Presentation about coronary angiography describing the definition, indications, contraindications and patient preparation required for a CT coronary angiography.
Global Hospitals’ Advanced Heart, Lung & Vascular Institute provides all kinds of endovascular procedures including coronary intervention and peripheral intervention, heart surgery, heart bypass surgery as well as heart transplantation surgery in Hyderabad, Chennai, and Bangalore
Global Hospitals’ Advanced Heart, Lung & Vascular Institute provides all kinds of endovascular procedures including coronary intervention and peripheral intervention, heart surgery, heart bypass surgery as well as heart transplantation surgery in Hyderabad, Chennai, and Bangalore
Does Preoperative Coronary Revascularization Improve Perioperative Cardiac Ou...Guilherme Barcellos
Draft que encontrei de apresentação em 201: Primeiro Encontro de Medicina Hospitalista da Argentina. Slides alguns já traduzidos, outros não - não encontrei versão final. De brasileiros no evento participaram eu, Lucas Zambon e Tiago Daltoé. Boas lembranças! Resgatei agora porque trata de evidência consolidada desde aquela época, e seguimos sobreutilizando o recurso. Ou algo novo que justifique?
Stroke IV thrombolysis beyond limitations; case series and review of literatureApollo Hospitals
Thrombolytic therapy is the only available medical treatment for acute ischemic stroke that has been proven to be effective. Intravenously administered recombinant tissue plasminogen activator (rtPA) has been shown to improve the long-term functional outcome and is recommended for the treatment of eligible acute stroke patients. However, due to the risk of major bleeding, particularly in the brain, patients need to be carefully selected on the basis of eligibility criteria. These have
been largely adopted from the inclusion and exclusion criteria used in the randomized clinical trials.
Does Preoperative Coronary Revascularization Improve Perioperative Cardiac Ou...Guilherme Barcellos
Draft que encontrei de apresentação em 201: Primeiro Encontro de Medicina Hospitalista da Argentina. Slides alguns já traduzidos, outros não - não encontrei versão final. De brasileiros no evento participaram eu, Lucas Zambon e Tiago Daltoé. Boas lembranças! Resgatei agora porque trata de evidência consolidada desde aquela época, e seguimos sobreutilizando o recurso. Ou algo novo que justifique?
Stroke IV thrombolysis beyond limitations; case series and review of literatureApollo Hospitals
Thrombolytic therapy is the only available medical treatment for acute ischemic stroke that has been proven to be effective. Intravenously administered recombinant tissue plasminogen activator (rtPA) has been shown to improve the long-term functional outcome and is recommended for the treatment of eligible acute stroke patients. However, due to the risk of major bleeding, particularly in the brain, patients need to be carefully selected on the basis of eligibility criteria. These have
been largely adopted from the inclusion and exclusion criteria used in the randomized clinical trials.
ICH Guidelines for Pharmacovigilance.pdfNEHA GUPTA
The "ICH Guidelines for Pharmacovigilance" PDF provides a comprehensive overview of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines related to pharmacovigilance. These guidelines aim to ensure that drugs are safe and effective for patients by monitoring and assessing adverse effects, ensuring proper reporting systems, and improving risk management practices. The document is essential for professionals in the pharmaceutical industry, regulatory authorities, and healthcare providers, offering detailed procedures and standards for pharmacovigilance activities to enhance drug safety and protect public health.
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
2. Introduction
● Used to visualize blood flow throughout the body to determine if either fatty
deposits or calcium deposits have built up in the arteries
● Used to visualize the distribution and anatomy of the vasculature.
● CT coronary angiography using scanners with at least 64 slices should be
recommended as a test to rule out obstructive coronary stenoses in order to
avoid inappropriate invasive coronary angiography in patients with an
intermediate pretest probability of CHD.
Gorenoi V, Schönermark MP, Hagen A. CT coronary angiography vs. invasive coronary angiography in CHD. GMS Health
Technol Assess. 2012;8:Doc02. doi: 10.3205/hta000100. Epub 2012 Apr 16. PMID: 22536300; PMCID: PMC3334923.
3. Introduction
● For identifying or excluding of obstructive coronary stenosis, CT coronary
angiography was shown to be more cost-saving at a pretest probability of
CHD of 50% or lower, and invasive coronary angiography at a pretest
probability of CHD of 70% or higher.
● The percentages of uninterpretable CCT studies have gradually decreased
from 20%–40% with 4-slice systems to 15%–25% with 16-slice systems and
are now as low as 3%–10% with 64-slice systems
Gorenoi V, Schönermark MP, Hagen A. CT coronary angiography vs. invasive coronary angiography in CHD. GMS Health
Technol Assess. 2012;8:Doc02. doi: 10.3205/hta000100. Epub 2012 Apr 16. PMID: 22536300; PMCID: PMC3334923.
