Review of a rare but important cardiac dysplasia causing high mortality and morbidity in mostly young patients.
In this presentation, the epidemiology, pathophysiology, diagnosis and treatment of said disease is examines.
How to deal with CALCIFIED CORONARY ARTERY LESIONS .Coronary artery calcification (CAC) is highly prevalent in patients with coronary heart disease (CHD) and is associated with major adverse cardiovascular events. There are two recognized type of CAC—intimal and medial calcification, and each of them have specific risk factors. Several theories about the mechanism of vascular calcification have been put forward, and we currently believe that vascular calcification is an active, regulated process. CAC can usually be found in patients with severe CHD, and this asymptomatic phenomenon make early diagnosis of CAC important. Coronary computed tomographic angiography is the main noninvasive tool to detect calcified lesions. Measurement of coronary artery calcification by scoring is a reasonable metric for cardiovascular risk assessment in asymptomatic adults at intermediate risk. To date, effective medical treatment of CAC has not been identified. Several strategies of percutaneous coronary intervention have been applied to CHD patients with CAC, but with unsatisfactory results. Prognosis of CAC is still a major problem of CHD patients. Thus, more details about the mechanisms of CAC need to be elucidated in order to improve the understanding and treatment of CAC.
rotablation is procedure used in complex pci with heavily calcified lesion for adequate expansion of stent.if used in indicated case and well aware of contraindication is necessary for achieving good results.
Review of a rare but important cardiac dysplasia causing high mortality and morbidity in mostly young patients.
In this presentation, the epidemiology, pathophysiology, diagnosis and treatment of said disease is examines.
How to deal with CALCIFIED CORONARY ARTERY LESIONS .Coronary artery calcification (CAC) is highly prevalent in patients with coronary heart disease (CHD) and is associated with major adverse cardiovascular events. There are two recognized type of CAC—intimal and medial calcification, and each of them have specific risk factors. Several theories about the mechanism of vascular calcification have been put forward, and we currently believe that vascular calcification is an active, regulated process. CAC can usually be found in patients with severe CHD, and this asymptomatic phenomenon make early diagnosis of CAC important. Coronary computed tomographic angiography is the main noninvasive tool to detect calcified lesions. Measurement of coronary artery calcification by scoring is a reasonable metric for cardiovascular risk assessment in asymptomatic adults at intermediate risk. To date, effective medical treatment of CAC has not been identified. Several strategies of percutaneous coronary intervention have been applied to CHD patients with CAC, but with unsatisfactory results. Prognosis of CAC is still a major problem of CHD patients. Thus, more details about the mechanisms of CAC need to be elucidated in order to improve the understanding and treatment of CAC.
rotablation is procedure used in complex pci with heavily calcified lesion for adequate expansion of stent.if used in indicated case and well aware of contraindication is necessary for achieving good results.
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
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.
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
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.
arrythmias and cardiac tumorsCone excision of the major ducts (subareolar res...ssuser8eb265
Cone excision of the major ducts (subareolar resection). When the duct of origin of nipple bleeding is uncertain or when there is bleeding or discharge from multiple ducts, the entire major duct system
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
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
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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
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
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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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
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.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?
Congenital heart disease for post graduates toufiqur rahman NICVD
1. Congenital Heart Disease
ffor Post graduates
Dr. Md.Toufiqur Rahman
MBBS, FCPS, MD, FACC, FESC, FRCPE, FSCAI,
FAPSC, FAPSIC, FAHA, FCCP, FRCPG
Associate Professor of Cardiology
National Institute of Cardiovascular Diseases(NICVD),
Sher-e-Bangla Nagar, Dhaka-1207
Consultant, Medinova, Malibagh branch
Honorary Consultant, Apollo Hospitals, Dhaka and
STS Life Care Centre, Dhanmondi
drtoufiq19711@yahoo.com
CRT 2014
Washingt
on DC, USA
2. USA - 5-8 Per 10,000 live births
Also a major cause of Abortion and Still birth
About 1500-2000 (stipulated) children born with
congenital Heart disease every year in Bangladesh.
