This document provides information on evaluating and diagnosing chest pain, including differential diagnoses and case scenarios. It outlines objectives of establishing a differential diagnosis for chest pain and knowing how to diagnose conditions like myocardial infarction (MI), pulmonary embolism (PE), pneumothorax, and aortic dissection. Common etiologies of chest pain are described. Case scenarios provide examples of applying history, physical exam findings, and test results to arrive at probable diagnoses for various patient presentations of chest pain. Key investigations and management strategies for conditions like MI are also reviewed.
palpitation is one of the most presentations in outpatients, about 16% of patients presenting to ER complaining from palpitation , for the juniors , my presentation aiming to help them to how to approach with a case complaining of palpitation
palpitation is one of the most presentations in outpatients, about 16% of patients presenting to ER complaining from palpitation , for the juniors , my presentation aiming to help them to how to approach with a case complaining of palpitation
Chronic Stable Angina- Diagnosis & management
By Dr Awadhesh Kumar Sharma
Dr. Awadhesh kumar sharma is a young, diligent and dynamic interventional cardiologist. He did his graduation from GSVM Medical College Kanpur and MD in Internal Medicine from MLB Medical college jhansi. Then he did his superspecilisation degree DM in Cardiology from PGIMER & DR Ram Manoher Lohia Hospital Delhi. He had excellent academic record with Gold medal in MBBS,MD and first class in DM.He was also awarded chief ministers medal in 2009 for his academic excellence by former chief minister of UP Smt Mayawati in 2009.He is also receiver of GEMS international award.He had many national & international publications.He is also in editorial board of international journal- Journal of clinical medicine & research(JCMR).He is also active member of reviewer board of many journals.He is also trainee fellow of American college of cardiology. He is currently working in NABH Approved Gracian Superspeciality Hospital Mohali as Consultant Cardiologist.
Chronic Stable Angina- Diagnosis & management
By Dr Awadhesh Kumar Sharma
Dr. Awadhesh kumar sharma is a young, diligent and dynamic interventional cardiologist. He did his graduation from GSVM Medical College Kanpur and MD in Internal Medicine from MLB Medical college jhansi. Then he did his superspecilisation degree DM in Cardiology from PGIMER & DR Ram Manoher Lohia Hospital Delhi. He had excellent academic record with Gold medal in MBBS,MD and first class in DM.He was also awarded chief ministers medal in 2009 for his academic excellence by former chief minister of UP Smt Mayawati in 2009.He is also receiver of GEMS international award.He had many national & international publications.He is also in editorial board of international journal- Journal of clinical medicine & research(JCMR).He is also active member of reviewer board of many journals.He is also trainee fellow of American college of cardiology. He is currently working in NABH Approved Gracian Superspeciality Hospital Mohali as Consultant Cardiologist.
An insight in Eacvi-Ase-Industry Initiative to Standardize Deformation ImagingMIDEAS
Deformation imaging, based on Speckle Tracking techniques, is
a promising technology for the evaluation and quantification of
cardiac mechanics. In particular, during the last decade , a growing
body of scientific evidences has shown that this technology,
can provide incremental information in many clinical settings1,2,3.
However, still the main drawback for a fully clinical exploitation
of the technique is nowadays represented by the perception that
global strain measurements differ between vendors. Reasons for
this potential difference could be found in the different tracking
algorithms, differences in values definition as well as the underestimation
of the impact that some imaging acquisition parameters,
such as the images acquisition FR, Telediastolic triggering
frame positioning, may have on the final results.
Nova linija ultrazvočnih aparatov Esaote, razreda MyLab40.
Ultrazvočni aparat MyLab 40 Blue Edition je kompaktni konzolni sistem z zmogljivo platformo in visoko stopnjo mobilnosti. Njegova modularna zasnova omogoča optimalno prilagoditev potrebam uporabnika.
Visoko občutljivi barvni in pulzni doppler ter CW in PW doppler se prikažejo na 19" LCD monitorju, ki poveča uporabnikovo udobje in zmanjša naprezanje oči.
Velik nabor dodatnih aplikacij in perifernih enot na ultrazvočnem aparatu MyLab 40 BE pomeni vsestranskost uporabe in primernost za vse proračune, brez ogrožanja kvalitete prikaza ali enostavnosti uporabe.
Ultrazvočni aparat MyLab 40 Blue Edition je namenjen vrsti aplikacij:
Kardiologija
Splošna interna / Radiologija
Ginekologija in porodništvo
Intervencijska kirurgija
Revmatologija
Regionalna anestezija
Žilna diagnostika
Neonatologija / Pediatrija
Ortopedija
www.mideas.si
Vascular Biomarkers in Cardiovascular Risk Prediction & Radiofrequency-based ...MIDEAS
Role of Vascular Biomarkers in
Cardiovascular Risk Assessment
The use of cardiovascular biomarkers in conjunction with risk scores
is expected to refine the risk stratification of an individual subject and
to guide his therapy. Biomarker is a characteristic that is objectively
measured and that reflects early functional and structural changes
in cardiovascular system, before overt disease manifestation. Vascular
biomarkers may be particularly informative, as they detect organ
damage in different parts of vascular bed, are measurable in a noninvasive
way, and reflect both aging process and adverse impact of
established cardiovascular risk factors, like plasma lipids, smoking,
high blood pressure, diabetes, inflammation1-2.
Nowadays, several vascular biomarkers have been proposed. According
to a position paper from the European Society of Cardiology
Working Group on peripheral circulation, the choice of vascular
biomarker or a combination depends on the clinical setting and
present comorbidities, and may differ for each individual patient3.
Peripheral nerve ultrasonography in patients with transthyretin amyloidosis MIDEAS
Objective: To systematically study peripheral nerve morphology in patients with transthyretin (TTR)
amyloidosis and TTR gene mutation carriers using high-resolution ultrasonography (US).
Methods: In this prospective cross-sectional study we took a structured history, performed neurological
examination, and measured peripheral nerve cross-sectional areas (CSAs) bilaterally at 28 standard locations
using US. Demographic and US findings were compared to controls.
Results: Peripheral nerve CSAs were significantly larger in 33 patients with familial amyloid polyneuropathy
(FAP) compared to 50 controls, most dramatically at the common entrapment sites (median
nerve at the wrist, ulnar nerve at the elbow), and in the proximal nerve segments (median nerve in
the upper arm, sciatic nerve in the thigh). Findings in 21 asymptomatic TTR gene mutation carriers were
less marked compared to controls, with CSAs being larger only in the median nerve in the upper arm.
