Cardiac arrest is the cessation of functional cardiac contraction and is the final common pathway in death from any pathology.
In the clinical context, cardiac arrest refers to the sudden loss of cardiac output that prompts an emergency response.
Pathogenesis, prognosis and management of in-hospital and out-of-hospital cardiac arrest are subtly different; however, the basic principles of cardiopulmonary resuscitation (CPR) are to maintain forward flow of oxygenated blood, correct the causative factor and restore spontaneous circulation.
A complete Theoretical as well as practical aspects of Cardiac defibrillation with the definition,history,defibrillator and cardiovesrsion,Equipments,pre procedural consideration,care of patient before and after defibrillation,cardiac defibrillation procedure steps with rationale,complications,documentation and legal aspects
Bradyarrhythmias, AV conduction block, Congenital complete heart block (CHB)- normal or abnormal heart structure L-Transposition (corrected transposition) Bundle of His long; AV node anterior Prone to CHB Trauma- surgical or other Slow sinus or junctional rhythm, Suppression of ectopy, Permanent pacer malfunction Drugs, electrolyte imbalances, Sick Sinus Syndrome
The 10 commandments of prosthetic valve - ESC 2014
1. Mechanical heart valve- life-long OA. Antiplatelet medications does not provide adequate protection against thromboembolic risk. The combination of low-dose aspirin and vitamin K antagonists (VKAs) is recommended for all patients with mechanical valve prostheses by the ACC)/AHA & selective aspirin – ACCP/ESC/EACTS .
2. Bioprosthetic - avoid the need for life-long anticoagulation.
3.INR- 2.5 for aortic without additional risk factors for thromboembolism (e.g., Afib, prior thromboembolism, left ventricular dysfunction, and hypercoagulable states). INR range of 3.0 (or 3.5) for mitral and any aortic valve prosthesis associated with thromboembolic risk factors.
4. INR variability - increased mortality . INR variability is dictated by genetic polymorphisms of cytochrome P450 2C9, genotyping of patients treated with VKA is not currently recommended.
5. INR (>6.0) but no severe bleeding, management includes transient withdrawal of the OA and administration of oral vitamin K according to the actual and target INR values. Patients with severe bleeding should be treated with immediate anticoagulant reversal (usually prothrombin concentrates or fresh frozen plasma) and vitamin K.
6. PTCA- 3-6 months of triple antithrombotic therapy (VKA, aspirin, and a P2Y12 inhibitor) are recommended. The combination of clopidogrel and VKA without aspirin should be considered because it may decrease the risk of bleeding without a significantly increased risk of thromboembolism.
7.DOA (dabigatran, rivaroxaban, apixaban, and edoxaban) –NOT to use
8. Thromboembolism risk x10 s higher in the first month following valve replacement surgery. Use of heparin 12-24 hours following surgery is recommended. Use of either UFH or LMWH is reasonable. Use of low-dose aspirin can lower the thromboembolic risk while increasing the bleeding risk postoperatively. Anticoagulation with VKA is recommended for the first 3 months in most patients receiving a bioprosthetic valve. ESC/EACTS/ ACCP - aspirin therapy in the first 3 months following a bioprosthetic aortic valve replacement. ACC/AHA/ACCP aspirin beyond 3 months in all patients with bioprosthetic valves.
9. Noncardiac surgery- can often be performed safely without interruption of VKA therapy if they are at low risk for bleeding (e.g., dental care, ophthalmologic and demographic surgery, many gastrointestinal endoscopic procedures). Major surgery- INR should be <1.5 and heparin bridging is advised for high-risk patients only (mitral valve prostheses or patients with aortic valve prostheses and thromboembolic risk factors). Heparin bridging is not required for aortic valve prostheses without thromboembolic risk factors. Use of either UFH or LMWH is reasonable when bridging is indicated.
10. TAVR- indefinite low-dose aspirin long-term and aspirin plus clopidogrel (or another thienopyridine) for the first 1-3 months.
