The document provides guidelines for catheter ablation procedures in pediatric and congenital heart disease patients. It discusses improvements in safety and efficacy due to advances in imaging technologies, ablation energy sources, and emphasis on patient weight over age. Key safety recommendations include having pediatric cardiovascular support available and minimizing radiation exposure. The guidelines cover indications for ablation of supraventricular tachycardias, ventricular arrhythmias, and accessory pathways.
Acute coronary syndrome(STEMI GUIDELINES AND RECENT ADVANCES)Aditya Sarin
This document summarizes guidelines for the management of ST-elevation myocardial infarction (STEMI). It discusses epidemiology trends showing declining incidence of STEMI but increasing non-ST elevation ACS. Key recommendations include establishing regional STEMI systems, performing primary percutaneous coronary intervention (PCI) over fibrinolysis when possible within 120 minutes of first medical contact, and giving antiplatelet therapies like aspirin, clopidogrel, prasugrel, or ticagrelor to support primary PCI. Recent advances in thrombus aspiration, drug-eluting stents, and antiplatelet agents are also summarized.
This document discusses pregnancy and valvular heart disease. It notes that pregnancy places significant strain on the heart and can negatively impact both mother and fetus if the mother has an existing heart condition. It provides details on physiological changes during pregnancy and delivery that impact the cardiovascular system. It then reviews specific valvular conditions like mitral stenosis, aortic stenosis, and mechanical heart valves. It recommends carefully planning and monitoring pregnancies for women with valvular disease, with vaginal delivery preferred in most cases depending on the severity of the condition. Close follow-up is important to monitor for complications.
2009 Focused Update:
ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults
J. Am. Coll. Cardiol. April 14, 2009; 53;1343-1382
Circulation. April 14, 2009;119;1977-2016
Hypertrophic cardiomyopathy
European society of cardiology guidelines,2014
Prevention of sudden cardiac death
Left ventricular outflow tract obstruction
1. Atrial fibrillation (AF) is classified based on duration and presence of symptoms, including first diagnosed, paroxysmal (<7 days), persistent (≥7 days), long-standing persistent (≥12 months), and permanent.
2. Risk factors for incident AF include structural heart disease, hypertension, obesity, smoking, diabetes, and age.
3. Treatment recommendations include long-term antiarrhythmic drugs like amiodarone, dronedarone, and flecainide/propafenone based on patient characteristics, as well as cardioversion and catheter ablation.
1. The document provides guidance on drug treatment for various cardiac arrhythmias that may occur after a heart attack or in the setting of cocaine use.
2. It recommends clopidogrel, prasugrel, or glycoprotein IIb/IIIa inhibitors for patients undergoing PCI, and amiodarone as first-line treatment for sustained monomorphic VT.
3. The document advises against administering beta-blockers in patients with ACS, cocaine use, or heart failure, and cautions against use of certain calcium channel blockers in heart failure or reduced ejection fraction.
This document provides guidelines for the management of ST-elevation myocardial infarction (STEMI). It discusses regional systems of STEMI care, reperfusion therapy options and time goals, primary percutaneous coronary intervention (PCI) at PCI-capable hospitals, fibrinolytic therapy at non-PCI hospitals, adjunctive antithrombotic therapies, and delayed invasive management. The key recommendations include performing primary PCI within 90 minutes for ideal patients and 120 minutes for non-ideal patients, and administering fibrinolytics within 30 minutes for those initially at non-PCI hospitals.
Patients with Chronic stable angina and unstable angina also present a dilemma for further management based on results of coronary angiography alone. Estimation of Fractional flow reserve (FFR) allows to identify ischemia producing lesions in coronary tree. It has been proved beyond doubt that interventions for the lesions causing ischemia improves morbidity and mortality.
