Cardiomyopathies
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Cardiomyopathy refers to diseases of the heart muscle. These diseases have many causes, signs and symptoms as well as treatments. In most cases, cardiomyopathy causes the heart muscle to become enlarged, thick or rigid. In rare instances, diseased heart muscle tissue is replaced with scar tissue.
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Cardiomyopathies
Cardiomyopathies are structural and functional abnormalities of the heart muscle that are not explained by coronary artery disease or abnormal loading. The main types are dilated, hypertrophic, restrictive, and arrhythmogenic right ventricular cardiomyopathy. Dilated cardiomyopathy is characterized by enlarged heart chambers and poor contraction. Causes include viruses, toxins, inherited factors, and metabolic issues. Treatment focuses on managing heart failure symptoms. Hypertrophic cardiomyopathy involves thickened heart muscle and outflow tract obstruction. Restrictive cardiomyopathy results in stiff heart muscles and high filling pressures. Arrhythmogenic right ventricular cardiomyopathy replaces the right ventricle with scar tissue.
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This document provides information about a seminar on aortic dissection presented by Monika Devi. It discusses the introduction, types, causes, symptoms, risk factors, diagnosis, treatment, complications and prevention of aortic dissection. The two main types are Type A, which involves the ascending aorta, and Type B, which only involves the descending aorta. Causes include high blood pressure, genetic conditions like Marfan syndrome, and traumatic injury. Symptoms can include chest pain and symptoms of a stroke. Treatment depends on the type but may involve medications to lower blood pressure or surgery to repair the tear in the aorta. Complications can include death, organ damage or stroke if not properly treated.
Constrictive pericarditis
- Constrictive pericarditis results from scarring and loss of elasticity of the pericardial sac, typically due to chronic inflammation and sometimes calcification. This causes the pericardium to thicken and lose its ability to expand and contract normally.
- The inelastic pericardium prevents normal filling of the heart chambers, especially in mid to late diastole. Inspiration does not decrease pressure in the left ventricle as it normally would due to the thickened pericardium isolating the heart.
- Diagnosis involves physical exam findings like elevated JVP, hepatomegaly, and Kussmaul's sign combined with echocardiography findings like sept
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Echocardiography in cardiac emergency
This document discusses the use of echocardiography in emergency clinical situations. It provides examples of common clinical indications for emergency echocardiography including hemodynamic instability, aortic dissection, acute coronary syndromes, and critically ill patients. The document outlines echocardiography algorithms and describes how to use echocardiography to diagnose conditions like cardiac tamponade, pulmonary embolism, hypotension, and penetrating chest trauma. Key findings are highlighted for various emergency scenarios.
Echo in pericardial diseases
This document provides an overview of echocardiography in pericardial diseases. It begins with an introduction to pericardial anatomy and pathophysiology. It then discusses various pericardial diseases that can be evaluated by echocardiography, including acute pericarditis, recurrent pericarditis, pericardial effusions, cardiac tamponade, and constrictive pericarditis. For each condition, it describes the echocardiographic findings and techniques used to evaluate the condition. It emphasizes that echocardiography is usually the initial imaging test of choice but that CT or CMR may be needed in some complex cases.
Echo assessment of cardiomyopathy pdf
This document discusses the use of echocardiography in evaluating various types of cardiomyopathies. It provides echocardiographic features of dilated cardiomyopathy including dilated chambers, normal wall thickness, and complications like mitral regurgitation. Hypertrophic cardiomyopathy features include unexplained hypertrophy, diastolic dysfunction, and left ventricular outflow tract obstruction. Restrictive cardiomyopathies show hypertrophy, enlarged atria, restricted filling, and elevated pressures. Left ventricular non-compaction and arrhythmogenic right ventricular cardiomyopathy also have distinct echocardiographic characteristics described.
Echo assessment of RV function
The document provides an overview of right ventricular assessment using echocardiography. It discusses normal RV anatomy, segmental nomenclature, and coronary supply. Key metrics for evaluating RV size, wall thickness, function, and pressures are outlined. Normal values and technical aspects of measuring RV dimensions, area/fractional area change, tricuspid annular plane systolic excursion, myocardial velocity, and diastolic function are summarized. Hemodynamic assessment of pulmonary pressures is also reviewed.
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Cardiomyopathies
Cardiomyopathies are structural and functional abnormalities of the heart muscle that are not explained by coronary artery disease or abnormal loading. The main types are dilated, hypertrophic, restrictive, and arrhythmogenic right ventricular cardiomyopathy. Dilated cardiomyopathy is characterized by enlarged heart chambers and poor contraction. Causes include viruses, toxins, inherited factors, and metabolic issues. Treatment focuses on managing heart failure symptoms. Hypertrophic cardiomyopathy involves thickened heart muscle and outflow tract obstruction. Restrictive cardiomyopathy results in stiff heart muscles and high filling pressures. Arrhythmogenic right ventricular cardiomyopathy replaces the right ventricle with scar tissue.
