Management of new onset atrial fibrillation involves assessing risk factors, controlling the ventricular rate, and determining an anticoagulation strategy. Rate control can be achieved acutely with intravenous medications like metoprolol or verapamil, with a target rate of 80-100 bpm. Pharmacological cardioversion with medications like ibutilide, flecainide or amiodarone may be considered. For anticoagulation, the CHA2DS2-VASc score is used to determine risk of stroke, and the HASBLED score evaluates bleeding risk. Long-term management focuses on preventing thromboembolism, symptom relief, managing underlying conditions, and rate or rhythm control.
Primary PCI involves performing urgent angioplasty and potentially stenting of the culprit artery in STEMI patients, with the goal of reopening the blocked vessel within 90 minutes of first medical contact. It is the preferred reperfusion strategy when it can be performed promptly by an experienced team. Factors such as patient age, time to treatment, comorbidities, and initial flow in the artery help determine whether primary PCI or thrombolysis is most appropriate. Optimal anticoagulation and antiplatelet regimens along with adjunctive therapies like manual thrombectomy can improve outcomes of primary PCI.
Atrial fibrillation is the most common cardiac arrhythmia. It is characterized by irregular heart rhythms without distinct P waves due to irregular activation of the atria. The prevalence increases with age and is higher in men. Risk factors include hypertension, heart disease, heart failure, thyroid disorders, obesity, and lung disease. If left untreated, atrial fibrillation can lead to stroke, heart failure, reduced quality of life, and death. The pathogenesis involves multiple activation wavelets in the atria which causes the muscle to shorten its refractory period, making further arrhythmias more likely. Atrial fibrillation is classified based on its pattern and duration.
This document provides guidelines for the classification and management of atrial fibrillation (AF). It discusses the introduction, classification, mechanisms, causes and features of AF. The diagnostic evaluation and management guidelines cover rate control versus rhythm control strategies, pharmacological and electrical cardioversion options, and drugs used for rate and rhythm control. The goals are to control the heart rate, prevent thromboembolism, and restore normal sinus rhythm when possible. Management is individualized based on the frequency, duration and symptoms of AF and patient characteristics.
Assessment of prosthetic valve functionSwapnil Garde
This document discusses the assessment of prosthetic valve function through various imaging modalities. It begins with an introduction to prosthetic valves and outlines topics to be covered, including classification of valve types. Evaluation methods like chest x-ray, fluoroscopy, echocardiography, and CT are described. Parameters assessed on each modality and guidelines for evaluation are provided. Complications of prosthetic valves and 3D imaging advances are also mentioned.
This document summarizes the echocardiographic assessment of mitral stenosis (MS). It describes the anatomy of the mitral valve and causes of MS. Methods for assessing MS severity include measuring the pressure gradient, mitral valve area using planimetry and pressure half-time, and pulmonary artery pressure. Suitability for percutaneous transvenous mitral commissurotomy is evaluated. Concomitant valve lesions are also identified. Stress echocardiography may be used when symptoms are equivocal. Transesophageal echocardiography is recommended in some cases.
This document discusses localization of accessory pathways using electrocardiography. It describes that accessory pathways can be located in eight anatomical positions along the tricuspid and mitral valve annuli. Several algorithms are proposed to determine the location based on delta wave polarity and amplitude in various leads. The most accurate is the Arruda approach, which uses step-wise analysis of delta wave characteristics in leads I, II, aVL, aVF and V1 to identify the specific accessory pathway location with 90% sensitivity and 99% specificity. Characteristic ECG patterns are presented that help localize right anteroseptal, right posteroseptal, left lateral and right free wall accessory pathways.
Contrast echocardiography uses microbubble ultrasound contrast agents to improve image quality. These microbubbles remain in the intravascular space and allow for assessment of cardiac structure, function, and perfusion. Second generation contrast agents use an inert gas encapsulated by albumin or phospholipid shells. They interact with ultrasound by reflecting at fundamental frequencies and resonating to produce harmonic frequencies. Continuous infusion provides steady contrast levels needed for perfusion assessment. Contrast echocardiography is a non-invasive technique that improves evaluation of the heart.
The document summarizes various strategies for managing thrombus burden during primary angioplasty for myocardial infarction. It discusses thrombus grading scales, the composition and types of thrombus, and the role of medications like GP IIb/IIIa inhibitors (abciximab, tirofiban, eptifibatide), heparin, and bivalirudin. It also compares intracoronary versus intravenous administration of these drugs and evaluates trials comparing different treatment strategies. Mechanical thrombectomy devices and a combined pharmacologic and mechanical approach are also reviewed.
Primary PCI involves performing urgent angioplasty and potentially stenting of the culprit artery in STEMI patients, with the goal of reopening the blocked vessel within 90 minutes of first medical contact. It is the preferred reperfusion strategy when it can be performed promptly by an experienced team. Factors such as patient age, time to treatment, comorbidities, and initial flow in the artery help determine whether primary PCI or thrombolysis is most appropriate. Optimal anticoagulation and antiplatelet regimens along with adjunctive therapies like manual thrombectomy can improve outcomes of primary PCI.
Atrial fibrillation is the most common cardiac arrhythmia. It is characterized by irregular heart rhythms without distinct P waves due to irregular activation of the atria. The prevalence increases with age and is higher in men. Risk factors include hypertension, heart disease, heart failure, thyroid disorders, obesity, and lung disease. If left untreated, atrial fibrillation can lead to stroke, heart failure, reduced quality of life, and death. The pathogenesis involves multiple activation wavelets in the atria which causes the muscle to shorten its refractory period, making further arrhythmias more likely. Atrial fibrillation is classified based on its pattern and duration.
This document provides guidelines for the classification and management of atrial fibrillation (AF). It discusses the introduction, classification, mechanisms, causes and features of AF. The diagnostic evaluation and management guidelines cover rate control versus rhythm control strategies, pharmacological and electrical cardioversion options, and drugs used for rate and rhythm control. The goals are to control the heart rate, prevent thromboembolism, and restore normal sinus rhythm when possible. Management is individualized based on the frequency, duration and symptoms of AF and patient characteristics.
Assessment of prosthetic valve functionSwapnil Garde
This document discusses the assessment of prosthetic valve function through various imaging modalities. It begins with an introduction to prosthetic valves and outlines topics to be covered, including classification of valve types. Evaluation methods like chest x-ray, fluoroscopy, echocardiography, and CT are described. Parameters assessed on each modality and guidelines for evaluation are provided. Complications of prosthetic valves and 3D imaging advances are also mentioned.
This document summarizes the echocardiographic assessment of mitral stenosis (MS). It describes the anatomy of the mitral valve and causes of MS. Methods for assessing MS severity include measuring the pressure gradient, mitral valve area using planimetry and pressure half-time, and pulmonary artery pressure. Suitability for percutaneous transvenous mitral commissurotomy is evaluated. Concomitant valve lesions are also identified. Stress echocardiography may be used when symptoms are equivocal. Transesophageal echocardiography is recommended in some cases.
This document discusses localization of accessory pathways using electrocardiography. It describes that accessory pathways can be located in eight anatomical positions along the tricuspid and mitral valve annuli. Several algorithms are proposed to determine the location based on delta wave polarity and amplitude in various leads. The most accurate is the Arruda approach, which uses step-wise analysis of delta wave characteristics in leads I, II, aVL, aVF and V1 to identify the specific accessory pathway location with 90% sensitivity and 99% specificity. Characteristic ECG patterns are presented that help localize right anteroseptal, right posteroseptal, left lateral and right free wall accessory pathways.
Contrast echocardiography uses microbubble ultrasound contrast agents to improve image quality. These microbubbles remain in the intravascular space and allow for assessment of cardiac structure, function, and perfusion. Second generation contrast agents use an inert gas encapsulated by albumin or phospholipid shells. They interact with ultrasound by reflecting at fundamental frequencies and resonating to produce harmonic frequencies. Continuous infusion provides steady contrast levels needed for perfusion assessment. Contrast echocardiography is a non-invasive technique that improves evaluation of the heart.