Nerve CSAs correlated with abnormalities on nerve conduction studies.
Conclusion: Using US, we confirmed previous pathohistological and imaging reports in FAP of the most
pronounced peripheral nerve thickening in the proximal limb segments.
Significance: Similar to US findings in diabetic and vasculitic neuropathies these predominantly proximal
locations of nerve thickening may be attributed to ischaemic nerve damage caused by poor perfusion in
the watershed zones along proximal limb segments.
https://www.linkedin.com/pulse/ultrasonographic-study-peripheral-nerves-bulgarian-mitja-dobovi%C4%8Dnik?trk=mp-author-card
Evolution of mechanical ventilation in the last 20 yearsDr.Mahmoud Abbas
Evolution of mechanical ventilation in the last 20 years lecture presented by Dr Andres Esteban at the Egyptian Critical care Summit 2015 held at Cairo, Egypt. The Summit is the leading medical event and exhibition for critical care medicine in Egypt
Approach to chest pain, case- based and pericarditis guidelines Ahmed Yehia Ahmed Yehia
Approach to chest pain, case- based and pericarditis guidelines Ahmed Yehia, MD, Internal Medicine, Beni-suef, Egypt
How to diagnose different causes of chest pain and causes not to be missed.
Pericardial diseases ESC guidelines
Most people with supraventricular tachycardia don't need activity restrictions or treatment. For others, lifestyle changes, medication and heart procedures may be needed to control or eliminate the rapid heartbeats and related symptoms.
Types
Supraventricular tachycardia (SVT) falls into three main groups:
Atrioventricular nodal reentrant tachycardia (AVNRT). This is the most common type of supraventricular tachycardia.
Atrioventricular reciprocating tachycardia (AVRT). AVRT is the second most common type of supraventricular tachycardia. It's most commonly diagnosed in younger people.
Atrial tachycardia. This type of SVT is more commonly diagnosed in people who have heart disease. Atrial tachycardia doesn't involve the AV node.
Other types of supraventricular tachycardia include:
Sinus tachycardia
Sinus nodal reentrant tachycardia (SNRT)
Inappropriate sinus tachycardia (IST)
Multifocal atrial tachycardia (MAT)
Junctional ectopic tachycardia (JET)
Nonparoxysmal junctional tachycardia (NPJT)
Symptoms
The main symptom of supraventricular tachycardia (SVT) is a very fast heartbeat (100 beats a minute or more) that may last for a few minutes to a few days. The fast heartbeat may come and go suddenly, with stretches of typical heart rates in between.
Some people with SVT have no signs or symptoms.
Signs and symptoms of supraventricular tachycardia may include:
Very fast (rapid) heartbeat
A fluttering or pounding in the chest (palpitations)
A pounding sensation in the neck
Weakness or feeling very tired (fatigue)
Chest pain
Shortness of breath
Lightheadedness or dizziness
Sweating
Fainting (syncope) or near fainting
In infants and very young children, signs and symptoms of SVT may be difficult to identify. They include sweating, poor feeding, pale skin and a rapid pulse. If your infant or young child has any of these symptoms, ask your child's care provider about SVT screening.
When to see a doctor
Supraventricular tachycardia (SVT) is generally not life-threatening unless you have heart damage or other heart conditions. However, in extreme cases, an episode of SVT may cause unconsciousness or cardiac arrest.
Call your health care provider if you have an episode of a very fast heartbeat for the first time or if an irregular heartbeat lasts longer than a few seconds.
Some signs and symptoms of SVT may be related to a serious health condition. Call 911 or your local emergency number if you have an episode of SVT that lasts for more than a few minutes or if you have an episode with any of the following symptoms:
Chest pain
Shortness of breath
Weakness
Dizziness
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Causes
For some people, a supraventricular tachycardia (SVT
Pulmonary hypertension (PH) is a complex and progressive
condition characterised by high blood pressure in the lungs, leading
to significant health challenges. This book is dedicated to unravelling
the intricacies of PH, encompassing its pathophysiology, diagnosis,
management and emerging research trends. It is designed to serve
as a comprehensive guide for clinicians, researchers and students
in the field of cardiology and respiratory medicine, as well as a
valuable resource for patients and their families seeking to deepen
their understanding of this condition.
The chapters of this book are structured to provide a detailed
insight into the various facets of PH. Starting with the basic
pathophysiology and classification systems, I delve into the
clinical presentation, diagnostic criteria and the nuances of
managing this condition, including both pharmacological and
non-pharmacological approaches. Special attention is given to
the unique challenges posed by pediatric PH, PH in pregnancy
and the management of co-morbidities and complications.
Recognizing the rapid advancements in the field, this book also
dedicates a significant portion to discussing current research
trends, future therapeutic targets and evolving diagnostic
techniques. Real-world case studies and patient testimonies are
included to provide a practical perspective, highlighting the
impact of PH on patients’ lives and the importance of a patient-
centered approach to care.
The field of pulmonary hypertension is one of dynamic change
and I growing understanding. Through this book, we aim to
provide a thorough and up-to-date resource that reflects the
current state of knowledge and practice in the field of PH, while
also offering a glimpse into the future directions of research and
treatment. It is my hope that this book will not only enhance the
understanding of PH among healthcare professionals but also offer
support and information to patients and their families navigating
this challenging condition.
I wish to express our heartfelt gratitude to the following
individuals whose unwavering support and contributions have
played a pivotal role in the creation of this book "Innovations in
Cardiology: From Fundamentals to Frontiers – Short Notes in
Cardiology," My sincere thanks go to: Professor Sufia Rahman,
Professor Abdullah Al Shafi Majumder, Professor dr. Abduz
Zaher, Professor Syed Azizul Haque, Professor Dr Nurunnahar
Fatema Begum; Professor Md. Atahar Ali, Professor Dr. Afzalur
Rahman, Professor Fazila- Tun- Nessa Malik, Professor Kh.
Qamrul Islam; Professor Dr. GM Faruque, Professor M.