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Constrictive pericarditis
- Constrictive pericarditis results from scarring and loss of elasticity of the pericardial sac, typically due to chronic inflammation and sometimes calcification. This causes the pericardium to thicken and lose its ability to expand and contract normally.
- The inelastic pericardium prevents normal filling of the heart chambers, especially in mid to late diastole. Inspiration does not decrease pressure in the left ventricle as it normally would due to the thickened pericardium isolating the heart.
- Diagnosis involves physical exam findings like elevated JVP, hepatomegaly, and Kussmaul's sign combined with echocardiography findings like sept
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This document provides an overview of echocardiography in pericardial diseases. It begins with an introduction to pericardial anatomy and pathophysiology. It then discusses various pericardial diseases that can be evaluated by echocardiography, including acute pericarditis, recurrent pericarditis, pericardial effusions, cardiac tamponade, and constrictive pericarditis. For each condition, it describes the echocardiographic findings and techniques used to evaluate the condition. It emphasizes that echocardiography is usually the initial imaging test of choice but that CT or CMR may be needed in some complex cases.
Echo assessment of cardiomyopathy pdf
This document discusses the use of echocardiography in evaluating various types of cardiomyopathies. It provides echocardiographic features of dilated cardiomyopathy including dilated chambers, normal wall thickness, and complications like mitral regurgitation. Hypertrophic cardiomyopathy features include unexplained hypertrophy, diastolic dysfunction, and left ventricular outflow tract obstruction. Restrictive cardiomyopathies show hypertrophy, enlarged atria, restricted filling, and elevated pressures. Left ventricular non-compaction and arrhythmogenic right ventricular cardiomyopathy also have distinct echocardiographic characteristics described.
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The document provides an overview of right ventricular assessment using echocardiography. It discusses normal RV anatomy, segmental nomenclature, and coronary supply. Key metrics for evaluating RV size, wall thickness, function, and pressures are outlined. Normal values and technical aspects of measuring RV dimensions, area/fractional area change, tricuspid annular plane systolic excursion, myocardial velocity, and diastolic function are summarized. Hemodynamic assessment of pulmonary pressures is also reviewed.
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Stress echocardiography
Stress echocardiography enables evaluation of cardiac function at rest and during exercise or pharmacologic stress. It can detect wall motion abnormalities indicative of ischemia and assess valvular function, left ventricular outflow tract gradients, and pulmonary pressures. Exercise or pharmacologic agents like dobutamine are used to induce stress. Indications include evaluating known or suspected coronary artery disease, viability, and valvular diseases. The test is contraindicated in acute coronary syndromes or hemodynamically significant valvular stenosis. Imaging is performed at rest and peak stress to detect new or worsening wall motion abnormalities. Doppler can also evaluate hemodynamic changes with stress.
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Contrast echocardiography
Contrast echocardiography uses microbubble contrast agents to improve echocardiographic image quality and assess cardiac structures and function. Second-generation agents can pass through the lungs to opacify the left ventricle. Clinical applications include detecting shunts, assessing ventricular function and volumes, guiding procedures like alcohol ablation, and evaluating perfusion and viability. Optimal settings enhance microbubble signals, like harmonic imaging and intermittent pulses. Contrast is useful when images are suboptimal and helps evaluate many conditions.
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- Doppler echocardiography is used to detect left ventricular outflow tract obstruction at rest and with provocative maneuvers like Valsalva.
- Features like systolic anterior motion of the mitral valve indicate dynamic obstruction and need to be monitored with maneuvers.
- Differential diagnosis includes secondary causes of left ventricular hypertrophy from things like hypertension which present differently on echocard
Transesophageal echocardiography(TEE)
A transesophageal echocardiogram, or TEE, is an alternative way to perform an echocardiogram. A specialized probe containing an ultrasound transducer at its tip is passed into the patient's esophagus. This allows image and Doppler evaluation which can be recorded. It has several advantages and some disadvantages compared with a transthoracic echocardiogram.
Aortic dissection
- Aortic dissection involves separation of the aortic media from the adventitia, creating a true and false lumen. It can be acute or chronic.
- Risk factors include hypertension, connective tissue disorders, congenital issues, trauma, pregnancy, and certain drugs or syndromes.
