ECHOCARDIOGRAPHIC EVALUATION OF MITRAL VALVE DISEASEPraveen Nagula
MITRAL VALVE ANATOMY , M MODE FINDINGS IN MITRAL STENOSIS,EVALUATION OF THE SEVERITY OF LESION,CALCIFIC MS,CCMA,CONGENITAL LESIONS,GUIDELINES ALL IN DETAIL....
preop TEE assessment of atrial septal defect is very important for making decision for device closure, properly assessed adequate rims of ASD will reduce risk of device embolization to almost nil.
Today, in addition to measurement of left ventricular ejection fraction, the simple 12-lead surface ECG remains the only evidence-based means of identifying patients who may obtain the substantial benefits of CRT
Our concepts of heart disease are based on the enormous reservoir of physiologic and anatomic knowledge derived from the past 70 years' of experience in the cardiac catheterization laboratory.
As Andre Cournand remarked in his Nobel lecture of December 11, 1956, the cardiac catheter was the key in the lock.
By turning this key, Cournand and his colleagues led us into a new era in the understanding of normal and disordered cardiac function in huma
A lecture on the echocardiographic evaluation of hypertrophic cardiomyopathy. Starts with an overview of the topic then a systematic approach to diagnosis and then a differential diagnosis followed by take-home messages and conclusion.
Introduction: Recent times have witnessed almost half, or sometimes more cardiac surgical procedures are performed in patients above 75 years of age. Traditionally, the EuroSCORE II and STS risk scoring systems have been widely used across the globe. Extensive reviews have shown that EuroSCORE II probably overestimates the perioperative risk at lower score levels while the STS score tends to underestimate the risk.
Frailty is a broad term that encircles aspects of nutrition, lack of agility, inactivity, lack of strength and wasting; and is seen in 25-50% of elderly patients. It has been defined as a geriatric syndrome reflecting a state of reduced physiological reserve and increased vulnerability to poor resolution of homeostasis after a stressor event. Conversely, pre-frailty, which is potentially reversible, is associated with higher risk of older adults developing cardiovascular disease.
Frailty assessment includes a variety of physical and cognitive tests, functional assessments and evaluating nutritional status. Literature has highlighted what is referred to as the ‘obesity paradox’, meaning obese patients with heart failure fair better than leaner patients, possibly because they have more metabolic reserve and also because weight loss in itself is a risk factor for frailty.
Patient Selection: To comprehensively assess a patient, factors that describe the biological status of the patient should be incorporated. There are various methods of assessment and modified Fried criteria or comprehensive assessment of frailty are a couple of systems commonly used.
Conclusion: Systematic reviews have shown that frail patients have higher chance of mortality, major adverse cardiac and cerebrovascular events and functional decline after cardiac surgery. A holistic assessment not only categorises patients into the apt risk category and hence match goals and treatments; but also, will pick up patients with pre-frailty who will benefit from multidisciplinary intervention and be better prepared for the intervention.
ECHOCARDIOGRAPHIC EVALUATION OF MITRAL VALVE DISEASEPraveen Nagula
MITRAL VALVE ANATOMY , M MODE FINDINGS IN MITRAL STENOSIS,EVALUATION OF THE SEVERITY OF LESION,CALCIFIC MS,CCMA,CONGENITAL LESIONS,GUIDELINES ALL IN DETAIL....
preop TEE assessment of atrial septal defect is very important for making decision for device closure, properly assessed adequate rims of ASD will reduce risk of device embolization to almost nil.
Today, in addition to measurement of left ventricular ejection fraction, the simple 12-lead surface ECG remains the only evidence-based means of identifying patients who may obtain the substantial benefits of CRT
Our concepts of heart disease are based on the enormous reservoir of physiologic and anatomic knowledge derived from the past 70 years' of experience in the cardiac catheterization laboratory.
As Andre Cournand remarked in his Nobel lecture of December 11, 1956, the cardiac catheter was the key in the lock.