The document summarizes various strategies for managing thrombus burden during primary angioplasty for myocardial infarction. It discusses thrombus grading scales, the composition and types of thrombus, and the role of medications like GP IIb/IIIa inhibitors (abciximab, tirofiban, eptifibatide), heparin, and bivalirudin. It also compares intracoronary versus intravenous administration of these drugs and evaluates trials comparing different treatment strategies. Mechanical thrombectomy devices and a combined pharmacologic and mechanical approach are also reviewed.
This document provides an overview of atrial fibrillation (AF), including its pathogenesis, types, diagnosis, and management. Some key points:
- AF is the most common cardiac arrhythmia, affecting around 6% of those over 65. It increases the risk of stroke.
- It occurs when the normal sinus rhythm is overridden by disorganized electrical impulses, usually originating in the lungs.
- Types include paroxysmal, persistent, and permanent. Symptoms range from none to palpitations, dyspnea, chest pain, and neurological issues.
- Diagnosis is made via ECG showing irregular rhythm without P waves. Workup evaluates for underlying causes and stroke risk factors.
This document discusses the management of atrial fibrillation. It provides information on the causes, consequences, classification, and epidemiology of AF. It describes the acute management of AF including assessing hemodynamic status, starting anticoagulation, and deciding between rate and rhythm control strategies. Methods for rhythm control include electrical cardioversion and pharmacological cardioversion with drugs like amiodarone, ibutilide, flecainide, and propafenone. Rate control strategies use drugs like digoxin, beta blockers, calcium channel blockers, and amiodarone. The document also discusses anticoagulation for thromboembolism prevention and newer oral anticoagulants.
This document discusses pulmonary stenosis, including its investigation and management. Some key points:
- ECG and echocardiography are recommended for initial evaluation and follow-up every 5-10 years. Cardiac catheterization is recommended if Doppler peak jet velocity is over 3m/s.
- Balloon valvuloplasty is recommended for symptomatic patients with gradients over 30mmHg or asymptomatic patients over 40mmHg. It produces excellent short and long-term results.
- Follow-up depends on severity but is usually visits at 6-12 months, 5 years, and every 10 years post-procedure. Pregnancy is generally tolerated for asymptomatic patients but activity should be limited in second half.
Evaluation and management of Pacemaker malfunctionPRAVEEN GUPTA
The document discusses the evaluation and management of pacemaker malfunctions. It describes how to differentiate between various types of single chamber pacemaker malfunctions including pacing stimuli present with failure to capture, pacing stimuli present with failure to sense, and pacing stimuli absent. Common causes of these malfunctions are then outlined such as lead dislodgment, insulation defects, threshold increases, and undersensing. The document stresses the importance of obtaining baseline pacemaker data during initial programming and follow-up to properly diagnose malfunctions.
A 58-year-old man presented with shortness of breath and chest pain. An ECG showed ST segment elevation consistent with pericarditis. Pericarditis is inflammation of the pericardium and can be caused by uremia in patients with chronic kidney disease. The ECG changes in acute pericarditis include diffuse concave ST elevation and upright T waves, except in leads aVR and V1 which are usually depressed. This differs from a myocardial infarction which shows more convex ST elevation and the presence of Q waves.
A 45-year-old female presented with difficulty breathing, palpitations, and sweating for 4 hours. An ECG showed Wolff-Parkinson-White (WPW) syndrome, characterized by a short PR interval, delta wave, and widened QRS complex. WPW is a congenital condition involving an accessory pathway that allows supraventricular impulses to bypass the AV node and activate the ventricles early. Treatment options include antiarrhythmic drugs or radiofrequency ablation to destroy the accessory pathway.
This document discusses acute aortic syndrome, including a case presentation of a 55-year-old female with chest pain. Key details include:
1. The patient presented with sudden onset chest pain and was found to have hypertension on examination.
2. Initial workup including ECG, labs and chest x-ray were non-diagnostic but showed a widened mediastinum.
3. Echocardiogram and CT angiogram revealed an aortic dissection involving the aortic arch and descending thoracic aorta.
4. She was referred urgently for cardiovascular surgery to treat this life-threatening condition within 24 hours of presentation.
This document summarizes the history and classification of sinus of Valsalva aneurysm (SOVA). Some key points:
- SOVA was first described in 1839 and the first successful repair was in 1956 using cardiopulmonary bypass.
- SOVAs can be congenital or acquired due to various connective tissue/inflammatory disorders.
- The majority originate from the right coronary cusp (77%) and most commonly rupture into the right ventricle (67.9%).
- The classic Sakakibara classification categorizes SOVAs arising from the right coronary cusp into three types based on location of rupture/protrusion. A modified classification exists for non-cor
A 56-year-old woman presents with symptoms of hyperthyroidism including palpitations, weight loss, and anxiety. Her pulse is irregular at 140-150 bpm. Examination shows signs of Graves' disease including a goiter and exophthalmos. The diagnosis is hyperthyroidism causing atrial fibrillation. Investigations would include thyroid function tests.
Rhythm control for atrial fibrillation is pursued over rate control when a patient remains symptomatic despite adequate rate control or has a strong preference for restoring normal rhythm.
This document discusses current management of atrial fibrillation including evaluating thromboembolic risk, rate or rhythm control strategies, anticoagulation guidelines, cardio
Brugada Syndrome is characterized by ST elevation in leads V1-V3, structurally normal hearts, and a risk of life-threatening ventricular arrhythmias. It is caused by mutations in the SCN5A gene which codes for cardiac sodium channels. It is more prevalent in Southeast Asian populations and clinical manifestations often first occur in the third to fourth decade of life. Diagnosis requires a characteristic ECG pattern that can be enhanced by sodium channel blockers. An ICD is the first-line treatment for preventing sudden cardiac death from ventricular arrhythmias in symptomatic patients.
This document discusses the classification, presentation, diagnosis, and treatment of acute coronary syndrome (ACS). ACS results from an imbalance between myocardial oxygen supply and demand due to a thrombotic coronary artery. It is classified as ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), or unstable angina (UA) based on electrocardiogram findings and cardiac biomarker levels. Initial treatment involves oxygen, nitroglycerin, aspirin, a P2Y12 inhibitor, and anticoagulation. STEMI patients should receive reperfusion via primary percutaneous coronary intervention or fibrinolysis if primary PCI cannot be performed in a timely manner.
This document discusses various echocardiographic scoring systems used to assess mitral valve anatomy and predict outcomes of percutaneous balloon mitral valvuloplasty (PBMV). The Wilkins score and Commissural Calcification score are described in detail. The Wilkins score grades leaflet thickening, mobility, calcification and subvalvular involvement on a scale of 4-16. A score ≤8 indicates favorable anatomy for PBMV. The Commissural Calcification score quantifies calcification at each commissure. Other discussed scores include the Cormier score, RT-3DE score, Chen score, Reid score and Nobuyoshi score. Limitations of the scoring systems and ideas for an ideal future scoring
This document provides information on Ebstein's anomaly, a rare congenital heart defect involving abnormal development of the tricuspid valve. It discusses the embryology, anatomy, physiology, clinical presentation and natural history. Key points include:
- Ebstein's anomaly results from a failure of the tricuspid valve leaflets to properly separate from the myocardium during development. This causes downward displacement of the valve and dilation of the right ventricle.
- Clinical presentations vary from fetal cyanosis to incidental murmurs later in life. Arrhythmias are common. Survival depends on severity but most children and adolescents have little disability.
- Long term outcomes are limited but available data shows around 15
A comprehensive approach to Atrial Fibrillation. Everything you need to know about Atrial fibrillation. Including recent 2014 AHA guidelines of management.
Risk stratification in UA and NSTEMI: Why and How?cardiositeindia
This document discusses risk stratification in patients with unstable angina (UA) and non-ST-segment elevation myocardial infarction (NSTEMI). It summarizes three risk scores - the TIMI score, PURSUIT score, and GRACE score - and evaluates their ability to predict adverse cardiac outcomes at 30 days and 1 year. The study found that all three scores had fair to good predictive accuracy at 30 days, while the GRACE score was best at predicting outcomes at 1 year. Revascularization was found to provide greater benefit in higher risk patients as classified by these risk scores.