Maksumul Haq,Professo Dr. Sajal Krisna Banerjee; Professor
Dr. STM Abu Azam; Professor Mir Jamal Uddin, Professor
Mohammad Abdur Rashid, Professor Dr. AKM Fazlur Rahman,
Professor Dr. Abdul Kader Akanda, Professor Dr. AQM Reza,
Professor Dr. Saiful Islam; Dr. Shams Munwar; Professor Dr.
Chaudhury Meshkat Ahmed, Professor Dr. Khaled Mohsin,
Professor Abdul Wadud Chowdhury, Professor Razia Sultana
Mahmud,Professor Dr. M Touhidul Haque; Professor Dr. Md.
Sahabuddin, Professor Prabir Kumar Das, Professor Dr. Baren
Chakraborty, Professor Dr. Amirul Khusru, Dr. Kaiser Nasrullah
Khan, Professor Ashok Dutta, Professor Md. Khalequzzaman,
Dr. Abdullah Al Jamil, Professor Dr. Amal Kumar Choudhury,
Professor Mostafa Zaman Babul, Professor Dr Dipal Krishna
Adhikary, Professor Dr. Dipankar Chandra Nag professor Dr.
Moeen Uddin Ahmed, professor Mir nesar Uddin; Brig. Gen. Dr.
Syeda Aleya Sultana,Professor Dr Syed Nasir Uddin; Professor
Dr Mohsin Hossain; Dr. Sm Shahidul Haque; Professor Dr
Tawfiq Shahriar Huq; Dr. SM Quamrul Haque; Professor Dr.
Mamunur Rashid Sizar, Professor Dr. Mohsin Ahmed, Professor
Dr. Zillur Rahman; Professor Dr. Tanjima Parveen; Professor Dr.
Harisul hoque, Dr. Reyan Anis, Dr. Ashish Dey, Dr. Mohammad
Ullah firoz, Professor Dr. Udoy Shankar Roy; Dr. Nuruddin
Tareq; Dr. Md. Towhiduzzaman, Dr. Kh. Asaduzzaman, Dr.
AKM Monwarul Islam, Dr. Abdul Momen, Dr. Md. Shafiqur
Rahman Patwary, Dr. Md, Zulfiker Ali Lenin; Dr. Mahbub
Mansur, Dr. CM Shaheen Kabir, Dr. Rumi Alam, Dr. Farah
ii
Tasneem Mowmi, Dr. Rashid Ahmed, Dr. Mohammad Anowar
Hossain, Dr. Mohammad Nasimul Gani,Professor Dr abu Tarek
Iqbal, Dr. Husnayen Nanna, Dr. Abdul Malek, Dr, Ajoy Kumar
Datta, Dr. Nur Alam; Dr. Sahela Nasrin; Dr. Haripada sarker, Dr.
Anisul Awal, Dr. Shaila Nabi; Professor Dr. Umme Salma Khan;
Dr SM Ahsan Habib; Professor Dr Solaiman Hossain; Dr. Bijoy
Dutta,Dr. Shahana Zaman; Dr. Ishrat Jahan shimu, Dr. Ibrahim
Khalil. Dr. Chayan Kumar Singha, Dr. Kazi Nazrul Islam, Dr.
Kamal pasha; professor Dr. Liakat Hossain Tapan, Professor Dr.
Mamun Iqbal, Professor Dr. MG Azam, Dr. Lima Asrin Sayami,
Dr. Smita Kanungo; Dr. Sadequl Islam Shamol; Dr. Swadesh
chakraborty; Dr. Md. Rasul Amin Shepon; Dr. Saqif shahriar;
Your collective wisdom, expertise and commitment to the field
of cardiology have enriched the content of this book. Your
mentorship and guidance have been invaluable in shapi
Definition: Cardiac arrhythmias refer to abnormal heart rhythms, where the heartbeat may be too slow (bradycardia), too fast (tachycardia), or irregular.
These irregularities disrupt the normal electrical signaling in the heart.
In a world where hearts beat free and bold,
A silent foe creeps, its story untold,
Rheumatic whispers, in hushed refrain,
A tale of love's struggle, of heartache and pain.
A childhood song, innocent and sweet,
Takes a tragic turn, hearts skip a beat,
Rheumatic winds blow, fierce and unseen,
Leaving scars on hearts that once danced so keen.
Valves that should open, a rhythmic embrace,
Now bear the weight of this silent chase,
Rheumatic echoes, a haunting refrain,
Leaving imprints of sorrow, of loss and of pain.
But amidst the shadows, there's hope that glows,
A symphony of care, compassion bestows,
With knowledge and love, we stand side by side,
To mend these hearts, to be a healing guide.
Rheumatic battles, we'll face them anew,
A united front, a relentless crew,
For every heart deserves freedom's embrace,
And in the face of rheumatic storms, we'll find grace.
So let's raise our voices, let the world hear,
The fight against rheumatic pain, we hold dear,
With courage and faith, we'll rewrite the verse,
A tale of triumph, of hearts that converse.
"Rheumatic fever reminds us that our body is a delicate symphony, and neglecting even the slightest discord can lead to profound consequences." -
"In the battle against rheumatic fever, awareness and early intervention are our most potent allies."
"Rheumatic fever teaches us the vital lesson that the heart, both physical and emotional, must be nurtured with care and vigilance." -
"Every case of rheumatic fever avoided is a triumph of knowledge, compassion, and the will to protect our most vital instrument, the heart." -
"Rheumatic fever serves as a reminder that even the strongest fortresses need vigilant guardians to shield against the unseen enemies within." -
Case Scenario: You're presenting research findings on hypertension prevalence in
different regions. What Excel chart type would best visualize the variation in
prevalence across regions?
Options: A) Line chart B) Pie chart C) Bar chart D) Scatter plot E) Radar chart Answer:
C) Bar chart
Explanation: A bar chart effectively compares values across different categories,
making it ideal for visualizing the variation in hypertension prevalence across different
regions.
Case Scenario: You're analyzing patient demographics, and you want to find the
most common blood type among your patients. What Excel function would help
you identify the mode of the blood types?
Options: A) MEDIAN B) MODE C) COUNTIF D) AVERAGE E) SUM Answer: B)
MODE
Explanation: The MODE function in Excel helps you find the most frequently occurring
value in a range, making it suitable for identifying the most common blood type among
patients.
Case Scenario: You're conducting a study on the effects of exercise on blood
pressure. What Excel tool would you use to create a summary table showing
average blood pressure before and after exercise?