4. Indications
● To test the presence and severity of coronary artery stenosis, in patients
presenting with chest pain with intermediate pretest probability of having
obstructive CAD.
● As the initial test in patients without known CAD who present with possible
acute coronary syndrome (ACS) when highly sensitive troponin assay testing
and the clinical evaluation cannot confidently exclude ACS.
● Coronary anatomical abnormalities (eg- adult patients with suspected
congenital anomalous coronary arteries)
Gorenoi V, Schönermark MP, Hagen A. CT coronary angiography vs. invasive coronary angiography in CHD. GMS Health
Technol Assess. 2012;8:Doc02. doi: 10.3205/hta000100. Epub 2012 Apr 16. PMID: 22536300; PMCID: PMC3334923.
5. Indications
● As an alternative to stress testing or invasive coronary angiography in
selected patients
○ without previously known CAD (AND)
○ who are diagnosed with non-ST-elevation ACS (AND)
○ with clinically low-risk presentation (eg, absence of heart failure and
refractory ischemic symptoms), (OR)
○ when the cause for troponin elevation is uncertain.
● Cardiac masses or pericardial disease with technically limited images
from echocardiogram, MRI, or transesophageal echocardiography
Cademartiri F, Casolo G, Clemente A, Seitun S, Mantini C, Bossone E, Saba L, Sverzellati N, Nistri S, Punzo B, Cavaliere C,
La Grutta L, Gentile G, Maffei E. Coronary CT angiography: a guide to examination, interpretation, and clinical indications.
Expert Rev Cardiovasc Ther. 2021 May;19(5):413-425. doi: 10.1080/14779072.2021.1915132. Epub 2021 Apr 22. PMID:
33884942.
6. Indications
● As the initial test in patients without known CAD
○ who present with possible acute coronary syndrome
(ACS)
○ when highly sensitive troponin assay testing and the
clinical evaluation cannot confidently exclude ACS.
7. ● CCT is the primary tool in the assessment of suspected Coronary
Artery Disease (CAD) and should be followed by functional
assessment when needed to stratify disease and to plan potential
interventional or surgical therapy.
● Screening high risk patients
● Evaluation of chest pain
● Post procedural study (CABG, stent)
● Dilated cardiomyopathy
Indications
8. Absolute Contraindications
● Hypersensitivity to contrast agent
● Pregnancy
● Patients with ongoing chest pain who may have ACS (since
transporting them is unsafe and CT suites are generally not
equipped to deal with potentially unstable patients.)
9. Relative Contraindications
● Irregular heart rate
● Renal insufficiency
● Hyperthyroidism
● Inability to hold breath for more than 10 sec
● Allergy to medications/ food
● Metallic interference (pacemaker etc.)
10. Patient Preparation
● Avoid caffeine and smoking 12 hours prior to the procedure
● Nil per oral for 4 hours
● In patients with heart rate > 65/min, oral or IV beta blockers is
used
○ Tab metoprolol 50-100 mg administered around 1 hour before procedure
or
○ Inj metaprolol 5-20 mg IV administered at the time of the procedure
● Sublingual nitroglycerine: given immediately before the
procedure to dilate the coronary arteries
11. Patient Preparation
● Patient placed in supine position
● ECG leads attached to obtain an adequate ECG tracing
● IV access of 18 gauge at right antecubital vein (to
minimise streak artifact and allow rapid infusion of
contrast)
● Training of patient with repeated breath holds
12. Induction of Bradycardia and its Wisdom
● Coronary arteries fill up during diastole.
● The duration of systole remains constant and its the diastole that is
compromised in the event of an increase in heart rate.
● By inducing bradycardia we are ensuring that the window of
opportunity for taking an image that clearly captures the coronary
arteries is possible.
● Beta blockers and ivabradine are useful in this.
13.
14. Medications used in coronary angiography
● Beta blocker and ivabradine are used to induce sinus bradycardia
○ Metoprolol is the ß-blocker of choice in CCTA, and it has been shown to be effective in
achieving the goal heart rate of less than 65 beats per minute for CCTA and in minimizing
variability of heart rate.
○ It is contraindicated in patients with hypotension or high degree AV block, and
○ It must be used with caution in patients with asthma or obstructive pulmonary disease, patients
with decompensated heart failure, and those with vasospastic or vaso-occlusive disease.
● Diltiazem, the CCB of choice in CCTA, is a reasonable alternative for heart rate control, particularly
in patients with asthma or bronchospastic disease, and patients with orthotopic heart transplants that
have been sympathetically denervated.