By turning this key, Cournand and his colleagues led us into a new era in the understanding of normal and disordered cardiac function in huma
A lecture on the echocardiographic evaluation of hypertrophic cardiomyopathy. Starts with an overview of the topic then a systematic approach to diagnosis and then a differential diagnosis followed by take-home messages and conclusion.
Introduction: Recent times have witnessed almost half, or sometimes more cardiac surgical procedures are performed in patients above 75 years of age. Traditionally, the EuroSCORE II and STS risk scoring systems have been widely used across the globe. Extensive reviews have shown that EuroSCORE II probably overestimates the perioperative risk at lower score levels while the STS score tends to underestimate the risk.
Frailty is a broad term that encircles aspects of nutrition, lack of agility, inactivity, lack of strength and wasting; and is seen in 25-50% of elderly patients. It has been defined as a geriatric syndrome reflecting a state of reduced physiological reserve and increased vulnerability to poor resolution of homeostasis after a stressor event. Conversely, pre-frailty, which is potentially reversible, is associated with higher risk of older adults developing cardiovascular disease.
Frailty assessment includes a variety of physical and cognitive tests, functional assessments and evaluating nutritional status. Literature has highlighted what is referred to as the ‘obesity paradox’, meaning obese patients with heart failure fair better than leaner patients, possibly because they have more metabolic reserve and also because weight loss in itself is a risk factor for frailty.
Patient Selection: To comprehensively assess a patient, factors that describe the biological status of the patient should be incorporated. There are various methods of assessment and modified Fried criteria or comprehensive assessment of frailty are a couple of systems commonly used.
Conclusion: Systematic reviews have shown that frail patients have higher chance of mortality, major adverse cardiac and cerebrovascular events and functional decline after cardiac surgery. A holistic assessment not only categorises patients into the apt risk category and hence match goals and treatments; but also, will pick up patients with pre-frailty who will benefit from multidisciplinary intervention and be better prepared for the intervention.
CT coronary angiography in ED chest pain patientskellyam18
CT coronary angiography is the new kid on the block for assessing emergency department patients with chest pain. How accurate is it? What are the down sides? How useful is it? Which patients is it suitable for? This presentation attempts to answer these questions in light of current evidence.
My talk in April 2015 Malaysia on Best Practices and Resuscitation Workflow. The new 2015 resuscitation guidelines is expected to be released in Oct 2015.
This presentation discusses the latest evidence for blood transfusion triggers in the intensive care unit of various clinical condition including severe sepsis, GI bleed, post surgical cases, and post cardiac surgery among other cnditions
High Frequency Low Tidal Volume Ventilation during AF ablationJose Osorio
High Frequency Low Tidal Volume ventilation during ablation of Afib can significantly improve catheter stability.
After concluding a single center experience, we implemented the technique in a large multi center network, with significant improvements in procedural time while maintaining safety outcomes.
Fluoroscopic reduction in a fib ablation - Ready for Prime Time?Jose Osorio
My journey with fluoroscopy reduction in AF ablation started back in 2010. ICE has been an integral part of the safe elimination of fluoroscopy for most of our procedures.
Over the past several years, we have shown that these techniques are safe, effective and can be performed efficiently. We have taught many electrophysiologists who have been able to replicate these results.
Quality Improvement in an AF Ablation ProgramJose Osorio
Atrial fibrillation ablation is an important treatment options for patients with AF. The number of AF ablations continue to rise annually but there is a limited number of Electrophysiology Laboratories and doctors. With the increasing prevalence of Afib, many institutions are finding bottlenecks with the increase volume.
We propose that a quality improvement initiative is the ideal way to improve efficiency, outcomes and safety of AF ablations with the end results being more patients treated with good results.
Standardizing Care and Increasing Efficiency in an Atrial Fibrillation ProgramJose Osorio
As the number of patients with afib continue to increase in the US, there is a growing need for Afib ablations. With a limited number of EP labs and doctors, each hospital will have to find safe ways to increase their number of procedures to meet the demand.