- It is classified using the Stanford or De Bakey system and usually affects those 50-70 years old, though it can occur in younger people with conditions like Marfan syndrome. Left untreated, it has a high mortality rate within weeks.
Pericardial diseases
This document discusses pericardial diseases and various conditions that affect the pericardium. It begins by describing normal pericardial fluid volume and ventricular interdependence under normal conditions. It then discusses the history of using ultrasound to image the pericardium. Various pathological conditions are covered, including increased pericardial thickness in constrictive pericarditis, how intrapericardial pressure changes with fluid volume and pericardial stiffness, and signs of cardiac tamponade seen on echocardiogram like right atrial and ventricular collapse and IVC plethora. Finally, it describes the presentation of effusive-constrictive pericarditis.
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Hypertrophic Cardiomyopathy
Hypertrophic cardiomyopathy (HCM) is defined as hypertrophy of the myocardium more than 1.5 cm, without an identifiable cause . Other causes of left ventricular (LV) hypertrophy, such as long-standing hypertension, amyloidosis, and aortic stenosis must first be excluded before HCM can be diagnosed. As our understanding of the genetics of HCM continues to progress, the diagnosis of HCM will continue to incorporate information obtained from genetic testing, while also continuing to rely on transthoracic echocardiography (TTE) for the assessment of the phenotypic manifestations and the overall clinical severity of the disease.
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Dilated cardiomyopathy
Dilated cardiomyopathy is defined as dilatation and impaired contraction of the left ventricle not caused by ischemic or valvular heart disease. The document discusses the epidemiology, etiology, pathology, genetics, clinical features, diagnosis, and management of idiopathic dilated cardiomyopathy. Key points include:
- The annual incidence is 5-8 per 100,000 people with increased risk in males, blacks, and those with hypertension or chronic beta-agonist use.
- Causes include genetic mutations, viral infections, autoimmune diseases, and drugs. Pathology shows dilatation, myocyte hypertrophy and death, and extracellular matrix remodeling.
- Diagnosis involves ECG
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3) Definitions of aortic aneurysm and classifications based on location and shape. Thoracic aortic aneurysms involve the ascending aorta while abdominal aortic aneurysms are infrarenal.
4) Screening recommendations, diagnosis using imaging like ultrasound, CT and echocardiography, and considerations for open surgical repair
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The document discusses constrictive pericarditis, providing details on:
1) The pathology of constrictive pericarditis which involves thickening and scarring of the pericardium leading to loss of elasticity.
2) The pathophysiology of constrictive pericarditis where the inelastic pericardium constrains cardiac filling and prevents adaptation to volume changes.
3) Key diagnostic features of constrictive pericarditis seen on echocardiogram include septal bounce, rapid early diastolic mitral inflow, and increased mitral annular velocities that rise with inspiration.
Echocardiographic evaluation of mitral regurgitation
This document discusses the echocardiographic evaluation of mitral regurgitation. It begins by listing common causes of MR such as mitral valve prolapse, rheumatic heart disease, and cardiomyopathy. It then outlines the indications for echocardiography in diagnosing and assessing the severity of MR. Key aspects of the echocardiogram are described such as the Carpentier classification of valve abnormalities, Doppler methods for grading severity including jet area and vena contracta width, and structural parameters like left atrial and ventricular size. Quantitative measurements using the PISA method to calculate regurgitant volume and orifice area are also summarized.
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Stress echocardiography
Stress echocardiography enables evaluation of cardiac function at rest and during exercise or pharmacologic stress. It can detect wall motion abnormalities indicative of ischemia and assess valvular function, left ventricular outflow tract gradients, and pulmonary pressures. Exercise or pharmacologic agents like dobutamine are used to induce stress. Indications include evaluating known or suspected coronary artery disease, viability, and valvular diseases. The test is contraindicated in acute coronary syndromes or hemodynamically significant valvular stenosis. Imaging is performed at rest and peak stress to detect new or worsening wall motion abnormalities. Doppler can also evaluate hemodynamic changes with stress.
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Echo in hypertrophic obstructive cardiomyopathies
This document discusses the echocardiographic evaluation of hypertrophic obstructive cardiomyopathy (HCM). Key points include:
- Echocardiography is used to diagnose HCM based on unexplained left ventricular hypertrophy and rule out other causes. Asymmetric septal hypertrophy is a characteristic pattern.
- Doppler echocardiography is used to detect left ventricular outflow tract obstruction at rest and with provocative maneuvers like Valsalva.
- Features like systolic anterior motion of the mitral valve indicate dynamic obstruction and need to be monitored with maneuvers.