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
A complete Theoretical as well as practical aspects of Cardiac defibrillation with the definition,history,defibrillator and cardiovesrsion,Equipments,pre procedural consideration,care of patient before and after defibrillation,cardiac defibrillation procedure steps with rationale,complications,documentation and legal aspects
Bradyarrhythmias, AV conduction block, Congenital complete heart block (CHB)- normal or abnormal heart structure L-Transposition (corrected transposition) Bundle of His long; AV node anterior Prone to CHB Trauma- surgical or other Slow sinus or junctional rhythm, Suppression of ectopy, Permanent pacer malfunction Drugs, electrolyte imbalances, Sick Sinus Syndrome
The 10 commandments of prosthetic valve - ESC 2014
1. Mechanical heart valve- life-long OA. Antiplatelet medications does not provide adequate protection against thromboembolic risk. The combination of low-dose aspirin and vitamin K antagonists (VKAs) is recommended for all patients with mechanical valve prostheses by the ACC)/AHA & selective aspirin – ACCP/ESC/EACTS .
2. Bioprosthetic - avoid the need for life-long anticoagulation.
3.INR- 2.5 for aortic without additional risk factors for thromboembolism (e.g., Afib, prior thromboembolism, left ventricular dysfunction, and hypercoagulable states). INR range of 3.0 (or 3.5) for mitral and any aortic valve prosthesis associated with thromboembolic risk factors.
4. INR variability - increased mortality . INR variability is dictated by genetic polymorphisms of cytochrome P450 2C9, genotyping of patients treated with VKA is not currently recommended.
5. INR (>6.0) but no severe bleeding, management includes transient withdrawal of the OA and administration of oral vitamin K according to the actual and target INR values. Patients with severe bleeding should be treated with immediate anticoagulant reversal (usually prothrombin concentrates or fresh frozen plasma) and vitamin K.
6. PTCA- 3-6 months of triple antithrombotic therapy (VKA, aspirin, and a P2Y12 inhibitor) are recommended. The combination of clopidogrel and VKA without aspirin should be considered because it may decrease the risk of bleeding without a significantly increased risk of thromboembolism.
7.DOA (dabigatran, rivaroxaban, apixaban, and edoxaban) –NOT to use
8. Thromboembolism risk x10 s higher in the first month following valve replacement surgery. Use of heparin 12-24 hours following surgery is recommended. Use of either UFH or LMWH is reasonable. Use of low-dose aspirin can lower the thromboembolic risk while increasing the bleeding risk postoperatively. Anticoagulation with VKA is recommended for the first 3 months in most patients receiving a bioprosthetic valve. ESC/EACTS/ ACCP - aspirin therapy in the first 3 months following a bioprosthetic aortic valve replacement. ACC/AHA/ACCP aspirin beyond 3 months in all patients with bioprosthetic valves.
9. Noncardiac surgery- can often be performed safely without interruption of VKA therapy if they are at low risk for bleeding (e.g., dental care, ophthalmologic and demographic surgery, many gastrointestinal endoscopic procedures). Major surgery- INR should be <1.5 and heparin bridging is advised for high-risk patients only (mitral valve prostheses or patients with aortic valve prostheses and thromboembolic risk factors). Heparin bridging is not required for aortic valve prostheses without thromboembolic risk factors. Use of either UFH or LMWH is reasonable when bridging is indicated.
10. TAVR- indefinite low-dose aspirin long-term and aspirin plus clopidogrel (or another thienopyridine) for the first 1-3 months.
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
Please find the power point on Management of Sub arachnoid hemorrhage. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
a clinical syndrome that results from inadequate tissue perfusion.
Hypovolemic shock - Blood or fluid loss, both leading to a decreased circulating blood volume, diastolic filling pressure, and volume.
Cardiogenic shock - due to cardiac pump failure related to loss of myocardial contractility/functional myocardium or structural/mechanical failure of the cardiac anatomy and characterized by elevations of diastolic filling pressures and volumes
Extra-cardiac/obstructive shock - due to obstruction to flow in the cardiovascular circuit and characterized by either impairment of diastolic filling or excessive afterload
Distributive shock - caused by loss of vasomotor control resulting in arteriolar/venular dilatation leading to a decrease in preload, with decreased, normal, or elevated cardiac output, depending on the presence of myocardial depression.