Our experience shows that by standardizing care and following guidelines and internal protocols, AF ablation programs can increase safety and efficacy while improving efficiency.
The Evolution of Atrial Fibrillation Ablation: Utilizing Current Technology ...Jose Osorio
The treatment of atrial fibrillation is rapidly evolving. Grandview Medical Center in Birmingham Alabama has a comprehensive afib center. We have extensive experience in the treatment and ablation of atrial fibrillation. Our experience was presented at the Asia Pacific Heart Rhythm Society Meeting - APHRS, in Tokyo.
Our workflow has led to significant improvements in success rates while procedure times were reduced. More importantly we have maintained very good safety profile.
Introduction to Electrophysiology - Ventricular Arrhtyhmias and Cardiac Devic...Jose Osorio
What is cardiac Electrophysiology?
This presentation will cover basics of EP. It is Part 2 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
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 (afib) is one of the main causes of strokes in the US. New treatment options are available - both medical therapy (such as new blood thinners) and procedures (watchman left atrial appendage closure).
Atrial fibrillation (afib) is a heart rhythm disorder (arrhythmia). It increases your risk of having a stroke and can affect your quality of life. There are many treatment options for patients with atrial fibrillation (afib).
In order to decrease the burden of the symptoms from afib, we can use medications or procedures - catheter ablation.
Patients with afib have a 5 fold higher risk of having a stroke. Traditionally blood thinners are used to decrease that risk. A new option available as an alternative to blood thinners is the Watchman left atrial appendage closure device.
Atrial fibrillation (or afib) is a common heart rhythm disorder. It can cause many symptoms, such as fatigue or palpitations, and also increase your risk of having a stroke.
There are many treatment options for patients with afib. Patients need to have treatment to reduce their risk of stroke and to decrease the symptoms.
The number of patients with implantable devices continues to grow. There are important aspects and difficulties in the perioperative management of these patients.
History of ICDs (Internal Cardiac Defibrillators)Jose Osorio
ICDs have been available since the 80s for the prevention of sudden cardiac death. The advancements are quite amazing, with a reduction in size from >250cc to less than 40cc, ease of implantation, safety and longevity.
Atrial Fibrillation - From Diagnosis to Treatment - St Vincent's BirminghamJose Osorio
CME Lecture for the medical staff at St Vincent's Hospital.
Atrial fibrillation is a common rhythm disorder. There are many treatment options available today.
Atrial Fibrillation Ablation - Improving Efficacy and Minimizing FluoroscopyJose Osorio
Atrial fibrillation ablation is a procedure performed to attempt to cure afib. It is traditionally performed using fluoroscopy (X-Ray) to guide, and exposure to radiation is a concern.
In order to minimize and sometimes completely avoid the use of radiation during the procedure newer techniques using the mapping systems have been developed.
This presentation shows some of the techniques I use to minimize fluoroscopy during ablation. This was presented at a course for electrophysiology fellows.
Internal Cardiac Defibrillators (ICDs) are devices implanted in patients that are at risk of dying suddenly. ICDs monitor the heart's rhythm and if a fatal arrhyhtmia is seen they can deliver shocks that can convert the patient back into normal rhythm and save a life.
Lean about ICDs, what they are and why they are used and how to life with one.
Atrial Fibrillation in Women - St Vincent's, Birmingham, ALJose Osorio
Go Red For Women - American Heart Association
Atrial fibrillation is a common condition in women, yet there are significant disparities in the treatment. Women with afib are more likely to have strokes and less likely to receive appropriate care.