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Transesophageal echocardiography(TEE)
A transesophageal echocardiogram, or TEE, is an alternative way to perform an echocardiogram. A specialized probe containing an ultrasound transducer at its tip is passed into the patient's esophagus. This allows image and Doppler evaluation which can be recorded. It has several advantages and some disadvantages compared with a transthoracic echocardiogram.
Aortic dissection
- Aortic dissection involves separation of the aortic media from the adventitia, creating a true and false lumen. It can be acute or chronic.
- Risk factors include hypertension, connective tissue disorders, congenital issues, trauma, pregnancy, and certain drugs or syndromes.
- It is classified using the Stanford or De Bakey system and usually affects those 50-70 years old, though it can occur in younger people with conditions like Marfan syndrome. Left untreated, it has a high mortality rate within weeks.
Pericardial diseases
This document discusses pericardial diseases and various conditions that affect the pericardium. It begins by describing normal pericardial fluid volume and ventricular interdependence under normal conditions. It then discusses the history of using ultrasound to image the pericardium. Various pathological conditions are covered, including increased pericardial thickness in constrictive pericarditis, how intrapericardial pressure changes with fluid volume and pericardial stiffness, and signs of cardiac tamponade seen on echocardiogram like right atrial and ventricular collapse and IVC plethora. Finally, it describes the presentation of effusive-constrictive pericarditis.
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Hypertrophic Cardiomyopathy
Hypertrophic cardiomyopathy (HCM) is defined as hypertrophy of the myocardium more than 1.5 cm, without an identifiable cause . Other causes of left ventricular (LV) hypertrophy, such as long-standing hypertension, amyloidosis, and aortic stenosis must first be excluded before HCM can be diagnosed. As our understanding of the genetics of HCM continues to progress, the diagnosis of HCM will continue to incorporate information obtained from genetic testing, while also continuing to rely on transthoracic echocardiography (TTE) for the assessment of the phenotypic manifestations and the overall clinical severity of the disease.
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Long QT Syndrome
The document discusses Long QT Syndrome (LQTS), an inherited heart condition characterized by an abnormally prolonged QT interval on electrocardiograms. It describes the causes and types of LQTS, including LQT1, LQT2 and LQT3, which are associated with different genetic mutations and ECG patterns. The main symptoms of LQTS are syncope and cardiac arrest, typically in children or teenagers. Diagnosis involves measuring the QT interval and identifying risk factors. Treatment focuses on beta-blockers, lifestyle changes and implantable cardioverter-defibrillators for high-risk patients.
Dilated cardiomyopathy
Dilated cardiomyopathy is defined as dilatation and impaired contraction of the left ventricle not caused by ischemic or valvular heart disease. The document discusses the epidemiology, etiology, pathology, genetics, clinical features, diagnosis, and management of idiopathic dilated cardiomyopathy. Key points include:
- The annual incidence is 5-8 per 100,000 people with increased risk in males, blacks, and those with hypertension or chronic beta-agonist use.
- Causes include genetic mutations, viral infections, autoimmune diseases, and drugs. Pathology shows dilatation, myocyte hypertrophy and death, and extracellular matrix remodeling.
- Diagnosis involves ECG
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2) Factors that cause the aortic wall to stiffen with age like increases in collagen and calcification of elastic fibers.
3) Definitions of aortic aneurysm and classifications based on location and shape. Thoracic aortic aneurysms involve the ascending aorta while abdominal aortic aneurysms are infrarenal.
4) Screening recommendations, diagnosis using imaging like ultrasound, CT and echocardiography, and considerations for open surgical repair
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The document discusses constrictive pericarditis, providing details on:
1) The pathology of constrictive pericarditis which involves thickening and scarring of the pericardium leading to loss of elasticity.
2) The pathophysiology of constrictive pericarditis where the inelastic pericardium constrains cardiac filling and prevents adaptation to volume changes.
3) Key diagnostic features of constrictive pericarditis seen on echocardiogram include septal bounce, rapid early diastolic mitral inflow, and increased mitral annular velocities that rise with inspiration.
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Presentazione realizzata dalla dr.ssa Daniela Miani, cardiologa presso l'AOU S. Maria della Misericordia di Udine" per il corso "La Malattia di Fabry: conoscere per riconoscere", Udine, 17 giugno 2015.
