Introduction to Electrophysiology - Supraventricular Tachycardias (1/4 lectures)Jose Osorio
What is cardiac Electrophysiology?
This presentation will cover basics of EP. It is Part 1 of 4 lectures about EP.
Part 1 - basics of EP and Supraventricular Tachycardias (SVT)
Part 2 - Ventricular arrhythmias and Cardiac Devices
Part 3 - Afib
Part 4 - EKG
Introduction to Electrophysiology - Supraventricular Tachycardias (1/4 lectures)Jose Osorio
What is cardiac Electrophysiology?
This presentation will cover basics of EP. It is Part 1 of 4 lectures about EP.
Part 1 - basics of EP and Supraventricular Tachycardias (SVT)
Part 2 - Ventricular arrhythmias and Cardiac Devices
Part 3 - Afib
Part 4 - EKG
AV nodal reentrant tachycardia (AVNRT), or atrioventricular nodal reentrant tachycardia, is a type of tachycardia (fast rhythm) of the heart. It is a type of supraventricular tachycardia (SVT), meaning that it originates from a location within the heart above the bundle of His. AV nodal reentrant tachycardia is the most common regular supraventricular tachycardia. It is more common in women than men (approximately 75% of cases occur in females). The main symptom is palpitations. Treatment may be with specific physical maneuvers, medication, or, rarely, synchronized cardioversion. Frequent attacks may require radiofrequency ablation, in which the abnormally conducting tissue in the heart is destroyed.
AVNRT occurs when a reentry circuit forms within or just next to the atrioventricular node. The circuit usually involves two anatomical pathways: the fast pathway and the slow pathway, which are both in the right atrium. The slow pathway (which is usually targeted for ablation) is located inferior and slightly posterior to the AV node, often following the anterior margin of the coronary sinus. The fast pathway is usually located just superior and posterior to the AV node. These pathways are formed from tissue that behaves very much like the AV node, and some authors regard them as part of the AV node.
The fast and slow pathways should not be confused with the accessory pathways that give rise to Wolff-Parkinson-White syndrome (WPW syndrome) or atrioventricular reciprocating tachycardia (AVRT). In AVNRT, the fast and slow pathways are located within the right atrium close to or within the AV node and exhibit electrophysiologic properties similar to AV nodal tissue. Accessory pathways that give rise to WPW syndrome and AVRT are located in the atrioventricular valvular rings. They provide a direct connection between the atria and ventricles, and have electrophysiologic properties similar to ventricular myocardium.
Trio of Rheumatic Mitral Stenosis, Right Posterior Septal Accessory Pathway a...Ramachandra Barik
A 57-year-old male presented with recurrent palpitations. He was diagnosed with rheumatic mitral stenosis, right posterior septal accessory pathway and atrial flutter. An electrophysiological study after percutaneous balloon mitral valvotomy showed that the palpitations were due to atrial flutter with right bundle branch aberrancy. The right posterior septal pathway was a bystander because it had a higher refractory period than the atrioventricular node.
AV nodal reentrant tachycardia (AVNRT), or atrioventricular nodal reentrant tachycardia, is a type of tachycardia (fast rhythm) of the heart. It is a type of supraventricular tachycardia (SVT), meaning that it originates from a location within the heart above the bundle of His. AV nodal reentrant tachycardia is the most common regular supraventricular tachycardia. It is more common in women than men (approximately 75% of cases occur in females). The main symptom is palpitations. Treatment may be with specific physical maneuvers, medication, or, rarely, synchronized cardioversion. Frequent attacks may require radiofrequency ablation, in which the abnormally conducting tissue in the heart is destroyed.
AVNRT occurs when a reentry circuit forms within or just next to the atrioventricular node. The circuit usually involves two anatomical pathways: the fast pathway and the slow pathway, which are both in the right atrium. The slow pathway (which is usually targeted for ablation) is located inferior and slightly posterior to the AV node, often following the anterior margin of the coronary sinus. The fast pathway is usually located just superior and posterior to the AV node. These pathways are formed from tissue that behaves very much like the AV node, and some authors regard them as part of the AV node.
