CARDIOLOGY SPOTTER 3.pptx
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A 57-year-old male with a history of coronary artery disease and prior stent placement presented for a routine follow-up. His clinical exam and echocardiogram were normal. His ECG showed an abnormality, with possible diagnoses including myocardial infarction, early repolarization, left ventricular hypertrophy, and others. However, pulse tapping on the ECG electrodes was identified as the likely cause of the changes seen, known as pulse tapping artifact. This phenomenon can occur due to the tapping of arterial pulses on electrodes and has been reported before in patients after percutaneous coronary interventions.
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- The ion channel mutations that cause each condition, such as loss of function mutations in SCN5A causing Brugada syndrome and gain of function mutations in SCN5A causing long QT syndrome type 3.
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The document discusses the effects of sympathetic and parasympathetic stimulation on the heart. Sympathetic stimulation increases heart rate, conduction velocity, contractility, and excitability of the atrioventricular junction. Parasympathetic stimulation decreases heart rate, conduction velocity, and contractility by increasing membrane permeability to potassium ions. The parasympathetic nervous system, via the vagus nerves, innervates the sinoatrial node and atrioventricular junctional fibers, while the sympathetic nervous system innervates all parts of the heart.
FREEDOM Trial.pptx
The document summarizes several key trials comparing outcomes of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) for revascularization of multivessel coronary artery disease and left main coronary artery disease. The FREEDOM trial found CABG superior to PCI for reducing mortality, myocardial infarction, and stroke at 5 years in patients with diabetes and multivessel disease. The NOBLE trial also found CABG superior to PCI for reducing major adverse cardiac events at 5 years in patients with left main disease. Subsequent EXCEL and PRECOMBAT trials found no difference in longer term outcomes between PCI and CABG for left main disease depending on syntax score and lesion location. Guidelines now support consideration of PCI
Presentation 4123.pptx
The document summarizes findings from the SYNTAX trial which compared percutaneous coronary intervention (PCI) with drug-eluting stents to coronary artery bypass grafting (CABG) in patients with complex coronary artery disease involving three vessels or the left main coronary artery. The trial found that rates of death, stroke, or heart attack were similar between PCI and CABG at 12 months. However, CABG was superior to PCI in reducing the risk of major adverse cardiac or cerebrovascular events. The rate of repeat revascularization was significantly higher in the PCI group. Among patients with the most complex disease, as indicated by high SYNTAX scores, the event rate at 12 months was significantly higher in the PCI group compared to CAB
BACKGROUND 1234.pptx
The trial used an "all-comers" design and excluded patients with previous interventions or acute myocardial infarction without consulting local doctors. Patients assigned to one treatment but receiving another or neither were analyzed based on their assigned treatment. The study also included registries of patients not eligible for randomization due to clinical characteristics, including those not suitable for CABG due to comorbidities or no graft material or for PCI due to complex anatomy or untreated chronic total occlusions. The primary endpoint was a composite of death, stroke, heart attack, or revascularization over 12 months as adjudicated by an independent committee.
Background 123.pptx
The SYNTAX trial compared percutaneous coronary intervention (PCI) using drug-eluting stents to coronary-artery bypass grafting (CABG) for treating patients with previously untreated three-vessel or left main coronary artery disease. It was a prospective, international clinical trial involving over 1,800 patients across 85 sites. The primary outcome was a composite of death, stroke, or myocardial infarction within 5 years. Patients were assessed using the SYNTAX score to evaluate disease complexity. The trial found CABG resulted in better long-term outcomes than PCI for patients with more complex multi-vessel coronary artery disease.
Presentation334545.pptx
A CT pulmonary angiogram was ordered due to elevated creatinine and potassium levels. The lung perfusion scan found multiple perfusion defects. A follow up normal lung perfusion scan showed resolution of the previously detected defects.