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.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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
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
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
6. 1995-1997: Mechanistic and longer-term
observational studies
1998-1999: Randomized studies to assess
exercise capacity, functional capacity and
QoL
2000-2002: Randomized trials to assess
combined mortality and hospitalization
NYHA III and ambulatory IV patients
www.theafcenter.com
7. • Mortality
benefit
• Reduced HF
hospitalizations• Mortality benefit
in LBBB population*
• Reduced HF
hospitalizations
• Improved cardiac
function*
• Improved CCR
• Improved
cardiac function
• Reduced HF
hospitalizations*
• Improved CCR*
• Improved cardiac
function
2003: CONTAK CD
6 mos; n = 263
2004: MICD II
6 mos; n = 186
2008: REVERSE
12 mos, n = 610;
24 mos, n = 262
2009: MADIT CRT
Average 29 mos, n = 1,820
2010: RAFT
Average 40 mos, n = 1,438
• Improved
cardiac function
www.theafcenter.com
9. 57%
57% reduction (p < 0.001) in
the risk of a composite of
all-cause mortality or heart
failure events.
• 35% reduction (p = 0.048)
in the risk of all-cause
mortality
• 63% reduction (p < 0.001)
in the risk of heart failure
events
Moss AJ, et al. N Engl J Med. 2009;361:1329-1338.
www.theafcenter.com
10. Cecilia Linde JACC 2008
Resynchronization Reverses Remodeling
in
Systolic Left Ventricular Dysfunction
REVERSE)
www.theafcenter.com
20. How do you classify your patient
Why some patients do not respond
What do you do
www.theafcenter.com
21. Mullens W, et al. JACC 2009; 53:765
Response to CRT
Causes for “Non-response”
www.theafcenter.com
22. Response to CRT
Causes for “Non-response”
Lack of electrical dysynchrony
Lack of Mechanical dysynchrony
Myocardial scar
RV failure
www.theafcenter.com
23. We aim to correct mechanical dyssynchrony with
CRT
The amount of baseline mechanical dyssynchrony
is currently the best predictor of response to CRT
A wide QRS (electrical dyssynchrony) is a
screening tool for mechanical dyssynchrony
1 Yu et al., PACE 2000;23-II:9
2 Nelson et al., Circulation 2001;101:2703-9
3 Yu et a., PACE 2000;23-II:148
4 Breithardt et al., PACE 2001;24-II:736
5. Sassara et al., Eurpace 2 SB, 2001
www.theafcenter.com
24. ~30% of patients with a wide QRS do not
show LV mechanical dyssynchrony:
◦ 50% may have induced dyssynchrony with CRT
Worse outcomes
Auger et al. Eur H J 2012; 33:913www.theafcenter.com
25. Auger et al. Eur H J 2012; 33:913www.theafcenter.com
26. Response to CRT
Pace Away From Scar
Van Deursen C, et al. Circ Arrhythm Electrophysiol 2009; 2:580
• Speckle Tracking Echo
• Target the most delayed
actively contracting site in
patients with ICMP
www.theafcenter.com
27. Apex in 14%
Apical lead placement
◦ Primary end point - up 64%
◦ Mortality – rose 2.6 times
◦ Resynchronization less effective
www.theafcenter.com
28. How do you classify your patient
Why some patients do not respond
What do you do
www.theafcenter.com
29. Clinical and Laboratory evaluation
Device parameters
LV lead position
ECHO guided AV optimitzation
Protocol evaluation
www.theafcenter.com
37. ICD without issues associated with
transvenous leads
◦ Lead not exposed to heart stresses
◦ Infection
Patients without pacing indications
www.theafcenter.com
40. CRT is a well established treatment option for
patients with HF and wide QRS
◦ NYHA Class I to IV
Non-responders
◦ Important to identify the cause
◦ Favorable intervention often possible
Advances in CRMD
www.theafcenter.com
Editor's Notes
Finally, the 4 trials (MADIT CRT, REVERSE, Miracle ICD II, and Contak CD) that evaluated cardiac structure and/or function all showed that, in the mildly symptomatic HF population, there was improved cardiac function and/or cardiac structure over time with CRT therapy.
