The document discusses indications for cardiac transplantation including refractory heart failure and ventricular arrhythmias. It outlines the evaluation, donor criteria, surgical techniques, post-operative management including immunosuppression and complications of rejection, infection, and malignancy. Long-term outcomes are generally good with 1-year survival rates of 82% though risks include cardiac allograft vasculopathy and factors like age, pulmonary disease, and diabetes.
coronary artery bypass graft surgery CABGSunil kumar
coronary artery bypass graft surgery, explanation of CABG on-pump and off-pump procedures, physiotherapy management after surgery. indications of CABG. description of the procedure, investigations before surgery, per operative and post operative management
coronary artery bypass graft surgery CABGSunil kumar
coronary artery bypass graft surgery, explanation of CABG on-pump and off-pump procedures, physiotherapy management after surgery. indications of CABG. description of the procedure, investigations before surgery, per operative and post operative management
Mitral valve replacement is a procedure whereby the diseased mitral valve of a patients heart is replaced by either a mechanical or tissue(bioprosthetic )valve.’
A treadmill exercise stress test is used to determine the effects of exercise on the heart. Exercise allows doctors to detect abnormal heart rhythms (arrhythmias) and diagnose the presence or absence of coronary artery disease.
This test involves walking in place on a treadmill while monitoring the electrical activity of your heart. Throughout the test, the speed and incline of the treadmill increase. The results show how well your heart responds to the stress of different levels of exercise.
Description
A technologist will explain the test to you, take a brief medical history, and answer any questions you may have. Your blood pressure, heart rate, and electrocardiogram (ECG) will be monitored before, during, and after the test.
You will be asked to sign a consent form. This form is required before the test can proceed.
You will be asked to remove all upper body clothing, and to put on a gown with the opening to the front.
Adhesive electrodes will be put onto your chest to capture an ECG. The sites where the electrodes are placed will be cleaned with alcohol and shaved if necessary. A mild abrasion may also be used to ensure a good quality ECG recording.
Your resting blood pressure, heart rate, and ECG will be recorded.
You will be asked to walk on a treadmill. The walk starts off slowly, then the speed and incline increases at set times. It is very important that you walk as long as possible because the test is effort-dependent.
You will be monitored throughout the test. If a problem occurs, the technologist will stop the test right away. It is very important for you to tell the technologist if you experience any symptoms, such as chest pain, dizziness, unusual shortness of breath, or extreme fatigue.
Following the test, you will be asked to lie down. Your blood pressure, heart rate, and ECG will be monitored for three to five minutes after exercise.
The data will be reviewed by a cardiologist after the test is completed. A report will be sent to the doctor(s) involved in your care.
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. As of 2008 the most common procedure is to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient. The patient's own heart is either removed (orthotopic procedure) or, less commonly, left in place to support the donor heart (heterotopic procedure). Post-operation survival periods average 15 years. Heart transplantation is not considered to be a cure for heart disease, but a life-saving treatment intended to improve the quality of life for recipients
CARDIAC TAMPONADE ( Cardiac emergency) • Cardiac Tamponade is a life threatening complication caused by excessive accumulation of fluid in the pericardium. Or • Compression of all cardiac chambers due to excessive accumulation of pericardial fluid leading to compromised cardiac out put.
Mitral valve replacement is a procedure whereby the diseased mitral valve of a patients heart is replaced by either a mechanical or tissue(bioprosthetic )valve.’
A treadmill exercise stress test is used to determine the effects of exercise on the heart. Exercise allows doctors to detect abnormal heart rhythms (arrhythmias) and diagnose the presence or absence of coronary artery disease.
This test involves walking in place on a treadmill while monitoring the electrical activity of your heart. Throughout the test, the speed and incline of the treadmill increase. The results show how well your heart responds to the stress of different levels of exercise.
Description
A technologist will explain the test to you, take a brief medical history, and answer any questions you may have. Your blood pressure, heart rate, and electrocardiogram (ECG) will be monitored before, during, and after the test.
You will be asked to sign a consent form. This form is required before the test can proceed.
You will be asked to remove all upper body clothing, and to put on a gown with the opening to the front.
Adhesive electrodes will be put onto your chest to capture an ECG. The sites where the electrodes are placed will be cleaned with alcohol and shaved if necessary. A mild abrasion may also be used to ensure a good quality ECG recording.