The fast and slow pathways should not be confused with the accessory pathways that give rise to Wolff-Parkinson-White syndrome (WPW syndrome) or atrioventricular reciprocating tachycardia (AVRT). In AVNRT, the fast and slow pathways are located within the right atrium close to or within the AV node and exhibit electrophysiologic properties similar to AV nodal tissue. Accessory pathways that give rise to WPW syndrome and AVRT are located in the atrioventricular valvular rings. They provide a direct connection between the atria and ventricles, and have electrophysiologic properties similar to ventricular myocardium.
Trio of Rheumatic Mitral Stenosis, Right Posterior Septal Accessory Pathway a...Ramachandra Barik
A 57-year-old male presented with recurrent palpitations. He was diagnosed with rheumatic mitral stenosis, right posterior septal accessory pathway and atrial flutter. An electrophysiological study after percutaneous balloon mitral valvotomy showed that the palpitations were due to atrial flutter with right bundle branch aberrancy. The right posterior septal pathway was a bystander because it had a higher refractory period than the atrioventricular node.
CHAPrER 21 r Cardiovascular SystemUsing the CPT and ICD-10.docxsleeperharwell
CHAPrER 21 r Cardiovascular System
Using the CPT and ICD-10-CM/ICD-9-CM manuals, code the fallowing:
41. Valvuloplasty of the aortic valve using transventdcular dilation with
cardiopulmonary bypass.
CPT Code:
,/
i+
y'+2. Xeptacement aortic valve, with cardiopulmonary bypass, with prosthetic
valve.
CPT Code:
43. Valvuloplasty, tricuspid valve, with ring insertion.
CPT Code:
d p"puirof a coronary arteriovenous fistula, without cardiopulmonary
bypass.
CPT Code:
d *r"rnal electrical cardioversion.
CPT Code:
47. Percutaneous balloon angioplasty; one coronary vessel.
CPT Code:
t*{. Cpp.(Cardiopulmonary resuscitatio4).
CPT Code:
49. Electrocardiogram with interpretation and report only.
CPT C6de:
C rrrurs graft of the common carotid-ipsilateral iriternal carotid artery
using synthetic vein.
CPT Code:
5L. Ligation of temporal artery.
CPT Code:
Odd-numbered answers are located in Appendtx B, while the full arrrwer key ts only avallable tn the TEACE
Instructor Resources on Evolve.
Copyrlght @ 2015 by Saunde$, an imprint of Elsevier Irrc. All rights reseryed.
45. Routine ECG with
components.
CPT Code:
L2leads with both the professional and technical
CHAPTER 21
a
I Cardiovascular System
,/
v52. Ligation of a common iliac vein.
CPT Code:
53. Open ftansluminal balloon angioplasty aorta.
CPT Code:
,An. Coronary artery bypass, single artery, for coronary atherosclerosis of
native coronary artery in a transplanted heart.
CPT Code:
ICD-10-CM Code:
(ICD-9-CM Code:
four veins, no arteries. Diagnosis of acute55. Coronary artery bypass,
coronary insufficiency.
& cpr code(s):
& tco-ro-cM code(s):
(& ICD-q-cM Code(s):
teriovenous fistula of a'Iower extremity.
CPT Code(s):
ICD-10-CM Code(s):
ICD-9-CM Code(s):
& Ur". to declde number of codes necessary to conectly answer the question.
Odd-numbered ansyyers are located in Appendix B, while the full anxwer key is only avallable in the TEACH
Instructof Resources on Evolve,
&
&
@
/
g/SO. nepair of injury to intra-abdominal blood vessel, inferior vena cava,
hepatic vein, with a vein graft.
& cpr code(s):
& tco-ro-cM Code(s):
(& ICD-o-cM code(s):
57. Percutaneous insertion of an intra-aortic balloon assist device due to
initial episode of acute myocardial infarction apd cardiogenic shock.
