A 23-year-old pregnant woman presented with shortness of breath and cyanosis. She was diagnosed with a muscular ventricular septal defect (VSD) that had progressed to pulmonary hypertension and Eisenmenger syndrome. Her management involved oxygen supplementation, diuretics, vasodilators, antibiotics, and termination of her 33-34 week pregnancy via cesarean section under epidural anesthesia due to high maternal risk. Pregnancy is contraindicated in Eisenmenger syndrome and special multidisciplinary care is required if continued, with cesarean delivery the preferred mode.
Drug managment of paitent with heart failure after cardiac pacingYazan Dwayat
DRUG MANAGEMENT OF PATIENT WITH HEART FAILURE AFTER CARDIAC PACING
Speaker: Student of 5th course Yazan Dwayat
Scientific advisers: prof. Iabluchanskyi M.I.
ass. prof. Zhuravka N.V.
This document discusses mitral stenosis in pregnancy. It begins by introducing mitral stenosis and its prevalence as a cause of maternal death in India. It then discusses the physiological cardiovascular changes that occur during pregnancy, labor, and the postpartum period. Several sections describe the pathophysiology of mitral stenosis and how it impacts hemodynamics during pregnancy. The document outlines methods for diagnosing and grading the severity of mitral stenosis, as well as predicting mortality and morbidity risks. General management approaches are discussed including medical, surgical, and obstetrical options. The goals of anesthetic management during delivery are provided. In summary, this document provides an overview of mitral stenosis in pregnancy, including its effects, diagnostic evaluation, severity grading
The document discusses cardiogenic shock, which occurs in 5-8% of patients hospitalized with ST elevation myocardial infarction (STEMI). It describes the pathophysiology, criteria for diagnosis, causes, clinical presentation, investigations including echocardiography and pulmonary artery catheterization, management with inotropes, vasopressors, IABP, and early revascularization, as well as prognosis. Early revascularization via PCI or CABG within 18 hours of shock improves survival substantially. Newer mechanical support devices such as percutaneous LVADs are promising but limited by complications. Most hospital survivors have excellent long term survival and quality of life.
A 2-day-old infant presented with shock and was found to have severe coarctation of the aorta. After discharge from the hospital following delivery, the infant collapsed at home. Examination showed poor perfusion and enlarged liver. Echocardiogram revealed severe coarctation, and the infant went into shock once the ductus arteriosus closed, obstructing left heart outflow. Management involved prostaglandin infusion to keep the ductus patent and stabilize the infant until surgery.
This document discusses several congenital heart diseases including their incidence, etiology, pathophysiology, clinical manifestations, diagnosis, and management. It provides details on ventricular septal defect (VSD), atrial septal defect (ASD), patent ductus arteriosus (PDA), tetralogy of Fallot, transposition of the great arteries, coarctation of the aorta, and pulmonary stenosis. The overall incidence of congenital heart diseases is about 8-10 per 1000 live births with VSD being the most common type, accounting for 25-30% of cases. Etiologies may include hereditary factors, infections, chromosomal or genetic abnormalities. Clinical exams, imaging tests, and cardiac catheterization
Pulmonary Embolism, Case Report of b/l PE & Literature ReviewBadarJamal4
A 50-year-old male presented with palpitations, chest discomfort and dyspnea for 3 days following hip replacement surgery 15 days prior. Investigations revealed elevated D-dimer, signs of right heart strain on echocardiogram, and CT pulmonary angiogram showed bilateral saddle pulmonary embolism. He was treated with oxygen, low molecular weight heparin and rivaroxaban. Symptoms resolved and follow up echo showed improvement. He was discharged on long term anticoagulation for pulmonary embolism.
A case of mitral stenosis with discussionnormantang123
This document presents the case of a 53-year-old female patient with a history of severe mitral valve stenosis since 2004, permanent atrial fibrillation, and congestive heart failure who presented with dyspnea for over 1 month. The patient has been followed in cardiology clinic and treated medically but her symptoms have progressed. On examination, she had decreased breath sounds on the right and a diastolic murmur. A right pleural effusion was drained. Echocardiogram showed severe mitral stenosis, huge left atrial dilation, and pulmonary hypertension. Coronary angiography showed no significant stenosis. The patient has severe longstanding mitral stenosis managed medically but now presents with worsening symptoms.
The document discusses acute pulmonary embolism (PE). PE is common but difficult to diagnose, with nonspecific symptoms. It describes a case of a 48-year-old woman presenting with sudden dyspnea, tachycardia, and leg swelling who may have PE. Risk factors for PE include recent surgery or trauma, prolonged immobilization, and inherited or acquired hypercoagulable states. Diagnosis involves clinical scoring, D-dimer, imaging like CTPA, and treatment includes anticoagulation with heparin or warfarin.
Drug managment of paitent with heart failure after cardiac pacingYazan Dwayat
DRUG MANAGEMENT OF PATIENT WITH HEART FAILURE AFTER CARDIAC PACING
Speaker: Student of 5th course Yazan Dwayat
Scientific advisers: prof. Iabluchanskyi M.I.
ass. prof. Zhuravka N.V.