Acute coronary syndrome(STEMI GUIDELINES AND RECENT ADVANCES)Aditya Sarin
This document summarizes guidelines for the management of ST-elevation myocardial infarction (STEMI). It discusses epidemiology trends showing declining incidence of STEMI but increasing non-ST elevation ACS. Key recommendations include establishing regional STEMI systems, performing primary percutaneous coronary intervention (PCI) over fibrinolysis when possible within 120 minutes of first medical contact, and giving antiplatelet therapies like aspirin, clopidogrel, prasugrel, or ticagrelor to support primary PCI. Recent advances in thrombus aspiration, drug-eluting stents, and antiplatelet agents are also summarized.
This document discusses pregnancy and valvular heart disease. It notes that pregnancy places significant strain on the heart and can negatively impact both mother and fetus if the mother has an existing heart condition. It provides details on physiological changes during pregnancy and delivery that impact the cardiovascular system. It then reviews specific valvular conditions like mitral stenosis, aortic stenosis, and mechanical heart valves. It recommends carefully planning and monitoring pregnancies for women with valvular disease, with vaginal delivery preferred in most cases depending on the severity of the condition. Close follow-up is important to monitor for complications.
2009 Focused Update:
ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults
J. Am. Coll. Cardiol. April 14, 2009; 53;1343-1382
Circulation. April 14, 2009;119;1977-2016
Hypertrophic cardiomyopathy
European society of cardiology guidelines,2014
Prevention of sudden cardiac death
Left ventricular outflow tract obstruction
1. Atrial fibrillation (AF) is classified based on duration and presence of symptoms, including first diagnosed, paroxysmal (<7 days), persistent (≥7 days), long-standing persistent (≥12 months), and permanent.
2. Risk factors for incident AF include structural heart disease, hypertension, obesity, smoking, diabetes, and age.
3. Treatment recommendations include long-term antiarrhythmic drugs like amiodarone, dronedarone, and flecainide/propafenone based on patient characteristics, as well as cardioversion and catheter ablation.
1. The document provides guidance on drug treatment for various cardiac arrhythmias that may occur after a heart attack or in the setting of cocaine use.
2. It recommends clopidogrel, prasugrel, or glycoprotein IIb/IIIa inhibitors for patients undergoing PCI, and amiodarone as first-line treatment for sustained monomorphic VT.
3. The document advises against administering beta-blockers in patients with ACS, cocaine use, or heart failure, and cautions against use of certain calcium channel blockers in heart failure or reduced ejection fraction.
This document provides guidelines for the management of ST-elevation myocardial infarction (STEMI). It discusses regional systems of STEMI care, reperfusion therapy options and time goals, primary percutaneous coronary intervention (PCI) at PCI-capable hospitals, fibrinolytic therapy at non-PCI hospitals, adjunctive antithrombotic therapies, and delayed invasive management. The key recommendations include performing primary PCI within 90 minutes for ideal patients and 120 minutes for non-ideal patients, and administering fibrinolytics within 30 minutes for those initially at non-PCI hospitals.
Patients with Chronic stable angina and unstable angina also present a dilemma for further management based on results of coronary angiography alone. Estimation of Fractional flow reserve (FFR) allows to identify ischemia producing lesions in coronary tree. It has been proved beyond doubt that interventions for the lesions causing ischemia improves morbidity and mortality.
1. The document discusses the management of acute coronary syndromes including unstable angina (UA), NSTEMI, and STEMI. It covers risk stratification, diagnostic evaluation using ECG and cardiac enzymes, and treatment options including antiplatelet therapy, anticoagulants, fibrinolytic therapy, percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG).
2. Management depends on risk level and involves antiplatelet and anticoagulant medications as well as revascularization with PCI or fibrinolytic therapy for STEMI. High risk NSTE-ACS patients receive an early invasive strategy with angiography while others get ischemia-guided therapy.
3. Adjunctive therapies
3 dan atar - rate versus rhythm control in afwebevo5
Professor Dan Atar presented on the CABANA trial, which compared catheter ablation to antiarrhythmic drug therapy for atrial fibrillation. The trial involved over 4,000 patients across 140 centers in 10 countries. The primary endpoint was all-cause mortality, disabling stroke, serious bleeding, or cardiac arrest. The trial found no difference in these clinical outcomes between the catheter ablation and drug therapy groups. However, catheter ablation was found to be an effective treatment for reducing symptoms in patients with atrial fibrillation. The trial supports current guidelines that catheter ablation should be considered for symptomatic patients after failed medical treatment.