Incidence
9. CYANOTIC
DECREASED PBF INCREASED PBF
TOF TGA
Tricuspid Atresia TAPVD
Pulmonary atresia TRUNCUS ARTERIOSUS(TA)
DORV SINGLE VENTRICLE(SV)
Ebstein’s Anomaly(E.A) HYPOPLASTIC LEFT HEART SYNDROME
OTHERS :-
Abnormal position of heart and heterotaxy syndrome
10. DIAGNOSIS OF CHD
S MAJOR COMPONENTS
History & Physical Examination
X-ray chest
E.C.G
Echo cardiography
Cardiac cathetarization
11. CLUES TO CHD
Feeding difficulties
Respiratory distress/Tachypnea
Cyanosis/clubbing/Cynotic spell
Apneic spell
Persistent tachycardia
Excessive sweating
Frequent RTI
Exercise intolerance/orthopnea
Syncope/seizure/Headache/ vomiting
Failure to thrive/Growth Retardation
Developmental Delay
CHD usually identified during routine clinical exm. Or with a emergency
e.g. CCF or with complains of exertional dyspnea, or with FTT.
12. PHYSICAL EXAMINATION
Appearance
Anaemia, Cyanosis, clabbing, oedema
Pulse/Heart rate - in quiet state, RR Apex beat, heart sound,
Murmur - innocent/organic(Thrill), Timing - systolic/diastolic,
location- where more intense ?
Hepatomegaly, bilateral basal creps
But always be sure before leveling a case of CHD
14. ECG
* QRS axis - Lead - I Lead - II
Normal Positive Positive
LAD Positive Negative
RAD Negative -----------
* Ventricular Hypertrophy
LVH S in V1 + R in V5/V6 > 40 mm ( > 1 yr)
RVH R>S in V1 > 30 mm (< 1 yr)
BVH R + S in V3 / V4 > 50 mm any age
17. Clinical Presentation
* Small (<0.5 cm) - asymptomatic,develops normally.
* Moderate to Large VSD with Large L-R shunt-
Symotomatic in early infancy, Dyspnea at rest or
during feeding, sweating, C.C.F. failure to thrive frequent
RTI.
* Large VSD with PHT-With above features, cyanosis
usually absent but intermittent with crying / exertion
(if R-L shunt)
18. On Examination
Normal pulse, S1 masked by murmur, S2 Accentuated if PH,
murmur - Pansystolic in LLSE, Apical mid-diastolic (if large
shunt), ESM in ULSE
On Investigation
X-ray - normal/Cardiomegly, Pul. Plethra
ECG - normal/LVH or RVH & LVH
ECHO - diagnostic, anatomical defect size location pressure
gradient & assoc. problems.
CATH - Diagnostic, determine PVR, QP : QS.
20. An opening in inter atrial septum.
Type - O.Secundum (c), O.Primum, S.Venosus.
C/F - Secundum type- Usually asymptomatic. With large L-R
shunt- recurent RTI, Easy fatigue, PHT in older.
Primum type- asymptomatic but with large L-R shunt-
Dyspnea, RTI & C.C.F may occur.
O/E - Normal pulse, S2 wide and fixed splitting. ESM in
ULSE, Apical mid-diastolic if large shunt.
On investigation- X-Ray chest normal/Cardiomegaly, Pul.Plethora.
ECG-rsR’in V1.ECHO-Diagnostic. Cath-QP:QS,
PVR.
ASD
21.
22. PDA
* Persistent communication by ductus between PA &
AO. Neonate - pre-term/term. Infant & children.
* Small-no symptom, large -Growth retardation, easy fatigue
exertional dyspnea, heart failure.
* Collapsing pulse, S1 S2 masked by continuos machinery
murmur in ULSE to left clavicle.
* X-Ray chest - Normal/cardiomegaly. Pul. Plethora.
* ECG - Normal or LVH.
* ECHO - Diagnostic.
* CATH - Diagnostic & Therapeutic.
* Complication - Infective endarteritis, PAHT.
23. * Type - Valvar, Infravalvar, Supravalvar.
* C/F - Mild to Modarate - No symtom. Severe stenosis-
Exertional Dyspnea & C.C.F. Critical stenosis - Neonatal
cyanosis with C.C.F.
* O/E - Normal pulse, Click if pliable valve, ESM in ULSE.
* Chest X-Ray - Normal/cardiomegaly.
* ECG - RVH with strain pattern.