This document discusses mitral stenosis in pregnancy. It begins by introducing mitral stenosis and its prevalence as a cause of maternal death in India. It then discusses the physiological cardiovascular changes that occur during pregnancy, labor, and the postpartum period. Several sections describe the pathophysiology of mitral stenosis and how it impacts hemodynamics during pregnancy. The document outlines methods for diagnosing and grading the severity of mitral stenosis, as well as predicting mortality and morbidity risks. General management approaches are discussed including medical, surgical, and obstetrical options. The goals of anesthetic management during delivery are provided. In summary, this document provides an overview of mitral stenosis in pregnancy, including its effects, diagnostic evaluation, severity grading
The document discusses cardiogenic shock, which occurs in 5-8% of patients hospitalized with ST elevation myocardial infarction (STEMI). It describes the pathophysiology, criteria for diagnosis, causes, clinical presentation, investigations including echocardiography and pulmonary artery catheterization, management with inotropes, vasopressors, IABP, and early revascularization, as well as prognosis. Early revascularization via PCI or CABG within 18 hours of shock improves survival substantially. Newer mechanical support devices such as percutaneous LVADs are promising but limited by complications. Most hospital survivors have excellent long term survival and quality of life.
A 2-day-old infant presented with shock and was found to have severe coarctation of the aorta. After discharge from the hospital following delivery, the infant collapsed at home. Examination showed poor perfusion and enlarged liver. Echocardiogram revealed severe coarctation, and the infant went into shock once the ductus arteriosus closed, obstructing left heart outflow. Management involved prostaglandin infusion to keep the ductus patent and stabilize the infant until surgery.
This document discusses several congenital heart diseases including their incidence, etiology, pathophysiology, clinical manifestations, diagnosis, and management. It provides details on ventricular septal defect (VSD), atrial septal defect (ASD), patent ductus arteriosus (PDA), tetralogy of Fallot, transposition of the great arteries, coarctation of the aorta, and pulmonary stenosis. The overall incidence of congenital heart diseases is about 8-10 per 1000 live births with VSD being the most common type, accounting for 25-30% of cases. Etiologies may include hereditary factors, infections, chromosomal or genetic abnormalities. Clinical exams, imaging tests, and cardiac catheterization
Pulmonary Embolism, Case Report of b/l PE & Literature ReviewBadarJamal4
A 50-year-old male presented with palpitations, chest discomfort and dyspnea for 3 days following hip replacement surgery 15 days prior. Investigations revealed elevated D-dimer, signs of right heart strain on echocardiogram, and CT pulmonary angiogram showed bilateral saddle pulmonary embolism. He was treated with oxygen, low molecular weight heparin and rivaroxaban. Symptoms resolved and follow up echo showed improvement. He was discharged on long term anticoagulation for pulmonary embolism.
A case of mitral stenosis with discussionnormantang123
This document presents the case of a 53-year-old female patient with a history of severe mitral valve stenosis since 2004, permanent atrial fibrillation, and congestive heart failure who presented with dyspnea for over 1 month. The patient has been followed in cardiology clinic and treated medically but her symptoms have progressed. On examination, she had decreased breath sounds on the right and a diastolic murmur. A right pleural effusion was drained. Echocardiogram showed severe mitral stenosis, huge left atrial dilation, and pulmonary hypertension. Coronary angiography showed no significant stenosis. The patient has severe longstanding mitral stenosis managed medically but now presents with worsening symptoms.
The document discusses acute pulmonary embolism (PE). PE is common but difficult to diagnose, with nonspecific symptoms. It describes a case of a 48-year-old woman presenting with sudden dyspnea, tachycardia, and leg swelling who may have PE. Risk factors for PE include recent surgery or trauma, prolonged immobilization, and inherited or acquired hypercoagulable states. Diagnosis involves clinical scoring, D-dimer, imaging like CTPA, and treatment includes anticoagulation with heparin or warfarin.
This document provides information on Eisenmenger syndrome (ES), including its etiology, pathophysiology, natural history, clinical features, and management. ES is defined as severe pulmonary hypertension developing as a consequence of a large pre-existing left-to-right shunt that has reversed flow or become bidirectional. The causes of ES include simple defects like atrial septal defects (ASDs) or complex defects. Clinical features include fatigue, syncope, chest pain, stroke, and sudden cardiac death. Management focuses on treating secondary erythrocytosis, thrombotic diathesis, hemoptysis, arrhythmias, and using targeted therapies like endothelin receptor antagonists, phosphodiesterase 5 inhibitors, prost
This document discusses the diagnosis and management of valvular heart disease. It covers stages of progression for various valve diseases like aortic stenosis and regurgitation. It provides guidelines on diagnostic testing and timing of interventions. It discusses surgical risk calculators like STS PROM and factors affecting surgical risk like frailty. It also summarizes various clinical trials on medications for aortic stenosis which did not show benefit. The document provides guidelines on choice of surgical versus transcatheter interventions. It includes some case scenarios on management decisions for patients with valve diseases.
