The document discusses various types of cardiomyopathies including dilated cardiomyopathy (DCM), hypertrophic cardiomyopathy (HCM), and restrictive cardiomyopathy (RCM). It provides details on the definition, causes, symptoms, diagnostic criteria and treatment options for each type. DCM is the most common cardiomyopathy, usually caused by idiopathic or viral factors, leading to ventricular dilation and dysfunction. HCM is a genetic disease causing left ventricular hypertrophy that can lead to obstruction of blood flow. RCM involves restrictive filling of the ventricles with normal wall thickness.
This document discusses strain and strain rate imaging techniques used to quantify regional myocardial function. It describes various methods to measure strain, including tissue Doppler, 2D speckle tracking, and cardiac MRI. It outlines normal values and patterns of strain in healthy individuals and how strain is altered in various cardiac diseases, such as coronary artery disease, heart failure, cardiomyopathies, and congenital heart disease. Strain imaging can identify myocardial scar, viability, dysfunction, and response to treatments.
A Speckle Tracking Echocardiographic Study for Correlation Between Global Lef...Premier Publishers
Global longitudinal strain (GLS) measured by Two-dimensional speckle tracking imaging (2D-STI) has been shown to be useful for assessing subtle changes in the left ventricular function with increasing severity of aortic stenosis (AS) in patients with preserved left ventricular ejection fraction (LVEF). To evaluate the relation between the severity of valve stenosis and GLS measured by 2D-STI in AS patients with normal LVEF. We studied 65 subjects (age, 53_75 years) with normal LVEF (≥50%) but without overt coronary artery disease. Patients were stratified into four groups (control, mild, moderate and severe AS), the clinical characteristics and echocardiographic findings were compared among the groups. Using dedicated software, we measured GLS in the apical four, two and three -chamber views. LVEF was not significantly different among the four groups. However, GLS showed significant differences among the four groups (controls;18.9±1.4, mild: 18.8±1.3, moderate: 15.35±1.6and severe: 12.42±1.4, ANOVA P = 0.001), GLS was significantly correlated with AVA, mean PG and LV mass index. Despite unchanged LVEF, GLS gradually decreased as severity of AS increases. GLS measured by 2D-STI is useful to assess subtle changes in LV function in AS patients.
Speckle tracking echocardiography (STE) is an echocardiographic imaging technique that analyzes the motion of tissues in the heart by using the naturally occurring speckle pattern in the myocardium or blood when imaged by ultrasound.
Strain presentation class presentatio - copyAshish Golwara
This document discusses the evolution and clinical applications of strain imaging using echocardiography. Strain imaging allows quantitative analysis of myocardial deformation and function beyond what can be seen with conventional echocardiography. It describes how speckle tracking can measure longitudinal, radial, and circumferential strain to assess different regions of the heart. Clinical uses of strain imaging include early detection of chemotherapy-induced cardiomyopathy and assessment of valvular heart disease before changes in ejection fraction occur.
This document discusses techniques for evaluating left ventricular function in patients with ischemic cardiomyopathy, including multigated angiography (MUGA), myocardial perfusion scintigraphy using thallium-201 or technetium-99m tracers, gated cardiac single photon emission computed tomography (SPECT), and positron emission tomography (PET). SPECT and PET can assess myocardial perfusion, function, volumes, and viability. Segmental analysis of wall motion and calculations of ejection fraction from gated imaging provide prognostic information. The identification of viable but ischemic tissue has implications for the potential benefits of revascularization.
This document discusses various parameters used to evaluate cardiac structure and function using echocardiography. It describes parameters such as ejection fraction, mitral inflow patterns, pulmonary venous flow, tissue Doppler imaging, and color M-mode measurements that are used to assess global and regional left ventricular function as well as diastolic function. The parameters are grouped into categories of ventricular structure and systolic function, diastolic function evaluation, and stages of diastolic dysfunction. Normal ranges for various measurements are also provided.
Echo assessment of coronary artery diseaseNizam Uddin
This document discusses the use of echocardiography to evaluate coronary artery disease. Echocardiography can detect regional wall motion abnormalities caused by acute myocardial ischemia or infarction. It is useful for identifying patients with suspected coronary artery disease or acute coronary syndrome. Echocardiography can assess left ventricular systolic function, detect regional dysfunction, and has prognostic value for patients with acute or chronic coronary artery disease. When combined with stress testing, echocardiography can identify myocardial ischemia and viability.
Left ventricular systolic function can be assessed through several echocardiographic parameters such as ejection fraction, fractional shortening, mitral annular plane systolic excursion, tissue Doppler imaging, and more recently, deformation imaging including global longitudinal strain. Ejection fraction is considered the gold standard measurement but requires obtaining left ventricular volumes, while fractional shortening and mitral annular plane systolic excursion provide simpler alternatives. Deformation imaging such as global longitudinal strain provides a sensitive measure of subclinical changes in systolic function.
This document discusses strain and strain rate imaging techniques used to quantify regional myocardial function. It describes various methods to measure strain, including tissue Doppler, 2D speckle tracking, and cardiac MRI. It outlines normal values and patterns of strain in healthy individuals and how strain is altered in various cardiac diseases, such as coronary artery disease, heart failure, cardiomyopathies, and congenital heart disease. Strain imaging can identify myocardial scar, viability, dysfunction, and response to treatments.
A Speckle Tracking Echocardiographic Study for Correlation Between Global Lef...Premier Publishers
Global longitudinal strain (GLS) measured by Two-dimensional speckle tracking imaging (2D-STI) has been shown to be useful for assessing subtle changes in the left ventricular function with increasing severity of aortic stenosis (AS) in patients with preserved left ventricular ejection fraction (LVEF). To evaluate the relation between the severity of valve stenosis and GLS measured by 2D-STI in AS patients with normal LVEF. We studied 65 subjects (age, 53_75 years) with normal LVEF (≥50%) but without overt coronary artery disease. Patients were stratified into four groups (control, mild, moderate and severe AS), the clinical characteristics and echocardiographic findings were compared among the groups. Using dedicated software, we measured GLS in the apical four, two and three -chamber views. LVEF was not significantly different among the four groups. However, GLS showed significant differences among the four groups (controls;18.9±1.4, mild: 18.8±1.3, moderate: 15.35±1.6and severe: 12.42±1.4, ANOVA P = 0.001), GLS was significantly correlated with AVA, mean PG and LV mass index. Despite unchanged LVEF, GLS gradually decreased as severity of AS increases. GLS measured by 2D-STI is useful to assess subtle changes in LV function in AS patients.
Speckle tracking echocardiography (STE) is an echocardiographic imaging technique that analyzes the motion of tissues in the heart by using the naturally occurring speckle pattern in the myocardium or blood when imaged by ultrasound.
Strain presentation class presentatio - copyAshish Golwara
This document discusses the evolution and clinical applications of strain imaging using echocardiography. Strain imaging allows quantitative analysis of myocardial deformation and function beyond what can be seen with conventional echocardiography. It describes how speckle tracking can measure longitudinal, radial, and circumferential strain to assess different regions of the heart. Clinical uses of strain imaging include early detection of chemotherapy-induced cardiomyopathy and assessment of valvular heart disease before changes in ejection fraction occur.
This document discusses techniques for evaluating left ventricular function in patients with ischemic cardiomyopathy, including multigated angiography (MUGA), myocardial perfusion scintigraphy using thallium-201 or technetium-99m tracers, gated cardiac single photon emission computed tomography (SPECT), and positron emission tomography (PET). SPECT and PET can assess myocardial perfusion, function, volumes, and viability. Segmental analysis of wall motion and calculations of ejection fraction from gated imaging provide prognostic information. The identification of viable but ischemic tissue has implications for the potential benefits of revascularization.