The document summarizes the 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Key recommendations include:
- Using the ESC 0h/2h algorithm with blood sampling at 0h and 2h if an hs-cTn test with a validated 0h/2h algorithm is available.
- Considering measuring BNP or NT-proBNP for prognostic information.
- Considering prasugrel in preference to ticagrelor for NSTE-ACS patients proceeding to PCI.
- Recommending an early invasive strategy within 24h for high-risk patients based on factors like diagnosis of NSTEMI or GRACE risk score >140.
Early and effective treatment of patients with acute coronary syndrome saves lives. Lot of progress has been made in last few years in understanding patho-physiology and management of these patients.
Esc guideline for atrial fibrillation 2020 [dr pranab]PranabanandaPal1
This document discusses atrial fibrillation (AF) and its management. It defines AF and describes its prevalence, complications, and patterns. It outlines how to confirm, characterize, and screen for AF. Investigations for AF are discussed. The integrated ABC pathway for managing AF is described, including assessing stroke risk and bleeding risk, and options for anticoagulation. Methods for rate control and rhythm control of AF are provided.
This document provides guidelines for the management of atrial fibrillation. It defines different types of AF and recommends use of the CHA2DS2-VASc score to assess stroke risk and determine need for oral anticoagulation. It recommends rate control with beta blockers, non-DHP calcium channel blockers, or digoxin. It provides recommendations for cardioversion and antiarrhythmic medications for rhythm control. It also provides AF management guidelines for specific patient groups such as those with heart failure, pulmonary disease, or hyperthyroidism.
XIII Reunión anual de la sección de Insuficiencia Cardiaca de la SEC
OVIEDO, 16-18 JUNIO 2016 HOSPITAL UNIVERSITARIO CENTRAL DE ASTURIAS (HUCA)
http://secardiologia.es/insuficiencia/cientifico/ic-oviedo-2016
¿Qué se recomienda y qué es lo que hacemos?
VIERNES, 17 DE JUNIO 12.45-14.15 SALÓN DE ACTOS
En la prevención y seguimiento de los pacientes en riesgo de cardiotoxicidad
Xavier Bosch Genover, Barcelona
This document discusses the physiological basis, methodology, safety, protocol, interpretation, and applications of stress echocardiography. Some key points:
- Stress echocardiography assesses the relationship between induced myocardial ischemia and regional wall motion abnormalities seen on ultrasound. Various stressors can be used including exercise, dobutamine, and dipyridamole.
- The technique is reasonably safe but pharmacological stress carries a higher risk than physical exercise. Side effects include arrhythmias, hypotension, and angina.
- Abnormalities are classified as hypokinesis, akinesis, dyskinesis, or scar. Inducible wall motion abnormalities indicate ischemia and have diagnostic and prognostic value for coronary artery
This document summarizes the 2016 European Society of Cardiology guidelines for the management of atrial fibrillation. It begins with an introduction stating that AF remains a major cause of stroke, heart failure, and other cardiovascular issues worldwide. It also notes that the number of AF patients is predicted to rise significantly. The document then discusses common problems seen with AF patients in critical care and outpatient settings. It lists "do nots" in AF management, such as not using antiplatelet therapy alone for stroke prevention. It provides recommendations on rate control, rhythm control, anticoagulation for stroke prevention, and managing bleeding. It asks about determining the CHA2DS2-VASC score for a hypothetical patient case and discusses
The guidelines provide recommendations for the secondary prevention of stroke in patients with previous ischemic stroke or transient ischemic attack (TIA). Key recommendations include: aggressively treating hypertension, diabetes, dyslipidemia and other vascular risk factors; initiating antiplatelet therapy; and considering carotid endarterectomy for severe carotid stenosis. Lifestyle modifications such as smoking cessation, weight control, diet and exercise are also encouraged. The guidelines were updated from 1999 based on new clinical trial evidence.