This document discusses anaesthetic considerations for closed heart procedures including those correcting lesions like patent ductus arteriosus and coarctation of the aorta, as well as palliative procedures like banding of the pulmonary artery. It covers the relevant anatomy, pathophysiology, clinical presentation, diagnosis and management of these conditions. Specifically, it emphasizes the importance of invasive hemodynamic monitoring during surgery due to risks of hypotension and paraplegia from spinal cord ischemia. Careful blood pressure control is needed during and after the procedures.
This document provides an overview of a case of a 70-year-old African American female presenting with acute respiratory distress and signs of a non-ST elevated myocardial infarction (NSTEMI). It discusses her medical history of cardiovascular risk factors and presents her vital signs, physical exam findings, laboratory and imaging results supporting the diagnosis of NSTEMI. The document then outlines her pharmacological management including antiplatelet therapy, anticoagulation, beta-blockers, ACE inhibitors and statins as well as her appropriate treatment options going forward.
The document discusses patent ductus arteriosus (PDA), which is the failure of the ductus arteriosus to close after birth. It defines PDA, discusses its incidence, risk factors, embryology, fetal circulation, closure at birth, classification, natural history, clinical manifestations including signs and symptoms, investigations including echocardiogram and cardiac catheterization, and management including medical treatment with drugs and nonsurgical closure using devices. PDA is usually diagnosed using echocardiogram and can often be closed nonsurgically using devices like the Amplatzer duct occluder.
Eisenmenger syndrome is a form of pulmonary hypertension caused by long-standing left-to-right shunting at the atrial or ventricular level, leading to reversed or bidirectional shunting. It most commonly presents in the second to third decade of life and is associated with uncorrected congenital heart defects. Management focuses on avoiding risks that could destabilize the patient's balanced physiology, such as pregnancy, surgery, travel to high altitudes, and medications like vasodilators. While life expectancy has improved with advanced medical care, mortality remains high due to complications like heart failure, stroke, hemorrhage and sudden death.
Atrial fibrillation is the most common arrhythmia and increases mortality risk. It is classified as paroxysmal, persistent, or permanent based on duration. The CHA2DS2-VASc score is used to assess stroke risk and determine need for anticoagulation. Treatment focuses on rate control with medications like calcium channel blockers or cardioversion for hemodynamic instability. Anticoagulation is recommended for CHA2DS2-VASc score over 2 to prevent stroke.
Congenital Heart Diseases in Children.pptxAshik Alvee
This document provides an overview of congenital heart disease in children. It discusses the epidemiology, risk factors, classification, and approach to diagnosis and management. Common congenital heart defects such as ventricular septal defect, atrial septal defect, patent ductus arteriosus, and tetralogy of Fallot are described in detail, including their typical presentation, physical exam findings, investigations, and treatment. The document is intended to educate medical students and trainees about pediatric congenital heart disease.
This document summarizes the diagnosis and management of critical congenital heart disease in neonates. It discusses prenatal evaluation, initial evaluation and stabilization, confirmation of diagnosis, preoperative evaluation of other organ systems, and lesion-specific surgical management. Key lesions discussed in detail include hypoplastic left heart syndrome, transposition of the great arteries, and total anomalous pulmonary venous connection.
This document discusses acute pulmonary embolism, including its causes, symptoms, diagnosis, and treatment. It notes that PE is a leading cause of preventable hospital death and that diagnosis can be difficult due to non-specific symptoms. The diagnosis involves a clinical probability assessment, d-dimer test, and CT scan. Treatment depends on risk stratification and may involve anticoagulation, thrombolysis for massive PE, or placement of an IVC filter. Prevention through prophylaxis in at-risk patients is emphasized.
1) Heart failure is a major and growing public health problem, affecting over 15 million people in Europe with a prevalence of over 2-3% overall and 10-20% in those over 70 years old.
2) It is a primary cause of hospital admissions and readmissions, accounting for 5% of admissions and 40% of patients being readmitted or dying within a year. It represents a significant cost burden on healthcare systems.
3) Diagnosis involves clinical examination, ECG, chest x-ray, echocardiography and natriuretic peptide levels of BNP or NT-proBNP which can help differentiate between possible and likely heart failure.
4) Heart failure is now recognized as a
This document discusses the pathophysiology and treatment of acute pulmonary embolism (PE). It covers:
- The pathophysiological effects of PE on right ventricular function and hemodynamics.
- Clinical prediction rules and diagnostic strategies for PE including D-dimer testing and imaging modalities like CT, VQ scan, and angiography.
- Treatment options for PE including anticoagulants like heparin, low molecular weight heparin, fondaparinux, and newer oral agents; as well as thrombolytics, vena cava filters, and embolectomy. LMWH is recommended as first-line treatment due to superior safety compared to unfractionated heparin
The document discusses postpericardiotomy syndrome, which is an inflammatory condition that can occur after surgery involving opening of the pericardium. It has three key characteristics:
1) It presents with symptoms like fever, chest pain, and pericardial friction rub within 1-6 weeks after cardiac surgery.