This document discusses various parameters used to evaluate cardiac structure and function using echocardiography. It describes parameters such as ejection fraction, mitral inflow patterns, pulmonary venous flow, tissue Doppler imaging, and color M-mode measurements that are used to assess global and regional left ventricular function as well as diastolic function. The parameters are grouped into categories of ventricular structure and systolic function, diastolic function evaluation, and stages of diastolic dysfunction. Normal ranges for various measurements are also provided.
Echo assessment of coronary artery diseaseNizam Uddin
This document discusses the use of echocardiography to evaluate coronary artery disease. Echocardiography can detect regional wall motion abnormalities caused by acute myocardial ischemia or infarction. It is useful for identifying patients with suspected coronary artery disease or acute coronary syndrome. Echocardiography can assess left ventricular systolic function, detect regional dysfunction, and has prognostic value for patients with acute or chronic coronary artery disease. When combined with stress testing, echocardiography can identify myocardial ischemia and viability.
Left ventricular systolic function can be assessed through several echocardiographic parameters such as ejection fraction, fractional shortening, mitral annular plane systolic excursion, tissue Doppler imaging, and more recently, deformation imaging including global longitudinal strain. Ejection fraction is considered the gold standard measurement but requires obtaining left ventricular volumes, while fractional shortening and mitral annular plane systolic excursion provide simpler alternatives. Deformation imaging such as global longitudinal strain provides a sensitive measure of subclinical changes in systolic function.
Tissue Doppler echocardiography allows assessment of myocardial motion using Doppler ultrasound. It uses frequency shifts of ultrasound waves to calculate myocardial velocity, focusing on lower velocities than blood flow Doppler. There are two techniques: pulsed TDE uses a sample volume gate while color-coded TDE uses autocorrelation to display multigated velocity data superimposed on images. TDE is useful for evaluating systolic and diastolic left ventricular function by measuring velocities of the mitral annulus, and can help distinguish conditions like constrictive pericarditis from restrictive cardiomyopathy.
M-Mode echocardiography uses rapid sampling of a narrow field to provide high temporal resolution images of heart structures over time. It works best in combination with 2D echocardiography. To improve temporal resolution, techniques are used like minimizing depth of view, using a single focus, narrowing the sector, and minimizing line density, though this can degrade image quality. M-Mode echocardiography can be used to identify and characterize various cardiac valve diseases and structural abnormalities of the heart.
Cardiac MRI provides high quality images of the heart and great vessels and can evaluate a wide range of cardiac diseases without exposing the patient to ionizing radiation. It has excellent soft tissue contrast and the ability to obtain multiplanar views. Rapid imaging sequences combined with ECG gating and respiratory gating help mitigate the challenges of cardiac motion. Different sequences such as T2-weighted, bright blood, and delayed enhancement are used to evaluate conditions such as myocardial infarction and viability. Cardiac MRI can assess injury extent, microvascular obstruction, hemorrhage, and predict response to therapy in acute MI. It is also useful for evaluating complications like thrombus and characterizing cardiac tumors.
Doppler echocardiography is the main method used to evaluate ventricular function in children. It provides important information not available from adult assessments due to differences in myocardial maturation and the effects of congenital heart disease. Echocardiography allows assessment of ventricular dimensions, ejection fraction, wall motion, and Doppler indices of systolic and diastolic function. Newer techniques like Doppler tissue imaging and strain rate imaging provide enhanced evaluation of regional myocardial function. Comprehensive echocardiography is crucial for understanding the complex effects of pediatric heart conditions on ventricular performance.
Echocardiographic assessment of left ventricular systolic functionWaseem Omar
The document discusses transthoracic echocardiography, which is commonly used to provide real-time images of the beating heart. It outlines the agenda, including transducer and imaging planes, echo modes, measurement of left ventricular size, and assessment of left ventricular function. Optimal image acquisition depends on patient characteristics, operator skill, and instrument settings, with proper positioning helping to optimize standard views of the heart.
This document discusses the echocardiographic evaluation of left ventricular systolic function. It indicates that assessment of LV systolic function is important for diagnosing and managing heart disease and conditions that can affect the heart. The document outlines the indications for evaluating LV systolic function and describes techniques like M-mode, measurements of LV dimensions and volumes, wall motion scoring, and newer techniques using tissue Doppler imaging and speckle tracking echocardiography to assess systolic function parameters. Echocardiography is recommended as the initial imaging modality to evaluate LV systolic function.
Tissue Doppler Imaging (TDI) provides low velocity, high amplitude signals from the myocardium that can be used to assess systolic and diastolic function. TDI utilizes pulsed wave and color Doppler techniques to measure peak myocardial velocities. The E/E' ratio, where E is transmitral early diastolic velocity and E' is early diastolic mitral annular velocity, correlates well with left ventricular filling pressures and can help distinguish normal from elevated pressures. TDI parameters are useful for evaluating global and regional systolic function, diastolic function, ischemia, and viability as well as distinguishing between restrictive cardiomyopathy and constrictive pericarditis.
Cardiac Measurements Guidelines | powered by EsaoteMIDEAS
Complete routine cardiac measurements Guidelines.
1) Left Ventricle:
a) Size: Dimensions or volumes, at end-systole and end-diastole
b) Wall thickness and/or mass: Ventricular septum and left ventricular posterior wall thicknesses (at end-systole and end-diastole) and/or mass (at end-diastole)
c) Function: Assessment of systolic function and regional wall motion. Assessment
of diastolic function
2) Left Atrium:
• Size: Area or dimension
3) Aortic Root:
• Dimension
4) Right Ventricle:
Size: Dimensions
Function: Systolic and diastolic function
RV & pulmonary hemodynamics
5) Right Atrium:
a) Size: Dimensions, area
b) RA pressure
6) Valvular Stenosis:
a) Valvular Stenosis: Assessment of severity, including trans-valvular gradient and area.
b) Subvalvular Stenosis: Assessment of severity, Including subvalvular gradient.
7) Valvular Regurgitation: Assessment of severity with semi-quantitative descriptive statements and/or quantitative measurements
8) Cardiac Shunts: Assessment of severity. Measurements of QP:QS (pulmonary-to systemic flow ratio) and/or orifice area or diameter of the defect are often helpful.
9) Prosthetic Valves:
a) Transvalvular gradient and effective orifice area
b) Description of regurgitation, if present
This document discusses cardiac imaging modalities such as CT, MRI, echocardiography, and nuclear scintigraphy used by cardiac surgeons. It provides information on how to perform good quality CT and MRI imaging, and what each modality can be used to visualize such as coronary artery anatomy, post-procedure evaluation, congenital heart disease, and cardiac function. The document also covers contraindications of CT and MRI, how to decide between the modalities, and risks of contrast-induced nephropathy.
This document discusses the use of cardiac CT (CCT) for evaluating non-coronary cardiac conditions. It describes how CCT can assess myocardial diseases like dilated cardiomyopathy, left ventricular noncompaction, and arrhythmogenic right ventricular dysplasia. It also discusses how CCT evaluates pericardial diseases, valvular heart disease, cardiac masses, and congenital heart defects. CCT provides high resolution images of the heart and surrounding structures and can detect abnormalities in cardiac function, morphology, and tissue characteristics.
Speckle tracking echocardiography is a new, unique and evolving tool to assess the myocardial deformation which can detect LV systolic dysfunction much earlier than can be reflected in LVEF. The importance of defining predictors is to predict whom patient will be at risk for the deleterious effect of RV pacing on LV function, and who will need observation with possible upgrading to biventricular pacing.
Echocardiographic Evaluation of LV Diastolic FunctionJunhao Koh
The document discusses methods for evaluating left ventricular diastolic function using echocardiography. It describes the four phases of diastole, parameters used to assess diastolic function including mitral inflow patterns, mitral annular tissue Doppler, pulmonary vein flow, left atrial size and the Tei index. Grades of diastolic dysfunction and approaches from ASE/EAE and Mayo Clinic are summarized. Continuous wave Doppler of aortic regurgitation is also presented as a noninvasive method to evaluate left ventricular relaxation.