Options: A) Goal Seek B) PivotTable C) Data Validation D) Filter E) Sort Answer: B)
PivotTable
Explanation: A PivotTable in Excel can summarize data and calculate averages,
making it suitable for creating a summary table showing average blood pressure before
and after exercise.
Case Scenario: You're managing patient records and need to categorize patients
into age groups for analysis. What Excel function would you use to assign each
patient to a specific age category?
Options: A) VLOOKUP B) IF C) COUNTIF D) INDEX E) MATCH Answer: B)
IF
Explanation: The IF function in Excel allows you to apply conditional logic. It's useful
for categorizing patients into age groups based on their ages.
Case Scenario: You're analyzing the effectiveness of a new drug on reducing
cholesterol levels in patients. Which Excel function would you use to calculate
the percentage reduction in cholesterol for each patient?
Options: A) SUMIF B) AVERAGEIF C) MEDIAN D) COUNTIF E) IF Answer: E) IF
Explanation: The IF function in Excel allows you to apply conditional logic. It's useful
for calculating the percentage reduction in cholesterol levels based on the original and
post-treatment values.
Case Scenario: You're preparing a presentation on global prevalence rates of
different heart diseases. What Excel chart type would best display the proportion
of each disease in relation to the whole?
Options: A) Line chart B) Scatter plot C) Bar chart D) Pie chart E) Area chart Answer:
D) Pie chart
Explanation: A pie chart effectively displays proportions and percentages, making it
ideal for showcasing the proportion of each heart disease in relation to the total.
Case Scenario: You're managing a database of medical research papers, including
titles, authors, and publication years. What Excel tool can you use to quickly find
papers published between cert
5. A 5 years old boy presents with fever & swelling of knee and ankle joint for 3 weeks. Write down 3 important D/D. Discuss the treatment of acute rheumatic fever with carditis. (DU-09Ju)
Three important differential diagnoses of a 5-year-old boy presenting with fever and joint swelling for 3 weeks include:
Septic arthritis: This is an acute bacterial infection of a joint that causes similar symptoms to rheumatic fever but is usually monoarticular and associated with more severe pain, redness, and tenderness of the affected joint. Septic arthritis requires urgent drainage and antibiotics.
Juvenile idiopathic arthritis: This is a group of chronic autoimmune disorders that can present with fever, joint swelling, and stiffness. The diagnosis is based on clinical features, laboratory tests, and imaging studies. The treatment may include nonsteroidal anti-inflammatory drugs, disease-modifying antirheumatic drugs, and biologic agents.
Reactive arthritis: This is an inflammatory joint disease that can occur after an infection, especially with certain bacteria such as Chlamydia, Salmonella, or Shigella. Reactive arthritis usually affects the lower limb joints, such as knees, ankles, and feet, and may be associated with skin rash, eye inflammation, or urethritis. The treatment may include antibiotics, nonsteroidal anti-inflammatory drugs, and corticosteroids.
Assuming the diagnosis of acute rheumatic fever with carditis, the treatment usually involves a combination of antibiotics and anti-inflammatory drugs. The antibiotics aim to eradicate the streptococcal infection and prevent further rheumatic fever recurrences, while the anti-inflammatory drugs aim to reduce the inflammation and symptoms of carditis. The specific regimen may vary depending on the severity of carditis, the presence of other complications, and the patient's age and weight. In general, the following principles apply:
Antibiotics: A 10-day course of oral or intramuscular penicillin is the first-line antibiotic for acute rheumatic fever, as it is effective against most strains of streptococci and has low toxicity. Alternative antibiotics may be used for patients who are allergic to penicillin or have recurrent rheumatic fever despite adequate penicillin therapy. Long-term prophylaxis with penicillin is recommended to prevent recurrences, usually until the age of 21 years or for 10 years after the last episode of rheumatic fever, whichever is longer.
Anti-inflammatory drugs: High-dose aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen are usually given for the first 2-3 weeks of acute rheumatic fever to control fever, pain, and inflammation. Corticosteroids such as prednisone or methylprednisolone may be used in severe cases of carditis or when other therapies are not effective or contraindicated. The duration and dose of anti-inflammatory drugs should be tailored to the patient's response and adverse effects, such as gastric
The Cardiovascular System: Life's Vital Transport System
The cardiovascular system, comprising the heart, blood vessels, and blood, is a fundamental physiological network in the body.
It facilitates the circulation of oxygen, nutrients, hormones, and immune cells while eliminating waste products.
Essential for maintaining tissue function, energy production, and overall homeostasis.
Defining the Cardiovascular System
The cardiovascular system, also known as the circulatory system, is a complex network responsible for circulating vital substances throughout the body.
Components of the Cardiovascular System
Heart: A muscular organ that pumps blood, generating the force required to propel blood through the blood vessels.
Blood Vessels: A network of tubes that carry blood to and from various body tissues.
Blood: A specialized fluid containing red and white blood cells, platelets, and plasma, essential for nutrient and gas exchange.
Exploring Applied Physiology of the Cardiovascular System
The cardiovascular system is a cornerstone of human health, regulating the circulation of vital nutrients, oxygen, and waste products throughout the body.
Understanding the applied physiology of this system is essential for healthcare professionals to provide effective medical care and interventions.
Importance of Applied Cardiovascular Physiology
Effective healthcare requires a deep comprehension of how the cardiovascular system functions under various conditions.
Applied physiology knowledge empowers healthcare practitioners to make informed decisions, diagnose disorders, and formulate targeted treatment plans.
Focus on Practical Applications in Healthcare
This presentation delves into the practical aspects of cardiovascular physiology that directly impact clinical practice.
We will explore how physiological concepts are translated into real-world medical scenarios and interventions.
By grasping the applied physiology of the cardiovascular system, healthcare providers can optimize patient care, enhance diagnostics, and improve treatment outcomes.
Throughout this presentation, we'll bridge the gap between theoretical understanding and its practical implications in the field of healthcare.
Understanding the Components
The cardiovascular system comprises three crucial components: the heart, blood vessels, and blood.
Heart: A muscular organ that pumps blood, ensuring a continuous flow throughout the body.
Blood Vessels: A network of tubes that transport blood to and from various tissues.
Blood: A specialized fluid that carries nutrients, oxygen, hormones, and removes waste products.