Updated Hypertension Management – ESH 2023.pdfDr. Nayan Ray
Hypertension is the most prevalent CV disorder in the world and according to the WHO, it affects 1.28 billion adults aged 30–79 years worldwide, two-thirds living in low-income and middle-income countries.
In 2019, the global age-standardized average prevalence of hypertension in adults aged 30–79 years was reported to be 34% in men and 32% in women.
At younger ages (<50 years), hypertension is more prevalent in men, whereas a steeper increase of SBP in women from their third decade (and more so following menopause) makes the prevalence of hypertension greater in women in older age categories (>65 years).
Rule of Halves
Half the people with high blood pressure are not known (“rule 1”),
Half of those known are not treated (“rule 2”) and
Half of those treated are not controlled (“rule 3”)'
Definition:
Hypertension is defined based on repeated office SBP values ≥ 140 mmHg and/or DBP ≥ 90 mmHg.
Renal function is greatly important in risk stratification, pharmacologic therapy, and the prognosis of patients with heart failure (HF).
The deterioration of heart function can result in the worsening renal function (WRF) and vice versa.
Besides the heart function itself, the Pharmacologic Treatment of HF is closely related to renal function as regards initiation, titration, and discontinuation, making the situation more complex.
CVD Risk Managemnt- Focus on HTN & Dys.pdfDr. Nayan Ray
Cardiovascular disease is a major cause of disability and premature death throughout the world and contributes substantially to the escalating costs of health care.
The underlying pathology is atherosclerosis, which develops over many years and is usually advanced by the time symptoms occur, generally in middle age.
Acute coronary and cerebrovascular events frequently occur suddenly and are often fatal before medical care can be given.
Modification of risk factors has been shown to reduce mortality and morbidity in people with diagnosed or undiagnosed cardiovascular disease.
In patients with coronary artery disease (CAD), percutaneous coronary interventions (PCI) are the cornerstone of treatment for those presenting with an acute coronary syndrome (ACS); PCI has also been largely adopted in patients with chronic coronary syndromes (CCS).
Adjunctive pharmacotherapy, in particular antithrombotic therapy, has a pivotal role in optimising outcomes in patients undergoing PCI23. In fact, patients undergoing PCI may develop both acute and long-term ischaemic events.
Therefore, antithrombotic drugs, in particular antiplatelet agents, are key to the treatment and prevention of both local and systemic thrombotic complications.
Coronary Revascularization in Chronic Kidney Disease Patient.pptxDr. Nayan Ray
Chronic kidney disease (CKD) is an independent risk factor for the development of coronary artery disease, and for more severe coronary heart disease (CHD).
CKD is also associated with adverse outcomes in those with existing cardiovascular disease.
This includes increased mortality after an acute coronary syndrome, after percutaneous coronary intervention (PCI) with or without stenting, and after coronary artery bypass. In addition, patients with CKD are more likely to present with atypical symptoms, which may delay diagnosis and adversely affect outcomes.
Having more than two year experiences, presently anticoagulant is an essential component of management of COVID 19
Its role is recommended in moderate to severe to critically ill patients with different opinion in the dosage
Giving anticoagulants in asymptomatic or mild cases is still need to be validated though there are suggestions in favor.
There is recommendation for post discharge patients who had clinically suspected/established thromboembolism events
Dyslipidemia in Chronic Kidney Diseases.pdfDr. Nayan Ray
Dyslipidaemia in Chronic Kidney Disease: An Approach to Pathogenesis and Treatment
Slides Include:
1. Stages of CKD
2. Developments of atherogenesis
3. Lipoprotein in CKD
4. Drug Therapies
5.Summary KDIGO Guideline
Management of HTN according to gender. This slides will answer some questions such as
1. Why there is BP variability difference between male and female?
2. What's the regulatory mechanism of HTN in gender?
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
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.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
2. INTRODUCTION
• Cardiac arrest is the cessation of functional cardiac contraction and is the final
common pathway in death from any pathology.
• In the clinical context, cardiac arrest refers to the sudden loss of cardiac output that
prompts an emergency response.
• Pathogenesis, prognosis and management of in-hospital and out-of-hospital cardiac
arrest are subtly different; however, the basic principles of cardiopulmonary
resuscitation (CPR) are to maintain forward flow of oxygenated blood, correct the
causative factor and restore spontaneous circulation.