* ECHO - Diagnostic, determine peak systolic gradient across
pulmonary valve & indicate the requirement of intervention.
* CATH - Diagnostic and therapeutic for valvuloplasty.
PUlMONARY STENOSISPUlMONARY STENOSIS
25. * Type - Valvar, Supravalvar, Infravalvar, IHSS.
* C/F - Mild from-asyptomatic. Moderate- dizziness, easy
fatigue, sweating, exertional dyspnea, syncope,
angina. Severe- C.C.F. sudden death, FTT.
* O/E - Pulse reduced in volume, click if pliable valve, ESM in
URSE, O/I
* X-Ray Chest - Normal/Cardiomegali.
* ECG - Normal / LVH with strain pattern.
* ECHO - Diagnostic. Thickend/Doomed AV. Peak systolic
gradient classify the degree of stenosis.
AORTIC STENOSIS
Narrowing at LVOT
26. COARCTATION OF AORTA
Discrete narrowing of Aorta from Arch to Iliac bifurcation
Type - Infantile & Adult. Preductal/Postductal.
C/F - Severe from - Headache, dyspnea on exertion, hypertension, C.C.F.
differential cyanosis & differential blood presser. Less severe from -
well during infancy but hypertension in later life. Pulse -Decreased or
delayed femorals. Click if bicuspid aortic valve. Mid-systolic murmur in
Apex and back.
O/I
X-Ray chest - Normal/ cardiomegaly. Figure of “3” sign. Notching of 4-8 ribs.
ECG - Normal or LVH.
ECHO - Diagnostic. Pressure gradient classify the degree of
coarctation.
CATH - Diagnostic and Therapeutic or Balloon angioplasty.
28. D-TGA
AO arises from RV and PA arises from LV with or without shunt (ASD, VSD,
PDA)
C/F - Without shunt: Early Neonatal severe cyanosis, Hypoxemia, acidosis,
Heart failure, Sudden Death if not urgently treated. With shunt: Late
neonatal Presentation of cyanosis, acidosis, Failure to thrive & CCF
O/E
Heart sound - S2 Loud
Murmur - Absent or systolic (if shunt)
O/I
Chest radiology - “Egg on side” Heart Shadow with narrow base,
pulmonary plethora.
E.C.G - RAD RVH, RVH+LVH, may be normal
Echo - Aorta arises from RV & PA from LV also confirms other associate.
Cath - Diagnostic & Therapeutic for atrial septostomy
29.
30.
31. TOF
1.RVOT obstruction, 2. Large VSD, 3. Overriding of AO to RV,
4. RV hypertrophy. Degree of cyanosis depends on Severity
of RVOT obstruction and systemic versus pul. resistance.
C/F - Neonatal cyanosis (if severe)
Infancy - Hypercyanotic spell, clubbing, Failure to thrive,
convulsion, Hemiplegia Cerebral infarction
(<2yrs.) or cerebral Abscess (>2yrs.)
O/E - Heart Sound - S2 single , Murmur- Ejection
Systolic in left sternal edge.
Less the intensity of murmur more severe the
32. TOF
Chest radiology - Boot shaped heart with pulmonary
concavity & apex tilted up, Oligaemic lungs.
E.C.G - RAD, RVH
Echo - Aorta Large with overriding to RV, RVOT-
Narrow PA/PV- Variable in morphology,
RV
Hypertrophied, Large Nonrestrictive VSD
with
bi-directional shunt.
33. TAPVD
All four pul. veins open to a common sac which opens to
other than LA
Type - Supracardiac (C), Cardiac, infracardiac, Mixed.
C/F - With obstruction: (With/Without ASD) Early/neonatal
cyanosis, Acidosis, Hypoxemia, Heart failure (with
small
heart in radiology).
Without obstruction:Late cyanosis / Clubbing, RTI,
failure to thrive.
34. TAPVD
Heart sound - Normal , or S1-loud S2- single accentuated
Murmur - Absent or Ejection Systolic in pul. area
radiating to lungs.
Chest radiology - Wide supracardiac shadow as figure of ‘8’
(supra cardiac form), pul. plethora.
E.C.G - Normal or RVH, RAD, Tall-P
Echo - LA, LV smaller, Rt sided volume overload,
Identify anomalous pul. venous
connections.