Management of Heart Failure in the ED Setting:
An Evidence-Based Review of the Literature
J Emerg Med, 2018 Sep 26.
doi: 10.1016/j.jemermed.2018.08.002
Emergency Medical System Network for STEMI ManagementPERKI Pekanbaru
This document discusses the emergency medical system network for managing ST-elevation myocardial infarction (STEMI). It outlines the importance of rapid diagnosis through early electrocardiograms and treatment through reperfusion therapies like primary percutaneous coronary intervention (PCI) or fibrinolysis. The target is first medical contact to reperfusion within 90 minutes for primary PCI or 30 minutes for fibrinolysis. It also discusses long-term secondary prevention therapies.
Guidelines on anticoagulation in Atrial FibrillationDr Raja Mohammed
Atrial fibrillation is the commonest cardiovascular rhythm disorder with a worldwide prevalence. ESC and AHA releases guidelines on anti-coagulation and is followed world over. This lecture is intended to help junior medical colleagues, budding cardiologists, internal medicine and family medicine colleagues, those work in coronary care and intensive care units, emergency room physicians, those involved in cardiovascular medical and nursing care and support staff.
Management of acute ischemic stroke (2013 ahaKNBadmin
Stroke is the 4th leading cause of death in the US. Less than 50% of stroke patients call 911 within an hour of symptoms and are transported to the most appropriate hospital. Public education on stroke signs is a priority. The document outlines recommendations for stroke diagnosis and treatment including patient positioning, oxygenation, temperature control, blood pressure and sugar management, fibrinolysis with rtPA within 3-4.5 hours, anticoagulation, antiplatelets, and preventing complications. Decompressive surgery is recommended for large hemispheric or cerebellar infarcts to reduce mortality. Thromboprophylaxis is also discussed for traumatic brain injury patients.
1. Chronic coronary syndromes (CCS) refer to conditions involving atherosclerotic plaque buildup in the coronary arteries that can cause various clinical presentations depending on the dynamic nature of the disease process.
2. The most common clinical scenarios in patients with suspected or established CCS involve those with stable angina symptoms, new onset of heart failure, recent acute coronary syndrome, or asymptomatic patients more than 1 year after initial diagnosis or revascularization.
3. Evaluation and management of patients with suspected CCS involves assessing symptoms, risk factors and comorbidities, performing basic testing, estimating pre-test probability of CAD, selecting appropriate non-invasive testing to confirm diagnosis when needed, calculating risk, and determining long-
1. The document discusses preoperative cardiac evaluation and risk stratification of patients undergoing non-cardiac surgery based on ACC/AHA guidelines.
2. It outlines 5 factors to consider for risk stratification: recency of cardiac procedures or evaluation, clinical predictors of risk, functional status, and risk of the planned surgery.
3. Based on risk assessment, the document recommends different preoperative testing like ECG, stress testing, echocardiogram or angiogram and outlines perioperative therapies like beta blockers to optimize patient condition and reduce cardiac risk during surgery.
Samir rafla ecg arrhythmia for medical students- added amr kamalSamirRafla1
This document provides an overview of cardiac arrhythmias for medical students. It begins by describing the normal conduction pathways in the heart and ECG patterns. It then classifies arrhythmias as rapid and regular, rapid and irregular, slow and regular, or slow and irregular based on heart rate and rhythm. Common types of arrhythmias are defined such as sinus tachycardia, atrial fibrillation, heart block, and ventricular fibrillation. Causes, characteristics, treatments, and examples of patients with various arrhythmias are outlined. The document also discusses antiarrhythmic drug classifications and indications for procedures like ablation and pacemakers.
This patient presented with acute onset right facial droop and right arm weakness consistent with a transient ischemic attack. However, CT imaging showed a large area of hypodensity involving over one third of the middle cerebral artery territory, making the patient ineligible for IV tPA. The patient's blood pressure was also uncontrolled despite medication, further precluding thrombolysis. For acute stroke management, guidelines recommend maintaining blood pressure below 180/105 mmHg but correcting any hypotension. Starting an IV heparin drip for new atrial fibrillation is not recommended acutely.