CARDIOMYOPATHY.pptx
Cardiomyopathy is a group of diseases that affect the heart muscle and electrical functioning. There are several types including dilated, hypertrophic, restrictive, and arrhythmogenic right ventricular cardiomyopathy. Dilated cardiomyopathy is the most common type in Africa, accounting for 10-17% of cardiac conditions. Risk factors include family history, diabetes, hypertension, infections, and alcoholism. The pathophysiology varies by type, such as dilated cardiomyopathy causing ventricular enlargement and reduced systolic function over time. Clinical features depend on the type, such as fatigue and swelling for dilated cardiomyopathy. Diagnosis involves ECG, echocardiogram, cardiac MRI, and biopsy. Complications include heart failure,
cardiomyopathy2-230605222918-365b12c0.pptx
Cardiomyopathy refers to diseases of the heart muscle. There are several types including dilated cardiomyopathy, hypertrophic cardiomyopathy, and restrictive cardiomyopathy. Dilated cardiomyopathy is characterized by enlarged heart chambers and poor systolic function, while hypertrophic cardiomyopathy involves thickened heart muscle walls, often asymmetrically involving the septum. Restrictive cardiomyopathy causes stiffening of the heart muscle resulting in diastolic dysfunction. Echocardiography and cardiac MRI are important diagnostic tools to classify and characterize cardiomyopathies. Treatment involves managing symptoms, reducing risk of complications like arrhythmias, and potentially treating underlying causes.
CARDIACMYOPATHY.pptx
An acquired or inherited disease of the heart muscle which makes it difficult for the heart to pump blood to other parts of the body. Can be dangerous or life threatening if untreated
DISEASES OF THE MYOCARDIUM (1).pptx
This document provides information on various types of cardiomyopathy. It defines cardiomyopathy as diseases that primarily affect the heart muscle and are not caused by other structural or vascular issues. The main types discussed are dilated cardiomyopathy, hypertrophic cardiomyopathy, restrictive cardiomyopathy, and arrhythmogenic right ventricular cardiomyopathy. Causes, signs and symptoms, diagnostic criteria, classification systems, treatment approaches, and prognosis are described for each type.
Cardiomyopathy
The American Heart Association (AHA) expert consensus panel proposed definition of cardiomyopathies is as follows: “Cardiomyopathies are a heterogeneous group of diseases of
the myocardium associated with mechanical and/or electrical dysfunction, which usually (but not invariably) exhibit inappropriate ventricular hypertrophy or dilatation, due to a variety of etiologies that frequently are genetic. Cardiomyopathies are either confined to the heart or are
part of generalized systemic disorders, and often lead to cardiovascular death or progressive heart failure–related disability.”
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Nursing management of a patient with cardiomyopathy
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A 57-year-old woman was admitted to the hospital with chest pain. Electrocardiograms and troponin levels were normal. Intravascular ultrasound was performed before placing a stent in the left main coronary artery and left anterior descending artery to treat a blockage. The minimum lumen area increased to 4.24mm x 4.13mm after stenting.
Intensive care of congenital heart disease.pptx
Congenital defects can put a strain on the heart, causing it to work harder. To stop your heart from getting weaker with this extra work, your doctor may try to treat you with medications. They are aimed at easing the burden on the heart muscle. You need to control your blood pressure if you have any type of heart problem.
Management of Hypetension.pptx
Changing your lifestyle can help control and manage high blood pressure. Your health care provider may recommend that you make lifestyle changes including:
Eating a heart-healthy diet with less salt
Getting regular physical activity
Maintaining a healthy weight or losing weight
Limiting alcohol
Not smoking
Getting 7 to 9 hours of sleep daily
CRISPR and cardiovascular diseases.pdf
CRISPR technologies have progressed by leaps and bounds over the past decade, not only having a transformative effect on
biomedical research but also yielding new therapies that are poised to enter the clinic. In this review, I give an overview of (i)
the various CRISPR DNA-editing technologies, including standard nuclease gene editing, base editing, prime editing, and epigenome editing, (ii) their impact on cardiovascular basic science research, including animal models, human pluripotent stem
cell models, and functional screens, and (iii) emerging therapeutic applications for patients with cardiovascular diseases, focusing on the examples of Hypercholesterolemia, transthyretin amyloidosis, and Duchenne muscular dystrophy.
Pacemaker Pocket Infection After Splenectomy
This case report describes a patient who underwent seven operations over one year to treat recurrent pacemaker pocket infections. The patient had undergone a splenectomy seven years prior due to a splenic rupture from a traffic accident. This left the patient immunocompromised and at higher risk for infection. The patient later required a pacemaker implantation for complete heart block. The pacemaker pocket developed repeated infections, likely due to the patient's asplenic state impairing immunity. The infections were difficult to treat due to multiple complicating factors, including an abandoned pacemaker lead and reuse of a sterilized pacemaker. This highlights the influence of patient factors like asplenia on procedural outcomes like pacemaker implantation.
