Magnetic Resonance Angiography and VenographyAnjan Dangal
Introduction to MR Angiography and Venography Procedure of Brain . Includes Indication, MRI protocol, planning and anatomy as well as brief intoduction to physics behind MRA and MRV principle.
Magnetic Resonance Angiography and VenographyAnjan Dangal
Introduction to MR Angiography and Venography Procedure of Brain . Includes Indication, MRI protocol, planning and anatomy as well as brief intoduction to physics behind MRA and MRV principle.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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.
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
These lecture slides, by Dr Sidra Arshad, offer a quick overview of 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 leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
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. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
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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.
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Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
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coronaryangiogram-140520060959-phpapp01.pdf
1. Presented by …
Dr. Muhammad Mobarock Hossain,
MD (cardiology) phase B( final part)
BSMMU, Dhaka.
Coronary angiogram
2. Definition:
Coronary angiography is
a procedure that uses a
special dye (contrast
material) and x-rays to
see how contrast
material filled blood
flows through the
coronary arteries of the
heart.
3. Importance of
Coronary Angiogram:
Coronary angiogram, is the "gold standard"
for the evaluation of coronary artery disease
(CAD).
A coronary angiogram can be used to identify
the exact location and severity of CAD.
4. Indications:
Acute MI
Unstable angina
Chronic stable angina (uncontrolled by medication)
Abnormal stress test
Ventricular arrythmias
Left ventricular dysfunction
Valvular heart disease
Preoperative coronary assessment for cardio vascular
surgery
Periodic follow up after cardiac transplantation
5. Contraindications:
Coagulopathy
Active bleeding
Malignant hypertension
Acute or chronic renal failure
Severe anemia ( Hb < 10gm/dl of blood)
Electrolyte imbalance
Fever
Active systemic infection
Uncontrolled rhythm disturbances (arrhythmias)
Uncompensated heart failure
Transient Ischemic attack
Patient unable to cooperate or does not desire
procedure
6. Requisite for coronary
angiogram:
Cardiac cath lab.
Puncture needle
Introducer
Short guide wire
Cordis sheath with dilator
Left Judkins catheter
Right Judkins catheter
contrast media
10. Contrast media:
Types of radiocontrast agents :
Iodinated radio contrast agents are either ionic or nonionic and are of
variable osmolality.
First generation:
► Ionic
► Highly hyperosmolal (1400 to 1800 mosmol/kg
compared with the osmolality of plasma.)
11. Cont…
Second generation:
Iohexol,
►nonionic monomers
►lower osmolality than the first generation but
have an increased osmolality (500 to 850
mosmol/kg) compared with plasma.
The newest nonionic contrast agents:
►iso-osmolal,
with an osmolality of approximately 290
mosmol/kg (iodixanol agent).
12. Steps of Coronary Angiogram:
Step 1 ( pre cath):
Written consent.
Fasting for at least 4 hours
Pre cath investigations.
Selection of arterial access point.
Shaving of the groin/ wrist according to the choice.
Opening the I/V line.
Connect with the cardiac monitor.
Oral or I/V sedatives.
13. Cont….
Step 2:
Radiation protection for the health care personnel.
An area of the arm or groin, is cleaned and numbed
with a local numbing medicine (anesthetic 15 ml).
Draping of the patient.
Using local anesthetics around the puncture site.
Puncture and introducing the short guide wear
through the puncture needle.
Introducing the cordis sheath and removal of dilator
along with short guide wire.
Flush the channel with heparinized solution.
14. Cont….
Step 3:
The cardiologist passes a thin hollow tube, called a catheter,
through an artery and carefully moves it up into the heart.
X-ray images help the doctor positioning the catheter.
Once the catheter is in place, dye (contrast material , better
to use <30 ml to prevent CIN) is injected into the catheter.
X-ray images are taken to see how the dye moves through
the artery. The dye helps highlight any blockages in blood
flow.
The procedure may last 30 to 60 minutes.
15. Coronary Anatomy
The left and right coronary cusp give rise to their respective
coronary arteries.
The major epicardial vessels are the left main coronary
artery that divides into the Left anterior Descending artery
and Left Circumflex Artery, anrespective coronary arteriesd
the Right Coronary artery.
16. Dominance
Coronary dominance is based on the vessel that gives rise to the
posterior descending artery which supplies the Atrio-ventricular
node.
Recognized by the presence of septal perforating branches,
arises from the RCA in 80% and from the LCX in 10% of the
population.
Co-Dominance is found in 10% of the population where the
posterior interventricular artery is formed by both the RCA and
LCx.
17. Left Main Coronary Artery (LMCA)
The Left main coronary artery originates from the left coronary
cusp and bifurcates to give rise to the Left anterior descending
and Left Circumflex arteries.