35.
36. Tricuspid Atresia
TV atretic, with ASD and VSD with variable RV and PA
C/F - Early central cyanosis & clubbing later on failure to
thrive, exertional dyspnea and C.C.F.
Heart sound - S1-Normal, S2-Single accentuated
Murmur - Soft systolic in LLSE
37. Tricuspid Atresia
Chest radiology - Small cardiac shadow Often square
shape, oligaemic lungs.
E.C.G - LAD , RAH, LVH
Echo - Thick atretic TV with ASD may be with
TGA/ without TGA, with variable size of
VSD or PDA.
38.
39. TRUNCUS ATERIOUSUS.
Ao & PA arises from single great vessel overriding a VSD
without right venticular infundibulum
Type - 1,2,3,4 according to position of origin of PA
C/F - At birth-minimal cyanosis, at 2-3 wks-collapsing
pulse, breathlessness, RTI, failure to thrive & finally
C.C.F.
Heart Sound - S2 loud & single
Murmur - Click, Systolic murmur
Chest radiology - Cardiomegaly, pul. plethora.
40. TRUNCUS ATERIOUSUS.
E.C.G - Normal in early case, RVH or (RVH
+LVH) in older case.
Echo - Diagnostic. Characteristic overriding of a
single great artery and determine the
position and flow across PA from
truncus and bi-directional shunt across
VSD.
Cath - Diagnostic
41.
42. EBSTEIN’S ANOMALY
Downward displacement of TV into the RV with a large RA
due to atrialized portion of RV which is reduced.
C/F - In Severe from - Neonatal cyanosis, C.C.F.
Less servere -Late presentation with palpitation,
dyspnea, chest deformity, failure to Thrive,
Arrhythmia like RBBB/AF.
Heart Sound - Gallop rhythm or irregular Heart beat. (if
CCF/AF)
Murmur - Systolic & Diastolic Murmur with/without
click.
43. EBSTEIN’S ANOMALY
Chest radiology - Cardiomegaly with Box-shaped heart
with Oligaemic Lungs.
E.C.G - Tall-P increased RP interval, RBBB or
AF
Echo - Downward displacement of TV with
atrialzed RV and also any associated
lesion.
Cath - Confirms Diagnosis.
44. PULMONARY ARTESIA
Absence of PV with no or very little communication between
RV and MPA usually with ASD, VSD or PDA.
Type I - With a small tricuspid and small RV
TypeII - With tricuspid vale insufficiency and a large
RV
C/F - Without shunt -Central cyanosis at birth.
Hypoxia acidosis & Right Heart failure.
With shunt - Variable cyanosis, Clubbing,
FTT, CCF
45. PULMONARY ARTESIA
Heart Sound - S2 Single
Murmur - Absent or may be systolic (If shunt)
Chest radioloy - Mild cardiomegaly, Oligaemic Lungs.
E.C.G - Normal or Tall-P (RAH)
Echo - PV not visualized or very thick with a little or
no blood flow. Small RV, variable TV
46. Congenital Heart Disease (CHD)
Look for
central cyanosis
Acyanotic Cyanotic
Auscultate Murmur
PSM in LLSE ESM
in ULSE
ESM
in URSE
Continuous
Machinery
in ULSE & LICLA
BSM in Left
Axilla & Radio
-femoral delay
CoAoPDA
As
RSCLA
PS/ASD
VSD
S2 Split & wide S2 Absent
ASD PS Contd...
47. Cyanotic
Look for Age
Early (<6M)
TGA, TAPVD (obs)
Sevre TOF, Tr. Ar.
Tricuspid Atresia (TA)
with small shunt
pulmonary atresia (PA)
(without shunt)
Late (>6M)
TOF
TAPVD (without obs)
TA (with large shunt
Ebstein’s Anomaly (EA)
S.V, A-V canal defect
Chest Radiography
Plethoric Lungs
TGA, TAPVD
Tr. Ar.
TOF, PA,
EA, TA
Oligaemic Lungs
Charactprostoc
Cardiac shadow
Egg shape Figure of 8 Square shape Boot shape Box shape Large RA
cardiomegaly
TGA TAPVD Tr, Ar TOF EA
PA/TA