1. The document discusses various surgical issues that may arise in intensive care unit (ICU) patients, including airway complications requiring procedures like tracheostomy, pulmonary issues like pneumothorax requiring chest tubes, cardiac tamponade requiring pericardial drainage, and abdominal issues like bowel obstruction.
2. Case studies are presented of patients with increased intra-abdominal pressures from hemorrhage and ileus that require decompression through laparotomy to treat abdominal compartment syndrome.
3. Guidelines are provided for management of issues like compartment syndrome through early diagnosis and fasciotomy if pressures are elevated.
Atrial fibrillation is the most common arrhythmia and increases mortality risk. It is classified as paroxysmal, persistent, or permanent based on duration. The CHA2DS2-VASc score is used to assess stroke risk and determine need for anticoagulation. Treatment focuses on rate control with medications like calcium channel blockers or cardioversion for hemodynamic instability. Anticoagulation is recommended for CHA2DS2-VASc score over 2 to prevent stroke.
1. The document discusses the management of acute coronary syndromes including unstable angina (UA), NSTEMI, and STEMI. It covers risk stratification, diagnostic evaluation using ECG and cardiac enzymes, and treatment options including antiplatelet therapy, anticoagulants, fibrinolytic therapy, percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG).
2. Management depends on risk level and involves antiplatelet and anticoagulant medications as well as revascularization with PCI or fibrinolytic therapy for STEMI. High risk NSTE-ACS patients receive an early invasive strategy with angiography while others get ischemia-guided therapy.
3. Adjunctive therapies
3 dan atar - rate versus rhythm control in afwebevo5
Professor Dan Atar presented on the CABANA trial, which compared catheter ablation to antiarrhythmic drug therapy for atrial fibrillation. The trial involved over 4,000 patients across 140 centers in 10 countries. The primary endpoint was all-cause mortality, disabling stroke, serious bleeding, or cardiac arrest. The trial found no difference in these clinical outcomes between the catheter ablation and drug therapy groups. However, catheter ablation was found to be an effective treatment for reducing symptoms in patients with atrial fibrillation. The trial supports current guidelines that catheter ablation should be considered for symptomatic patients after failed medical treatment.
The document summarizes the 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Key recommendations include:
- Using the ESC 0h/2h algorithm with blood sampling at 0h and 2h if an hs-cTn test with a validated 0h/2h algorithm is available.
- Considering measuring BNP or NT-proBNP for prognostic information.
- Considering prasugrel in preference to ticagrelor for NSTE-ACS patients proceeding to PCI.
- Recommending an early invasive strategy within 24h for high-risk patients based on factors like diagnosis of NSTEMI or GRACE risk score >140.
Early and effective treatment of patients with acute coronary syndrome saves lives. Lot of progress has been made in last few years in understanding patho-physiology and management of these patients.
Esc guideline for atrial fibrillation 2020 [dr pranab]PranabanandaPal1
This document discusses atrial fibrillation (AF) and its management. It defines AF and describes its prevalence, complications, and patterns. It outlines how to confirm, characterize, and screen for AF. Investigations for AF are discussed. The integrated ABC pathway for managing AF is described, including assessing stroke risk and bleeding risk, and options for anticoagulation. Methods for rate control and rhythm control of AF are provided.
This document provides guidelines for the management of atrial fibrillation. It defines different types of AF and recommends use of the CHA2DS2-VASc score to assess stroke risk and determine need for oral anticoagulation. It recommends rate control with beta blockers, non-DHP calcium channel blockers, or digoxin. It provides recommendations for cardioversion and antiarrhythmic medications for rhythm control. It also provides AF management guidelines for specific patient groups such as those with heart failure, pulmonary disease, or hyperthyroidism.