Role in Oxygen and Nutrient Delivery
Oxygen from the lungs and nutrients from the digestive system are transported to body tissues through the bloodstream.
These essential components are required for cellular metabolism and energy production.
Peripartum cardiomyopathy (PPCM) is a type of heart disease that affects women during the last month of pregnancy or in the first few months after delivery. It is characterized by a weakened and enlarged heart muscle, which makes it difficult for the heart to pump blood efficiently to the rest of the body. The exact cause of PPCM is unknown, but it is believed to be related to the hormonal changes and increased demands on the heart that occur during pregnancy. Symptoms of PPCM can include shortness of breath, fatigue, chest pain, swelling in the legs and feet, and palpitations. Treatment for PPCM usually involves medications to improve heart function and supportive care to manage symptoms. In severe cases, advanced treatments such as implantable devices or heart transplantation may be necessary. With early diagnosis and treatment, most women with PPCM can recover completely and go on to lead healthy lives.during pregnancy.
The diagnosis of PPCM is based on clinical symptoms, such as shortness of breath, fatigue, chest pain, and edema, along with imaging studies, such as echocardiography. Treatment for PPCM usually involves medications to improve heart function and supportive care to manage symptoms. These medications can include beta-blockers, ACE inhibitors, diuretics, and inotropic agents. In severe cases, advanced treatments such as mechanical circulatory support or heart transplantation may be necessary.
The prognosis for PPCM varies depending on the severity of the disease and the presence of underlying comorbidities. However, with early diagnosis and appropriate treatment, most women with PPCM can recover completely and go on to lead healthy lives. The recurrence rate of PPCM in subsequent pregnancies is approximately 20%, and women who have had PPCM are advised to avoid future pregnancies or undergo careful monitoring and management during pregnancy.
There are still many unanswered questions about PPCM, including its exact cause, optimal diagnostic and treatment strategies, and long-term outcomes. Further research is needed to better understand this complex and potentially life-threatening condition.
In conclusion, PPCM is a rare but serious form of heart disease that can occur during or after pregnancy. Early recognition and management of this condition are critical in preventing complications and improving outcomes for both the mother and the baby. Future research will continue to shed light on the pathophysiology and optimal management of PPCM.
Cardiac rehabilitation is a comprehensive program that aims to improve the health and quality of life of individuals with cardiovascular disease. This review article provides an overview of current evidence-based practices and the benefits of cardiac rehabilitation. The article discusses the components of cardiac rehabilitation, including medical evaluation, physical activity and exercise training, nutrition counseling and education, psycho social support and counseling, cardiac risk factor management, medication management, and tobacco cessation counseling. The article also discusses the effectiveness of cardiac rehabilitation in reducing mortality rates, improving functional capacity, and reducing the risk of future cardiovascular events. Additionally, the article explores the future directions of cardiac rehabilitation, including personalized medicine, technology integration, home-based programs, expanded target populations, and a multidisciplinary approach. Healthcare providers play a crucial role in encouraging and referring eligible patients to cardiac rehabilitation programs as part of their treatment plan. The review concludes that cardiac rehabilitation is an essential aspect of the management of cardiovascular disease and highlights the need for further research and development in this dynamic field.
Outline of CPR manual
I. Introduction
A. Definition of CPR
1. Explanation of what CPR stands for
2. Definition of CPR as a life-saving technique
B. Importance of CPR
1. Statistics on cardiac arrest and survival rates
2. Explanation of why CPR is crucial for saving lives
C. Objective of the manual
1. Explanation of what readers will learn from the manual
2. Statement of the manual's purpose
II. Getting Started with CPR
A. Assessing the situation
1. Importance of assessing the situation before starting CPR
2. Factors to consider when assessing the situation
B. Checking for responsiveness
1. Explanation of how to check for responsiveness
2. Importance of checking for responsiveness
C. Activating the emergency response system
1. Explanation of when to activate the emergency response system
2. Step-by-step guide to activating the emergency response system
III. Basic Life Support Techniques
A. Key components of basic life support
1. Explanation of the components of basic life support
2. Importance of each component
B. The ABCs of CPR
1. Explanation of the ABCs of CPR
2. Importance of each step in the ABCs of CPR
C. Performing chest compressions
1. Explanation of how to perform chest compressions
2. Importance of proper chest compression technique
D. Delivering rescue breaths
1. Explanation of how to deliver rescue breaths
2. Importance of proper rescue breath technique
E. Utilizing an automated external defibrillator (AED)
1. Explanation of what an AED is and how it works
2. Step-by-step guide to using an AED
F. Administering medications during CPR
1. Explanation of medications used during CPR
2. Dosages and administration guidelines for each medication
IV. Advanced Life Support Techniques
A. Advanced airway management
1. Explanation of advanced airway management techniques
2. Importance of advanced airway management in CPR
B. Advanced monitoring techniques
1. Explanation of advanced monitoring techniques
2. Importance of advanced monitoring in CPR
C. Invasive interventions
1. Explanation of invasive interventions
2. Importance of invasive interventions in CPR
D. Extracorporeal membrane oxygenation (ECMO)
1. Explanation of ECMO
2. Importance of ECMO in CPR
V. Improving Outcomes in CPR
A. Factors influencing CPR outcomes
1. Explanation of factors that influence CPR outcomes
2. Importance of understanding these factors
B. Strategies for improving CPR outcomes
1. Explanation of strategies for improving CPR outcomes
2. Importance of implementing these strategies
C. The role of high-quality CPR in improving outcomes
1. Explanation of what high-quality CPR is
2. Importance of performing high-quality CPR
VI. Special Considerations in CPR
A. CPR in special populations
1. Explanation of special populations that require unique CPR techniques
2. Importance of understanding these unique CPR techniques
B. CPR in special settings
1. Explanation of special settings that require unique CPR techniques
2. Importance of understanding these unique CPR techniques
C.