NYN/DMA/BPL
3. • Sudden cardiac arrest (SCA): Sudden cessation of normal cardiac activity with
haemodynamic collapse.
• Sudden cardiac death (SCD): Sudden natural death presumed to be of cardiac cause that
occurs within 1 h of onset of symptoms in witnessed cases, and within 24 h of last being seen alive
when it is unwitnessed. SCD in autopsied cases is defined as the natural unexpected death of
unknown or cardiac cause.
• Sudden unexplained death: Unexplained sudden death occurring in an individual older
than 1 year.
NYN/DMA/BPL
4. • Sudden infant death syndrome (SIDS): Unexplained sudden death occurring in an
individual younger than 1 year with negative pathological and toxicological assessment and
negative forensic examination of the circumstances of death.
• Sudden arrhythmic death syndrome (SADS): Unexplained sudden death occurring in an
individual older than 1 year with negative pathological and toxicological assessment. Note:
Synonymous with ‘autopsy-negative sudden unexplained death’.
NYN/DMA/BPL
5. EPIDEMIOLOGY
SCD accounts for approximately 50% of all cardiovascular
deaths, with up to 50% being the first manifestation of
cardiac disease.
NYN/DMA/BPL
6. •The incidence of SCD increases markedly with age.
• With a very low incidence during infancy and childhood (1 per 100
000 person- years),
• the incidence is approximately 50 per 100 000 person- years in
middle-aged individuals (in the fifth to sixth decades of life).
• In the eighth decade of life, it reaches an annual incidence of at
least 200 per 100 000 person-years.
NYN/DMA/BPL
7. At any age, males have higher SCD rates compared with females, even
after adjustment for risk factors of coronary artery disease (CAD).
Ethnic background also seems to have large effects. It is estimated that
10–20% of all deaths in Europe are SCD.
Approximately 300 000 people in Europe have out-of-hospital cardiac
arrest (OHCA) treated by emergency medical systems every year.
NYN/DMA/BPL
8. SCD IN SPORTS
• Although regular physical activity benefits cardiovascular health,
sport, particularly when practiced vigorously, has been shown to be
associated with SCD during or shortly after exercise in selected
populations.
• Reports have suggested that the majority of sports- related SCD
occurs in a recreational rather than competitive setting, especially
among middle-aged male participants, suggesting that CAD is the
most common underlying cause.
NYN/DMA/BPL
15. AWARENESS AND INTERVENTION: PUBLIC
BASIC LIFE SUPPORT, AND ACCESS TO
AUTOMATED EXTERNAL DEfiBRILLATORS
NYN/DMA/BPL
Bystander cardiopulmonary resuscitation (CPR) and use of
public automated external defibrillators (AEDs) have demon-
started improvement of neurological and functional outcome as
well as survival of OHCA patients.
17. BASIC LIFE SUPPORT
ABCDE approach
• Prompt assessment and restoration of the Airway,
• Maintenance of ventilation using rescue Breathing (‘mouth-to-mouth’ breathing),
• Maintenance of the Circulation using chest compressions;
• Disability, in resuscitated patients, refers to assessment of neurological status, and
• Exposure entails removal of clothes to enable defibrillation, auscultation of the chest and
assessment for a rash caused by anaphylaxis, for injuries and so on
NYN/DMA/BPL
19. ADVANCED LIFE SUPPORT
• Advanced life support (ALS) aims to restore normal cardiac rhythm by defibrillation
when the cause of cardiac arrest is a tachyarrhythmia, or to restore cardiac output
by correcting other reversible causes of cardiac arrest.
• The initial priority is to assess the patient's cardiac rhythm by attaching a
defibrillator or monitor.
• Once this has been done, treatment should be instituted based on the clinical findings.
• Only a minority of patients will have a shockable rhythm at the commencement of
resuscitation.
NYN/DMA/BPL
22. DEFIBRILLATION
• Ventricular defibrillation or pulseless ventricular tachycardia should be treated with
immediate defibrillation.
• Defibrillation is more likely to be effective if a biphasic shock defibrillator is used,
where the polarity of the shock is reversed midway through its delivery.