Doppler echocardiography uses the Doppler effect to analyze the velocity and direction of blood flow. There are several Doppler modalities used in cardiac evaluation including continuous wave Doppler, pulsed wave Doppler, and color flow Doppler. Continuous wave Doppler measures very high velocities, pulsed wave Doppler samples local low velocities, and color flow Doppler visually displays velocities using color scales. The Nyquist limit defines the maximum detectable velocity and avoiding aliasing. Tissue Doppler also evaluates myocardial velocities. The Bernoulli equation relates velocity and pressure gradients which allows Doppler to estimate valve pressures.
This document provides an overview of M-mode echocardiography. It discusses the history, physics, clinical use and limitations of M-mode. Key points include:
- M-mode allows for high temporal resolution to evaluate the timing of cardiac events and high axial resolution of delicate structures. However, it only assesses motion in one dimension.
- Normal M-mode findings of structures like the left ventricle, mitral valve and aortic valve are described.
- Pathologic conditions that can be identified include hypertrophic cardiomyopathy, dilated cardiomyopathy, mitral valve prolapse/flail, and valvular stenosis/regurgitation.
- Additional applications of M
Normal Cardiac CT
This document summarizes the key aspects of performing and interpreting a normal cardiac CT scan. It discusses the technique, including protocols for ECG gating and contrast injection. It then reviews the anatomy of the coronary arteries and important post-processing techniques like MPR, MIP, and VR. Segmental models for describing coronary artery anatomy are presented. Metrics for normal coronary artery diameter and left atrial area are provided. Common cardiac imaging planes and structures like the left ventricle and valves are also depicted.
The document discusses mitral regurgitation (MR), including the anatomy of the mitral valve, mechanisms and etiologies of MR, assessment of MR severity using echocardiography techniques like Doppler imaging, and consequences and management of MR. It provides details on evaluating MR severity based on vena contracta width, proximal isovelocity surface area, mitral-aortic time velocity integral ratios, and pulmonary venous flow. Primary causes of MR include degenerative diseases of the valve like Barlow's syndrome, while secondary MR is typically functional and due to left ventricular remodeling without structural valve abnormalities.
This document outlines techniques for measuring the heart using echocardiography. It discusses measuring the sizes of the left ventricle, left atrium, right atrium, and right ventricle using linear dimensions, volumes, and Doppler. Normal values for dimensions are provided. Common pitfalls in measurements are described, such as measuring at incorrect points in the cardiac cycle. The document emphasizes evaluating all cardiac chambers and structures thoroughly using multiple windows and methods.
Signs of aortic regurgitation include light house sign, Landolfi's sign, Becker's sign, de Musset's sign, Muller's sign, Quincke's sign, Corrigan's sign, Locomotor brachii, collapsing pulse, Pulsus bisferiens, Traube's sign, Duroziez s sign, Hill's sign, Rosenbach’s-sign, Gerhardt’s sign. The severity of aortic regurgitation is indicated by the duration of the diastolic murmur, presence of bisferiens pulse, positive Hill's sign greater than 60 mm Hg, displaced apical impulse, Austin-Flint murmur
This document provides an overview of hypertension including its definition, causes, prevalence, risk factors, evaluation, treatment goals, lifestyle modifications, medication classes, and treatment targets. Some key points:
- Hypertension is defined as blood pressure over 140/90 mmHg and increases cardiovascular risk. The prevalence increases with age from 4% in children to over 60% in those over 70 years old.
- Risk factors include age, family history, obesity, sleep apnea, smoking, diet, physical inactivity, alcohol, and stress. Evaluation includes tests to identify secondary causes and assess target organ damage.
- Lifestyle modifications like weight loss, the DASH diet, sodium reduction, and exercise can significantly lower blood
Management of hypertrophic cardiomyopathyDeep Chandh
The document discusses the management of hypertrophic cardiomyopathy (HCM). It covers the diagnosis of HCM using echocardiography, cardiac MRI, and genetic testing. Treatment options discussed include medical management with beta blockers and verapamil, as well as interventional strategies like alcohol septal ablation and myectomy surgery to relieve outflow tract obstruction in severe cases. The goal of treatment is to reduce symptoms from LV outflow tract obstruction and prevent sudden cardiac death through risk stratification and ICD placement if needed.
Hypertrophic cardiomyopathy is a genetic heart condition characterized by thickened heart muscle and potential outflow tract obstruction. It affects 0.2-0.5% of the population and is caused by mutations in genes encoding sarcomere proteins. Symptoms include chest pain, dizziness, and palpitations. Diagnosis is made via echocardiogram and genetic testing. Treatment focuses on symptom relief through medications or procedures to reduce outflow tract obstruction, as well as preventing sudden cardiac death through ICD implantation in high-risk patients.
Tissue Doppler echocardiography allows assessment of myocardial motion using Doppler ultrasound. It uses frequency shifts of ultrasound waves to calculate myocardial velocity, focusing on lower velocities than blood flow Doppler. There are two techniques: pulsed TDE uses a sample volume gate while color-coded TDE uses autocorrelation to display multigated velocity data superimposed on images. TDE is useful for evaluating systolic and diastolic left ventricular function by measuring velocities of the mitral annulus, and can help distinguish conditions like constrictive pericarditis from restrictive cardiomyopathy.
M-Mode echocardiography uses rapid sampling of a narrow field to provide high temporal resolution images of heart structures over time. It works best in combination with 2D echocardiography. To improve temporal resolution, techniques are used like minimizing depth of view, using a single focus, narrowing the sector, and minimizing line density, though this can degrade image quality. M-Mode echocardiography can be used to identify and characterize various cardiac valve diseases and structural abnormalities of the heart.
Cardiac MRI provides high quality images of the heart and great vessels and can evaluate a wide range of cardiac diseases without exposing the patient to ionizing radiation. It has excellent soft tissue contrast and the ability to obtain multiplanar views. Rapid imaging sequences combined with ECG gating and respiratory gating help mitigate the challenges of cardiac motion. Different sequences such as T2-weighted, bright blood, and delayed enhancement are used to evaluate conditions such as myocardial infarction and viability. Cardiac MRI can assess injury extent, microvascular obstruction, hemorrhage, and predict response to therapy in acute MI. It is also useful for evaluating complications like thrombus and characterizing cardiac tumors.
Doppler echocardiography is the main method used to evaluate ventricular function in children. It provides important information not available from adult assessments due to differences in myocardial maturation and the effects of congenital heart disease. Echocardiography allows assessment of ventricular dimensions, ejection fraction, wall motion, and Doppler indices of systolic and diastolic function. Newer techniques like Doppler tissue imaging and strain rate imaging provide enhanced evaluation of regional myocardial function. Comprehensive echocardiography is crucial for understanding the complex effects of pediatric heart conditions on ventricular performance.
Echocardiographic assessment of left ventricular systolic functionWaseem Omar
The document discusses transthoracic echocardiography, which is commonly used to provide real-time images of the beating heart. It outlines the agenda, including transducer and imaging planes, echo modes, measurement of left ventricular size, and assessment of left ventricular function. Optimal image acquisition depends on patient characteristics, operator skill, and instrument settings, with proper positioning helping to optimize standard views of the heart.
This document discusses the echocardiographic evaluation of left ventricular systolic function. It indicates that assessment of LV systolic function is important for diagnosing and managing heart disease and conditions that can affect the heart. The document outlines the indications for evaluating LV systolic function and describes techniques like M-mode, measurements of LV dimensions and volumes, wall motion scoring, and newer techniques using tissue Doppler imaging and speckle tracking echocardiography to assess systolic function parameters. Echocardiography is recommended as the initial imaging modality to evaluate LV systolic function.