ACUTE CORONARY SYNDROME FOR CRITICAL CAREAbhinovKandur
The document defines acute coronary syndrome (ACS) as a group of diseases including unstable angina, myocardial infarction, and sudden cardiac death. ACS is classified into STEMI, NSTEMI, or unstable angina based on ECG and cardiac biomarker findings. The diagnosis of ACS involves taking a medical history, performing an ECG, and measuring cardiac biomarkers like troponin and CK-MB. Treatment involves pain relief medications, antiplatelet drugs, anticoagulants, and sometimes revascularization through procedures like angioplasty.
Management of Atrial Fibrillation Science:Myths & Fashiontheheartofthematter
This document discusses the management of atrial fibrillation. It notes that AF prevalence is increasing with an aging population and is associated with increased risk of stroke and mortality. Treatment involves rate or rhythm control with medications, electrical cardioversion, or newer options like catheter ablation. Risk stratification tools like CHADS2 are used to determine stroke risk and need for anticoagulation. Newer oral anticoagulants offer alternatives to warfarin by avoiding the need for INR monitoring.
1. Atrial fibrillation (AF) is a common arrhythmia where abnormal electrical signals in the atria cause an irregular heartbeat.
2. AF increases the risk of stroke by 5 times and is associated with increased mortality, hospitalization, and reduced quality of life.
3. Management involves rate or rhythm control as well as anticoagulation to prevent stroke, with treatment tailored based on the pattern and burden of AF and individual patient factors.
This document provides an overview of atrial fibrillation (AF), including its pathogenesis, types, diagnosis, and management. Some key points:
- AF is the most common cardiac arrhythmia, affecting around 6% of those over 65. It increases the risk of stroke.
- It occurs when the normal sinus rhythm is overridden by disorganized electrical impulses, usually originating in the lungs.
- Types include paroxysmal, persistent, and permanent. Symptoms range from none to palpitations, dyspnea, chest pain, and neurological issues.
- Diagnosis is made via ECG showing irregular rhythm without P waves. Workup evaluates for underlying causes and stroke risk factors.
This document discusses the management of atrial fibrillation. It provides information on the causes, consequences, classification, and epidemiology of AF. It describes the acute management of AF including assessing hemodynamic status, starting anticoagulation, and deciding between rate and rhythm control strategies. Methods for rhythm control include electrical cardioversion and pharmacological cardioversion with drugs like amiodarone, ibutilide, flecainide, and propafenone. Rate control strategies use drugs like digoxin, beta blockers, calcium channel blockers, and amiodarone. The document also discusses anticoagulation for thromboembolism prevention and newer oral anticoagulants.
This document discusses pulmonary stenosis, including its investigation and management. Some key points:
- ECG and echocardiography are recommended for initial evaluation and follow-up every 5-10 years. Cardiac catheterization is recommended if Doppler peak jet velocity is over 3m/s.
- Balloon valvuloplasty is recommended for symptomatic patients with gradients over 30mmHg or asymptomatic patients over 40mmHg. It produces excellent short and long-term results.
- Follow-up depends on severity but is usually visits at 6-12 months, 5 years, and every 10 years post-procedure. Pregnancy is generally tolerated for asymptomatic patients but activity should be limited in second half.
Evaluation and management of Pacemaker malfunctionPRAVEEN GUPTA
The document discusses the evaluation and management of pacemaker malfunctions. It describes how to differentiate between various types of single chamber pacemaker malfunctions including pacing stimuli present with failure to capture, pacing stimuli present with failure to sense, and pacing stimuli absent. Common causes of these malfunctions are then outlined such as lead dislodgment, insulation defects, threshold increases, and undersensing. The document stresses the importance of obtaining baseline pacemaker data during initial programming and follow-up to properly diagnose malfunctions.
A 58-year-old man presented with shortness of breath and chest pain. An ECG showed ST segment elevation consistent with pericarditis. Pericarditis is inflammation of the pericardium and can be caused by uremia in patients with chronic kidney disease. The ECG changes in acute pericarditis include diffuse concave ST elevation and upright T waves, except in leads aVR and V1 which are usually depressed. This differs from a myocardial infarction which shows more convex ST elevation and the presence of Q waves.
A 45-year-old female presented with difficulty breathing, palpitations, and sweating for 4 hours. An ECG showed Wolff-Parkinson-White (WPW) syndrome, characterized by a short PR interval, delta wave, and widened QRS complex. WPW is a congenital condition involving an accessory pathway that allows supraventricular impulses to bypass the AV node and activate the ventricles early. Treatment options include antiarrhythmic drugs or radiofrequency ablation to destroy the accessory pathway.
This document discusses acute aortic syndrome, including a case presentation of a 55-year-old female with chest pain. Key details include:
1. The patient presented with sudden onset chest pain and was found to have hypertension on examination.
2. Initial workup including ECG, labs and chest x-ray were non-diagnostic but showed a widened mediastinum.
3. Echocardiogram and CT angiogram revealed an aortic dissection involving the aortic arch and descending thoracic aorta.
4. She was referred urgently for cardiovascular surgery to treat this life-threatening condition within 24 hours of presentation.
This document summarizes the history and classification of sinus of Valsalva aneurysm (SOVA). Some key points:
- SOVA was first described in 1839 and the first successful repair was in 1956 using cardiopulmonary bypass.
- SOVAs can be congenital or acquired due to various connective tissue/inflammatory disorders.
- The majority originate from the right coronary cusp (77%) and most commonly rupture into the right ventricle (67.9%).
- The classic Sakakibara classification categorizes SOVAs arising from the right coronary cusp into three types based on location of rupture/protrusion. A modified classification exists for non-cor
A 56-year-old woman presents with symptoms of hyperthyroidism including palpitations, weight loss, and anxiety. Her pulse is irregular at 140-150 bpm. Examination shows signs of Graves' disease including a goiter and exophthalmos. The diagnosis is hyperthyroidism causing atrial fibrillation. Investigations would include thyroid function tests.
Rhythm control for atrial fibrillation is pursued over rate control when a patient remains symptomatic despite adequate rate control or has a strong preference for restoring normal rhythm.
This document discusses current management of atrial fibrillation including evaluating thromboembolic risk, rate or rhythm control strategies, anticoagulation guidelines, cardio
Brugada Syndrome is characterized by ST elevation in leads V1-V3, structurally normal hearts, and a risk of life-threatening ventricular arrhythmias. It is caused by mutations in the SCN5A gene which codes for cardiac sodium channels. It is more prevalent in Southeast Asian populations and clinical manifestations often first occur in the third to fourth decade of life. Diagnosis requires a characteristic ECG pattern that can be enhanced by sodium channel blockers. An ICD is the first-line treatment for preventing sudden cardiac death from ventricular arrhythmias in symptomatic patients.
This document discusses the classification, presentation, diagnosis, and treatment of acute coronary syndrome (ACS). ACS results from an imbalance between myocardial oxygen supply and demand due to a thrombotic coronary artery. It is classified as ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), or unstable angina (UA) based on electrocardiogram findings and cardiac biomarker levels. Initial treatment involves oxygen, nitroglycerin, aspirin, a P2Y12 inhibitor, and anticoagulation. STEMI patients should receive reperfusion via primary percutaneous coronary intervention or fibrinolysis if primary PCI cannot be performed in a timely manner.
This document discusses various echocardiographic scoring systems used to assess mitral valve anatomy and predict outcomes of percutaneous balloon mitral valvuloplasty (PBMV). The Wilkins score and Commissural Calcification score are described in detail. The Wilkins score grades leaflet thickening, mobility, calcification and subvalvular involvement on a scale of 4-16. A score ≤8 indicates favorable anatomy for PBMV. The Commissural Calcification score quantifies calcification at each commissure. Other discussed scores include the Cormier score, RT-3DE score, Chen score, Reid score and Nobuyoshi score. Limitations of the scoring systems and ideas for an ideal future scoring
This document provides information on Ebstein's anomaly, a rare congenital heart defect involving abnormal development of the tricuspid valve. It discusses the embryology, anatomy, physiology, clinical presentation and natural history. Key points include:
- Ebstein's anomaly results from a failure of the tricuspid valve leaflets to properly separate from the myocardium during development. This causes downward displacement of the valve and dilation of the right ventricle.