I. Introduction
A. Brief explanation of World Hypertension Day
B. Importance of addressing hypertension as a global health issue
C. Overview of the objectives of the presentation
II. Understanding Hypertension
A. Definition and classification of hypertension
B. Prevalence and global burden of hypertension
C. Risk factors and causes of hypertension
D. Health implications and complications associated with hypertension
III. World Hypertension Day 2023
A. Background and significance of World Hypertension Day
B. Theme and key messages for World Hypertension Day 2023
C. Activities and events organized worldwide to raise awareness
IV. Goals and Objectives
A. Key goals set for World Hypertension Day 2023
B. Promoting prevention and early detection of hypertension
C. Encouraging healthy lifestyle modifications
D. Enhancing public knowledge about hypertension management
V. Initiatives and Campaigns
A. Overview of global initiatives and campaigns
B. Collaborations with international organizations, NGOs, and healthcare professionals
C. Campaign materials and resources available for public use
VI. Strategies for Hypertension Prevention and Control
A. Implementing population-level interventions
B. Screening and diagnosis strategies
C. Lifestyle modifications (diet, physical activity, stress management)
D. Pharmacological management and treatment guidelines
VII. Public Awareness and Education
A. Importance of raising public awareness about hypertension
B. Educational campaigns and resources for the general public
C. Role of healthcare professionals in educating patients
VIII. Impact and Achievements
A. Highlighting the impact of previous World Hypertension Day campaigns
B. Success stories and achievements in hypertension prevention and control
C. Lessons learned and areas for improvement
IX. Conclusion
A. Recap of the key points discussed
B. Call to action for individuals, communities, and policymakers
C. Encouragement to spread awareness and take steps towards hypertension prevention
. Introduction
A. Definition and prevalence of hypertension in the elderly
B. Importance of managing hypertension in this population
II. Risk Factors and Complications
A. Common risk factors for hypertension in the elderly
B. Potential complications associated with uncontrolled hypertension
III. Diagnostic Process
A. Blood pressure measurement techniques and guidelines
B. Target blood pressure goals for elderly patients
C. Identification of secondary causes of hypertension
IV. Non-Pharmacological Management
A. Lifestyle modifications
1. Dietary recommendations (e.g., DASH diet, sodium reduction)
2. Weight management and physical activity
3. Smoking cessation and alcohol moderation
B. Stress management and relaxation techniques
V. Pharmacological Management
A. First-line antihypertensive medications
B. Considerations for drug selection in the elderly
1. Drug interactions and comorbidities
2. Adverse effects and tolerability
C. Individualized treatment approach based on patient characteristics
VI. Monitoring and Follow-Up
A. Frequency of blood pressure monitoring
B. Importance of medication adherence
C. Adjusting treatment based on patient response
D. Collaborative care and involvement of healthcare professionals
VII. Special Considerations
A. Polypharmacy and medication management
B. Management of hypertension in frail and institutionalized elderly
C. Cognitive impairment and medication adherence
VIII. Controversies and Challenges
A. Blood pressure targets and guidelines in the elderly
B. Conflicting evidence on specific antihypertensive agents
C. Adherence issues and barriers to effective management
IX. Conclusion
A. Summary of key points discussed
B. Importance of comprehensive management in elderly patients
C. Future directions in hypertension management for the elderly
I. Introduction
A. Definition of CPR
1. Explanation of what CPR stands for
2. Definition of CPR as a life-saving technique
B. Importance of CPR
1. Statistics on cardiac arrest and survival rates
2. Explanation of why CPR is crucial for saving lives
C. Objective of the manual
1. Explanation of what readers will learn from the manual
2. Statement of the manual's purpose
II. Getting Started with CPR
A. Assessing the situation
1. Importance of assessing the situation before starting CPR
2. Factors to consider when assessing the situation
B. Checking for responsiveness
1. Explanation of how to check for responsiveness
2. Importance of checking for responsiveness
C. Activating the emergency response system
1. Explanation of when to activate the emergency response system
2. Step-by-step guide to activating the emergency response system
III. Basic Life Support Techniques
A. Key components of basic life support
1. Explanation of the components of basic life support
2. Importance of each component
B. The ABCs of CPR
1. Explanation of the ABCs of CPR
2. Importance of each step in the ABCs of CPR
C. Performing chest compressions
1. Explanation of how to perform chest compressions
2. Importance of proper chest compression technique
D. Delivering rescue breaths
1. Explanation of how to deliver rescue breaths
2. Importance of proper rescue breath technique
E. Utilizing an automated external defibrillator (AED)
1. Explanation of what an AED is and how it works
2. Step-by-step guide to using an AED
F. Administering medications during CPR
1. Explanation of medications used during CPR
2. Dosages and administration guidelines for each medication
IV. Advanced Life Support Techniques
A. Advanced airway management
1. Explanation of advanced airway management techniques
2. Importance of advanced airway management in CPR
B. Advanced monitoring techniques
1. Explanation of advanced monitoring techniques
2. Importance of advanced monitoring in CPR
C. Invasive interventions
1. Explanation of invasive interventions
2. Importance of invasive interventions in CPR
D. Extracorporeal membrane oxygenation (ECMO)
1. Explanation of ECMO
2. Importance of ECMO in CPR
V. Improving Outcomes in CPR
A. Factors influencing CPR outcomes
1. Explanation of factors that influence CPR outcomes
2. Importance of understanding these factors
B. Strategies for improving CPR outcomes
1. Explanation of strategies for improving CPR outcomes
2. Importance of implementing these strategies
C. The role of high-quality CPR in improving outcomes
1. Explanation of what high-quality CPR is
2. Importance of performing high-quality CPR
VI. Special Considerations in CPR
A. CPR in special populations
1. Explanation of special populations that require unique CPR techniques
2. Importance of understanding these unique CPR techniques
B. CPR in special settings
1. Explanation of special settings that require unique CPR techniques
2. Importance of understanding these unique CPR techniques
C. CPR during a pandemic
1
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
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
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.
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.
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.
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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
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
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2 Case Reports of Gastric Ultrasound
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
2. Dr. Md.Toufiqur Rahman
MBBS, FCPS, MD, FACC, FESC, FRCP, FSCAI,
FAPSC, FAPSIC, FAHA
Associate Professor of Cardiology
National Institute of Cardiovascular Diseases
Sher-e-Bangla Nagar, Dhaka-1207
drtoufiq19711@yahoo.com
3. Objectives
Establish a differential diagnosis for chest pain
Know what clues to obtain on history to rule-in or out MI,
PE, pneumothorax and aortic dissection
Identify risk factors for MI
Know how to do a focused physical exam, identifying
features that would distinguish between MI, PE,
pneumothorax and aortic dissection.