Tissue Doppler Imaging (TDI) provides low velocity, high amplitude signals from the myocardium that can be used to assess systolic and diastolic function. TDI utilizes pulsed wave and color Doppler techniques to measure peak myocardial velocities. The E/E' ratio, where E is transmitral early diastolic velocity and E' is early diastolic mitral annular velocity, correlates well with left ventricular filling pressures and can help distinguish normal from elevated pressures. TDI parameters are useful for evaluating global and regional systolic function, diastolic function, ischemia, and viability as well as distinguishing between restrictive cardiomyopathy and constrictive pericarditis.
Cardiac Measurements Guidelines | powered by EsaoteMIDEAS
Complete routine cardiac measurements Guidelines.
1) Left Ventricle:
a) Size: Dimensions or volumes, at end-systole and end-diastole
b) Wall thickness and/or mass: Ventricular septum and left ventricular posterior wall thicknesses (at end-systole and end-diastole) and/or mass (at end-diastole)
c) Function: Assessment of systolic function and regional wall motion. Assessment
of diastolic function
2) Left Atrium:
• Size: Area or dimension
3) Aortic Root:
• Dimension
4) Right Ventricle:
Size: Dimensions
Function: Systolic and diastolic function
RV & pulmonary hemodynamics
5) Right Atrium:
a) Size: Dimensions, area
b) RA pressure
6) Valvular Stenosis:
a) Valvular Stenosis: Assessment of severity, including trans-valvular gradient and area.
b) Subvalvular Stenosis: Assessment of severity, Including subvalvular gradient.
7) Valvular Regurgitation: Assessment of severity with semi-quantitative descriptive statements and/or quantitative measurements
8) Cardiac Shunts: Assessment of severity. Measurements of QP:QS (pulmonary-to systemic flow ratio) and/or orifice area or diameter of the defect are often helpful.
9) Prosthetic Valves:
a) Transvalvular gradient and effective orifice area
b) Description of regurgitation, if present
This document discusses cardiac imaging modalities such as CT, MRI, echocardiography, and nuclear scintigraphy used by cardiac surgeons. It provides information on how to perform good quality CT and MRI imaging, and what each modality can be used to visualize such as coronary artery anatomy, post-procedure evaluation, congenital heart disease, and cardiac function. The document also covers contraindications of CT and MRI, how to decide between the modalities, and risks of contrast-induced nephropathy.
This document discusses the use of cardiac CT (CCT) for evaluating non-coronary cardiac conditions. It describes how CCT can assess myocardial diseases like dilated cardiomyopathy, left ventricular noncompaction, and arrhythmogenic right ventricular dysplasia. It also discusses how CCT evaluates pericardial diseases, valvular heart disease, cardiac masses, and congenital heart defects. CCT provides high resolution images of the heart and surrounding structures and can detect abnormalities in cardiac function, morphology, and tissue characteristics.
Speckle tracking echocardiography is a new, unique and evolving tool to assess the myocardial deformation which can detect LV systolic dysfunction much earlier than can be reflected in LVEF. The importance of defining predictors is to predict whom patient will be at risk for the deleterious effect of RV pacing on LV function, and who will need observation with possible upgrading to biventricular pacing.
Echocardiographic Evaluation of LV Diastolic FunctionJunhao Koh
The document discusses methods for evaluating left ventricular diastolic function using echocardiography. It describes the four phases of diastole, parameters used to assess diastolic function including mitral inflow patterns, mitral annular tissue Doppler, pulmonary vein flow, left atrial size and the Tei index. Grades of diastolic dysfunction and approaches from ASE/EAE and Mayo Clinic are summarized. Continuous wave Doppler of aortic regurgitation is also presented as a noninvasive method to evaluate left ventricular relaxation.
Doppler echocardiography uses the Doppler effect to analyze the velocity and direction of blood flow. There are several Doppler modalities used in cardiac evaluation including continuous wave Doppler, pulsed wave Doppler, and color flow Doppler. Continuous wave Doppler measures very high velocities, pulsed wave Doppler samples local low velocities, and color flow Doppler visually displays velocities using color scales. The Nyquist limit defines the maximum detectable velocity and avoiding aliasing. Tissue Doppler also evaluates myocardial velocities. The Bernoulli equation relates velocity and pressure gradients which allows Doppler to estimate valve pressures.
This document provides an overview of M-mode echocardiography. It discusses the history, physics, clinical use and limitations of M-mode. Key points include:
- M-mode allows for high temporal resolution to evaluate the timing of cardiac events and high axial resolution of delicate structures. However, it only assesses motion in one dimension.
- Normal M-mode findings of structures like the left ventricle, mitral valve and aortic valve are described.
- Pathologic conditions that can be identified include hypertrophic cardiomyopathy, dilated cardiomyopathy, mitral valve prolapse/flail, and valvular stenosis/regurgitation.
- Additional applications of M
Normal Cardiac CT
This document summarizes the key aspects of performing and interpreting a normal cardiac CT scan. It discusses the technique, including protocols for ECG gating and contrast injection. It then reviews the anatomy of the coronary arteries and important post-processing techniques like MPR, MIP, and VR. Segmental models for describing coronary artery anatomy are presented. Metrics for normal coronary artery diameter and left atrial area are provided. Common cardiac imaging planes and structures like the left ventricle and valves are also depicted.
The document discusses mitral regurgitation (MR), including the anatomy of the mitral valve, mechanisms and etiologies of MR, assessment of MR severity using echocardiography techniques like Doppler imaging, and consequences and management of MR. It provides details on evaluating MR severity based on vena contracta width, proximal isovelocity surface area, mitral-aortic time velocity integral ratios, and pulmonary venous flow. Primary causes of MR include degenerative diseases of the valve like Barlow's syndrome, while secondary MR is typically functional and due to left ventricular remodeling without structural valve abnormalities.
This document outlines techniques for measuring the heart using echocardiography. It discusses measuring the sizes of the left ventricle, left atrium, right atrium, and right ventricle using linear dimensions, volumes, and Doppler. Normal values for dimensions are provided. Common pitfalls in measurements are described, such as measuring at incorrect points in the cardiac cycle. The document emphasizes evaluating all cardiac chambers and structures thoroughly using multiple windows and methods.
Signs of aortic regurgitation include light house sign, Landolfi's sign, Becker's sign, de Musset's sign, Muller's sign, Quincke's sign, Corrigan's sign, Locomotor brachii, collapsing pulse, Pulsus bisferiens, Traube's sign, Duroziez s sign, Hill's sign, Rosenbach’s-sign, Gerhardt’s sign. The severity of aortic regurgitation is indicated by the duration of the diastolic murmur, presence of bisferiens pulse, positive Hill's sign greater than 60 mm Hg, displaced apical impulse, Austin-Flint murmur
This document provides an overview of hypertension including its definition, causes, prevalence, risk factors, evaluation, treatment goals, lifestyle modifications, medication classes, and treatment targets. Some key points:
- Hypertension is defined as blood pressure over 140/90 mmHg and increases cardiovascular risk. The prevalence increases with age from 4% in children to over 60% in those over 70 years old.
- Risk factors include age, family history, obesity, sleep apnea, smoking, diet, physical inactivity, alcohol, and stress. Evaluation includes tests to identify secondary causes and assess target organ damage.
- Lifestyle modifications like weight loss, the DASH diet, sodium reduction, and exercise can significantly lower blood
Management of hypertrophic cardiomyopathyDeep Chandh
The document discusses the management of hypertrophic cardiomyopathy (HCM). It covers the diagnosis of HCM using echocardiography, cardiac MRI, and genetic testing. Treatment options discussed include medical management with beta blockers and verapamil, as well as interventional strategies like alcohol septal ablation and myectomy surgery to relieve outflow tract obstruction in severe cases. The goal of treatment is to reduce symptoms from LV outflow tract obstruction and prevent sudden cardiac death through risk stratification and ICD placement if needed.
Hypertrophic cardiomyopathy is a genetic heart condition characterized by thickened heart muscle and potential outflow tract obstruction. It affects 0.2-0.5% of the population and is caused by mutations in genes encoding sarcomere proteins. Symptoms include chest pain, dizziness, and palpitations. Diagnosis is made via echocardiogram and genetic testing. Treatment focuses on symptom relief through medications or procedures to reduce outflow tract obstruction, as well as preventing sudden cardiac death through ICD implantation in high-risk patients.