Piccolo Duct Occluder.pdf
Transcatheter closure of patent ductus arteriosus (PDA) is feasible in low-birth-weight infants. A female baby was born prematurely with a birth weight of 924 g. She had a PDA measuring 3.7 mm. She was dependent on positive pressure ventilation for congestive heart failure in addition to the heart failure medications. She could not be discharged from the hospital even after 79 days of birth, and even though her weight reached 1.9 kg in the neonatal intensive care unit. We attempted to plug the PDA using an Amplatzer Piccolo Occluder, but the device failed to anchor. Then, the PDA was plugged using a 4-6 Amplatzer Duct Occluder using a 6-Fr sheath which was challenging.
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Accidental misplacement of the limb lead electrodes is a common cause of ECG abnormality and may simulate pathology such as ectopic atrial rhythm, chamber enlargement or myocardial ischaemia and infarction
A Case of Device Closure of an Eccentric Atrial Septal Defect Using a Large D...
Device closure of an eccentric atrial septal defect can be challenging and needs technical modifications to avoid unnecessary complications. Here, we present a case of a 45-year-old woman who underwent device closure of an eccentric defect with a large device. The patient developed pericardial effusion and left-sided pleural effusion due to injury to the junction of right atrium and superior vena cava because of the malalignment of the delivery sheath and left atrial disc before the device was pulled across the eccentric defect despite releasing the left atrial disc in the left atrium in place of the left pulmonary vein. These two serious complications were managed conservatively with close monitoring of the case during and after the procedure.
Arrythmia-IV.pptx
1) Bradycardia can be caused by abnormalities in the conduction system or autonomic nervous system. The conduction system includes the sinus node, AV node, His-Purkinje system and different types of heart block can occur when impulses are blocked at different locations.
2) There are three main types of AV block - first degree, second degree (Mobitz types I and II), and third degree. High grade AV block involves blockage of two or more consecutive impulses.
3) Third degree or complete heart block results in complete dissociation between the atria and ventricles with independent pacemakers. It can occur at the AV node or below in the His-Purkin
Arrythmia-III.pptx
1. Bradycardia is defined as a resting heart rate below 50 beats per minute. It can be physiological or pathological.
2. Sinus bradycardia originates from the sinus node and has a normal P wave morphology with a prolonged PR interval. It can be caused by increased vagal tone, medications, or hypothyroidism.
3. Sick sinus syndrome is characterized by sinus bradycardia, sinus arrest, or combinations of sinus node and AV node dysfunction. It may involve intermittent bradycardia and tachycardia. Pacemaker implantation is usually treatment.
Arrythmia-II.pptx
This document discusses ventricular arrhythmias including their origins, characteristics, classifications, and causes. It provides details on:
- The sites of origin for supraventricular tachycardia (SVT) and ventricular arrhythmias.
- Characteristics that distinguish SVT from ventricular arrhythmias such as QRS width.
- Classifications of ventricular arrhythmias including premature ventricular complexes, ventricular tachycardia, fibrillation, and electrical storm.
- Causes and characteristics of different types of ventricular tachycardia such as monomorphic VT, polymorphic VT, and torsades de pointes.
- Investigations and treatments for ventricular arrhythmias including cardiac imaging
Arrythmia-I.pptx
This document provides information on supraventricular tachycardia (SVT), including:
- The anatomy and conduction system of the heart that is relevant to SVT.
- The mechanisms that can cause cardiac arrhythmias, including disorders of impulse formation, conduction, and combinations of the two.
- Characteristics used to classify different types of arrhythmias based on rate, rhythm, site of origin, and QRS morphology.
- Specific types of SVT like atrial fibrillation, AV nodal reentry tachycardia, and accessory pathway mediated tachycardias.
- Methods for diagnosing and treating SVT such as electrophysiology studies, catheter ablation
Trio of Rheumatic Mitral Stenosis, Right Posterior Septal Accessory Pathway a...
A 57-year-old male presented with recurrent palpitations. He was diagnosed with rheumatic mitral stenosis, right posterior septal accessory pathway and atrial flutter. An electrophysiological study after percutaneous balloon mitral valvotomy showed that the palpitations were due to atrial flutter with right bundle branch aberrancy. The right posterior septal pathway was a bystander because it had a higher refractory period than the atrioventricular node.