Your resting blood pressure, heart rate, and ECG will be recorded.
You will be asked to walk on a treadmill. The walk starts off slowly, then the speed and incline increases at set times. It is very important that you walk as long as possible because the test is effort-dependent.
You will be monitored throughout the test. If a problem occurs, the technologist will stop the test right away. It is very important for you to tell the technologist if you experience any symptoms, such as chest pain, dizziness, unusual shortness of breath, or extreme fatigue.
Following the test, you will be asked to lie down. Your blood pressure, heart rate, and ECG will be monitored for three to five minutes after exercise.
The data will be reviewed by a cardiologist after the test is completed. A report will be sent to the doctor(s) involved in your care.
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. As of 2008 the most common procedure is to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient. The patient's own heart is either removed (orthotopic procedure) or, less commonly, left in place to support the donor heart (heterotopic procedure). Post-operation survival periods average 15 years. Heart transplantation is not considered to be a cure for heart disease, but a life-saving treatment intended to improve the quality of life for recipients
CARDIAC TAMPONADE ( Cardiac emergency) • Cardiac Tamponade is a life threatening complication caused by excessive accumulation of fluid in the pericardium. Or • Compression of all cardiac chambers due to excessive accumulation of pericardial fluid leading to compromised cardiac out put.
Physician should have a high suspicion to diagnose patient with pulmonary Embolism, this slides will give you precise Diagnosis, Investigation and guideline directed Treatment.
Renal Transplantation and Patients managementsachintutor
A kidney transplant is a surgery done to replace a diseased kidney with a healthy kidney from a donor. The kidney may come from a deceased organ donor or from a living donor. Family members or others who are a good match may be able to donate one of their kidneys. This type of transplant is called a living transplant.
Management of acute lymphoblatic leukemia with light on etiology, clinical features, diagnosis and different aspects of management including chemotherapy and radiation therapy
Disseminated intravascular coagulation (DIC) is a condition in which blood clots form throughout the body, blocking small blood vessels. Symptoms may include chest pain, shortness of breath, leg pain, problems speaking, or problems moving parts of the body.
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!
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
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2. Indications for Cardiac Transplantation
• Cardiogenic shock requiring mechanical assistance.
• Refractory heart failure with continuous inotropic infusion.
• Progressive symptoms with maximal therapy.
• Severe symptomatic hypertrophic or restrictive
cardiomyopathy.
• Medically refractory angina with unsuitable anatomy for
revascularization.
• Life-threatening ventricular arrhythmias despite aggressive
medical and device interventions.
• Cardiac tumors with low likelihood of metastasis.
• Hypoplastic left heart and complex congenital heart disease.
3. Indications of Cardiac Transplantation
• Patients should receive maximal medical therapy before being
considered for transplantation. They should also be considered for
alternative surgical therapies including CABG, valve repair /
replacement, cardiac septalplasty, etc.
• VO2 (oxygen carrying capacity) has been used as a reproducible
way to evaluate potential transplant candidates and their long term
risk. Generally a peak VO2 >14ml/kg/min has been considered “too
well” for transplant as transplantation has not been shown to
improve survival over conventional medical therapy. Peak VO2 10
to 14 ml/kg/min had some survival benefit, and peak VO2 <10 had
the greatest survival benefit.
5. Evaluation of Cardiac Transplantation
Recipient
• Right and Left Heart Catheterization.
• Cardiopulmonary testing.
• Labs including BMP, CBC, LFT, UA, coags., TSH, UDS,
ETOH level, HIV, Hepatitis panel, PPD, CMV IgG, RPR /
VDRL, PRA (panel of reactive antibodies), ABO and Rh blood
type, lipids.
• CXR, PFT’s including DLCO, EKG.
• Substance abuse history and evidence of abstinence for at
least 6 months and enrollment in formal rehabilitation.
• Mental health evaluation including substance abuse hx and
social support.
• Financial support.
• Weight no more than 140% of ideal body weight.
6. Cardiac Donor
• Brain death is necessary for any cadaveric organ
donation. This is defined as absent cerebral function
and brainstem reflexes with apnea during hypercapnea
in the absence of any central nervous system
depression.
• There should be no hypothermia, hypotension, metabolic
abnormalities, or drug intoxication.