- Clinical presentations vary from fetal cyanosis to incidental murmurs later in life. Arrhythmias are common. Survival depends on severity but most children and adolescents have little disability.
- Long term outcomes are limited but available data shows around 15
A comprehensive approach to Atrial Fibrillation. Everything you need to know about Atrial fibrillation. Including recent 2014 AHA guidelines of management.
Risk stratification in UA and NSTEMI: Why and How?cardiositeindia
This document discusses risk stratification in patients with unstable angina (UA) and non-ST-segment elevation myocardial infarction (NSTEMI). It summarizes three risk scores - the TIMI score, PURSUIT score, and GRACE score - and evaluates their ability to predict adverse cardiac outcomes at 30 days and 1 year. The study found that all three scores had fair to good predictive accuracy at 30 days, while the GRACE score was best at predicting outcomes at 1 year. Revascularization was found to provide greater benefit in higher risk patients as classified by these risk scores.
ACUTE CORONARY SYNDROME FOR CRITICAL CAREAbhinovKandur
The document defines acute coronary syndrome (ACS) as a group of diseases including unstable angina, myocardial infarction, and sudden cardiac death. ACS is classified into STEMI, NSTEMI, or unstable angina based on ECG and cardiac biomarker findings. The diagnosis of ACS involves taking a medical history, performing an ECG, and measuring cardiac biomarkers like troponin and CK-MB. Treatment involves pain relief medications, antiplatelet drugs, anticoagulants, and sometimes revascularization through procedures like angioplasty.
Management of Atrial Fibrillation Science:Myths & Fashiontheheartofthematter
This document discusses the management of atrial fibrillation. It notes that AF prevalence is increasing with an aging population and is associated with increased risk of stroke and mortality. Treatment involves rate or rhythm control with medications, electrical cardioversion, or newer options like catheter ablation. Risk stratification tools like CHADS2 are used to determine stroke risk and need for anticoagulation. Newer oral anticoagulants offer alternatives to warfarin by avoiding the need for INR monitoring.
1. Atrial fibrillation (AF) is a common arrhythmia where abnormal electrical signals in the atria cause an irregular heartbeat.
2. AF increases the risk of stroke by 5 times and is associated with increased mortality, hospitalization, and reduced quality of life.
3. Management involves rate or rhythm control as well as anticoagulation to prevent stroke, with treatment tailored based on the pattern and burden of AF and individual patient factors.
Ferraro S. L'Otorinolaringoiatria nel III° Millennio: cosa è cambiato e cosa ...Gianfranco Tammaro
DOTT.SSA FERRARO SIMONA (Sessione del 10/12/2015) - Convegno "Lunch Meeting al Pasteur: What's New In..." - dal 01/10/2015 al 10/12/2015 - Studio Pasteur - Viale Pasteur, 66 - Roma
Sito: www.asmad.net
Canale Youtube: https://www.youtube.com/channel/UCIggSJlnC77uDHuX5TUoFHg
Silent atrial fibrillation after cryptogenetic stroke. Mexico City 2016Antonio Raviele
1) Asymptomatic atrial fibrillation (AF) is commonly found in patients with cryptogenic stroke when prolonged ECG monitoring is performed.
2) While silent AF seems to confer the same prognosis as symptomatic AF, the episode duration and arrhythmia burden that increase stroke risk are still uncertain.
3) In most patients, there is no close temporal relationship between silent AF and stroke, suggesting AF may be a marker rather than direct cause of stroke.
O documento descreve a vida e obra do pintor alemão Max Ernst, um dos principais criadores do movimento dadaísta. Ernst nasceu na Alemanha em 1891 e faleceu na França em 1976, onde desenvolveu técnicas como a colagem e fotomontagem influenciadas pelo dadaísmo e surrealismo. O documento lista e descreve algumas de suas obras mais importantes produzidas nesses movimentos.
O documento descreve as propriedades medicinais e benefícios do óleo essencial de lavanda. Discutem-se suas propriedades calmantes, analgésicas, anti-sépticas e como pode aliviar dores de cabeça, tensão muscular e problemas de garganta. Também menciona a importância da lavanda na região da Provença na França, onde é cultivada.
Artigo apresentado no Congresso Internacional da Afirse (Associação Fancofone Internacional de Pesquisa em Educação) - V Colóquio Nacional - Na Universidade Federal da Paraíba.
Autoria e co-autoria de Antônio Ferreira Lima e Amâncio Leandro Corrêa Pimentel
O documento descreve as propriedades medicinais e usos do óleo essencial de lavanda, incluindo suas propriedades calmantes, analgésicas e antibacterianas. Detalha também as plantações de lavanda na região da Provença na França, descrevendo o processo de colheita e a importância econômica da lavanda para a região.
O documento descreve as propriedades medicinais e usos do óleo essencial de lavanda, bem como a cultura da lavanda na região da Provença, na França. O óleo de lavanda tem propriedades calmantes, analgésicas, anti-sépticas e cicatrizantes e é usado para aliviar dores musculares, tensão nervosa, dores de cabeça, tosse e queimaduras. A lavanda é cultivada principalmente na Provença e colhida manualmente no verão, quando seu óleo apresenta maior
El documento resume la biografía y aportaciones del médico francés Joseph-Clement Tissot. Fue pionero en proponer el uso terapéutico de ejercicios y la terapia ocupacional. Publicó el libro "Gimnasia medicinal y quirúrgica" en 1780 donde describió ejercicios para tratar úlceras por presión, hemiplejía y artritis. Recomendaba cambios de postura cada 2 horas en pacientes encamados y conocimientos anatómicos para prescribir ejercicios. Sus ideas influyer
O documento descreve as propriedades medicinais e usos do óleo essencial de lavanda. Detalha as plantações de lavanda na região da Provença na França, incluindo descrições das paisagens, processos de colheita e usos tradicionais da lavanda na medicina e aromaterapia.
Franca campos de lavanda - provence (1)Edson Glauco
O documento descreve as propriedades medicinais e usos do óleo essencial de lavanda, bem como uma viagem pela região da Provença na França, conhecida por suas plantações de lavanda. O documento destaca que o óleo de lavanda tem propriedades calmantes, analgésicas e cicatrizantes e pode ser usado para aliviar dores musculares, tensão nervosa, dores de cabeça, tosses e queimaduras.
O documento descreve o manifesto do Futurismo Italiano de 1909. Os principais pontos são: 1) Exalta o movimento, velocidade e rebelião contra a arte tradicional; 2) A beleza da velocidade e das máquinas modernas como automóveis; 3) Lançamento do manifesto em Itália para libertar o país da "gangrena de arqueólogos, cicerones e antiquários".
diaporama découverte des rythmes du sommeil
rôle du sport, caféine, sieste...
modification des rythmes chez la personne agée
consignes pour bien s'endormir
1. Rate control is the initial approach for elderly patients with minor AF symptoms, while rhythm control may be considered for symptomatic patients despite rate control.
2. Catheter ablation is recommended for symptomatic patients where medical therapy fails, and can be considered as initial therapy in some selected patients.
3. Anticoagulation is recommended for AF patients based on their stroke risk profile according to CHA2DS2-VASc score. Warfarin requires careful management during pregnancy.
Atrial fibrillation is characterized by an irregular heartbeat and is classified as paroxysmal, persistent, or permanent based on duration. It is associated with risks like stroke and is diagnosed by ECG showing irregular rhythms. Treatment involves rate control with medications, anticoagulation based on stroke risk scores, and catheter ablation or antiarrhythmic drugs for rhythm control.