XIII Reunión anual de la sección de Insuficiencia Cardiaca de la SEC
OVIEDO, 16-18 JUNIO 2016 HOSPITAL UNIVERSITARIO CENTRAL DE ASTURIAS (HUCA)
http://secardiologia.es/insuficiencia/cientifico/ic-oviedo-2016
¿Qué se recomienda y qué es lo que hacemos?
VIERNES, 17 DE JUNIO 12.45-14.15 SALÓN DE ACTOS
En la prevención y seguimiento de los pacientes en riesgo de cardiotoxicidad
Xavier Bosch Genover, Barcelona
This document discusses the physiological basis, methodology, safety, protocol, interpretation, and applications of stress echocardiography. Some key points:
- Stress echocardiography assesses the relationship between induced myocardial ischemia and regional wall motion abnormalities seen on ultrasound. Various stressors can be used including exercise, dobutamine, and dipyridamole.
- The technique is reasonably safe but pharmacological stress carries a higher risk than physical exercise. Side effects include arrhythmias, hypotension, and angina.
- Abnormalities are classified as hypokinesis, akinesis, dyskinesis, or scar. Inducible wall motion abnormalities indicate ischemia and have diagnostic and prognostic value for coronary artery
This document summarizes the 2016 European Society of Cardiology guidelines for the management of atrial fibrillation. It begins with an introduction stating that AF remains a major cause of stroke, heart failure, and other cardiovascular issues worldwide. It also notes that the number of AF patients is predicted to rise significantly. The document then discusses common problems seen with AF patients in critical care and outpatient settings. It lists "do nots" in AF management, such as not using antiplatelet therapy alone for stroke prevention. It provides recommendations on rate control, rhythm control, anticoagulation for stroke prevention, and managing bleeding. It asks about determining the CHA2DS2-VASC score for a hypothetical patient case and discusses
The guidelines provide recommendations for the secondary prevention of stroke in patients with previous ischemic stroke or transient ischemic attack (TIA). Key recommendations include: aggressively treating hypertension, diabetes, dyslipidemia and other vascular risk factors; initiating antiplatelet therapy; and considering carotid endarterectomy for severe carotid stenosis. Lifestyle modifications such as smoking cessation, weight control, diet and exercise are also encouraged. The guidelines were updated from 1999 based on new clinical trial evidence.
Management of Heart Failure in the ED Setting:
An Evidence-Based Review of the Literature
J Emerg Med, 2018 Sep 26.
doi: 10.1016/j.jemermed.2018.08.002
Emergency Medical System Network for STEMI ManagementPERKI Pekanbaru
This document discusses the emergency medical system network for managing ST-elevation myocardial infarction (STEMI). It outlines the importance of rapid diagnosis through early electrocardiograms and treatment through reperfusion therapies like primary percutaneous coronary intervention (PCI) or fibrinolysis. The target is first medical contact to reperfusion within 90 minutes for primary PCI or 30 minutes for fibrinolysis. It also discusses long-term secondary prevention therapies.
Guidelines on anticoagulation in Atrial FibrillationDr Raja Mohammed
Atrial fibrillation is the commonest cardiovascular rhythm disorder with a worldwide prevalence. ESC and AHA releases guidelines on anti-coagulation and is followed world over. This lecture is intended to help junior medical colleagues, budding cardiologists, internal medicine and family medicine colleagues, those work in coronary care and intensive care units, emergency room physicians, those involved in cardiovascular medical and nursing care and support staff.
Management of acute ischemic stroke (2013 ahaKNBadmin
Stroke is the 4th leading cause of death in the US. Less than 50% of stroke patients call 911 within an hour of symptoms and are transported to the most appropriate hospital. Public education on stroke signs is a priority. The document outlines recommendations for stroke diagnosis and treatment including patient positioning, oxygenation, temperature control, blood pressure and sugar management, fibrinolysis with rtPA within 3-4.5 hours, anticoagulation, antiplatelets, and preventing complications. Decompressive surgery is recommended for large hemispheric or cerebellar infarcts to reduce mortality. Thromboprophylaxis is also discussed for traumatic brain injury patients.