A 17-year-old male basketball player collapsed during practice and suffered cardiac arrest. An autopsy later revealed he had hypertrophic cardiomyopathy (HCM), a genetic heart condition where the heart muscle becomes abnormally thick. HCM is a leading cause of sudden cardiac death in young athletes. The patient had previously noticed some shortness of breath with exertion but it did not limit his activity. He was found to have a heart murmur as a child but it was never investigated. HCM causes the left ventricle to become thickened and stiff, which can obstruct blood flow out of the heart and cause heart failure, chest pain, arrhythmias, and sudden cardiac death.
This document provides an overview of pancytopenia, including its definition, etiology, clinical presentation, diagnostic workup, and treatment approach. Pancytopenia is defined as a low hemoglobin, white blood cell count, and platelet count. It can be caused by primary bone marrow diseases or secondary to other conditions that impair bone marrow function. The diagnostic workup involves blood tests, peripheral smear examination, bone marrow aspiration and biopsy for cytogenetics and immunophenotyping to identify the underlying cause. Specific tests help diagnose conditions like Fanconi anemia, lymphoproloferative disorders, and paroxysmal nocturnal hemoglobinuria. Treatment is directed at managing the specific disease identified as the cause
HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY (HOCM)Kurian Joseph
Hypertrophic cardiomyopathy (HCM) is a genetic heart condition characterized by excessive thickening of the heart muscle. It was initially described in the 1950s and causes significant morbidity and mortality due to heart failure, arrhythmias, and sudden cardiac death. The pathophysiology involves left ventricular outflow tract obstruction, diastolic dysfunction, myocardial ischemia, and mitral regurgitation. Treatment involves medications, septal reduction procedures like myectomy or alcohol ablation, and implantable cardioverter-defibrillators in high-risk patients. Prognosis depends on symptom severity and risk factors for sudden cardiac death.
This document discusses different types of cardiomyopathies including their classification, etiology, and treatment. It focuses on dilated cardiomyopathy (DCM), providing details on its classification, causes, clinical presentation, diagnosis, and management. It also discusses other forms of cardiomyopathy such as hypertrophic cardiomyopathy (HCM), describing its characteristic left ventricular hypertrophy and outflow tract obstruction. The document aims to comprehensively classify and describe different cardiomyopathies for medical professionals.
Inflammatory Heart Disease can cause pericarditis, myocarditis, endocarditis, or rheumatic fever. Pericarditis is inflammation of the sac around the heart while myocarditis involves the heart muscle. Endocarditis is a bacterial infection of the heart valves. Rheumatic fever develops after a streptococcal throat infection and can cause long-term heart damage through rheumatic heart disease.
This document discusses dilated cardiomyopathy (DCM), the most common type of cardiomyopathy. It provides details on:
1) The causes, symptoms, signs, diagnostic tests and goals of treatment for DCM. The mainstay of therapy includes vasodilators, digoxin and diuretics.
2) The morphological and microscopic features of DCM which involve enlargement and spherical dilation of the heart chambers.
3) Disease progression can lead to marked left ventricular dilatation and circulatory failure if left untreated. Management aims to relieve symptoms and slow progression.
Cardiomyopathy is a disease of the heart muscle that weakens the heart's ability to pump blood effectively. The main types are dilated, hypertrophic, and restrictive cardiomyopathy. Dilated cardiomyopathy is the most common type and causes the heart chambers to enlarge over time. Treatment involves managing symptoms and risk factors with medications, lifestyle changes, surgery such as implantable devices or transplant, and treating any underlying causes. A heart transplant may be an option for severe cases but carries risks of organ rejection, infection, and side effects of immunosuppressant drugs.
Dilated cardiomyopathy is the most common type of cardiomyopathy and is characterized by left ventricular dilation and systolic dysfunction. Causes include genetic factors in 20-50% of cases as well as myocarditis, alcohol toxicity, and peripartum cardiomyopathy. Hypertrophic cardiomyopathy is caused by mutations in sarcomeric genes and is characterized by asymmetric hypertrophy of the ventricular septum. Restrictive cardiomyopathy results in stiff ventricles with impaired diastolic filling and is associated with conditions causing fibrosis like radiation, amyloidosis, and sarcoidosis. The main types of cardiomyopathy are dilated, hypertrophic, restrictive, and arrhythmogenic right ventricular cardiomyopathy.
This document summarizes hypertrophic cardiomyopathy (HCM), beginning with its pathology and pathogenesis. HCM causes thickening of the ventricular walls asymmetrically, most commonly affecting the interventricular septum. The main pathophysiological mechanisms include dynamic left ventricular outflow tract obstruction, mitral regurgitation, diastolic dysfunction, myocardial ischemia, and cardiac arrhythmias. Clinical manifestations range from no symptoms to dyspnea, fatigue, syncope, and sudden cardiac death. Diagnosis is made primarily via echocardiogram. Treatment involves medications, septal reduction procedures, or implantable cardioverter-defibrillators depending on symptoms and risk factors. Prognosis depends on factors like degree of
This document discusses various types of cardiomyopathies:
- Dilated cardiomyopathy is caused by an unknown etiology and results in left ventricular dilatation and systolic dysfunction. It is a common cause of heart failure.
- Hypertrophic cardiomyopathy involves abnormal thickening of the heart muscle and can lead to outflow obstruction. It is a common cause of sudden death in young athletes.
- Restrictive cardiomyopathy causes stiff ventricles and impaired ventricular filling due to disorders like amyloidosis. It presents with symptoms of right and left heart failure.
- Other rare types discussed include arrhythmogenic right ventricular dysplasia and obliterative cardiomyopathy. Diagnosis involves imaging and endomyocardial biopsy
Cardiogenic shock is defined as inadequate tissue perfusion due to cardiac dysfunction or hypo-perfusion of end organs due to cardiac failure. It has a high mortality rate of 50-80% and is most commonly caused by extensive acute myocardial infarction. Symptoms include cyanosis, decreased consciousness, and low blood pressure. Diagnosis involves identifying hypotension, low cardiac index, and signs of hypoperfusion on physical exam along with supportive tests like EKG, echocardiogram, and Swan-Ganz catheter. Treatment focuses on optimizing prefusion with vasopressors or inotropes, diuretics, emergent revascularization through cardiac catheterization, and mechanical circulatory support like IABP,
Hypertrophic cardiomyopathy (HCM) is a genetic heart condition characterized by thickened heart muscle. It has an autosomal dominant pattern of inheritance, with mutations in genes encoding sarcomeric proteins. HCM causes a non-dilated, hypertrophied left ventricle and can lead to heart failure, arrhythmias, and sudden cardiac death. Treatment involves medications like beta-blockers or verapamil to reduce symptoms, and interventions like septal reduction procedures or implantable cardioverter-defibrillators to reduce risk of complications. Regular screening of family members is important for early detection of HCM.
Cardiomyopathy refers to diseases of the heart muscle that weaken the heart's ability to pump blood. Dilated cardiomyopathy is characterized by the enlargement and weakening of the heart's main pumping chamber, the left ventricle. The major causes of dilated cardiomyopathy include infections, toxins, inherited conditions, and unknown causes. Symptoms include heart failure and arrhythmias. Diagnosis involves echocardiography and treatments focus on managing symptoms through medications, devices, and transplantation if needed.
Cardiogenic shock is caused by severe impairment of myocardial performance resulting in diminished cardiac output and end-organ hypoperfusion. It presents clinically as hypotension refractory to fluids with signs of poor tissue perfusion. Acute myocardial infarction accounts for most cases of cardiogenic shock. Rapid diagnosis and treatment is needed to prevent end-organ damage. Management involves hemodynamic support, revascularization when possible, and mechanical circulatory support for refractory cases.