This document outlines guidelines for secondary stroke prevention through lifestyle modifications, medication management of risk factors like hypertension, diabetes, and dyslipidemia, use of antiplatelet and anticoagulant medications, and surgical or endovascular interventions if needed. Key recommendations include maintaining a Mediterranean diet, regular exercise, smoking cessation, controlling blood pressure to 130/80 mmHg or lower, managing diabetes to an A1C of 7% or lower, using high intensity statins to target an LDL of 70 mg/dL or lower, and prescribing antiplatelet or anticoagulant medications depending on individual risk factors. Surgical procedures may be considered for severe carotid stenosis, atrial fibrillation with contraindications to ant
This document summarizes the management of atrial fibrillation. It outlines that the main approaches are rate control, anticoagulation, and rhythm control. A key decision is determining a patient's stroke risk using the CHA2DS2-Vasc score to guide appropriate anticoagulation. For acute atrial fibrillation under 48 hours, the priorities are hemodynamic stability, rate control with medications, and anticoagulation if cardioversion is planned. For chronic atrial fibrillation, long-term anticoagulation and rate control are emphasized along with considering rhythm control if symptomatic.
The document defines different types of acute coronary syndrome (ACS), including unstable angina, non-ST elevation myocardial infarction (NSTEMI), and ST elevation myocardial infarction (STEMI). It provides guidelines for the initial management and treatment of ACS, including medications, revascularization procedures, and timelines for invasive strategies depending on patient risk factors. The treatment guidelines are from organizations such as ACC/AHA, ESC, and Uptodate and aim to rapidly diagnose and treat ACS to reduce mortality.
Atrial fibrilation diagnosis and management updated guidline. NICE 2021.GMHasan3
This document discusses the presentation, diagnosis, and management of atrial fibrillation. It begins with an overview of atrial fibrillation, including its pathogenesis and classification. It then covers detection and diagnosis, including assessment of cardiac function. Major sections discuss management strategies for non-acute and acute presentations, including rate control, rhythm control, anticoagulation, and prevention of postoperative atrial fibrillation. Scoring systems to assess stroke and bleeding risk are also presented.
current stroke management guideline.pptxrigomontejo
This document provides guidelines for the current management of stroke. It recommends against urgent anticoagulation to prevent early recurrent stroke or improve outcomes. It also recommends against pharmacological or nonpharmacological emergency treatments lacking proven neuroprotective effects. Additionally, it advises dysphagia screening before oral intake and intermittent pneumatic compression for immobile patients to prevent DVT. Lastly, it recommends statin therapy during acute periods to reduce atherosclerotic risk and measuring lipid profiles to document baseline LDL levels.
1) Atrial fibrillation is the most common cardiac arrhythmia characterized by irregular electrical activity in the atria. It increases in prevalence with age and can cause complications like heart failure, stroke, and systemic embolism.
2) Management of atrial fibrillation involves rate or rhythm control as well as long-term anticoagulation to prevent thromboembolism depending on stroke risk factors. The CHA2DS2-VASc score is used to assess this risk.
3) While antiarrhythmic drugs and cardioversion can restore normal sinus rhythm, rate control is preferred for many patients. Newer anticoagulants like dabigatran and rivar
This presentation describes the epidemiology, initial assessment, investigation and emergency department management of a patient with atrial fibrillation. Some new research evidences are also discussed to answer some dilemmas.
AF.pdf in special conditions 2020 guidelinesMinaElbramosy
This document discusses several topics related to atrial fibrillation (AF):
1) Acute hemodynamic instability in AF patients requires prompt intervention such as electrical cardioversion or anticoagulation.
2) The risk of AF is increased in acute coronary syndrome patients, who may receive less appropriate treatment and have worse outcomes.
3) Managing antithrombotic therapy risks in AF patients having acute coronary syndromes or undergoing PCI requires balancing stroke, bleeding, and ischemic risks.
This presentation describes the emergency department management of sinus tachycardia, supraventricular tachycardia, atrial flutter, atrial fibrillation, ventricular tachycardia and ventricular ectopic
Management of atrial fibrillation in critically ill patientsChamika Huruggamuwa
This document discusses the management of atrial fibrillation in critically ill patients. It finds that AF is a common arrhythmia in ICU patients and is associated with increased mortality and morbidity. The incidence of new-onset AF increases with age, underlying cardiac conditions, and severity of acute illness. AF can cause hemodynamic instability and organ dysfunction if untreated. Treatment involves restoring hemodynamic stability, pharmacological or electrical cardioversion for rhythm control, and anticoagulation based on stroke risk scores. Rate control drugs like beta-blockers are preferred initially for hemodynamically stable patients.
This document discusses various types of supraventricular tachycardias (SVTs), including their causes, mechanisms, diagnosis, and treatment. It covers atrial fibrillation, atrial flutter, atrial tachycardia, and AV nodal reentrant tachycardia. For each type, it discusses epidemiology, mechanisms, classification, evaluation with tests like ECG and echocardiogram, anticoagulation measures, and treatment options like medications, cardioversion, and catheter ablation. Rate control is emphasized as usually preferable to rhythm control for atrial fibrillation.
1. Atrial fibrillation (AF) is classified based on duration and presence of symptoms, including first diagnosed, paroxysmal (<7 days), persistent (≥7 days), long-standing persistent (≥12 months), and permanent.
2. Risk factors for incident AF include structural heart disease, hypertension, obesity, smoking, diabetes, and age.
3. Treatment recommendations include long-term antiarrhythmic drugs like amiodarone, dronedarone, and flecainide/propafenone based on patient characteristics, as well as cardioversion and catheter ablation.
Esc guideline for atrial fibrillation 2020 [dr pranab]PranabanandaPal1
This document discusses atrial fibrillation (AF) and its management. It defines AF and describes its prevalence, complications, and patterns. It outlines how to confirm, characterize, and screen for AF. Investigations for AF are discussed. The integrated ABC pathway for managing AF is described, including assessing stroke risk and bleeding risk, and options for anticoagulation. Methods for rate control and rhythm control of AF are provided.
1. The document discusses classification, management, and treatment of atrial fibrillation. It describes classification as paroxysmal, persistent, or permanent based on episode duration.
2. For stable patients, the first steps are evaluation, rate control if needed, and decision on cardioversion. For unstable patients, urgent cardioversion may be required. Electrical cardioversion is preferred but drugs can be used.
3. Anticoagulation for at least 3 weeks prior to and 4 weeks after cardioversion is recommended for episodes over 48 hours. For episodes under 48 hours, practices vary from anticoagulation in all to risk-based approaches.
medical evaluation of the surgical patientAmit Shrestha
The document provides guidelines for preoperative medical evaluation and optimization of surgical patients. It discusses grading surgical risk, collecting patient history and health information, assessing cardiac and pulmonary risk, managing common comorbidities like diabetes, and recommending prophylaxis for infections and blood clots. Key aspects include using standardized questionnaires; evaluating risk factors like age, functional status and clinical markers; providing preventative therapies like beta blockers and statins as needed; and implementing measures to reduce pulmonary and thrombotic complications through the pre-, intra-, and postoperative periods.
- Atrial fibrillation (AF) prevalence increases with age, with over 1/3 of patients over 80 years old. It is associated with a higher risk of stroke, heart failure, and mortality.
- Common risk factors for AF include hypertension, diabetes, heart disease, obesity, sleep apnea, smoking, and excessive alcohol use.
- The CHA2DS2-VASc score is used to stratify stroke risk and determine need for anticoagulation in patients with non-valvular AF. Warfarin, dabigatran, rivaroxaban, and apixaban are recommended for stroke prevention depending on stroke risk and renal function.
- Rate
mitral regurgitation american guidlines 2014Basem Enany
This document discusses mitral regurgitation (MR), including its etiology, clinical manifestations, physical exam findings, diagnostic testing, and management according to American Heart Association guidelines. The most common cause of primary MR in developed countries is mitral valve prolapse. Secondary MR is usually caused by ischemic heart disease, left ventricular dysfunction, or hypertrophic cardiomyopathy. Diagnosis involves echocardiography to determine the severity and mechanism of MR. Management is generally medical for mild MR but may involve surgery for severe primary MR.