2) It is characterized by pericardial and sometimes pleural effusions seen on imaging like echocardiography.
3) It is typically treated with anti-inflammatory drugs like NSAIDs or corticosteroids, and pericardiocentesis if cardiac tamponade develops.
Peri op management of mitral stenosis patient coming for non cardiac surgeryanaesthesiaESICMCH
Mitral stenosis is a chronic mechanical obstruction of the left ventricular inflow caused by narrowing of the mitral valve orifice. This document discusses the anesthetic considerations for a patient with mitral stenosis undergoing non-cardiac surgery. It covers the pathophysiology of mitral stenosis, preoperative evaluation and optimization of the patient, and intraoperative anesthetic goals of maintaining normal hemodynamics while avoiding tachycardia, changes in preload or afterload, and worsening of pulmonary hypertension.
This document discusses a case of dengue fever with myocarditis in an 18-year-old male construction worker presenting with fever, headache, and body aches. Initial tests showed mild left ventricular dysfunction which later improved. Dengue IgM was positive, confirming dengue fever with cardiac involvement. Recent studies show that while cardiac complications of dengue are uncommon, myocarditis is the most documented pathology and can present asymptomatically. Echocardiography is useful for diagnosis where sinus bradycardia is often the only ECG finding.
This document provides an overview of STEMI (ST-segment elevation myocardial infarction). It defines STEMI and lists its clinical features and complications. It discusses the important investigations for STEMI including electrocardiogram, cardiac markers, echocardiogram, and MRI. It also outlines the management of STEMI both in the emergency department and hospital, including reperfusion therapies, medications, monitoring for complications, and addressing issues like hypotension and hypovolemia.
This document discusses cerebral aneurysms and subarachnoid hemorrhage. It provides details on:
- The incidence, risk factors, locations, and causes of cerebral aneurysms
- Grading scales used to assess the severity of subarachnoid hemorrhage
- Complications associated with subarachnoid hemorrhage such as vasospasm, rebleeding, and elevated intracranial pressure
- Management strategies for unruptured and ruptured aneurysms including surgical clipping and endovascular coiling to prevent rebleeding
This document discusses cerebral aneurysms and subarachnoid hemorrhage. It notes that ruptured cerebral aneurysms account for 75% of subarachnoid hemorrhages, which affect 27,000 Americans per year. The majority of cerebral aneurysms occur at specific locations on major cerebral vessels. Ruptured aneurysms have high rates of morbidity and mortality, while unruptured aneurysms have lower risks if left untreated. The document discusses risks factors, classifications, complications including vasospasm, and approaches to treatment and anesthesia management for patients with cerebral aneurysms and subarachnoid hemorrhage.
This document presents information from a presentation on acyanotic congenital heart disease. It begins with objectives that cover fetal circulation, defining CHD and risk factors, classifying CHD, explaining acyanotic heart disease and specific defects. It then provides detailed information on ventricular septal defect, atrial septal defect, patent ductus arteriosus, aortic stenosis, pulmonary stenosis, and coarctation of aorta. For each defect, it discusses clinical manifestation, diagnostic criteria, management, and complications. It also includes summaries of two research papers on neurodevelopmental outcomes after surgery for acyanotic CHD and a comparison of renal function between cyanotic and acyanotic CHD in children.
Principles of diagnosis & management of acute pulmonaryVijay Yadav
This document provides an overview of the principles of diagnosis and management of acute pulmonary embolism (PE). It discusses the epidemiology of PE including incidence and mortality rates. It covers the pre-test clinical assessment, diagnostic testing including D-dimer, chest imaging, echocardiogram and CT pulmonary angiography. It also discusses prognostic factors in echocardiogram and other biomarkers. The document outlines the management of PE including hemodynamic support, anticoagulation, thrombolysis, percutaneous interventions, surgical thrombectomy and inferior vena cava filters. It concludes with recommendations for long-term anticoagulation or secondary prophylaxis based on the condition that caused the PE.
This document provides information on Eisenmenger syndrome (ES), including its etiology, pathophysiology, natural history, clinical features, and management. ES is defined as severe pulmonary hypertension developing as a consequence of a large pre-existing left-to-right shunt that has reversed flow or become bidirectional. The causes of ES include simple defects like atrial septal defects (ASDs) or complex defects. Clinical features include fatigue, syncope, chest pain, stroke, and sudden cardiac death. Management focuses on treating secondary erythrocytosis, thrombotic diathesis, hemoptysis, arrhythmias, and using targeted therapies like endothelin receptor antagonists, phosphodiesterase 5 inhibitors, prost
This document discusses the diagnosis and management of valvular heart disease. It covers stages of progression for various valve diseases like aortic stenosis and regurgitation. It provides guidelines on diagnostic testing and timing of interventions. It discusses surgical risk calculators like STS PROM and factors affecting surgical risk like frailty. It also summarizes various clinical trials on medications for aortic stenosis which did not show benefit. The document provides guidelines on choice of surgical versus transcatheter interventions. It includes some case scenarios on management decisions for patients with valve diseases.