1. Mitral stenosis is most commonly caused by rheumatic fever and results in thickening and calcification of the mitral valve, reducing the valve orifice area and obstructing blood flow from the left atrium to ventricle.
2. The pathophysiology involves elevated left atrial pressure, pulmonary hypertension, and reduced cardiac output. Symptoms range from easy fatigability to pulmonary edema.
3. Physical exam findings include an opening snap, rumbling diastolic murmur, and signs of right heart failure in severe cases. Severity is graded based on orifice area, pulmonary artery pressure, and NYHA functional
Patients with cardiomyopathy have deterioration of heart muscle function for various reasons. It can be classified into specific types including dilated, hypertrophic, restrictive, and others. Dilated cardiomyopathy involves large heart cavity and impaired systolic function. Symptoms include fatigue, edema and heart sounds. Management focuses on improving function and preventing arrhythmias through medications, devices like ICD, and potentially transplantation. Anesthetic management for surgery is high risk due to minimal cardiac reserve, so meticulous preparation including fluid management, electrolytes, and device handling is critical.
This document provides information on restrictive cardiomyopathy (RCM), including its definition, classification, etiology, symptoms, diagnosis, and treatment. Some key points:
- RCM is characterized by diastolic dysfunction with a stiffened myocardium that impairs ventricular filling. It is usually not associated with ventricular dilation or hypertrophy.
- Causes include infiltrative diseases of the myocardium (e.g. amyloidosis, sarcoidosis), endomyocardial fibrosis, and genetic/familial factors.
- Symptoms are related to reduced cardiac output and include dyspnea, fatigue, arrhythmias. Diagnosis involves echocardiogram, cardiac catheterization and MRI to evaluate
Coronary Artery Bypass Graft Under Cardiopulmonary BypassDharmraj Singh
This document discusses coronary artery bypass graft (CABG) surgery under cardiopulmonary bypass. It covers the preoperative evaluation, indications for CABG, intraoperative monitoring, cardiopulmonary bypass procedure, myocardial protection techniques, and considerations for weaning the patient off bypass.
Cardiac transplantation involves surgically implanting a donor heart into a recipient with heart failure. It is indicated for end-stage heart disease that is refractory to maximal medical therapy. Absolute contraindications include active infections, cancers, and pulmonary hypertension. Evaluation of recipients includes cardiac testing and screening for medical/psychosocial risks. Donor hearts must be from brain dead individuals without systemic disease or infection. Post-operative care requires lifelong immunosuppression to prevent rejection while managing complications like infection, rejection, and arrhythmias. Long-term follow-up focuses on screening for issues like allograft vasculopathy.
1) Acute coronary syndrome includes unstable angina and myocardial infarction, characterized by chest pain and elevated cardiac biomarkers.
2) Clinical features include severe, prolonged chest pain that may radiate to other areas, as well as syncope, vomiting, and arrhythmias.
3) Complications include heart failure, arrhythmias like ventricular fibrillation, cardiac rupture, and remodelling. Diagnosis involves ECG, cardiac enzymes, and angiography. Management focuses on reperfusion therapy, anticoagulation, and risk factor reduction.
Congestive heart failure can be caused by conditions that weaken the heart muscle or overload it. The main symptoms are shortness of breath, fatigue, cough, and fluid retention. Treatment focuses on correcting reversible causes, reducing fluid overload with diuretics, and inhibiting the renin-angiotensin-aldosterone system with ACE inhibitors. Other medications like beta blockers, digitalis, and vasodilators may also be used depending on the individual case. Monitoring through physical exams, labs, and imaging can help guide management and prevent exacerbations.
Heart failure is a serious medical condition that occurs when the heart cannot pump enough blood to meet the body's needs. It can be caused by a variety of factors, including heart disease, high blood pressure, diabetes, and obesity. In this essay, we will explore the symptoms, causes, and treatments of heart failure.
One of the most common symptoms of heart failure is shortness of breath. This occurs because the heart is not able to pump enough oxygenated blood to the lungs, leading to a feeling of suffocation. Other symptoms may include fatigue, swelling in the legs and feet, and a persistent cough. These symptoms can be very uncomfortable and can significantly reduce a person's quality of life.
There are many possible causes of heart failure. In some cases, it may be the result of an underlying heart condition, such as coronary artery disease, a heart attack, or a heart valve problem. In other cases, it may be caused by lifestyle factors such as smoking, high blood pressure, or obesity. Other risk factors for heart failure include a family history of heart disease, diabetes, and certain medications.
Treatments for heart failure may vary depending on the severity of the condition and the underlying causes. In some cases, medications such as diuretics or beta-blockers may be prescribed to help reduce symptoms and improve heart function. Lifestyle changes such as quitting smoking, losing weight, and reducing salt intake may also be recommended. In more severe cases, surgery may be required to repair or replace damaged heart valves or to implant a device such as a pacemaker or defibrillator.
While heart failure can be a very serious condition, there are many effective treatments available. It is important to seek medical attention if you experience any symptoms of heart failure, as early diagnosis and treatment can help improve outcomes and quality of life. With proper care and management, many people with heart failure are able to live healthy, active lives.
Cardiac tamponade occurs when fluid accumulates in the pericardial space, reducing cardiac filling and output. It can develop acutely or subacutely. Echocardiography is key for diagnosis, showing pericardial effusion, chamber collapse, and respiratory variations in flow velocities. Treatment involves drainage of fluid, usually by pericardiocentesis under ultrasound guidance. Subxiphoid approach carries liver/vessel injury risk but is safest in emergencies, while apical is easiest but risks heart wall puncture. Drainage resolves tamponade, and catheters are typically removed within 2 days if drainage is low.
This document discusses different types of cardiomyopathy, including dilated cardiomyopathy (DCM), hypertrophic cardiomyopathy (HCM), and restrictive cardiomyopathy. DCM is characterized by enlarged heart chambers and reduced systolic function. HCM involves thickened heart muscle and potential outflow tract obstruction. Restrictive cardiomyopathy restricts heart filling due to stiff heart muscles. The causes, clinical presentations, diagnostic evaluations, and management strategies are described for each type of cardiomyopathy.
This document discusses three major types of cardiomyopathies: dilated, restrictive, and hypertrophic. Dilated cardiomyopathy is characterized by enlarged heart chambers and reduced contractility. Common causes include idiopathic, familial, alcoholism, and viral infections. Symptoms include breathing difficulties and edema. Treatment focuses on managing heart failure and preventing arrhythmias. Restrictive cardiomyopathy is defined by decreased ventricular compliance due to myocardial infiltration. Causes include amyloidosis and sarcoidosis. Patients experience heart failure symptoms from impaired ventricular filling. Hypertrophic cardiomyopathy is marked by thickened ventricular walls.
The document summarizes heart failure, including its causes, pathophysiology, clinical presentation, investigation, classification, treatment, and prognosis. Heart failure represents the inability of the heart to pump enough blood to meet the body's needs. It can be caused by conditions that impair the heart muscle or overload it. The pathophysiology involves neurohormonal activation that maladaptively remodels the heart. Treatment involves managing symptoms, preventing progression, and correcting reversible causes. Prognosis depends on disease stage, with 5-year mortality of 50% and annual mortality rates ranging from 5-30% depending on severity.
This document discusses the classification and management of ventricular arrhythmias. It is divided into sections on classification by clinical presentation, electrocardiography, disease entity. Management of VT in structurally abnormal hearts is discussed, including those related to coronary artery disease, dilated cardiomyopathy, bundle branch reentrant tachycardia, arrhythmogenic right ventricular dysplasia, and other conditions. Clinical presentation, mechanisms, diagnostic testing, and treatment options are summarized for each condition.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
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• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
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.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
2. WHO in 1995 defined Cardiomyopathies as
diseases of myocardium associated with cardiac
dysfunction
Types
Dilated Cardiomyopathy(DCM)
Hypertrophic Cardiomyopathy(HCM)
Restrictive Cardiomyopathy(RCM)
Arrythmogenic RVCardiomyopathy(ARVC)
3.