Khan M, Cummings KW, Gutierrez FR, Bhalla S, Woodard PK, Saeed IM. Contraindications and side effects of commonly used
medications in coronary CT angiography. Int J Cardiovasc Imaging. 2011 Mar;27(3):441-9. doi: 10.1007/s10554-010-9654-8. Epub
2010 Jun 23. PMID: 20571874.
15. Medications used in coronary angiography
● Nitroglycerine
○ For vasodilation and good visualization of coronary arteries and stenosis
○ Sublingual nitroglycerin is especially useful in order to dilate distal arteries to
improve stenosis visibility.
○ Contraindications:
■ Severe hypotension or use of phosphodiesterase inhibitors
■ Patients on erectile dysfunction medications and those with severe anemia.
■ It must be used cautiously in patients with aortic stenosis or other preload-
dependant cardiac pathologies.
Khan M, Cummings KW, Gutierrez FR, Bhalla S, Woodard PK, Saeed IM. Contraindications and side effects of commonly used
medications in coronary CT angiography. Int J Cardiovasc Imaging. 2011 Mar;27(3):441-9. doi: 10.1007/s10554-010-9654-8. Epub
2010 Jun 23. PMID: 20571874.
16. Breath holding
● During the test, a breath hold of 15–20 s will need to be performed.
● If the patient cannot hold still and follow breathing instructions, he or she
should not be scanned.
● Breathing during the scan significantly compromises image quality and
produces segments that cannot be evaluated.
● Before the scan, practicing breath holding helps to avoid such artifacts.
17. A: CCT image obtained from patient who was
breathing during image acquisition. Note “stair-step”
artifacts, with displacement of trajectory of coronary
vessels and chest wall (arrows)
B: 3-D volume-rendered CT image reconstruction
of whole heart. Motion artifacts (arrows) are seen
in patients who experience multiple extrasystolic
beats during image acquisition
18. ECG gating protocols
● Two different approaches:
○ Prospective ECG gating
○ Retrospective ECG gating
19. Prospective ECG gating
● Scan acquisition is triggered by the ECG signal at the prospected mid-
diastolic phase of the cardiac cycle
● Between 40% and 80% of the R-R interval
● Advantage: Smaller radiation exposure
20. Retrospective ECG gating
● Heart is scanned continuously
● Contiguous data of cardiac region is acquired, while ECG is
recorded at the same time
● Scan data with the least cardiac motion, usually the diastolic phase,
is used for image reconstruction
● Advantage: Continuous and gapless acquisition of entire volume
● Disadvantage: Higher radiation exposure
21. Pitfalls and artifacts in CCTA
● Artifacts in CCTA are discrepancies between the reconstructed Hounsfield Unit
(HU) values in the image and true attenuation coefficients of the object that can
cause a clinically significant difference in diagnosis.
● Artifacts can be broadly classified as those that may be related to patient,
procedure, contrast, technique or reconstruction, although several artifacts result
from a combination of these causes.
● Elevated heart rate:
○ Higher or variable heart rates increase motion artifacts.
○ Image quality is often suboptimal in patients with irregular heart rates.
○ Scanning patients during atrial fibrillation should be avoided unless there are
relatively stable R-R intervals.
○ Similarly, strong consideration should be given to aborting a scan if frequent
ventricular ectopy is present.
Tridandapani S, Banait-Deshmane S, Aziz MU, Bhatti P, Singh SP. Coronary computed tomographic angiography: A review of
the techniques, protocols, pitfalls, and radiation dose. J Med Imaging Radiat Sci. 2021 Nov;52(3S):S1-S11. doi:
10.1016/j.jmir.2021.08.014. Epub 2021 Sep 24. PMID: 34565701.
22. ● Evaluating coronary artery stenosis in patients with extensive coronary artery
calcifications may be difficult and represents a major limiting factor.
● Reconstructions involving calcified structures tend to overestimate the volume set
representing calcium (“blooming”) because of partial-volume averaging effects,
which suggest that much of the coronary lumen is apparently occupied by
calcified plaque.
● In addition, the true lumen results in a low-density area because of beam-
hardening artifacts.
● In some situations, it can be difficult to distinguish these artifacts from noncalcified
coronary plaque.
● Because symptomatic patients with very high calcium scores have a very high
probability of having obstructive CAD, it is reasonable to avoid CCT coronary
angiography and proceed directly to invasive catheterization in these patients
Pitfalls and artifacts in CCTA
Cardiac CT: Indications and Limitations Susanna Prat-Gonzalez, Javier Sanz and Mario J. Garcia Journal of Nuclear
Medicine Technology March 2008, 36 (1) 18-24; DOI: https://doi.org/10.2967/jnmt.107.042424