• Defibrillation is usually administered using a 150 Joule biphasic shock, and CPR
resumed immediately for 2 minutes without attempting to confirm restoration of a
pulse, because restoration of mechanical cardiac output rarely occurs immediately
after successful defibrillation.
NYN/DMA/BPL
23. • If, after 2 minutes, a pulse is not restored, a further biphasic shock of 150–
200 J should be given. Thereafter, additional biphasic shocks of 150–200 J
are given every 2 minutes after each cycle of CPR.
• During resuscitation, adrenaline (epinephrine, 1 mg IV) should be given every
3–5 minutes and consideration given to the use of intravenous amiodarone,
especially if ventricular defibrillation or ventricular tachycardia re-initiates
after successful defibrillation.
NYN/DMA/BPL
53. OUT-OF-HOSPITAL CARDIAC ARREST (OHCA)
• This is the sudden and complete loss of cardiac output occurring in the
community.
• The clinical diagnosis is based on the victim being unconscious and pulseless;
breathing may take some time to stop completely after cardiac arrest. Death
is virtually inevitable, unless effective treatment is given promptly.
NYN/DMA/BPL
54. PATHOGENESIS
• Cardiac arrest may be caused by ventricular fibrillation, pulseless ventricular
tachycardia, asystole or pulseless electrical activity.
NYN/DMA/BPL
55. PATHOGENESIS
• Myocardial ischaemia is the most common trigger of OHCA. This can be due
to an acute infarct, acute on chronic coronary insufficiency, post-infarct
ventricular scarring or structural cardiac disease (cardiomyopathy, aortic
stenosis).
NYN/DMA/BPL
56. PATHOGENESIS
• Ventricular fibrillation can occur in the absence of recognised structural
abnormalities, e.g. congenital syndromes such as Brugada syndrome.
• Occasionally, sudden cardiac death can occur from an acute mechanical
catastrophe such as cardiac rupture or aortic dissection.
NYN/DMA/BPL
57. IN-HOSPITAL CARDIAC ARREST (IHCA)
• Historically, outcomes from IHCA were extremely poor. However, with
appropriate anticipatory care planning and prompt intervention of hospital
resuscitation teams, outcomes can be significantly better than for OHCA.
NYN/DMA/BPL
58. PATHOGENESIS
• Although primary cardiac causes are the most common cause of IHCA,
additional factors such as organ failure, sepsis or respiratory
decompensation are often more pertinent.
• Correction of hypoxaemia with early tracheal intubation and ventilation is
therefore of higher importance in this group than in OHCA, provided it can
be achieved without interruption of chest compressions.
NYN/DMA/BPL
59. RISK FACTORS CARDIAC ARREST
• A family history of coronary artery disease.
• Smoking.
• High blood pressure.
• High blood cholesterol.
• Obesity.
• Diabetes.
• An inactive lifestyle.
NYN/DMA/BPL
60. SYMPTOMS
• Collapse suddenly and lose consciousness (pass out)
• Are not breathing or their breathing is ineffective or they are gasping for air
• Do not respond to shouting or shaking
• Do not have a pulse
NYN/DMA/BPL
61. WHAT ARE THE WARNING SIGNS?
• Shortness of breath (more common in women than men)
• Extreme tiredness (unusual fatigue)
• Back pain
• Flu-like symptoms
• Belly pain, nausea, and vomiting
• Chest pain, mainly angina (more common in men than women)
• Repeated dizziness or fainting, especially while exercising hard, sitting, or lying on back
• Heart palpitations, or feeling as if the heart is racing, fluttering, or skipping a beat
NYN/DMA/BPL
63. THE CHAIN OF SURVIVAL IN CARDIAC ARREST
NYN/DMA/BPL
• The ‘Chain of Survival’ refers to the sequence of events that is necessary to maximise the
chances of a cardiac arrest victim surviving.
• Survival is most likely if all links in the chain are strong: that is, if the arrest is
witnessed, help is called immediately, basic life support is administered by a trained
individual, the emergency medical services respond promptly, and defibrillation is
achieved within a few minutes.