CARDIOLOGY SPOTTER 1111111.pptx
A 70-year-old man presented with right sided chest pain and dyspnea for 2 weeks. An ECG showed no significant ST or T wave changes. He was found to have significant right ventricular dysfunction and pulmonary oligemia.
answer.pptx
This document discusses acute pulmonary embolism, including its clinical features, diagnosis, and management. It presents pulmonary embolism as a blockage in the lungs caused by blood clots that can be life-threatening. Diagnosis involves tests like a CT scan or lung scan to detect clots, while treatment focuses on anticoagulant drugs to prevent further clotting as well as other procedures in severe cases. Managing the condition requires identifying risk factors, diagnosing properly, and providing appropriate treatment to resolve symptoms and reduce long-term complications.
qqq.pptx
Heart failure with preserved ejection fraction (HFpEF) is a condition where the heart muscle stiffens, making it difficult to fill and pump blood efficiently. While medications like candesartan and empagliflozin can help reduce hospitalizations for HFpEF by improving symptoms, other drugs like irbesartan and spironolactone have not shown benefits. Management of HFpEF focuses on controlling blood pressure, reducing fluid retention, and treating the underlying causes.
SYNTAX TRIAL.pptx
- The SYNTAX trial compared outcomes of percutaneous coronary intervention (PCI) using drug-eluting stents versus coronary artery bypass grafting (CABG) for treating three-vessel or left main coronary artery disease.
- For the primary endpoint of major adverse cardiac and cerebrovascular events at 12 months, CABG was superior to PCI. However, outcomes were similar between treatments for patients with less complex disease as measured by low or intermediate SYNTAX scores.
- For patients with more complex disease and high SYNTAX scores, CABG had significantly fewer primary events than PCI at 12 months.
JVP AND WAVEFORMS.ppt
This document provides an overview of jugular venous pressure and waveforms. It discusses the anatomy of the jugular veins and the technique for measuring jugular venous pressure at the bedside. Normal jugular venous waveform patterns are described including the a, x, c, x', v, and y waves. Abnormal waveform patterns are also outlined that may indicate conditions like tricuspid regurgitation, constrictive pericarditis, pulmonary hypertension, and cardiac tamponade. The document concludes with how jugular venous waveforms can help identify various cardiac arrhythmias.
SUDDEN CARDIAC DEATH.pptx
This document provides an overview of sudden cardiac death, including its definition, epidemiology, risk factors, etiologies, clinical features, management, and prevention. Some key points include:
- Sudden cardiac death is defined as natural death from cardiac causes within 1 hour of symptom onset. It accounts for about 50% of cardiovascular deaths.
- Risk factors include increasing age, male sex, coronary heart disease, smoking, elevated cholesterol, emotional stress, depression, low socioeconomic status, and left ventricular dysfunction.
- Transient factors like ischemia, electrolyte abnormalities, drugs, and autonomic influences can trigger lethal arrhythmias in those with underlying structural heart issues. Antiarrhythmic drugs in particular carry
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Cell Therapy Expansion and Challenges in Autoimmune Disease
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In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
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CARDIOLOGY SPOTTER 3.pptx
- 1. SPOTTER DR VARSHITH K DrNB CARDIOLOGY RESIDENT ASTER MIMS
- 2. • 57yr MALE • CAD • S/P PTCA TO LAD & LCX - 2YEARS BACK • COMES FOR ROUTINE FOLLOW UP • CLINICAL EXAMINATION • ECHO NORMAL
- 3. ECG
- 4. WHAT IS THE DIAGNOSIS ?
- 5. 2ND ECG
- 6. ARTERIAL PULSE TAPPING ARTIFACT
- 7. ST SEGMENT DIFFERENTIAL DIAGNOSIS • MYOCARDIAL INFARCTION • EARLY REPOLARIZATION • LEFT VENTRICULAR HYPERTROPHY • LEFT BUNDDLE BRANCH BLOCK • ACUTE PERICARDITIS • HYPERKALEMIA • BRUGADA SYNDROME • PULMONARY EMBOLISM • ARTIFACT
- 8. PULSE TAPPING ARTIFACT • THIS PHENOMENON OCCURS DUE TO TAPPING OF ARTERIAL PULSE ON ECG ELECTRODES • 1st reported by OZHAN et al in a post percutaneous coronary intervention patient-----> attributed as silient ISCHEMIA. (2005) • ASLANGER and BJERREGAARD described the mechanism of ECG changes. (2011)
- 9. • Arteriovenous fistula • Hyperdynamic circulation states • Anemia • Thyrotoxicosis • Obesity • Beriberi • Sepsis • Cirrhosis
- 10. THANK YOU