• If brain death is uncertain, confirmation tests using EEG,
cerebral flow imaging, or cerebral angiography are
indicated.
7. Cardiac Donor – Exclusion Criteria
• Age older than 55 years.
• Serologic results (+) for HIV, Hepatitis B or C.
• Systemic Infection.
• Malignant tumors with metastatic potential (except primary brain
tumors)
• Systemic comorbidity (diabetes mellitus, collagen vascular disease)
• Cardiac disease or trauma
• Coronary artery disease
• Allograft ischemic time estimated to be > than 4-5 hours
• LVH or LV dysfunction on echocardiography
• Death of carbon monoxide poisoning
• IV drug abuse.
8. Matching Donor and Recipient
• Because ischemic time during cardiac transplantation is
crucial, donor recipient matching is based primarily not on
HLA typing but on the
– severity of illness
– ABO blood type (match or compatible),
– response to PRA
– donor weight to recipient ratio (must be 75% to 125%)
– geographic location relative to donor
– length of time at current status.
9. Surgical Transplantation Techniques
• Orthotopic implantation is the most common – it involves
complete explantation of the native heart.
• Heterotopic implantation is an alternative technique in
which the donor heart functions in parallel with the
recipient’s heart.
10. Physiologic concerns of Transplant
• Biatrial connection means less atrial contribution to
stroke volume.
• Resting heart rate is faster (95 to 110 bpm) and
acceleration of heart rate is slower during exercise
because of denervation.
• Diurnal changes in blood pressure are abolished.
• Diastolic dysfunction is very common because the
myocardium is stiff from some degree of rejection and
possibly from denervation.
11. Postoperative Complications
• Surgical
– Aortic pseudoaneurysm or rupture at cannulation site
– Hemorrhagic pericardial effusion due to bleeding or
coagulopathy
• Medical
– Severe tricuspid regurgitation
– RV failure
• Pulmonary artery compression
• Pulmonary hypertension
– LV failure
• Ischemia
• Operative Injury
• Acute rejection
12. Postoperative Complications
• Rhythm disturbances
• Asystole
• Complete heart block.
• Sinus node dysfunction with bradyarrhythmias (25% permanent but
most resolve within 1-2 weeks).
• Atrial fibrillation.
• Ventricular tachycardia.
• Coagulopathy induced by cardiopulmonary bypass
• Respiratory failure
• Cardiogenic pulmonary edema.
• Noncardiogenic pulmonary edema.
• Infection.
• Renal or hepatic insufficiency
• Drugs.
• CHF.
13. Postoperative Management
• Initiation of medications, particularly
immunosuppressive agents begins on the day of
the operation.
– Cyclosporin
– Azathioprine
– Solumedrol
– +/- Muromonab-CD3 (OKT3)
14. Postoperative Management
• Pneumocystis carinii prophylaxis is started within the first
week after transplant.
• If patient or donor is CMV positive then ganciclovir is
started on postop day 2.
• Endomyocardial biopsy is performed on postop day 4
and steroids can begin to be tapered if there is no
rejection greater than grade 2b.
• Anticoagulation is started if heterotopic transplantation
has been performed.
• Amylase and lipase are measured on day 3 to detect
pancreatitis.
• ECG’s are obtained every day.
15. Long-term Management
Endomycardial biopsy is performed once a week
for the first month and then less frequently
depending on the presence or absence of
rejection (usual regimen is qweek x 4 weeks,
qmonth x 3 months, q3months in 1st year,
q4months in 2nd year, 1 to 2 times per year
subsequently).
16. Long-term Management
• Cyclosporine levels are checked periodically by
individual center protocols.
• Echocardiography is useful periodically and as an
adjunct to endomyocardial biopsy.
• Cardiac catheterization is performed annually for early
detection of allograft vasculopathy.
• There is probably no need for routine exercise or nuclear
stress testing.
17. Complications - Rejection
• Avoidance with preoperative therapy with cyclosporin,
corticosteroids, and azathioprine.
• If rejection is suspected then workup should include:
measurement of cyclosporine level CKMB level,
echocardiography for LV function, and endomyocardial
biopsy.
• Signs and symptoms of rejection only manifest in the late
stages and usually as CHF (rarely arrhythmias). Due to
close surveillance, most rejection is picked up in
asymptomatic patients.