Long LMCA when the length is > 15 mm.
Short LMCA when the length is ≤ 5 mm.
Occasionally, a third branch vessel, the Ramus Intermedius arises
from the LMCA.
In a small number of patients, the two major branch vessels arise
from separate origins.
18. Left Anterior Descending Artery
(LAD)
LAD provides blood supply to the anterior wall of the
left ventricle.
It provides multiple septal branches to the
interventricular septum and diagonal branches to the
anterior lateral wall.
The LAD in some patients wraps around the apex to
supply a small amount of the posterior apex.
19. Left Circumflex Artery (LCx)
LCx courses around the lateral or left atrio-ventricular
groove and gives rise to multiple marginal or lateral
branches. The branches are termed obtuse marginal
(OM) branches.
OM branches are sequentially numbered (OM1, OM2
etc…).
As the LCx courses the AV groove it also gives rise to
several atrial branches, and occasionally the sino-atrial
branch (40% of the population).
20. Right Coronary Artery (RCA)
RCA arises from the right coronary cusp and follows the
right AV groove.
The most proximal branches of the RCA are the conus-
branch which supplies the Right ventricular outflow
tract and a branch that supplies the sino-atrial (SA) node
(60% of patients).
RCA gives off the postero lateral and posterior
descending branches at the crux cordis
23. Angiographic views
Anatomic landmarks formed by the
spine,
catheter and diaphragm
provide information to view the image.
In the LAO view the catheter and spine are seen on
the left side of the image, while in the RAO they are
found on the right.
24. Cont…
PA imaging places these landmarks in the center.
Cranial can usually be distinguished from caudal
angulations by the presence of the diaphragm. For
cranial imaging, the patient should be asked to
inspire to remove the diaphragmatic shadow from
the image.
25. Left Coronary System
Generally, for circumflex and proximal epicardial
visualization the caudal views are most useful.
For LAD and LAD/diagonal bifurcation visualization, the
cranial views are most useful.
28. Grading stenosis
The severity or degree of stenosis is measured by
comparing the area of narrowing to an adjacent
normal segment, and as a percentage reduction and
calculated in the projection which demonstrates the
most severe narrowing.
29. Classification of distal
angiographic contrast runoff
(TIMI Grade)
Normal distal runoff (TIMI 3)
Good distal runoff (TIMI 2)
Poor distal runoff (TIMI 1)
Absence of distal runoff (TIMI 0)
Ref: Morton J. Kern/ p-131/2nd edition.
30. Grading of collateral circulation
Grade Collateral appearance
0 No collateral circulation
1 Very weak reopcification
2 Reopacified segment, less dense than the
feeding vessel and filling slowly. 3
3 Reopacified segment as dense as the
feeding vessel and filling rapidly
31. Complication:
Life threatening complications are rare (~1 in 1000) but more common in
patients with serious disease, eg. Left main stem disease, aortic or
peripheral vascular disease.
Major complications:
1. MI
2. Stroke
3. Renal failure
4. Aortic or coronary dissection
5. Cardiac rupture
6. Air embolism
7. Arrythmia
8. Peripheral vascular damage
33. Management of
complication:
Hematoma:
► Most hematomas don't need intervention. Only analgesia.
If it is tense, expansile,bruit or very tender then the altenative
diagnosis will be femoral artery pseudoaneurysm.
Pseudo aneurysm:
Represents partial rupture of the femoral artery with formation of false
aneurysm. Diagnosed by ultra sound.
► small – prolong compression for 20-30 min under ultra sound
guidance.
► large – needs surgical repair.
34. Cont….
Hemorrhage:
►Despite prolong pressure more than 30 min then use
mechanical clamp or haemostatic device .
►Check for coagulation profile.
►To reverse the effect of heparin use protamine and for
warfarin use factor IX concentrate.
Limb Ischemia:
► Rare but usually occurs in patients with significant
peripheral vascular disease.
►Check for the peripheral pedal pulses before
and after angiogram for comparison.
36. Cont…
Vaso-vegal reaction:
The patient will develop hypotension and bradycardia .
► Disengage catheter
► Elevate patient’s leg
► I/V atropine 1 mg
► I/V plasma expander 200-500 ml rapidly.
37. Contrast
nephropathy(CIN):
Radiocontrast media can lead to a usually reversible
form of acute kidney injury (formerly called ARF)
that begins soon after the contrast is administered .
In most cases, there are no permanent sequelae, but there
is some evidence that its development is associated with
adverse outcomes.