4. DCM is most common of all CMs(60%)
Aetiology
-Idiopathic (50%)
-Myocarditis (9%)
-Ischemic (7%)
-Others-Viral, Peripartum, Substance abuse etc
Morphologically
Enlargement of RV & LV cavities without an increase
in ventricular septal or free wall thickness →
spherical shape & dilatation of heart → Displacement
of papillary muscles → Regurgitant lesions despite
valve leaflets being normal
6. Microscopically –Patchy & diffuse loss of tissue
with interstistial fibrosis & scarring
Systolic Dysfunction>>> Diastolic dysfunction
SV is initially maintained by ↑↑ EDV
With disease progression→Marked LV dilatation
with normal or thin wall →↑ Wall stress +
Valvular Regurgitation →Overt Circulatory
Failure
7. Symptoms
-Typically pts c/o months of
fatigue, weakness, reduced exercise tolerance due
to CHF
-May also present as a Stroke, Arrythmia or
Sudden Death
Physical Signs
-Tachycardia
-pulsus alternans
-Jugular venous distension
-Murmurs of AV valve regurgitation
-Gallop heart sounds
8. CXR- Cardiomegaly , Pulmonary venous congestion
ECG- Normal or low QRS voltage , abn axis, non
specific ST seg abnormalities, LV
hypertrophy, conduction defects, AF, Non sustained
VT
2D Echo
Coronary Angiography
-usually normal coronaries
-coronary vasodilatation is impaired by ↑ LV filling
pressures
-distinguishes b/w Ischemic & Idiopathic DCM
Endomyocardial Biopsy
rarely valuable to identify the aetiology
9.
10.
11. Aim of treatment
-Manage the symptoms
-Reduce the progression of disease
-Prevent Complications
Mainstay of Therapy
Vasodilators
+
Digoxin
+
Diuretics
12. ACE Inhibitors
-Indicated for all patients
- Reduce symptoms & improve effort tolerance
- Suppress ventricular remodelling & endothelial
dysfunction
-Reduce CV mortality
Milrinone
-Selective PDE-3 inhibitor
-may improve quality of life but doesn’t affect
mortality
-rarely adm in chronic situations
13. Spironolactone
used along with ACE Inhibitors has shown to reduce
mortality by 30% in a large double blind randomized
trial
Digoxin
clinically beneficial as reaffirmed by two large trials in
adults
β Blockers
untill recently contraindicated but recent studies show
that they not only provide symptomatic improvement
but substantial reduction in sudden death in NYHA
class II & III HF pts
14. Amiodarone
-High grade ventricular arrythmias (Sustained VT or
VF) are common in DCM→↑ risk of SCD
-Preferred antiarrythmic agent as it has least negative
inotropic effect & proarrythmogenic potential
-Implantable Defibrillators are used for refractory
arrythmias
Anticoagulants
-indicated for pts with moderate ventricular
dilatation+mod-severe systolic dysfunction
-H/O stroke , AF or evidence of Intracardiac
thrombus
15. Dual Chamber Pacing
Cardiomyoplasty
LV Assist Devices
improved pts sufficiently to avoid transplant or
enable later transplant
Cardiac Transplantation
has substantially prolonged survival in DCM pts
with 5 yr survival rate of 78%
16. Cardiac procedures which DCM pts undergo
-Correction of AV valve insufficiency
-Placement of ICD device
-LV Assist device placement
-Allograft Transplantation
Goals of Anaesthetic Mx
- Reduction of afterload
-Optimizing preload
-Minimize myocardial depression
DCM pts are extremely sensitive to cardiac
depressant anaesthetic drugs
17. Fentanyl-(30u/kg )provides excellent anaesthesia &
hemodynamics in pts with EF<0.3
Remifentanyl- assoc with severe hypotension &
bradycardia ,therefore unsuitable in low EF pts
Etomidate-least effect on cardiac contractility in pts
undergoing cardiac transplant
Ketamine-excellent choice in combination with fentanyl
for induction in pts with severe myocardial depression
Propofol-causes CV depression due to inhibition of
sympathomimetic activity & vasodilatation
Volatile agents-Desflurane with lowest BG partition
coefficient may allow some benefit for rapid
induction, rapid recovery from anaesthesia & early
extubation
18. Invasive hemodynamic monitoring
-Mandatory in pts with DCM undergoing surgery
-Physical s/s may not accurately reflect
physiological parameters
-Pts with Implanted defibrillators have severely
depressed cardiac function but are routinely
managed without a PAC
Hemodynamic Instability
-managed by low dose of inotrope & vasodilator
19. Afterload reduction
-improves regional & global indices of ventricular
relaxation & EF during anaesthesia when myocardial
depression may be significant
-it also reduces valvular regurgitation & volumes
Patients on Amiodarone on long term basis
can interact with anaesthetic agents & further reduce
contractility & conduction-requires careful titration
Arrythmogenic factors –
Hypokalemia, Hypomagnesemia, & Sympathatic
activation should be monitored & corrected
25. Cause -Assymetrical Septal Myocardial Hypertrophy
Unlike Aortic stenosis hypertrophy begets pressure gradient , not
the other way around
Wide spectrum of severity of obstruction ch by
Variability- absent to critically severe
Dynamic nature - depends on contractility & loading conditions
Timing - begins early & peaks variably
Location -subaortic
26. Subaortic Obstruction
Cause-Hypertrophic septum encroaching on the systolic
outflow tract
Bounded-Anteriorly by IVS & Posteriorly by AML
Effect-Systolic anterior motion(SAM) of AML →
accentuating obstruction
Mechanism of SAM
Thickened IVS→Restricted LVOT → ejection of blood at
a higher velocity closer to the AML → Drawing of AML
closure towards the hypertrophied septum due to the
venturi effect during LV systole→ Dynamic LVOT
obstruction
27.