This document discusses anaesthetic considerations for closed heart procedures including those correcting lesions like patent ductus arteriosus and coarctation of the aorta, as well as palliative procedures like banding of the pulmonary artery. It covers the relevant anatomy, pathophysiology, clinical presentation, diagnosis and management of these conditions. Specifically, it emphasizes the importance of invasive hemodynamic monitoring during surgery due to risks of hypotension and paraplegia from spinal cord ischemia. Careful blood pressure control is needed during and after the procedures.
This document provides an overview of a case of a 70-year-old African American female presenting with acute respiratory distress and signs of a non-ST elevated myocardial infarction (NSTEMI). It discusses her medical history of cardiovascular risk factors and presents her vital signs, physical exam findings, laboratory and imaging results supporting the diagnosis of NSTEMI. The document then outlines her pharmacological management including antiplatelet therapy, anticoagulation, beta-blockers, ACE inhibitors and statins as well as her appropriate treatment options going forward.
The document discusses patent ductus arteriosus (PDA), which is the failure of the ductus arteriosus to close after birth. It defines PDA, discusses its incidence, risk factors, embryology, fetal circulation, closure at birth, classification, natural history, clinical manifestations including signs and symptoms, investigations including echocardiogram and cardiac catheterization, and management including medical treatment with drugs and nonsurgical closure using devices. PDA is usually diagnosed using echocardiogram and can often be closed nonsurgically using devices like the Amplatzer duct occluder.
Eisenmenger syndrome is a form of pulmonary hypertension caused by long-standing left-to-right shunting at the atrial or ventricular level, leading to reversed or bidirectional shunting. It most commonly presents in the second to third decade of life and is associated with uncorrected congenital heart defects. Management focuses on avoiding risks that could destabilize the patient's balanced physiology, such as pregnancy, surgery, travel to high altitudes, and medications like vasodilators. While life expectancy has improved with advanced medical care, mortality remains high due to complications like heart failure, stroke, hemorrhage and sudden death.
Atrial fibrillation is the most common arrhythmia and increases mortality risk. It is classified as paroxysmal, persistent, or permanent based on duration. The CHA2DS2-VASc score is used to assess stroke risk and determine need for anticoagulation. Treatment focuses on rate control with medications like calcium channel blockers or cardioversion for hemodynamic instability. Anticoagulation is recommended for CHA2DS2-VASc score over 2 to prevent stroke.
Congenital Heart Diseases in Children.pptxAshik Alvee
This document provides an overview of congenital heart disease in children. It discusses the epidemiology, risk factors, classification, and approach to diagnosis and management. Common congenital heart defects such as ventricular septal defect, atrial septal defect, patent ductus arteriosus, and tetralogy of Fallot are described in detail, including their typical presentation, physical exam findings, investigations, and treatment. The document is intended to educate medical students and trainees about pediatric congenital heart disease.
This document summarizes the diagnosis and management of critical congenital heart disease in neonates. It discusses prenatal evaluation, initial evaluation and stabilization, confirmation of diagnosis, preoperative evaluation of other organ systems, and lesion-specific surgical management. Key lesions discussed in detail include hypoplastic left heart syndrome, transposition of the great arteries, and total anomalous pulmonary venous connection.
This document discusses acute pulmonary embolism, including its causes, symptoms, diagnosis, and treatment. It notes that PE is a leading cause of preventable hospital death and that diagnosis can be difficult due to non-specific symptoms. The diagnosis involves a clinical probability assessment, d-dimer test, and CT scan. Treatment depends on risk stratification and may involve anticoagulation, thrombolysis for massive PE, or placement of an IVC filter. Prevention through prophylaxis in at-risk patients is emphasized.
1) Heart failure is a major and growing public health problem, affecting over 15 million people in Europe with a prevalence of over 2-3% overall and 10-20% in those over 70 years old.
2) It is a primary cause of hospital admissions and readmissions, accounting for 5% of admissions and 40% of patients being readmitted or dying within a year. It represents a significant cost burden on healthcare systems.
3) Diagnosis involves clinical examination, ECG, chest x-ray, echocardiography and natriuretic peptide levels of BNP or NT-proBNP which can help differentiate between possible and likely heart failure.
4) Heart failure is now recognized as a
This document discusses the pathophysiology and treatment of acute pulmonary embolism (PE). It covers:
- The pathophysiological effects of PE on right ventricular function and hemodynamics.
- Clinical prediction rules and diagnostic strategies for PE including D-dimer testing and imaging modalities like CT, VQ scan, and angiography.
- Treatment options for PE including anticoagulants like heparin, low molecular weight heparin, fondaparinux, and newer oral agents; as well as thrombolytics, vena cava filters, and embolectomy. LMWH is recommended as first-line treatment due to superior safety compared to unfractionated heparin
The document discusses postpericardiotomy syndrome, which is an inflammatory condition that can occur after surgery involving opening of the pericardium. It has three key characteristics:
1) It presents with symptoms like fever, chest pain, and pericardial friction rub within 1-6 weeks after cardiac surgery.