1. Chronic coronary syndromes (CCS) refer to conditions involving atherosclerotic plaque buildup in the coronary arteries that can cause various clinical presentations depending on the dynamic nature of the disease process.
2. The most common clinical scenarios in patients with suspected or established CCS involve those with stable angina symptoms, new onset of heart failure, recent acute coronary syndrome, or asymptomatic patients more than 1 year after initial diagnosis or revascularization.
3. Evaluation and management of patients with suspected CCS involves assessing symptoms, risk factors and comorbidities, performing basic testing, estimating pre-test probability of CAD, selecting appropriate non-invasive testing to confirm diagnosis when needed, calculating risk, and determining long-
1. The document discusses preoperative cardiac evaluation and risk stratification of patients undergoing non-cardiac surgery based on ACC/AHA guidelines.
2. It outlines 5 factors to consider for risk stratification: recency of cardiac procedures or evaluation, clinical predictors of risk, functional status, and risk of the planned surgery.
3. Based on risk assessment, the document recommends different preoperative testing like ECG, stress testing, echocardiogram or angiogram and outlines perioperative therapies like beta blockers to optimize patient condition and reduce cardiac risk during surgery.
Samir rafla ecg arrhythmia for medical students- added amr kamalSamirRafla1
This document provides an overview of cardiac arrhythmias for medical students. It begins by describing the normal conduction pathways in the heart and ECG patterns. It then classifies arrhythmias as rapid and regular, rapid and irregular, slow and regular, or slow and irregular based on heart rate and rhythm. Common types of arrhythmias are defined such as sinus tachycardia, atrial fibrillation, heart block, and ventricular fibrillation. Causes, characteristics, treatments, and examples of patients with various arrhythmias are outlined. The document also discusses antiarrhythmic drug classifications and indications for procedures like ablation and pacemakers.
This patient presented with acute onset right facial droop and right arm weakness consistent with a transient ischemic attack. However, CT imaging showed a large area of hypodensity involving over one third of the middle cerebral artery territory, making the patient ineligible for IV tPA. The patient's blood pressure was also uncontrolled despite medication, further precluding thrombolysis. For acute stroke management, guidelines recommend maintaining blood pressure below 180/105 mmHg but correcting any hypotension. Starting an IV heparin drip for new atrial fibrillation is not recommended acutely.
1. The document discusses various surgical issues that may arise in intensive care unit (ICU) patients, including airway complications requiring procedures like tracheostomy, pulmonary issues like pneumothorax requiring chest tubes, cardiac tamponade requiring pericardial drainage, and abdominal issues like bowel obstruction.
2. Case studies are presented of patients with increased intra-abdominal pressures from hemorrhage and ileus that require decompression through laparotomy to treat abdominal compartment syndrome.
3. Guidelines are provided for management of issues like compartment syndrome through early diagnosis and fasciotomy if pressures are elevated.
Atrial fibrillation is the most common arrhythmia and increases mortality risk. It is classified as paroxysmal, persistent, or permanent based on duration. The CHA2DS2-VASc score is used to assess stroke risk and determine need for anticoagulation. Treatment focuses on rate control with medications like calcium channel blockers or cardioversion for hemodynamic instability. Anticoagulation is recommended for CHA2DS2-VASc score over 2 to prevent stroke.
Pulmonary embolism (PE) is a common and potentially fatal cardiovascular condition caused by blood clots in the lungs. The document discusses the classification, pathophysiology, risk factors, clinical features, diagnostic testing and management of PE. Key points include that PE has a 15% fatality rate if untreated, but mortality decreases to around 10% with anticoagulation therapy. Rapid risk stratification and treatment of high-risk PE cases with thrombolysis, surgery or other interventions is important for reducing mortality.
