The document discusses the management of atrial fibrillation (AF) through rate or rhythm control approaches. It defines different types of AF and describes how to determine the appropriate control strategy based on a patient's symptoms, age, and cardiac status. For acute or unstable patients, rhythm control using pharmacological or electrical cardioversion is preferred if the patient has severe AF symptoms or hemodynamic instability. Otherwise, rate control is sufficient. In stable patients, both rate and rhythm control involve anticoagulation. Randomized trials found no difference in outcomes between the two approaches for most older patients. However, rhythm control may be better for younger individuals or those with paroxysmal lone AF to prevent remodeling. The document reviews drug therapies,
Various coronary physiological measurements can be made in the cardiac catheterization laboratory using sensor-tipped guidewires; they include the measurement of poststenotic absolute coronary flow reserve, the relative coronary flow reserve, and the pressure-derived fractional flow reserve of the myocardium. Ambiguity regarding abnormal microcirculation has been reduced or eliminated with measurements of relative coronary flow reserve and fractional flow reserve. The role of microvascular flow impairment can be separately determined with coronary flow velocity reserve measurements. In addition to lesion assessment before and after intervention, emerging applications of coronary physiology include the determination of physiological responses to new pharmacological agents, such as glycoprotein IIb/IIIa blockers, in patients with acute myocardial infarction. Measurements of coronary physiology in the catheterization laboratory provide objective data that complement angiography for clinical decision-making
For each patient with AF, the two principal goals of therapy are symptom control and the prevention of thromboembolism.
Rate- and rhythm-control strategies improve symptoms, but neither has been conclusively shown to improve survival compared to the other.
Various coronary physiological measurements can be made in the cardiac catheterization laboratory using sensor-tipped guidewires; they include the measurement of poststenotic absolute coronary flow reserve, the relative coronary flow reserve, and the pressure-derived fractional flow reserve of the myocardium. Ambiguity regarding abnormal microcirculation has been reduced or eliminated with measurements of relative coronary flow reserve and fractional flow reserve. The role of microvascular flow impairment can be separately determined with coronary flow velocity reserve measurements. In addition to lesion assessment before and after intervention, emerging applications of coronary physiology include the determination of physiological responses to new pharmacological agents, such as glycoprotein IIb/IIIa blockers, in patients with acute myocardial infarction. Measurements of coronary physiology in the catheterization laboratory provide objective data that complement angiography for clinical decision-making
For each patient with AF, the two principal goals of therapy are symptom control and the prevention of thromboembolism.
Rate- and rhythm-control strategies improve symptoms, but neither has been conclusively shown to improve survival compared to the other.
Non infarction Q waves
Precise guide for Allied Health Science Students especially cardiac specialty students, DGNM, B.Sc Nursing & M.Sc Nursing Students regarding Non Infarction Q waves
Atrial fibrillation (AF) is the most frequently diagnosed cardiac rhythm disorder. It affecting 2.5 million people in the United States, and may be associated with an increased risk for death, congestive heart failure, and stroke. Our cardiac electrophysiologist will review the latest treatment options for patients with AF, including recent advances in pharmacologic therapy to keep patients heart rhythms normal. He also will discuss catheter ablation to eliminate sources of AF and anticoagulation to prevent thromboembolic strokes. Presented by Summit Medical Group cardiologist, Roy Sauberman, MD, FACC
Early and effective treatment of patients with acute coronary syndrome saves lives. Lot of progress has been made in last few years in understanding patho-physiology and management of these patients.
Introduction to Electrophysiology - Supraventricular Tachycardias (1/4 lectures)Jose Osorio
What is cardiac Electrophysiology?
This presentation will cover basics of EP. It is Part 1 of 4 lectures about EP.
Part 1 - basics of EP and Supraventricular Tachycardias (SVT)
Part 2 - Ventricular arrhythmias and Cardiac Devices
Part 3 - Afib
Part 4 - EKG
Non infarction Q waves
Precise guide for Allied Health Science Students especially cardiac specialty students, DGNM, B.Sc Nursing & M.Sc Nursing Students regarding Non Infarction Q waves
Atrial fibrillation (AF) is the most frequently diagnosed cardiac rhythm disorder. It affecting 2.5 million people in the United States, and may be associated with an increased risk for death, congestive heart failure, and stroke. Our cardiac electrophysiologist will review the latest treatment options for patients with AF, including recent advances in pharmacologic therapy to keep patients heart rhythms normal. He also will discuss catheter ablation to eliminate sources of AF and anticoagulation to prevent thromboembolic strokes. Presented by Summit Medical Group cardiologist, Roy Sauberman, MD, FACC
Early and effective treatment of patients with acute coronary syndrome saves lives. Lot of progress has been made in last few years in understanding patho-physiology and management of these patients.
Introduction to Electrophysiology - Supraventricular Tachycardias (1/4 lectures)Jose Osorio
What is cardiac Electrophysiology?
This presentation will cover basics of EP. It is Part 1 of 4 lectures about EP.
Part 1 - basics of EP and Supraventricular Tachycardias (SVT)
Part 2 - Ventricular arrhythmias and Cardiac Devices
Part 3 - Afib
Part 4 - EKG
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.
During atrial fibrillation, the heart's upper chambers — called the atria — beat chaotically and irregularly. They beat out of sync with the lower heart chambers, called the ventricles. For many people, AFib may have no symptoms. But AFib may cause a fast, pounding heartbeat, shortness of breath or light-headedness.
This presentation describes the emergency department management of sinus tachycardia, supraventricular tachycardia, atrial flutter, atrial fibrillation, ventricular tachycardia and ventricular ectopic
A comprehensive approach to Atrial Fibrillation. Everything you need to know about Atrial fibrillation. Including recent 2014 AHA guidelines of management.