2) It is characterized by pericardial and sometimes pleural effusions seen on imaging like echocardiography.
3) It is typically treated with anti-inflammatory drugs like NSAIDs or corticosteroids, and pericardiocentesis if cardiac tamponade develops.
Peri op management of mitral stenosis patient coming for non cardiac surgeryanaesthesiaESICMCH
Mitral stenosis is a chronic mechanical obstruction of the left ventricular inflow caused by narrowing of the mitral valve orifice. This document discusses the anesthetic considerations for a patient with mitral stenosis undergoing non-cardiac surgery. It covers the pathophysiology of mitral stenosis, preoperative evaluation and optimization of the patient, and intraoperative anesthetic goals of maintaining normal hemodynamics while avoiding tachycardia, changes in preload or afterload, and worsening of pulmonary hypertension.
This document discusses a case of dengue fever with myocarditis in an 18-year-old male construction worker presenting with fever, headache, and body aches. Initial tests showed mild left ventricular dysfunction which later improved. Dengue IgM was positive, confirming dengue fever with cardiac involvement. Recent studies show that while cardiac complications of dengue are uncommon, myocarditis is the most documented pathology and can present asymptomatically. Echocardiography is useful for diagnosis where sinus bradycardia is often the only ECG finding.
This document provides an overview of STEMI (ST-segment elevation myocardial infarction). It defines STEMI and lists its clinical features and complications. It discusses the important investigations for STEMI including electrocardiogram, cardiac markers, echocardiogram, and MRI. It also outlines the management of STEMI both in the emergency department and hospital, including reperfusion therapies, medications, monitoring for complications, and addressing issues like hypotension and hypovolemia.
This document discusses cerebral aneurysms and subarachnoid hemorrhage. It provides details on:
- The incidence, risk factors, locations, and causes of cerebral aneurysms
- Grading scales used to assess the severity of subarachnoid hemorrhage
- Complications associated with subarachnoid hemorrhage such as vasospasm, rebleeding, and elevated intracranial pressure
- Management strategies for unruptured and ruptured aneurysms including surgical clipping and endovascular coiling to prevent rebleeding
This document discusses cerebral aneurysms and subarachnoid hemorrhage. It notes that ruptured cerebral aneurysms account for 75% of subarachnoid hemorrhages, which affect 27,000 Americans per year. The majority of cerebral aneurysms occur at specific locations on major cerebral vessels. Ruptured aneurysms have high rates of morbidity and mortality, while unruptured aneurysms have lower risks if left untreated. The document discusses risks factors, classifications, complications including vasospasm, and approaches to treatment and anesthesia management for patients with cerebral aneurysms and subarachnoid hemorrhage.
This document presents information from a presentation on acyanotic congenital heart disease. It begins with objectives that cover fetal circulation, defining CHD and risk factors, classifying CHD, explaining acyanotic heart disease and specific defects. It then provides detailed information on ventricular septal defect, atrial septal defect, patent ductus arteriosus, aortic stenosis, pulmonary stenosis, and coarctation of aorta. For each defect, it discusses clinical manifestation, diagnostic criteria, management, and complications. It also includes summaries of two research papers on neurodevelopmental outcomes after surgery for acyanotic CHD and a comparison of renal function between cyanotic and acyanotic CHD in children.
Principles of diagnosis & management of acute pulmonaryVijay Yadav
This document provides an overview of the principles of diagnosis and management of acute pulmonary embolism (PE). It discusses the epidemiology of PE including incidence and mortality rates. It covers the pre-test clinical assessment, diagnostic testing including D-dimer, chest imaging, echocardiogram and CT pulmonary angiography. It also discusses prognostic factors in echocardiogram and other biomarkers. The document outlines the management of PE including hemodynamic support, anticoagulation, thrombolysis, percutaneous interventions, surgical thrombectomy and inferior vena cava filters. It concludes with recommendations for long-term anticoagulation or secondary prophylaxis based on the condition that caused the PE.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
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.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Integrating Ayurveda into Parkinson’s Management: A Holistic Approach
CASE DEWASA .pptx
1. Diagnosis and Management of Ventricular
Septal Defect (VSD) with Eisenmenger
syndrome
MONICA OKTARIYANTHY
1
Division of Clinical Cardiology
Department Cardiology and Vascular Medicine
RS DR M Djamil PADANG
2023
2. VSD is the most common congenital heart
defect in children
Asymptomatic VSD without functional
complications (NYHA Class I and II) usually does
not have an impact on pregnancy.
8-10% of VSD develop into Pulmonary
Hypertension (esenmenger syndrom) and
maternal mortality about 55%
2
INTRODUCTION
Mann DL,. Braundwald’s Heart Disease. 10th ed. 2015.