Identify investigations required in diagnosing MI
Outline management strategy in MI
5. Case Scenario----1
A 65 years old hypertensive, smoker, diabetic and
dyslipidemic gentleman from Mymensingh district
presented with central chest tightness on exertion for last 1
months. His pulse was 104 b/min, BP-150/95 mm Hg,
HbA1c-8.2%. His ECG was normal . What should be his
next investigation? What was the probable cause of his
chest tightness?
a. Esophageal spasm
b. Chronic stable angina
c. acute coronary syndrome
d. acute pericarditis
6. Case Scenario----2
A 55 years old hypertensive, smoker, diabetic and
dyslipidemic gentleman from Dhanmondi presented with
central chest tightness with excessive sweating for last 30
minutes not relieved by taking sublingual nitrates. His
pulse was 104 b/min, BP-150/95 mm Hg, HbA1c-8.2%. His
ECG showed ST segment elevation in V1-V5 . What was the
probable cause of his chest tightness?
a. Esophageal spasm
b. Chronic stable angina
c. acute coronary syndrome(STEMI)
d. acute pericarditis
7. Case Scenario----3
A 55 years old hypertensive, smoker, diabetic and dyslipidemic
gentleman from Tejgaon presented with central chest tightness
with excessive sweating for last 30 minutes not relieved by
taking sublingual nitrates. His pulse was 104 b/min, BP-150/95
mm Hg, HbA1c-8.2%. His ECG showed ST segment depression
in V1-V5 . His Troponin I level is 30 ng/L. What was the
probable cause of his chest tightness?
a. Esophageal spasm
b. Chronic stable angina
c. acute coronary syndrome(NSTEMI)
d. acute pericarditis
8. Case Scenario----4
A 52 years old hypertensive, smoker, diabetic and dyslipidemic
gentleman from Bashaboo presented with central chest
tightness with excessive sweating for last 20 minutes not
relieved by taking sublingual nitrates. His pulse was 110 b/min,
BP-140/95 mm Hg, HbA1c-9.2%. His ECG showed T inversion
in V1-V4 . His Troponin I level is normal. What was the
probable cause of his chest tightness?
a. Esophageal spasm
b. Chronic stable angina
c. acute coronary syndrome(Unstable angina)
d. acute pericarditis
9. Case Scenario----5
A 32 years old smoker gentleman from Naogaon
presented with central chest pain for last 5 days with fever.
His pulse was 120 b/min, BP-140/95 mm Hg. His ECG
showed ST segment elevation in lead V1-V6 and lead 2, 3
and aVF . What was the probable cause of his chest pain ?
a. Esophageal spasm
b. Chronic stable angina
c. acute coronary syndrome
d. acute pericarditis
10. Case Scenario----6
A 42 years old smoker gentleman from Rajshahi
presented with central chest pain for last 35 days increased
at night lying flat relieved by taking antacid syrup. His
pulse was 80 b/min, BP-130/85 mm Hg. His ECG showed
normal. What was the probable cause of his chest pain?
a. Reflux esophagitis
b. Chronic stable angina
c. acute coronary syndrome
d. acute pericarditis
11. Case Scenario----7
A 22 years old lady from Khulna district presented with
central chest pain with palpitations for last 5 months.
Her pulse was 110 b/min, BP-120/80 mm Hg. Her ECG
showed normal , Echocardiography showed normal study,
ETT done previously for 2 times were negative. What was
the probable cause of his chest pain?
a. Reflux esophagitis
b. Chronic stable angina
c. acute coronary syndrome
d. Generalized Anxiety Disorder
12. Case Scenario----8
A 25 years old lady from Kustia district presented with
central chest heaviness with palpitations with low grade
fever for last 2 months. Her pulse was 110 b/min, BP-
110/70 mm Hg. Her ECG showed low voltage ,
Echocardiography showed echo free space in pericardium.
What was the probable cause of his chest pain?
a. Reflux esophagitis
b. Chronic stable angina
c. Pericardial Effussion
d. Generalized Anxiety Disorder
13. Case Scenario----9
A 25 years old lady from Kustia district presented with
central chest heaviness with palpitations with low grade
fever for last 2 months. Her pulse was 110 b/min, BP-
110/70 mm Hg. Her ECG showed low voltage ,
Echocardiography showed echo free space in pericardium.
What was the probable cause of his chest pain?
a. Reflux esophagitis
b. Chronic stable angina
c. Pericardial Effussion
d. Generalized Anxiety Disorder
14. Case Scenario----10
A 19 years old smoker gentleman from Panchagor
presented with central chest pain for last 5 days with fever
and shortness of breath. His pulse was 120 b/min, BP-
110/75 mm Hg. His ECG showed T inversion in lead V1-
V6 . His echocardiography showed global hypokinesia with
EF-40%, Troponin I positive. What was the probable cause
of his chest pain ?
a. Myocarditis
b. Chronic stable angina
c. acute coronary syndrome
d. acute pericarditis
15. Case Scenario----11
A 27 years old gentleman from Chuadanga district
presented with occasional chest pain with palpitations
for last 2 years. His pulse was 110 b/min, BP-110/70 mm
Hg. His ECG showed normal , Echocardiography showed
echo mitral valvular disease. What was the probable cause
of his chest pain?
a. Mitral valve prolapse
b. Chronic stable angina
c. Pericardial Effusion
d. Generalized Anxiety Disorder
16. Case Scenario----12
A 21 years old gentleman from Sathkhira district
presented with occasional central chest pain with
palpitations for last 3 years. He was diagnosed as a case
of Marfans Syndrome. His pulse was 112 b/min, BP-110/70
mm Hg. His ECG showed normal , Echocardiography
showed echo aortic root dilataion. What was the probable
cause of his chest pain?
a. Mitral valve prolapse
b. Chronic stable angina
c. Pericardial Effusion
d. Aortic Aneurysm
17. Case Scenario----13
A 50 years old hypertensive, smoker, diabetic and dyslipidemic
gentleman from Jatrabari presented with severe tearing central
chest pain with excessive sweating for last 30 minutes not
relieved by taking sublingual nitrates. His pulse was 104 b/min,
no pulse in lower limbs BP-150/95 mm Hg, HbA1c-8.2%. His
ECG showed left ventricular hypertrophy . What was the
probable cause of his chest tightness?
a. Esophageal spasm
b. aortic dissection
c. acute coronary syndrome(STEMI)
d. acute pericarditis
18. Case Scenario----14
A 70 years old hypertensive, smoker, diabetic and
dyslipidemic gentleman from Jessore presented with
central chest pain with burning sensation in mouth while
taking food. His pulse was 86 b/min, BP-140/95 mm Hg,
HbA1c-8.2%. Oral examination showed oral thrush. His
ECG showed left ventricular hypertrophy . What was the
probable cause of his chest tightness?
a. Esophagitis ( Fungal infection)
b. aortic dissection
c. acute coronary syndrome(STEMI)
d. acute pericarditis
19. 26 Old army officer had flu last week,felt chest pain while driving his car,pain
increased by deep breath,he has no history of DM or HTN,nonsmoker,lipid profile LDL
2.0 MMMOL/L
20. A 26 year old woman presented 1 week post
delivery of her first baby. She has sharp L sided
chest pain and she is short of breath.