Anticoagulation therapy during pregnancy
This document discusses anticoagulation therapy options during pregnancy for different cardiac conditions. It notes that vitamin K antagonists (VKAs) should be avoided in the first trimester due to risk of embryopathy but can be used in the second and third trimester with risks of 0.7-2% of foetopathy. Unfractionated heparin does not cross the placenta but its use throughout pregnancy is not recommended due to risk of foetopathy. Low molecular weight heparin is considered the safest option for anticoagulation in weeks 6-12 when risk of embryopathy is a concern and has not been associated with risk of foetopathy. Fondaparinux use should be limited
Coronary guidewire
Percutaneous balloon dilatation, first described by
Andreas Gruentzig in 1979, was initially performed
without the use of guidewires.1 The prototype
balloon catheter was developed as a double lumen
catheter (one lumen for pressure monitoring or
distal perfusion, the other lumen for balloon inflation/deflation) with a short fixed and atraumatic
guidewire at the tip. Indeed, initially the technique
involved advancing a rather rigid balloon catheter
freely without much torque control into a coronary
artery. Bends, tortuosities, angulations, bifurcations,
and eccentric lesions could hardly, if at all, be negotiated, resulting in a rather frustrating low procedural success rate whenever the initial limited
indications (proximal, short, concentric, noncalcified) were negated.2 Luck was almost as
important as expertise, not only for the operator,
but also for the patient. It is to the merit of
Simpson who, in 1982, introduced the novelty of
advancing the balloon catheter over a removable
guidewire, which had first been advanced in the
target vessel.3 This major technical improvement
resulted overnight in a notable increase in the procedural success rate. Guidewires have since evolved
into very sophisticated devices.
Intracoronary optical coherence tomography
Optical coherence tomography-guided algorithm for percutaneous coronary intervention. Vessel diameter should be assessed using the external elastic lamina (EEL)-EEL diameter at the reference segments, and rounded down to select interventional devices (balloons, stents). If the EEL cannot be identified, luminal measures are used and rounded up to 0.5 mm larger for selection of the devices. Optical coherence tomography (OCT)-guided optimisation strategies post stent implantation per EEL-based diameter measurement and per lumen-based diameter measurement are shown. For instance, if the distal EEL-EEL diameter measures 3.2 mm×3.1 mm (i.e., the mean EEL-based diameter is 3.15 mm), this number is rounded down to the next available stent size and post-dilation balloon to be used at the distal segment. Thus, a 3.0 mm stent and non-compliant balloon diameter is selected. If the proximal EEL cannot be visualised, the mean lumen diameter should be used for device sizing. For instance, if the mean proximal lumen diameter measures 3.4 mm, this number is rounded up to the next available balloon diameter (within up to 0.5 mm larger) for post-dilation. MLA: minimal lumen area; MSA: minimal stent area;NC: non-compliant
Brugada syndrome
Brugada syndrome (BrS) is an inherited cardiac disorder,
characterised by a typical ECG pattern and an increased
risk of arrhythmias and sudden cardiac death (SCD).
BrS is a challenging entity, in regard to diagnosis as
well as arrhythmia risk prediction and management.
Nowadays, asymptomatic patients represent the majority
of newly diagnosed patients with BrS, and its incidence
is expected to rise due to (genetic) family screening.
Progress in our understanding of the genetic and
molecular pathophysiology is limited by the absence
of a true gold standard, with consensus on its clinical
definition changing over time. Nevertheless, novel
insights continue to arise from detailed and in-depth
studies, including the complex genetic and molecular
basis. This includes the increasingly recognised
relevance of an underlying structural substrate. Risk
stratification in patients with BrS remains challenging,
particularly in those who are asymptomatic, but recent
studies have demonstrated the potential usefulness
of risk scores to identify patients at high risk of
arrhythmia and SCD. Development and validation of
a model that incorporates clinical and genetic factors,
comorbidities, age and gender, and environmental
aspects may facilitate improved prediction of disease
expressivity and arrhythmia/SCD risk, and potentially
guide patient management and therapy. This review
provides an update of the diagnosis, pathophysiology
and management of BrS, and discusses its future
perspectives.
A roadmap for the human development
The Human Developmental Cell Atlas (HDCA) initiative, which is part of the Human Cell Atlas, aims to create a comprehensive reference map of cells during development. This will be critical to understanding normal organogenesis, the effect of mutations, environmental factors and infectious agents on human development, congenital and childhood disorders, and the cellular basis of ageing, cancer and regenerative medicine. Here we outline the HDCA initiative and the challenges of mapping and modelling human development using state-of-the-art technologies to create a reference atlas across gestation. Similar to the Human Genome Project, the HDCA will integrate the output from a growing community of scientists who are mapping human development into a unified atlas. We describe the early milestones that have been achieved and the use of human stem-cell-derived cultures, organoids and animal models to inform the HDCA, especially for prenatal tissues that are hard to acquire. Finally, we provide a roadmap towards a complete atlas of human development.
Intra aortic balloon pump
The treatment of patients with advanced acute heart failure is still challenging.