3. Four Types of VSD
Infundibular, outlet
•Rare 6-8% of all VSD
•at below the semilunar valve in the right ventricular outlet
Membran
•Most commmon 80% of all VSD
•At septum membran inferior to supraventricular crista.
Inlet
•8% of all CSD
•>> located at below the inlet valves in the inlet portion of right ventricular septum
•at muscular septum, bounded by the musculature ussually in the apical, central, and outer parts of
intraventricular septum
Muscular, trabecular
3
th
4. CASE ILLUSTRATION
23♀, pregnant • 33-34 weeks
shortness of breath
3 day before being
admitted,
•Not shrinking
•Not influence by food and weather
•Increase even though resting
•Woken up at night due to tightness
•fatique
The nails turned
blue
• 3 month before coming to the
hospital
HISTORY TAKING
4
8. 8
ECG
ST ,QRS rate 110x/min, RAD Extreme, P wave normal and PR interval 0.16 ", QRS 0.08", ST
changes (-/-), LVH (-), RVH (+), QTc 411 msec,
9. 9
Echocardiography
Muscular VSD measuring 18-20 mm R → L
shunt with a trans-VSD gradient of 10 mmHg
with Eisenmenger syndrome. TR Moderate,
high probability PH. LV global systolic with
good function, EF 60% (Simpson), global
normokinetic, good RV contractility, Left
Arch, Coa (-). Muscular VSD + PH
impression.
17. Physiological Adaptation to Pregnancy
• ↑ blood volume ≈50%
• ↑ CO 30-50%, max between
5th and 8th months
• ↓ systolic and diastolic
blood pressure
• ↓ systemic arterial resistance
18. Hemodynamic changes during delivery
• Labour
• ↑ O2 consumption
• ↑ baseline CO
• ↑ CO and blood pressure
during uterine contraction
(depend on mode of
delivery: epidural
analgesia/SC)
• Post partum
• ↑ Blood shift from placenta
• ↑ preload and CO
significant haemodynamic changes
Uterine contractions,positioning (left lateral vs.
supine), pain, anxiety, exertion, haemorrhage, and
uterine involution, anaesthesia and infection
19. CONGENITAL HEART DEFECT TYPE ACYANOTIC
19
Park, Myung K. Pediatric Cardiology for Practitioners. 5th ed; 2008
20. Diagnosis of VSD with
Eisenmenger Syndrom
Anamnesa
Clinical Findings
A widely split and fixed S2 and a grade 2 to 3 of 6
systolic ejection murmur at LLSB
ECG
RAD,RVH, or RBBB
Chest X ray
Cardiomegaly with enlargement of the RA RV prominent PA
segment Increased pulmonary vascular marking
20
Ventricular Septal Defect
Pulmonary Hypertension
(Left to the Right Shunt)
ECHOCARDIOGRAHY
Park, Myung K. Pediatric Cardiology for Practitioners. 5th ed; 2008:
24. 24
• Where these patients are contraindicated for pregnancy.
• If the pregnancy continuesit is strongly recommended for patients to
control regularly to the cardiologists and obstetricians during
pregnancy, during delivery and the puerperium.
25. The class of drugs that are safe for consumption is determined for pregnant
patient VSD with – Eisenmenger syndrome
25
Phosphodiesterase Inhibitor
• Inhibit specificcGMP phosphodiesterase (phosphodiesterase type 5
inhibitor ) icrease the puklmonary vascular respon to inhalational and
endogenous NO in pulmonary hypertension
Antiplatelet therapy
• Patinent with Eisenmenger syndrome are at increased risk of
thrombocytopenia, deficiencies in vitamin K-depende clotting factor,
but the evidence base for using antiplatelet or LMWH is less develop
26. 26
Cesarean delivery
Cesarean delivery needs a plan
In high risk lesions specialist multidisciplinary team.
Preparation of Operations the chosen type of Analgesia is the
Lumbar Epidural.
Continuous lumbar epidural analgesia with local or opiate
anesthesia, or continuous spinal opioid anesthesia can be given
safely
Management Delivery of VSD-PH in Pregnancy Patient
Regitz-Zagrosek V,ESC Guidelines on the Management of Cardiovascular Diseases during Pregnancy, 2011
27. Summary
Pregnancy is contraindicated in cases eisenmenger syndrome
Special attention and comprehensive management are required for pregnant
patients with VSD-Eisennenger (Section Cesaeran, Epidural lumbal analgesia,
sterilization)
One way is termination of pregnancy
27
A 16-year-old woman admitted to Cardiovascular Department of RSUP Dr. M. Djamil Padang with chief complaint of fever since 2 weeks before admission.