Contrast-mediated nephropathy (CIN) was defined by an
absolute increase of serum creatinine ≥0.5 mg/dL or a
relative increase of ≥25% measured 2 to 5 days after the
procedure. (AHA)
38. Prevention of CIN:
American Heart Association
Ascorbic acid, 3 g at least 2 hours before
the procedure and 2 g in the night and
the morning after the procedure.
Ref: (Ascorbic Acid Prevents Contrast-Mediated Nephropathy in Patients With Renal
Dysfunction Undergoing Coronary Angiography or Intervention Konstantinos Spargias,
MD; Elias Alexopoulos, MD; Stamatis Kyrzopoulos, MD; Panayiotis Iacovis, MD; Darren C.
Greenwood, MSc; Athanassios Manginas, MD; Vassilis Voudris, MD; Gregory Pavlides, MD;
Christopher E. Buller, MD; Dimitrios Kremastinos, MD;Dennis V. Cokkinos, MD
39. Prevention of CIN:
European Heart Journal
Sodium chloride 0.9% 1 mL/kg/h for at least
12h prior and after the procedure
Sodium bicarbonate (166 mEq/L) 3 ml/kg for
1h before and 1 ml/kg/h for 6h after the procedure.
Sodium bicarbonate (166 mEq/L) 3 ml/kg
over 20min before the procedure plus sodium
bicarbonate orally (500 mg per 10 kg).
Volume supplementation with 24 h sodium chloride 0.9% is superior to sodium
bicarbonate for the prevention of CIN. A short-term regimen with sodium
bicarbonate is non-inferior to a 7 h regimen.
Ref: (Oxford Journals Medicine European Heart Journal Volume 33, Issue 16 Pp.
2071-2079)
40. Follow up:
Check for the peripheral pulses, local temperature of the
limbs and any abnormal feelings like
numbness,coldness etc.
Check for the body temperature.
Check for the hematoma, rashes, loin pain.
Ask the patient for any chest pain or discomfort.
Check for the urinary out put.
Advice the patient to immobilize the limb where the
procedure was done for several hours.
41. References:
1) Indications for and objectives of cardiac catheterization in aortic valve disease. A D Johnson. West J
Med. 1977 June; 126(6): 471–473. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1237633
2) Effect of Transradial Access on Quality of Life and Cost of Cardiac Catheterization: A randomized
Comparison. Christopher J. Cooper, MD, Reda A. El-Shiekh, MD, David J. Cohen, MD, MSc, Linda Blaesing,
RN, Mark W. Burket, MD, Asish Basu, MD, etal. Am Heart J 138(3):430-436, 1999.
3) The effect of early education on patient anxiety while waiting for elective cardiac catheterization.
Harkness K, Morrow L, Smith K, Kiczula M, Arthur HM. European journal of cardiovascular nursing: journal of the
Working Group on Cardiovascular Nursing of the European Society of Cardiology 2003 July.
Other Internet References1) Cardiac catheterization
http://www.nlm.nih.gov/medlineplus/ency/article/003419.htm
2) Cardiac Catheterization http://www.webmd.com/heart-disease/cardiac-catheterization
3) Cardiac Catheterization http://www.cardiologychannel.com/cardiaccath/
4) Diseases and conditions: What is diagnostic cardiac catheterization?
http://mo.essortment.com/whatisdiagnost_ojn.htm
5) Cardiac Catheterization and Coronary Angiogram http://www.cpmc.org/services/cardiac/card-cath.html
6) Preparing a patient for cardiac catheterization http://findarticles.com/p/articles/mi_qa3689/
is_200209/ai_n9145642
42. Cont…
7) Cardiac Catheterization
http://www.childrens.com/cardiology/diagnoses/
cardiac_catheterization.cfm
8) Cardiac Catheterization
http://www.merck.com/mmpe/sec07/ch070/ch070b.html
9) Cardiac Catheterization
http://www.sjm.com/procedures/procedure.aspx?
name=Cardiac+Catheterizationsion=Overview
10) Cardiac Catheterization And Angiography
http://www.answers.com/topic/
cardiac-catheterization-and-angiography?cat=health
11) Interventional Procedures - Questions and Answers about Stents, Angioplasty and New Approaches
to Treat Heart Disease — May 25, 2007
http://www.clevelandclinic.org/heartcenter/pub/guide/
webchat/ellis052507.htm
12) Cardiac Catheterization FAQs
http://www.hfmhealth.org/card-cath-faq.htm
Read more: Cardiac Catheterization - References | Medindia
http://www.medindia.net/patients/patientinfo/cardiac-catheterization-references.htm#ixzz2IJtXsuK8
13) Rudnick M, Feldman H. Contrast-induced nephropathy: what are the true clinical consequences? Clin
J Am Soc Nephrol 2008; 3:263.
14). Cardiology-neil r grub and manual of cardioliovascular medicine by Brain P Griffin