (Diltiazem, Verapamil)
Digoxin
Exceptional Cases- Implant a permanent pacemaker
Plus Complete AV node block with catheter ablation
Last Resort - IV Amiodarone
<110/min
< 80/Min
34. 66 years old Male with severe Retrosternal chest pain 1 h
Pulse 150 /Min Irregular BP 140 / 70 mmHg RR 22/Min
No Pedal enema, JVP not raised, Chest Clear
CVS- S1 S2 irregular, No murmur
35. 45 year old male has
Dyspnoea NYHA II & palpitations 6 Months
ECHO - moderate MS
36. 62 years Female
Diabetes, Hypertension – 10 years on medications.
Has palpitations since 4 months.
ECG show AF, ECHO is WNL