• CPR from bystanders, often assisted by ambulance service telephone dispatchers, is
crucial.
64. THE CHAIN OF SURVIVAL IN CARDIAC ARREST
NYN/DMA/BPL
• Good training in both basic and advanced life support is essential and
should be maintained by regular refresher courses.
• Automated external defibrillators (AEDs) are increasingly available in
public places, particularly where traffic congestion may impede the
response of emergency service, and should be used as soon as possible.
• Designated individuals can respond to a cardiac arrest using basic life
support and an automated external defibrillator.
65. THE CHAIN OF SURVIVAL IN CARDIAC ARREST
NYN/DMA/BPL
67. ACE INHIBITOR
DILATE THE BLOOD VESSELS &
IMPROVE YOUR BLOOD FLOW
(CAPTOPRIL,ENELAPRIL)
B BLOCKER
REDUCE THE RISK OF REINFARCTION
& OCCURANCE OF HEART FAILURE
(ATENELOL,ESMOLOL)
ANTIARRHYMIC DRUG
TREAT ARRHYTHMIAS
(PROCAINAMIDE)
CALCIUM CHANNEL BLOCKER
RELAX SMOOTH MUSCLE
(AMLODIPINE)
MEDICAL MANAGEMENT
Papastylianou A, Mentzelopoulos S. Current pharmacological advances in the treatment of cardiac arrest. Emerg Med Int.
2012;2012:815857. doi: 10.1155/2012/815857. Epub 2011 Nov 20. PMID: 22145080; PMCID: PMC3226361.
NYN/DMA/BPL
68. CORONARY ANGIOPLASTY
Coronary angioplasty is a medical procedure in which a balloon is used to
open a blockage in a coronary artery narrowed by atherosclerosis.
CORONARY BYPASS SURGERY
Coronary bypass surgery is a procedure that restores blood flow to your
heart muscle by diverting the flow of blood around a section of a blocked
artery in your heart.
HEART TRANSPLANTATION
A heart transplant, or a cardiac transplant, is a surgical transplant procedure
performed on patients with end-stage heart failure or severe coronary artery
disease when other medical or surgical treatments have failed.
SURGICAL TREATMENT
SANJIB
https://www.mayoclinic.org/diseases-conditions/sudden-cardiac-arrest/diagnosis-treatment/drc-20350640#:~:text=Coronary%20bypass%20surgery.,the%20frequency%20of%20racing%20heartbeats.
NYN/DMA/BPL
69. POST CARDIAC ARREST
The majority of cardiac arrest survivors will need a period of time in
intensive care to achieve physiological stability, identify and
manage the underlying cause of the arrest, and optimise
neurological recovery.
NYN/DMA/BPL
70. ACUTE MANAGEMENT
• A MAP of > 70 mmHg should be maintained to optimise cerebral perfusion.
• Shock is common following return of spontaneous circulation (ROSC) and is
caused by a combination of the underlying condition leading to the arrest,
myocardial stunning and a post-arrest vasodilated state.
• Support with inotropes, vasopressors and occasionally mechanical support
from an intra-aortic balloon pump or venous–arterial ECMO may be required.
NYN/DMA/BPL
72. PROGNOSIS
• Predicting which patients will not recover from the brain injury sustained at the
time of cardiac arrest is very difficult.
• Certain features suggest that the outcome will be poor: for example, the
absence of pupillary and corneal reflexes, absence of a motor response and
persistent myoclonic jerking.
NYN/DMA/BPL
74. • The clinician should, where feasible, delay prognostication until a period of 72
hours of targeted temperature management has been completed.
• The bilateral absence of the ‘N20’ spike on the somatosensory evoked
potential is the most specific test to predict irrecoverable brain injury.
• This test is performed by administering an electrical impulse over a peripheral
nerve and recording the electrical impulses measured by the scalp electrodes
overlying the part of the brain expected to receive the impulse.
NYN/DMA/BPL
75. • Where this is not available, prognostication based on all other available
information, along with the perceived wishes relating to the level of disability
the individual would be prepared to accept, should allow a decision
regarding ongoing treatment to be made.
• Where there is doubt, more time should be given to allow assessment of
neurological recovery.
NYN/DMA/BPL