Beta blockers in SIHD: Yes, all patients should receive them !cardiositeindia
A presentation made by Dr. Akshay Mehta on the topic- Beta blockers in SIHD: yes, all patients should receive them !.
This was presented at the SIHD conference, Mumbai, 2015.
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
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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.
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
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
3. First Diagnosed Episode of AF
Paroxysmal Persistent (> 7 Long standing Permanent
(usually days or Persistent (accepted)
<= 48 h) requires CV) ( >1 year)
4. EHRA score of AF-related
symptoms
EHRA class Explanation
EHRA I ‘No symptoms’
EHRA II ‘Mild symptoms’; normal daily activity not
affected
EHRA III ‘Severe symptoms’; normal daily activity
affected
EHRA IV ‘Disabling symptoms’; normal daily activity
discontinued
5. Choosing Rate v/s Rhythm Control
Two types of settings
Acute/Unstable
Non acute/Stable
6. Acute/Unstable setting
Rate Control Rhythm Control
Cause: underlying cond severe AF Sx or
Ex- pneumonia, PE, Thyroid h-dynamic instab
No severe AF Sx or
h-dynamic instab pharmac cv electric cv
Older age
Large LA
13. AIMS of management of AF
patients:
• Prevent complications
• Reduce symptoms (palpitations, dyspnoea,
fatigue, and dizziness)
antithrombotic therapy
control of ventricular rate
Rx of associated CV disease
• ± Additional rhythm control therapy by
cardioversion, antiarrhythmic drug therapy, or
ablation therapy
14. Randomized trials comparing rate
control with rhythm control
• Atrial Fibrillation Follow-up Investigation of Rhythm
Management (AFFIRM) : no difference in all cause mortality
(primary outcome) or stroke rate
• The Rate Control versus Electrical cardioversion for persistent
atrial fibrillation (RACE) trial :rate control not inferior to rhythm
control for prevention of cardiovascular mortality and morbidity
(composite endpoint).
• The Atrial Fibrillation and Congestive Heart Failure
(AF-CHF) trial : in patients with an LVEF ≤35%, no difference in
cardiovascular mortality (primary outcome) symptoms
of congestive heart failure, or in the secondary outcomes
including death from any cause and worsening of heart failure
15. However….
• These studies enrolled predominantly older patients (average
70 y)
• Most of whom had persistent AF and heart disease,
• Follow-up extended over just a few years
• Pts were at a stage where difficult to maintain sinus rhythm
Hence :
• Data don’t necessarily apply in young
• Must not lose “window” of opportunity due to electrical and
structural remodeling
16. Hence…
Rate control may be reasonable initial therapy in
older patients with persistent AF with mild
symptoms
For younger individuals, especially those with
paroxysmal lone AF, rhythm control may be a better
initial approach.
19. How MUCH rate control ?
< 80, 110 Exercise test if
excessive heart rate
is anticipated during
More strict rate exercise
Symptoms control
Rate
Control 24 h ECG for safety
No or tolerable Accept lenient
symptoms rate control
resting<110/mt
20. Rhythm Control
Rhythm control therapy is reasonable to
ameliorate symptoms, in paroxysmal/persistent
AF
27. Recommendation for atrioventricular
node ablation in AF patients
Should be considered
When the rate cannot be controlled with pharmacological agents and
when AF cannot be prevented by antiarrhythmic therapy or is
associated with intolerable side effects,
when direct catheter-based or surgical ablation of AF is not indicated,
has failed, or is rejected. IIa
Should be considered for patients with permanent AF and an indication
for CRT (IIa)
Should be considered for CRT nonresponders in whom AF prevents
effective biventricular stimulation and amiodarone is ineffective or
contraindicated- IIa
• In patients with any type of AF and severely depressed LV function
biventricular stimulation should be considered after AV node
ablation.
28. Summary- management of patients with
recurrent paroxysmal AF
Recurrent Paroxysmal AF
Minimal or no Disabling
symptoms symptoms in AF
Anticoagulation Anticoagulation
and rate control* and rate control
as needed as needed
No drug for AAD therapy *
prevention of
AF
AF ablation if AAD
treatment fails
29. Summary- management of patients with recurrent
persistent or permanent AF
Recurrent Persistent AF Permanent AF
Minimal or no Disabling Anticoagulation and rate
symptoms control* as needed
symptoms in AF
Anticoagulation and Anticoagulation and
rate control* as rate control
needed
AAD drug therapy
Electrical cardioversion as
needed
Continuous anticoagulation as
needed and therapy to maintain
sinus rhythm *
Consider ablation for severely symptomatic
recurrent AF after failure of greater than or equal
to 1 AAD plus rate control
These therapeutic goals need to be pursued in parallel, especially upon the initial presentation of newly detected AF.These therapies may already alleviate symptoms, but symptom relief may require additional rhythm control therapy by cardioversion, antiarrhythmic drug therapy, or ablation therapy An irregular rhythm and a rapid ventricular rate in AF can cause symptoms including palpitations, dyspnoea, fatigue, and dizziness.Adequate control of the ventricular rate may reduce symptoms and improve haemodynamics, by allowing enough time for ventricularfilling and prevention of tachycardiomyopathy
Requirement of OAC for 45 day, DAPT for 1 yr and life long aspirin in the PROTECT AF trialAdverse events with procedurebased on expert consensus only.
Requirement of OAC for 45 day, DAPT for 1 yr and life long aspirin in the PROTECT AF trialAdverse events with procedurebased on expert consensus only.