Myocardial infarction clinical picture, investigations European guidlines 2012Basem Enany
This document discusses myocardial infarction (MI), also known as a heart attack. It defines MI as the death of heart muscle cells due to reduced blood flow. The two main types of MI are transmural, affecting the full thickness of the heart wall, and nontransmural, affecting only part of the wall. Symptoms of MI can include chest pain, shortness of breath, nausea, and sweating. Diagnosis involves electrocardiogram (EKG) showing elevated ST segments or new Q waves, and blood tests showing elevated cardiac troponin or CK-MB levels. Early diagnosis and treatment are important to reduce risk of complications and death.
Acute mitral regurgitation is a life-threatening condition requiring urgent medical treatment and usually surgery. It can be caused by flail mitral valve leaflets due to conditions like mitral valve prolapse or infective endocarditis, or ruptured chordae tendineae from trauma, spontaneous rupture, or acute rheumatic fever. Patients present with pulmonary edema, low blood pressure, and signs of shock. Echocardiography is used for diagnosis and assessing severity, showing a flail leaflet or vegetations and quantifying the regurgitation. Medical stabilization involves reducing afterload and increasing cardiac output until urgent surgery, which aims to repair the valve if possible to avoid a prosthetic valve's risks.
This document discusses examination of the jugular venous pulse and provides details on:
- The normal jugular venous waveform including the a, c, x, v, and y waves.
- How to examine the internal or external jugular veins and estimate venous pressure.
- Abnormalities in the jugular venous pulse seen in conditions like cardiac tamponade, constrictive pericarditis, and tricuspid regurgitation.
Infective endocarditis european guidlines 2012Basem Enany
Staphylococci and streptococci account for the majority of infective endocarditis cases. The most common organism causing subacute native valve endocarditis is Streptococcus viridans, while Staphylococcus aureus is most common in intravenous drug users. Blood cultures, echocardiography, and physical exam are important for diagnosis, with echocardiography able to identify valvular vegetations. Transesophageal echocardiography has higher sensitivity than transthoracic echocardiography for detecting vegetations.
This document discusses the etiology, pathophysiology, symptoms, physical exam findings, and electrocardiogram characteristics of mitral stenosis. The main causes are rheumatic heart disease in the majority of cases, and to a lesser extent infective endocarditis, mitral annular calcification, and congenital malformations. Pathophysiologically, mitral stenosis causes elevated left atrial pressure and pulmonary hypertension. Common symptoms include dyspnea, hemoptysis, thromboembolism, and right-sided heart failure. The physical exam may reveal mitral facies, elevated jugular venous pressure, an opening snap, and a decrescendo diastolic murmur.
1. Chronic aortic regurgitation is most commonly caused by rheumatic heart disease in developing countries and aortic root dilation or bicuspid aortic valve in developed countries.
2. It is initially asymptomatic but over time can cause symptoms of heart failure as well as chest pain due to the enlarged left ventricle.
3. Diagnosis is made through echocardiogram demonstrating the regurgitant jet, chest x-ray showing cardiomegaly, and examination findings like widened pulse pressure and diastolic murmur.
This document discusses aortic stenosis, including its etiology, pathogenesis, pathophysiology, clinical manifestations, diagnosis and management. It notes that aortic stenosis can be caused by congenitally abnormal heart valves, rheumatic heart disease or calcific degeneration of the aortic valve. Symptoms include dyspnea, dizziness, syncope and angina. Physical exam may reveal a diminished carotid pulse and ejection murmur. Echocardiography is the primary diagnostic test to assess aortic valve area and function.
This document discusses guidelines for the treatment of hypertension. It recommends treating patients with a blood pressure consistently above 140/90 mmHg or 130/80 mmHg for those with risk factors. Lifestyle modifications like the DASH diet are encouraged first before drug treatment. The main drug classes for initial monotherapy are thiazide diuretics, calcium channel blockers, and ACE inhibitors/ARBs, with thiazides like chlorthalidone preferred. The goal is to lower blood pressure, not necessarily the specific drug, though combination treatment may provide additional benefits over monotherapy alone. Ongoing monitoring is important to detect side effects like hypokalemia.
This document discusses resistant hypertension and its treatment. It defines resistant hypertension as blood pressure that remains above goal despite use of three antihypertensive agents from different classes including a diuretic. Treatment involves identifying and treating secondary causes, adjusting medications that raise blood pressure, monitoring blood pressure outside the office, making lifestyle changes, and using pharmacologic therapies like diuretics, aldosterone antagonists, and catheter-based renal denervation. While renal denervation showed promise in early trials, the SYMPLICITY HTN-3 trial found it did not significantly reduce blood pressure compared to a sham procedure.
This document discusses the management of hypertension in patients undergoing surgery. It notes that hypertension can cause blood pressure and heart rate to rise significantly during anesthesia induction, and these patients are also more likely to experience significant fluctuations in blood pressure intraoperatively and postoperatively. For elective surgery, blood pressure should be controlled below 170/110 mmHg, and surgery should not be delayed if blood pressure is below 110/90 mmHg as long as blood pressure is closely monitored. Most chronic antihypertensive medications should be continued up to and after surgery to prevent rebound effects, though diuretics can cause hypokalemia and beta blockers withdrawal may cause cardiac issues. Parenteral alternatives are recommended for patients unable to take oral
- Treatment of hypertension is the most common reason for physician office visits in the US. The number of hypertensive individuals is increasing due to an aging population and rising obesity rates.
- Up to 5% of hypertension cases are secondary, meaning a specific cause can be identified like renal artery stenosis or pheochromocytoma. However, routine screening for secondary causes is not usually recommended due to low prevalence.
- Complications of uncontrolled hypertension include heart failure, stroke, kidney disease, and heart attacks. Proper treatment and control of blood pressure can significantly reduce risks of these complications.
Heart failure treatment II european guidlines 2012Basem Enany
This document discusses various treatments and considerations for heart failure. It covers topics like ventricular reconstruction surgery, aortic valve replacement, mitral valve repair, heart transplantation challenges, exercise recommendations, mechanical circulatory support issues, managing comorbidities, and treating conditions like anemia, hypertension, cachexia, cancer effects on the heart, COPD, depression, diabetes, kidney dysfunction, gout, obesity, and sleep disorders. Management of heart failure involves addressing the underlying cardiac problem while balancing treatments for comorbidities and potential drug interactions.
Heart failure treatment european guidlines 2012Basem Enany
This document provides guidelines for the treatment of systolic heart failure. It recommends treating patients with angiotensin-converting enzyme inhibitors, beta-blockers, and mineralocorticoid receptor antagonists to relieve symptoms, prevent hospitalization, and improve survival. It discusses the benefits and side effects of these drug classes. The document also addresses other treatments such as digoxin, diuretics, ivabradine, and device therapies. It provides guidance on managing heart failure with preserved ejection fraction as well as heart failure complicated by atrial fibrillation.
This document summarizes the pathophysiology of heart failure (HF). It discusses how HF results from abnormalities in cardiac structure/function that limit oxygen delivery to tissues, despite normal filling pressures. The progression of HF is driven by neurohumoral activation of the sympathetic nervous system and renin-angiotensin-aldosterone system, which initially help compensate but eventually exacerbate cardiac remodeling and dysfunction. The document outlines the effects of various neurohormones involved in HF, including their normal and maladaptive roles in the progression of disease. Management of HF focuses on interrupting the harmful effects of long-term neurohumoral activation.
Heart failure diagnosis: european guidlines 2012Basem Enany
This document provides information on diagnosing and classifying heart failure. It discusses:
- The ACC/AHA stages of heart failure from A to D based on risk and symptoms.
- Causes of systolic and diastolic dysfunction like coronary heart disease, cardiomyopathy, hypertension.
- Evaluating a patient's history, physical exam findings, and using diagnostic tests like echocardiography, cardiac MRI, and natriuretic peptide levels to diagnose and assess heart failure.