Intra-aortic balloon pump (IABP) has widely been used in the management of
patients with cardiogenic shock. However, according to international guidelines, its
routinary use in patients with cardiogenic shock is not recommended. This recommendation is derived from the results of the IABP-SHOCK II trial, which demonstrated
that IABP does not reduce all-cause mortality in patients with acute myocardial infarction and cardiogenic shock. The present position paper, released by the Italian
Association of Hospital Cardiologists, reviews the available data derived from clinical
studies. It also provides practical recommendations for the optimal use of IABP in
the treatment of cardiogenic shock and advanced acute heart failure.
Left ventricular false tendons
Left ventricular false tendons (LVFTs) are fibromuscular
structures, connecting the left ventricular
free wall or papillary muscle and the ventricular
septum.
There is some discussion about safety issues during
intense exercise in athletes with LVFTs, as these
bands have been associated with ventricular arrhythmias
and abnormal cardiac remodelling. However,
presence of LVFTs appears to be much more common
than previously noted as imaging techniques
have improved and the association between LVFTs
and abnormal remodelling could very well be explained
by better visibility in a dilated left ventricular
lumen.
Although LVFTsmay result in electrocardiographic abnormalities
and could form a substrate for ventricular
arrhythmias, it should be considered as a normal
anatomic variant. Persons with LVFTs do not appear
to have increased risk for ventricular arrhythmias or
sudden cardiac death.
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Cardiomyopathies
- 2. 1995 WHO/International Society and Federation of Cardiology (ISFC) Task Force on the Definition • All diseases affecting heart muscle and to take into consideration etiology • Dilated cardiomyopathy (DCM) • Hypertrophic cardiomyopathy (HCM) • Restrictive cardiomyopathy (RCM) • Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) • Unclassified cardiomyopathies
- 3. The MOGE(S) classification - 2013 • The morphofunctional (M) notation indicates a descriptive phenotypic diagnosis (eg, MD = dilated cardiomyopathy) • The organ involvement (O) notation • The genetic or familial inheritance (G) • The etiological annotation (E) provides description of the specific cause • functional status (S) -[NYHA] functional class
- 4. BEGNING TO END • Phenome to Genome but not always
- 5. Heart failure vs NYHA FC
- 6. Athlete's heart: A close differential diagnosis • LVH is generally symmetric and wall thickness is ≤12 mm; however, in some athletes, LVH reaches 14 to 16 mm • Reliance on LV wall thickness alone may be problematic and diagnostic evaluations of athletes with suspected cardiovascular disease should include a family history, 12-lead electrocardiogram, and echocardiographic assessment of the distinguishing features of athlete's heart versus HCM.
- 7. Etiologic classification of cardiomyopathy • INFECTIVE • GENETIC • METABLIC • FAMILIAL STORAGE DISORDERS • NUTRIONAL • OTHER • Hematologic/oncologic • Deposits • Heredofamilial neurologic and neuromuscular diseases • Endomyocardial diseases • Inflammatory • Connective tissue diseases • Granulomatous • Other inflammation
- 8. How cardiovascular system works in heart failure ?
- 12. FAMILIAL CMP
- 13. NON FAMILIAL CMP
- 14. DCMP
- 15. DCM
- 16. Genes of DCM
- 18. HCM VS NORMAL • Myocyte disarray with an irregular arrangement of abnormal shaped myocytes that contain bizarre nuclei and surrounding areas of increased connective tissue.
- 20. RCM • The echocardiographic features typical of an idiopathic restrictive cardiomyopathy include a nondilated, nonhypertrophied ventricle with dilated atria
- 21. Doppler in flow pattern in RCM • The pulse wave Doppler in a patient with an idiopathic restrictive cardiomyopathy demonstrates an increased E/A ratio (2.4), with shortened deceleration time (DT = 128 milliseconds).
- 22. ARVD • transmural fatty replacement of the right ventricular free wall and the translucent infundibulum. • the replacement of the myocardium by fat is largely confined to the right ventricle (arrow) and substantially spares the interventricular septum as well as the left ventricular free wall
- 23. NON COMPACTION • Compacted epicardial layer and noncompacted endocardial layer with marked hypertrabeculation and deep recesses.
- 24. DIAGNSOIS OF CMP • Clinical • ECG • CHEST X-RAY • ECHO • CMRI • Genetic
- 25. Symptomatic Treatment • SYMPTOMATIC :PRELOAD ,AFTERLOAD,HR,SV,BLOOD PRESSURE
- 26. Treatment towards prolonging life • Beta blocker • ACEI/ARB • ARNI • NITRATE+VASODILATOR • TREATMENT OF CAUSE
- 27. THANK YOU It doesn't matter The incognito from where The world does appreciate Anyone who does care