21. Pulmonary Embolism
Why ?
Young female
Pegnancy hypercoagulable state
Occurrence one week post partum
22.
23. 65 year old man(H/O DM,HTN) presented with a 1 hour history
of severe central crushing chest pain. He is sweaty, clammy and
has vomited twice .
Anterior (extensive) Myocardial infarction.
Why ?
Male 65 years.
H/O DM+HTN( remember INTERHEART study)
Crushing chest pain.
Associated sweaty,clammy,vomiting.
24. 70 years old male with long history of untreated HTN,
nonsmoker came complaining of chest pain migrated to
interscapular region & became severe(tearing), SBP 200,ECG
mild inferior changes
Most likely diagnosis is
? AMI
?PE
?Esophagear Rupture
?Aortic Dissection
25. 26 yr old thin man with sudden onset of severe L
sided sharp chest pain , tachypnoeic.
26. Myocardial ischemia or infarction
Pressure-type of chest pain
Generally involves central to left-sided pain with radiation
to jaw or arms
Exacerbated by activity, relieved with rest
Relieved with nitro spray
Associated with nausea, diaphoresis, syncope, shortness of
breath
Enquire about cardiac risk factors: age, sex, smoking
history, diabetes, hypertension, hyperlipidemia, previous
myocardial infarction and family history
27. Myocardial ischemia or infarction
↓BP indicates cardiogenic shock
↑JVP, pulsatile liver and peripheral edema seen in right-
sided heart failure
Oxygen desaturation, crackles, S3 seen in left-sided heart
failure
New murmurs: mitral regurgitation murmur in papillary
muscle dysfunction
28. Work-up
EKG (should be knee-jerk reflex in chest pain scenario!)
CXR to look for signs of congestive heart failure
Cardiac enzymes: CK (will begin to rise 6 hours after
infarct and remain elevated for 24-48 hours), troponin (will
begin to rise 12 hours after infarct and remain elevated for 2
weeks). Need to follow serially if first set negative.
29.
30.
31. Management Strategy for NSTEMI
Initial therapy
Morphine for pain
Oxygen if hypoxic
Nitro spray/drip for pain
Aspirin
32. Management Strategy for
NSTEMI/NST Chest Pain
Establish risk level using the TIMI scoring system:
Low risk: May be discharged after symptom control
Moderate risk: Admit for further evaluation; add beta
blockers , Ace inhibitors . Follow cardiac enzyme levels.
If Mi ruled out, Exercise or Adenosine stress test before
discharge
High Risk: Admit for cardiac catheterization
33. Management Strategy for STEMI
Morphine, oxygen, nitro, aspirin
Beta blockers, Ace inhibitors
Early invasive strategy with either thrombolytic therapy
or percutaneous coronary intervention (preferred)
34. Pulmonary Embolism
Sudden-onset sharp chest pain
Exacerbated by inspiratory effort
Can be associated with hemoptysis, sycope, dyspnea, calf
swelling/pain from DVT
Risk factors: immobilization, fracture of a limb, post-
operative complications, hypercoagulable states
(underlying carcinoma, high-dose exogenous estrogen
administration, pregnancy, inherited deficiencies of
antithrombin III, activated protein C, S, lupus
anticoagulant, prior history of DVT/PE [Virchow’s triad]
35. Pulmonary Embolism
Anxious patient, sense of impending doom
Tachycardia, tachypnea, hypoxia
EKG: sinus tachycardia most common, S1Q3invertedT3
with large embolus (classic, but rare!), look for right-axis
deviation
V/Q scan very sensitive but not specific
Spiral CT with contrast show large, central emboli
Pulmonary angiogram is gold standard but carries risk
Consider Doppler U/S of legs
36. Pneumothorax
Can be asymptomatic or present with acute pleuritic
chest pain and dyspnea
Primary pneumothorax predominantly in healthy
young tall males
Due to trauma (MVA accidents – associated with rib
fractures, iatrogenic – during line placement,
thoracentesis)
Increased alveolar pressure from asthma or
barotraumas (BiPAP, ventilator-associated)
Rupture of bleb in COPD patients
37. Pneumothorax
Decreased expansion of chest
Decreased breath sounds and
Decreased tactile/vocal fremitus on side of
pneumothorax
Hyperresonant percussion note
Usually easily confirmed by CXR
38. Aortic Dissection
Abrupt onset
The pain usually is described as ripping or tearing
Tearing or ripping pain that is felt in the intrascapular area
New diastolic murmur, asymmetrical pulses, and
asymmetrical blood pressure measurements
Risk factors: HTN, Marfan syndrome, coarctation of aorta..
Widened mediastinum on a portable anteroposterior (AP)
radiograph
TEE considered diagnostic test of choice
39. Key Points
Not every chest pain is MI, however every chest pain should be
considered as ischemic until proven otherwise
A good history and physical exam may help with the diagnosis
EKG is the best single diagnostic test to help rule out MI
Use the TIMI scoring system to help for the diagnosis and prognosis of
MI
40. Chest Pain Definitions
Acute Chest Pain:
Acute - sudden or recent onset (usually within minutes
to hours), presenting typically <24 hrs
Chest - thorax midaxillary to midaxillary line, xiphoid
to suprasternum notch
Pain – noxious uncomfortable sensation
Ache or discomfort
41. Initial Approach
Triage
Chest pain
Significant abnormal pulse
Abnormal blood pressure
Dyspnea
These pts need IV, O2, Monitor, ECG