This document presents guidelines for cardiac pacing and cardiac resynchronization therapy (CRT) from the European Society of Cardiology (ESC). It was developed by an international Task Force and covers recommendations for using pacemakers to treat various arrhythmias and heart failure. The guidelines provide evidence-based recommendations for indications and modes of pacing in conditions like sinus node disease, atrioventricular block, and heart failure. It also reviews the clinical effects of CRT as supported by randomized controlled trials. The task force developed the first ESC guidelines on appropriate use of pacemaker devices in Europe.
The document discusses examination of various pulses and abnormalities that may be present. It examines pulses at different locations that should be checked and differences that may indicate issues. Specific abnormalities are then defined and causes explained, including pulsus alternans indicating left ventricular failure, pulsus paradoxus seen in cardiac tamponade, and characteristics of pulses in aortic stenosis like an anacrotic pulse and delayed upstroke.
Cardiovascular diseases during pregnancy, european guidlines 2011Basem Enany
This document discusses cardiac signs, symptoms, and management during pregnancy. Some normal signs include palpitations, edema, and dizziness due to increased blood volume and heart rate. Abnormal signs like anasarca and syncope require evaluation. Testing like echocardiograms are generally safe in pregnancy but radiation exposure should be minimized. Conditions like pulmonary hypertension carry high risks, while repaired defects usually pose little risk. Medical management of valvular issues and heart failure aims to support volume and avoid hypotension.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the 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 lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
1. D . B A S E M E L S A I D E N A N Y
L E C T U R E R O F C A R D I O L O G Y
A I N S H A M S U N I V E R S I T Y
Atrial fibrillation management
2. Management of New onset AF
-A complete history and physical examination should be
performed in all patients with new onset AF (for disease,
comorbidities, complications). Old records should be
searched for evidence of a prior episode of AF or other
atrial tachyarrhythmias
-Detect time of onset
-Assess risk of stroke: Most patients with acute AF will
require anticoagulation unless they are at low risk and no
cardioversion is necessary (e.g. AF terminates within 24–
48 h).
-Most patients who present with AF will require slowing of
the ventricular rate to improve symptoms then longterm
plan
3.
4. --Acute rate control:
Stable oral b-blockers or nondihydropyridine CCB
Severely compromisedi.v. verapamil or metoprolol
Target ventricular rate should usually be 80–100 bpm.
Severely depressed LV functionamiodarone, digoxine
In pre-excitationclass I antiarrhythmic drugs or
amiodarone.
AF with slow ventricular ratesatropine (0.5–2 mg i.v.),
urgent cardioversion or placement of a temporary
pacemaker
5. --Pharmacological CV of recent AF:
-Flecainide:
i.v. less than 24 h
2 mg/kg over 10 min.
Rarely effective for termination of atrial flutter or
persistent AF.
Avoided in abnormal LV function, ischaemia.
May prolong QRS duration, and hence the QT interval
May inadvertently increase the ventricular rate
due to conversion to atrial flutter and 1:1 conduction
6. --Ibutilide:
1 mg i.v. over 10 min—repeated 1 mg i.v. over 10 min
after waiting for 10 min
Can cause prolongation of the QT interval and torsades
de pointes
Will slow the ventricular rate.
7. --Propafenone:
2 mg/kg i.v. over 10 min, or 450–600 mg p.o.
Not suitable for patients with marked structural heart
disease; may prolong QRS duration; will slightly slow
the ventricular rate
May inadvertently increase the ventricular rate due to
conversion to atrial flutter and 1:1 conduction to the
ventricles.
8. --Vernakalant:
3 mg/kg i.v. over 10 min
Second infusion of 2 mg/kg i.v. over 10 min after15
min rest
So far only evaluated in clinical trials; recently
approved
9.
10. --Amiodarone:
5 mg/kg i.v. over 1 h –follow up dose50 mg/h
Phlebitis, hypotension.
Will slow the ventricular rate.
11. --Recent onset AFhaemodynamic instability—CV
nostructural heart disease—Amiodarone no
i.v. flecainide or
i.v. propafenone
i.v. ibutilide
--In selected patients with recent onset AF and no
significant structural heart disease, a single high oral dose
of flecainide(200-300mg) or propafenone(450-600mg)
{{the ‘pill-in-the-pocket’ approach}} should be considered,
provided this treatment has proven safe during previous
testing in a medically secure environment (IIa)
--Digoxin, verapamil, sotalol, metoprolol are ineffective in
CV
12. --OAC therapy (INR 2.0–3.0) is recommended for at least
3 weeks prior to and for 4 weeks after cardioversion
(longterm in high risk for thromboembolism)
--If TOE detects a thrombus in the left atrium or LAA, VKA
(INR 2.0–3.0) treatment is required for at least 3 weeks
repeat TOE
thrombus resolutioncardioversion can be performed,
and post-cardioversion OAC is continued lifelong.
thrombus is still evidentrate control strategy,
especially when AF-related symptoms are controlled, since
there is a high risk of thrombo-embolism if cardioversion is
performed
13. INDICATIONS FOR URGENT CARDIOVERSION
•Active ischemia (symptomatic or electrocardiographic
evidence)
•Evidence for organ hypoperfusion
•Severe manifestations of heart failure (HF) including
pulmonary edema
•preexcitation syndromeextremely rapid ventricular
rate
--heparin (i.v.UFH bolus followed by infusion, or
weight-adjusted therapeutic dose LMWH), but it
should not cause a delay in emergent cardioversion
14. Direct current cardioversion
--Pre-treatment with amiodarone, flecainide, propafenone, ibutilide,
or sotalol should be considered to enhance success, prevent recurrent
AF.
--Contraindicated in patients with digitalis toxicity
--AP electrode placement is more effective than anterolateral
placement
--At least 3 h of ECG and haemodynamic monitoring are needed after
--Complications:
1–2% risk of thrombo-embolism
Skin burns
Prolonged sinus arrest without an adequate escape rhythm especially
in elderly patients with structural heart disease
Dangerous arrhythmias hypokalaemia, digitalis intoxication, or
improper synchronization
hypoxic or hypoventilate from sedation
15. If PPM
-At least 8 cm from the pacemaker battery
-The AP paddle positioning is recommended
-Biphasic shocks are preferred because they require
less energy
-In pacemaker-dependent patients, an increase in
pacing threshold should be anticipated
-After cardioversion, the device should be interrogated
16.
17. Factors that predispose to AF recurrence:
-age
-AF duration before cardioversion
-Number of previous recurrences
-Increased LA size or reduced LA function
-Presence of coronary heart disease or pulmonary or
mitral valve disease
18. Long-term management
(1) Prevention of thrombo-embolism.
(2) Symptom relief.
(3) Optimal management of concomitant
cardiovascular disease.
(4) Rate control.
(5) Correction of rhythm disturbance.
19. Antithrombotic management
Assessing the risk of embolization =CHADS2
Congestive heart failure (any history)=1
Hypertension (prior history)=1
Age ≥75 years =1
Diabetes mellitus=1
Secondary prevention in patients with a prior ischemic
stroke or a transient ischemic attack; most experts also
include patients with a systemic embolic event=2
{0=low risk, 1-2= intermediate risk, 3-6=high risk}
20. Risk factor-based approach for non-valvular AF =
CHA2DS2-VASc
Congestive heart failure/LV dysfunction= 1
Hypertension= 1
Age >75= 2
Diabetes mellitus= 1
Stroke/TIA/thrombo-embolism= 2
Vascular disease= 1
Age 65–74= 1
Sex category (i.e. female sex)= 1
21.
22. HASBLED score
H Hypertension(uncontorlled, systolic blood pressure>160
mmHg)= 1
A Abnormal renal and liver function (1 point each)=
1 or 2
S Stroke= 1 (previous history, particularly lacunar)
B Bleeding(previous bleeding history and/or predisposition to
bleeding, e.g. bleeding diathesis, anaemia)= 1
L Labile INRs= 1
E Elderly (e.g. age >65 years)= 1
D Drugs (antiplatelet agents, non-steroidal anti-inflammatory
drugs) or alcohol (1 point each)= 1 or 2
{≥3 indicates ‘high risk’}
23. CHA2DS2-VASc > 2 OACa
CHA2DS2-VASc=1 Either OACa or aspirin 75–325
mg daily {Preferred: OAC rather than aspirin} XX
CHA2DS2-VASc =0Either aspirin 75–325 mg daily
or noantithrombotic therapy {Preferred: no
antithrombotic therapy rather than aspirin}.