18. Complications - Rejection
• Hyperacute Rejection: Caused by preformed antibodies
against the donor in the recipient. It occurs within
minutes to hours and is uniformly fatal. PRA screening
is the best method in avoiding hyperacute rejection.
• Acute Cellular Rejection: Most common form and occurs
at least once in about 50% of cardiac transplant
recipients. Half of all episodes occur within the first 2 to
3 months. It is rarely observed beyond 12 months
unless immunosuppression has been decreased.
19. Complications - Rejection
• Vascular (Humoral) Rejection: not well defined.
– Characterized by immunoglobulin and complement in
the microvasculature with little cellular infiltrate.
– It is associated with positive cross match,
sensitization to OKT3, female sex, and younger
recipient age.
– It is more difficult to treat than acute cellular rejection,
is associated with hemodynamic instability, and
carries a worse prognosis.
20. Staging of Acute Rejection
• If acute rejection is found, histologic review of endomyocardial
biopsy is performed to determine the grade of rejection.
• Grade 0 — no evidence of cellular rejection
• Grade 1A — focal perivascular or interstitial infiltrate without
myocyte injury.
• Grade 1B — multifocal or diffuse sparse infiltrate without myocyte
injury.
• Grade 2 — single focus of dense infiltrate with myocyte injury.
• Grade 3A — multifocal dense infiltrates with myocyte injury.
• Grade 3B — diffuse, dense infiltrates with myocyte injury.
• Grade 4 — diffuse and extensive polymorphous infiltrate with
myocyte injury; may have hemorrhage, edema, and microvascular
injury.
21. Complications - Infection
• There are two peak infection periods after
transplantation:
• The first 30 days postoperatively: nosocomial infections
related to indwelling catheters and wound infections.
• Two to six months postoperatively: opportunistic
immunosuppresive-related infections.
• There is considerable overlap, however as fungal
infections and toxoplasmosis can be seen during the first
month.
• It is important to remember that immunosuppressed
transplant patients can develop severe infections in
unusual locations and remain afebrile.
23. Complications - Malignancy
• Transplant recipients have a 100-fold increase in the prevalence of
malignant tumors as compared with age-matched controls.
• Most common tumor is posttransplantation lymphoproliferative
disorder (PTLD), a type of non-Hodgkin’s lymphoma believed to be
related to EBV.
• The incidence is as high as 50% in EBV-negative recipients of EBV-positive
hearts.
• Treatment involves reduction of immunosuppressive agents, administration
of acyclovir, and chemotherapy for widespread disease.
• Skin cancer is common with azathioprine use.
• Any malignant tumor present before transplantation carries the risk
for growth once immunosuppresion is initiated because of the
negative effects on the function of T-cells.
24. Complications - Hypertension
• As many as 75% of transplant recipients treated with
cyclosporine or corticosteroids eventual develop
hypertension.
• Treatment is empiric with a diuretic added to a calcium
channel blocker, B-blocker, or Ace inhibitor.
• If either diltiazem or verapamil is used, the dosage of
cyclosporin should be reduced.
25. Complications - Dyslipidemia
• As many as 80% of transplant recipients eventually have
lipid abnormalities related to immunosuppression
medications.
• These dyslipidemias have been linked to accelerated
allograft arteriopathy.
• These disorders should be treated aggressively with
statins and fibrates to hopefully alleviate transplant
coronary vasculopathy.
26. Outcomes
• The survival rate according to the United States Scientific
Registry for Organ Transplantation reports the 1-year survival
rate to be 82% and 3 year survival rate to be 74%.
• The most common cause of mortality was cardiac allograft
vasculopathy.
• The UNOS data suggested some group differences with 3-
year survival rate for white persons 75%, Hispanics 71%, and
African Americans 68%
• Similar survival rates between men and women.
27. Outcomes
• Poor outcomes are associated with the following
risk factors:
• Age less than 1 year or approaching age 65.
• Ventilator use at time of transplant.
• Elevated pulmonary vascular resistance.
• Underlying pulmonary disease.
• Diffuse atherosclerotic vascular disease.
• Small body surface area.
• The need for inotropic support pre-transplant.
• Diabetes mellitus.
• Ischemic time longer than 4 hours of transplanted heart.
• Sarcoidosis or amyloidosis as reason for transplant (as they
may occur in the transplanted heart).