& cpr code(s):
& tco-ro-cM code(s):
/ (& ICD-o-cM code(s):
I
VSa. nepair of a traumatic ar
Copy,right @ 2015 by Saunders, an impdnt of Elsevier Inc. Al1 rights teserved.
59. Repair congenital
CHAITTER 21 r
atrial septal defect, secundum, with
Cardiovasculat System
bypass and patch.
& cpr code(s):
& Ico-to-cM code(s):
.1& lco-o-cM code(s): )
ffiO. Repair of a patent ductus arteriosus by division on a 16-year-old patient.
& cpr code(s):
& Ico-ro-cM code(s):
1& Ico-e-cM code(s):
61. Reoperation of one arterial coronary bypass graft and one vein bypass
graft for arteriosclerosis of native arteries, 3 months following the initial
procedure.
& cpr Code(s):
& tco-ro-c.
Surgery for atrial fibrillation abhijit presentationAbhijit Joshi
this presentation starts with the description of atrial fibrillation and goes on to describe the basis of it's surgical cure, viz. The Maze procedure. I then describe the technical aspects of Maze 1,2,3,4...
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- 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
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.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
1. Ablation of a wide complexAblation of a wide complex
tachycardia in a young adulttachycardia in a young adult
Salah Atta, MD
Lecturer of Cardiology
Department of Cardiology, Assiut
University Hospitals
2. A 17 years old male from Kena, a student in
the 3rd year of secondary school presented
to us suffering from recurrent attacks of
rapid regular palpitation which was
associated with marked low cardiac output
manifestations.
3. On clinical examination:
The patient was clinically free.
Echocardiographic examination also
revealed no abnormality.
4.
5. The baseline ECG of the patient was
sinus rythm of a rate of 70 B/min with
no evidence of pre-excitation.
6.
7. ECG during the tachycardia:
Regular wide complex tachycardia of a rate of
150 B/min with the LBBB, LAD.
8. EPS procedure:
Standard 6 French quadripolar electrode
catheters were positioned in the high right
atrium and at the right ventricular apex
from the left femoral vein, respectively. A
third similar catheter was placed to record
the His-bundle activation. Coronary sinus
mapping was acheived by placing a 6
French 'USCI' octapolar catheter in the
coronary sinus through the left subclavian
vein.
9.
10.
11.
12.
13. By programmed stimulation the patient’s
clinical tachycardia was induced by atrial
pacing and the following intracardiac
electrograms were recorded.
14.
15. An atrial flutter (Macrore-entry in the
right atrium with atrial rate: 300/min) with
two to one conduction to the ventricles
with LBBB aberration was evident.
16.
17.
18. Atrial flutter has an area of narrow
conduction located anatomically in the in
the subeustachian isthmus and bounded by
the inferior vena cava and eustachian ridge
posterioly and the tricuspid valve annulus
anteriorly, both of which form barriers
creating a protected zone in the re-entry
circuit.
19. So the plan was to do linear ablation of
the Cavo-tricuspid isthmus.
starting at the ventricular side of the
cavotricuspid isthmus and extending
lesion by lesion to the Cavo-atrial
junction side of the isthmus,
Aiming to achieve bidirectional block
in the isthmus and thus cut the circuit and
prevent re-inducibility of the flutter.
20.
21. Then a Halo catheter was introduced for
mapping, placed along the tricuspid annulus
for both mapping and pacing.
A 7 french catheter with a 4 mm tip
electrode Cordis D curve ablation catheter
with 2.5 mm interelectrode distance was
used for mapping/ radiofrequency ablation
of the Cavo-tricuspid isthmus in this patient
during pacing from the proximal coronary
sinus to detect the bidirectional conduction.
25. Eight radiofrequency applications were needed to
achieve bidirectional block as proved by pacing
from both the PCS and the distal Halo cathetr placed
at the low lateral atrial aspect of the anulus and both
showed only unidirectional pattern of conduction
(birectional block in the isthmus). There-after the
tachycardia was no more inducible.