28. Factors aggravating SAM & producing Dynamic
Obstruction-
-↑ Contractility
-↓ Afterload (Aortic outflow resistance)
-↓ Preload (End diastolic volume)
Therapeutically Myocardial depression, Vasoconstriction &
Volume overloading should minimize obstruction & augment
forward flow
LVOT gradient ≥ 30mmHg assoc with physiologic &
prognostic importance
LVOTO is assoc with ↑ wall stress, myocardial
ischemia, cell death & eventually fibrosis→VT /VF
Dynamic LVOTO may also occur in Cardiac tamponade
or Acute MI
30. Myocardial Ischemia
◦ Often occurs without atherosclerotic coronary artery
disease
◦ Postulated mechanisms
Abnormally small and partially obliterated intramural
coronary arteries as a result of hypertrophy
Inadequate number of capillaries for the degree of LV mass
31. Dyspnea on exertion (90%)
Angina (70-80%)
Syncope (20%)
Sudden cardiac death
32. ECG-↑ QRS voltage, ST-T changes, Axis
deviation, LV Hypertrophy +strain pattern
CXR-Lt atrial enlargement or normal
Echo
Invasive Cardiac Cath- indicated for suspected
CAD or Severe mitral valve disease
- shows LV pressure gradient,↓ ventricular
volume, ↑ LVEDP
37. β Blockers- mainstay of therapy
relieves symptoms of exercise intolerance & dyspnoea assoc with
CHF by- negative inotropic effect
-HR reduction
-lower myocardial O2 demand
- longer diastolic filling times
CCB-Verapamil is indicated if β Blockers not tolerated or
ineffective
-it improves diastolc function & ventricular relaxation causing
improved filling decreased obstructive features in 50% pts
-CCBs with strong vasodilatory effect are C/I in pts with
obstructive symptoms
Disopyramide- has negative inotropic & vasoconstrictive effects
-most effective agent to reduce LVOTO , gradient & relieving the
symptoms
38. Indications
Subaortic gradients≥ 50mmHg frequently assoc with
CHF & are refractory to medication
Septal Myotomy +Partial Mymectomy thru a
transaortic approach relieves the obstruction, reduces
the LVOTO gradient, SAM & MR
Complications –CHB or septal perforation (0-2%)
Mortality rate-1to 3%
Intraop guidance & Evaluation of surgical result by an
experienced echocardiographer are essential for the
success of the procedure
40. Septal Ablation with Ethanol
-Non surgical septal reduction therapy
-2-5 ml of Ethanol is adm thru an angioplasty balloon catheter
lumen to the first major septal perforator of the LAD
- reduce LVOT grad in 85-90% pts immediately
-Further ↓in grad & sympt improvement seen over next 3-6mths
- Permanent heart blocks ( 5-10%)
Dual Chamber or AV Sequential Pacing(DDD)
-Exact mechanism unkn
-Possible mech: Excitation of the septum of LV contracts it away
from apposing wall which may reduce the LVOT gradient
-now rarely recommended since symptoms actually worsen despite
gradient reductions
43. HCM is the most common cause of SCD in otherwise
healthy young individuals
VT /VF is primarily responsible for SCD
Identification of High Risk Individuals is very important
-Pts < 30yrs at the time of diagnosis
-Prior cardiac arrest
-Symptomatic VT on Holter monitor
-Family H/O SCD or Syncope
The only effective modality to prevent SCD in HCM
pts is an ICD
Pharmacological therapy for prevention of SCD in these
pts has been abandoned
44. Aim of Anaesthetic management - Avoid aggravating the subaortic
gradient
Anaesthetic goals for a patient with HCM are same for cardiac or
non cardiac surgery :
Preload- Increased
Afterload-Increased
Contractility-Depressed
Avoid tachycardia, Inotropes, Vasodilators
To achieve these,
-Maintain adequate volume status
-Avoid direct or reflex increase in HR or contractility by heavy
premedication & maintaining adequate anaesthesia & analgesia
-Continuation of β blockers or CCBs upto the day of sx & restart
immediately after sx
-Use of vasoconstrictors to maintain MAP or CPP instead of
Inotropes
45. Induction- IV Narcotics/
Propofol in carefully titrated doses can be used
Maintenance-Halothane is advantageous because of its negative
inotropic & chronotropic effect
Intraop Hypotension- Trendelenburg position, Volume
replacement, & Vasoconstrictors
Arrythmia management
-Asymptomatic Nonsustained VT-benign
-Pts with ICD device needs to be suspended in presence of
Electrocautery
-Chronic AF :B Blocker+Verapamil
-Amiodarone is effectve in restoring NSR in pts with HCM
Monitoring
ECG-closely monitor for arrythmias
CVP/PAC/TEE- for volume status, Hemodynamic monitoring
Avoid Inotropes, B agonists & Calcium
46. HCM Athletic heart
Can be asymmetric Concentric & regresses with deconditioning
Wall thickness: > 15 mm < 15 mm
LA: > 40 mm < 40 mm
LVEDD : < 45 mm > 45 mm
Diastolic function: always Normal
abnormal Occurs in about 2% of elite althetes – typical
sports, rowing, cycling, canoeing
46 of 48
47. WHO in 1995 defined RCM as restrictive filling & reduced
diastolic volume of either or both ventricles with normal or
near normal systolic function & wall thickness
Classification of RCM
Myocardial
Nonifiltrative – Idiopathic, Familial, HCM, Diabetic
Infiltrative- Amyloidosis, Sarcoidosis
Storage diseases- Haemochromatosis, Glycogen storage diseases
Endomyocardial
Endomyocardial fibrosis
Carcinoid
Radiation
Drug Induced –Serotonin, Methysergide, Busulfan, Ergotamine
48. Hallmark –Abnormal Diastolic Dysfunction
Impaired ventricular relaxation & abnormal Compliance causes
rapid filling in early diastole & impeded filling during rest of diastole
Characteristic
-Ventricular diast waveform of Dip & Plateau (Square root sign)
-RA pressure waveform-M or W shaped due to rapid y descent
Pressure in the ventricle rises precipitously in response to small
volume
Both ventricles appear thick with small cavities in contrast to
corresponding dilated atria
Lt sided Pulmonary venous pressure >Rt sided venous pressure by
5mmHg
PASP↑↑ upto 50mmHg
Either RVF or LVF or BVF
49.
50.
51. Symptoms of Rt &/or Lt heart failure
Kussmaul’s sign- ↑ JVP during inspiration
Pulsus paradoxus- infrquent
CXR- pulmonary congestion, small heart size
ECG- BBBs, low voltage, QR or QS complexes
2D Echo
52.
53. Characteristic RCM Constrictive Pericarditis
Jugular venous ↑ with more rapid y descent ↑ with less rapid y descent
waveform
Paradoxical Pulse Rare Frequent
Auscultation Late S3, low pitched, S4 occ Early S3,highpitched, No S4
Heart size N to ↑ N to ↑
MR/TR Frequently present Frequently absent
CXR Pericardial calcification rare common
ECG Conduction abn common rare
ECHO Major enlargmt of Atria Slight enlargmt of Atria
LAP>RAP Always Absent
RVP waveform Square root pattern, Dip & Square root pattern
Plateau less prominent
RVEDP/LVEDP
LVEDP>RVEDP by ↑ ↑ & Equal
5mmHg
CT/MRI Rarely thickened Thickened pericardium>3mm
pericardium
Endomycardial Non specific abn Normal
Biopsy
54. Idiopathic
Diuretics-To relieve congestion
B-blockers, Amiodarne, CCBs- Control of HR
Long term anticoagulation
CCBs, ACEI- To enhance myocardial relaxation
Dual Chamber Pacing- AV block
Cardiac Transplantation- Refractory Heart Failure
Amyloidosis- Melphelan, prednisone, H+L transplant
Haemochromatosis- Phlebotomy, Desferrioxamine
Carcinoid- Somatostatin analogs, Valvuloplasty/Valve
replacement
Sarcoidosis –Steroids , Pacing, ICD, Transplantation
EMF with eosinophilic cardiomyopathy:
Endocardiectomy +TV/MV replacement
55. Adults with RCM present for CT or MVR/TVR
Diastolic dysfunction + filling abn- Poor CO & systemic perfusion
Aggresive preop diuretic tharapy- Severe hypovolemia
Pulmonary Congestion leads to ↑ Airway pressures
Induction-Avoid drugs causing ↓ venous return, bradycardia &
myocardial depression
Fentanyl (30u/kg), Sufentanyl, Etomidate , Ketamine provide stable
hemodynamics for induction
Remifentanil, Propofol –unsuitable
Invasive hemodynamic monitoring & TEE
Inotropic support to maintain CO
Diuretics / Vasodilators may be deleterious because higher filling
pressures are needed to maintain the CO
56. Progressive replacement of RV myocardium with fat &
fibrous tissue creating an excellent envt of fatal arrythmias
Typical involves regional RV→Global RV→Partial LV
involvement with sparing of septum
Familial Inheritance, adolescents
Presentation
-Onset of Arrythmias from RV range fromVPCs-VF
-SCD 75% due to VT/VF in sports related exercise
-CHF 25%
-Progressive RV & LV Dysfunction
Diagnosis- Genetics, ECG, Serial Echo, EM Biopsy
ECG-Inverted T waves (Rt precordial leads)
QRS >110ms
Extrasystoles +LBBB
57. Any Family H/O SCD or syncope at an early age must
alert the anaesthesiologist
Arrythmias are more likely in the periop period
Intraop /Postop Avoid any noxious stimuli
Light anaesthesia
Inadequate analgesia
Hypercarbia
Hypovolemia
Acidosis-detrimental due to its effect on arrythmia
generation & myocardial function
GA perse doesn’t appear to be arrythmogenic
Propofol , Midazolam, fentanyl-successfully used
Amiodarone- Antiarrythmic of choice during
Anaesthesia