--N.B.female patients aged <65 years with
no other risk factors, aspirin may be considered rather
than OAC therapy
24.
25.
26. --Stroke risk in paroxysmal AF is not different from
that in persistent or permanent AF
--Antithrombotic therapy is recommended for patients
with atrial flutter as for those with AF.
--Combination therapy with aspirin 75–100 mg plus
clopidogrel 75 mg daily, should be considered for
stroke prevention in patients refusing to take OAC
therapy or a clear contraindication to OAC therapy,
where there is a low risk of bleeding.
27.
28.
29. INR
--Cohort studies suggest a 2-fold increase in stroke risk at INR 1.5–2.0
and, therefore, an INR <2.0 is not recommended
--In patients with AF who sustain an ischaemic stroke despite adjusted
dose VKA (INR 2.0–3.0), raising the intensity of anticoagulation to a
higher INR range of 3.0–3.5 may be considered {appreciable risk in
major bleeding only starts at INRs >3.5}
--At least 2.5 in the mitral prosthesis and at least 2.0 for an aortic
--Treatment should be interrupted 5 days before surgery to allow the
INR to fall<1.5
--If still elevated, administer low-dose oral vitamin K (1–2 mg)
--mechanical heart valve or high risk ‘bridging’ anticoagulation with
therapeutic doses of either LMWH or unfractionated heparin
--resumption of OAC therapy ‘usual’ maintenance dose (without a
loading dose) on the evening of (or the next morning after) surgery,
assuming there is adequate haemostasis.
30. -Foods that increase the INR include fish oil,
mango, grapefruit juice, and cranberry juice. Foods
and supplements that reduce the INR
include high vitamin K–content food, enteral feeds,
soy milk, ginseng, and sushi containing
seaweed.
31.
32. PCI
--Triple therapy seems to have an acceptable risk–
benefit ratio provided it is kept short (e.g. 4 weeks in
BMS, 3m in olimus, 6m in paclitaxel)
--DES should be avoided in HASBLED>3 and triple
therapy (VKA, aspirin, and clopidogrel) used in the
short term, followed by longer therapy with VKA plus a
single antiplatelet drug (either clopidogrel or aspirin)
--An uninterrupted strategy of OAC is preferred in very
high risk of thrombo-embolism, and radial access
should be used as the first choice in ACS
--INR range of 2.0–2.5 if triple therapy
33.
34. the 2012 ACCP guidelines:
-Recommend against routine vitamin K administration unless the INR is
more than 10.
-For INRs less than 4.5 without bleeding, the guidelines recommend lowering
the dose or holding the next dose with frequent INR monitoring until the INR
is within the therapeutic range and then resuming a lower dose.
-For INRs 4.5 to 10 without bleeding, the 2012 ACCP guidelines recommend
omitting 1 to 2 doses, frequent INR monitoring, and resuming a lower
warfarin dose when the INR is within the therapeutic range.
-When the INR is greater than 10 without overt bleeding, the 2012 ACCP
guidelines recommend low-dose (5 mg or less) oral vitamin K.
-For patients experiencing minor bleeding with an elevated INR, oral vitamin
K is recommended at a dose of 2.5 to 5 mg, repeated at 24 hour intervals until
the INR is within the therapeutic range and then resuming a lower dose of
warfarin.
35.
36.
37. Direct thrombin inhibitors
--(RE-LY) study:
Dabigatran 110 mg b.i.d. was non-inferior to VKA for the prevention of stroke and
systemic embolism with lower rates of major bleeding,
Dabigatran 150 mg b.i.d. was associated with lower rates of stroke and systemic
embolism with similar rates of major haemorrhage, compared with VKA.
--Where oral anticoagulation is appropriate therapy, dabigatran may be considered
(i) If a patient is at low risk of bleeding (e.g. HAS-BLED score of 0–2, dabigatran 150
mg b.i.d. may be considered
(ii) If a patient has a measurable risk of bleeding (e.g. HAS-BLED score of ≥3),
dabigatran 110 mg b.i.d. may be considered
--In patients with one ‘clinically relevant non-major’ stroke risk factor, dabigatran 110
mg b.i.d. may be considered, in view of a similar efficacy with VKA in the prevention of
stroke and systemic embolism but lower rates of intracranial haemorrhage and major
bleeding compared with the VKA and (probably) aspirin
--Antidotes have not been developed yet for these drugs, although strategies for
overdose treatment and bleeding (e.g., charcoal therapy and hemodialysis in
dabigatran overdose) have been proposed.
38. Oral factor Xa inhibitors (rivaroxaban, apixaban, edoxaban,
betrixaban)
(AVERROES) study:
Was stopped early due to clear evidence of a reduction
in stroke and systemic embolism with apixaban 5 mg
b.i.d. compared with aspirin 81–324 mg once daily in
patients intolerant of or unsuitable for VKA, with
an acceptable safety profile.
39.
40.
41.
42. There is early research suggesting that the
preferred coagulation test for determining
accumulation
of dabigatran concentrations may be the
dilute thrombin time (dTT), with trough
dTT concentrations of
more than 200 ng/mL suggesting
increased bleeding risk.
Because apixaban and rivaroxaban are
factor Xa inhibitors, the preferred
monitoring test measures
anti–factor Xa activity levels, but tests are
not readily available and there is no
guidance on interpretation
of their results at this time.
43. -At this time, there is insufficient data and experience to recommend any methods of
reversing the anticoagulant effects of dabigatran etexilate, apixaban, or rivaroxaban.
-Administration of activated charcoal is recommended if less than 2 hours has passed since the
anticoagulant has been ingested.
-Hemodialysis removes about 60% of dabigatran over a 2 to 3 hour dialysis session and should be
initiated immediately for life-threatening bleeding in a patient with recent dabigatran exposure.
-Administration of fresh frozen plasma alone is ineffective and not recommended.
-A four-factor prothrombin complex concentrate (PCC) containing clotting factors II, VII, IX, and
X, has shown reversal of prolonged PTs in healthy volunteers given rivaroxaban, and in animal
models with dabigatran. However, the only available PCC in the U.S. at this time is a three-factor
PCC, which has a lower concentration of factor VII. Recombinant factor VIIa (rVIIa)
administration has demonstrated partial reversal of thrombin generation due to rivaroxaban in an
in vitro model but does not reverse the effects of dabigatran.
-Low-dose anticoagulant inhibitor complex (factor VIII inhibitor bypassing activity FEIBA NF;
Baxter Bioscience, Deerfield, Ill.) has demonstrated reversal of endogenous thrombin
potential, maximum concentration, lag-time, and time to reach maximum concentration of
thrombin after both dabigatran and rivaroxaban administration
in an ex vivo healthy volunteer study. However, higher doses of FEIBA increased thrombin
generation in this study, and administration of any clotting factor heightens all thromboembolic
risk.
-So the best advice in the case of significant bleeding associated with any of the new oral
anticoagulants is to discontinue the anticoagulant and consult with a hematology anticoagulation
specialist.
44.
45. --New score (SAMe-TT2R2), which is a newly described score to predict those who
would do well on Vitamin K antagonists (SAMe-TT2R2 score 0-1) or those who are
likely to have poor anticoagulation control with VKA (SAMe-TT2R2 score ≥2)
where a novel OAC could be a better option.
46. Non-pharmacological methods to prevent stroke
--Occlusion of the LAA {considered the main site of atrial
thrombogenesis} may reduce the development
of atrial thrombi and stroke in patients with AF
--The 2006 American College of Cardiology/American
Heart Association (ACC/AHA) guidelines on the
management of valvular heart disease recommended
amputation of the LAA at the time of mitral valve surgery
to reduce the likelihood of postoperative thromboembolic
events
--Composite endpoint of stroke, cardiovascular death, and
systemic embolism of the WATCHMAN device was
considered non-inferior to that of VKA