On the second day of treatment, there were still complaints of shortness of breath, fever, and phlegm cough with blood pressure was 100/47 mmHg, with heart rate 91 bpm (beat per minute), respiratory rate 24 times per minute, temperature 37.8°C and diuresis 0.8 cc/kg/hour. On physical examination, pansystolic murmur at the apex of the heart and soft wet rales were found, while wheezing and lower extremities edema were not found. Patient was diagnosed with Possible IE. Furosemide bolus iv therapy in the patient was replaced by Furosemide drip iv 3 mg/hour, while antibiotic therapy was continued. PRC transfusions and routine blood tests, MCV, MCH, MCHC, reticulocytes, and post correction electrolyte examinations were also performed in the patient. The patient then was consulted to the Internal Medicine Department. The Internist diagnosed the patient with Normochrome Normocytic Mild Anemia ec Hemolytic ec Autoimmune Suspension/Non-autoimmune Suspension. The patient was recommended to have routine blood tests (Hb, Ht, Leukocytes, Platelets) after transfusion.
The patient was consulted to the Pulmonology Department as well. From history taking, physical and other examinations, the patient was diagnosed with Community Acquired Pneumonia (CAP) and minimal dextral pleural effusion. The patient was recommended for culture and sensitivity test of sputum as well as Molecular Rapid Test (TCM) and Thoracic Ultrasound, if it is possible. The Pulmonologist gave recommendation therapy, i.e. continuing antibiotic therapy as the Cardiologist advised and nebulization of N-Acetylsistein 2x 300 mg.
On the third day of treatment, there were still complaints of phlegm cough, while shortness of breath had decreased and fever had been treated, with with blood pressure was 100/57 mmHg, with heart rate 79 bpm (beat per minute), respiratory rate 22 times per minute, temperature 37.1°C and diuresis 1.2 cc/kg/hour. On physical examination, pansystolic murmur at the apex of the heart and soft wet rales were found, lower extremities edema was not found.
Laboratory tests results showed normochromic anisocytosis, leukocytosis with shift to the right neutrophilia, and thrombocytopenia. Electrolyte blood tests results were calcium 8.2 mg/dL, sodium 133 mmol/L, potassium 3.4 mg/dL and serum chloride 103 mmol/L which showed improvement of hypocalcemia and hypokalemia. Treatments were IVFD RL 500 cc/24 hours, Furosemide drip iv which was maintained at 3 mg/hour, Ramipril which the dose was increased become 1x5 mg, and antibiotics therapy i.e. Ampicillin iv 4x3 g and Gentamicin iv 1x160 mg were continued for 15 days, then potassium was corrected with KCl 30 mEq. The ACE-I was planned to be up titrated, while other therapies were continued.
On the second day of treatment, there were still complaints of shortness of breath, fever, and phlegm cough with blood pressure was 100/47 mmHg, with heart rate 91 bpm (beat per minute), respiratory rate 24 times per minute, temperature 37.8°C and diuresis 0.8 cc/kg/hour. On physical examination, pansystolic murmur at the apex of the heart and soft wet rales were found, while wheezing and lower extremities edema were not found. Patient was diagnosed with Possible IE. Furosemide bolus iv therapy in the patient was replaced by Furosemide drip iv 3 mg/hour, while antibiotic therapy was continued. PRC transfusions and routine blood tests, MCV, MCH, MCHC, reticulocytes, and post correction electrolyte examinations were also performed in the patient. The patient then was consulted to the Internal Medicine Department. The Internist diagnosed the patient with Normochrome Normocytic Mild Anemia ec Hemolytic ec Autoimmune Suspension/Non-autoimmune Suspension. The patient was recommended to have routine blood tests (Hb, Ht, Leukocytes, Platelets) after transfusion.
The patient was consulted to the Pulmonology Department as well. From history taking, physical and other examinations, the patient was diagnosed with Community Acquired Pneumonia (CAP) and minimal dextral pleural effusion. The patient was recommended for culture and sensitivity test of sputum as well as Molecular Rapid Test (TCM) and Thoracic Ultrasound, if it is possible. The Pulmonologist gave recommendation therapy, i.e. continuing antibiotic therapy as the Cardiologist advised and nebulization of N-Acetylsistein 2x 300 mg.
On the third day of treatment, there were still complaints of phlegm cough, while shortness of breath had decreased and fever had been treated, with with blood pressure was 100/57 mmHg, with heart rate 79 bpm (beat per minute), respiratory rate 22 times per minute, temperature 37.1°C and diuresis 1.2 cc/kg/hour. On physical examination, pansystolic murmur at the apex of the heart and soft wet rales were found, lower extremities edema was not found.
Laboratory tests results showed normochromic anisocytosis, leukocytosis with shift to the right neutrophilia, and thrombocytopenia. Electrolyte blood tests results were calcium 8.2 mg/dL, sodium 133 mmol/L, potassium 3.4 mg/dL and serum chloride 103 mmol/L which showed improvement of hypocalcemia and hypokalemia. Treatments were IVFD RL 500 cc/24 hours, Furosemide drip iv which was maintained at 3 mg/hour, Ramipril which the dose was increased become 1x5 mg, and antibiotics therapy i.e. Ampicillin iv 4x3 g and Gentamicin iv 1x160 mg were continued for 15 days, then potassium was corrected with KCl 30 mEq. The ACE-I was planned to be up titrated, while other therapies were continued.