Management of Massive & Submassive Pulmonary EmbolismSun Yai-Cheng
This document provides definitions and treatment recommendations for massive, submassive, and low-risk pulmonary embolism (PE). It defines massive PE as presenting with hypotension, pulselessness, or bradycardia. Submassive PE is defined as having right ventricular dysfunction or myocardial necrosis without hypotension. Low-risk PE lacks these clinical signs. Treatment depends on risk categorization and includes anticoagulation, fibrinolysis for massive/high-risk submassive PE, and catheter or surgical embolectomy for massive PE with contraindications to fibrinolysis. Inferior vena cava filters are recommended for contraindications to anticoagulation but should be retrievable.
This document discusses acute pulmonary embolism, including its causes, symptoms, diagnosis, and treatment. It notes that PE is a leading cause of preventable hospital death and that diagnosis can be difficult due to non-specific symptoms. The diagnosis involves a clinical probability assessment, d-dimer test, and CT scan. Treatment depends on risk stratification and may involve anticoagulation, thrombolysis for massive PE, or placement of an IVC filter. Prevention through prophylaxis in at-risk patients is emphasized.
The document provides guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death based on ACC/AHA/ESC guidelines from 2006. It discusses the classification of recommendations and levels of evidence, epidemiology of ventricular arrhythmias and sudden cardiac death, clinical presentations, diagnostic testing including ECG, imaging, and electrophysiological testing.
Chronic coronary syndrome (CCS) is a term that defines coronary artery disease as a chronic progressive course. It has been introduced to replace the previous term ‘stable coronary artery disease’.
The document discusses three topics:
1) A pilot study of an extravascular implantable cardioverter-defibrillator (EV ICD) that showed feasibility of substernal lead placement and effective defibrillation and pacing. No major complications occurred.
2) A study finding that very low-density lipoprotein (VLDL) cholesterol, not triglycerides, explains about half the risk of myocardial infarction from apoB-containing lipoproteins.
3) A presentation by Dr. Sivanand Patel on cardiology topics including the EV ICD and implications of VLDL cholesterol and triglycerides.
Tavi,Transcatheter Aortic Valve Replacement, TAVI,TAVR,Dr.Hasan Mahmud
Transcatheter aortic valve implantation (TAVI) has been developed as an alternative to surgical aortic valve replacement for high-risk patients. TAVI involves threading a collapsible valve through blood vessels and implanting it to replace the diseased valve. Over 30,000 high-risk patients with severe aortic stenosis have undergone TAVI, based on evidence from studies showing it is safer than surgery for this group. TAVI indications may expand as longer-term data on outcomes becomes available and the procedure requires a multidisciplinary team approach and dedicated training.
The document summarizes different cardiac procedures including percutaneous transluminal coronary angioplasty (PTCA), stenting, laser angioplasty, atherectomy, and coronary artery bypass grafting (CABG). PTCA involves inserting a balloon catheter into narrowed coronary arteries to widen them. Stents may be placed to keep arteries open. CABG is a surgical technique that uses leg veins or arteries to bypass blocked portions of coronary arteries. The document discusses indications, contraindications, pre-operative preparations, intraoperative and postoperative care for these procedures.
This document summarizes information on device therapy for congestive heart failure, including cardiac resynchronization therapy (CRT). It discusses:
1) The prevalence and mortality rates of heart failure in the US. Up to 30% of CHF patients have intraventricular conduction delays which increase mortality.
2) NYHA heart failure classifications and guidelines for CRT approval for classes III and IV.
3) Clinical trials that demonstrated the benefits of CRT including increased exercise capacity, quality of life, and decreased hospitalizations and mortality.
4) Anatomical challenges of CRT implantation via the coronary sinus and risks of the procedure. Proper lead placement is important to reduce asynchrony.
This document discusses catecholaminergic polymorphic ventricular tachycardia (CPVT), a condition characterized by adrenergically mediated polymorphic ventricular arrhythmias without structural heart disease. It has a prevalence of 1 in 10,000 and mortality of up to 50% before age 20 if untreated. The gold standard for diagnosis is exercise stress testing showing exercise-induced bidirectional or polymorphic ventricular tachycardia. Treatment involves lifestyle changes, beta-blockers, flecainide, and an ICD for those with cardiac arrest or recurrent arrhythmias despite medical therapy. Genetic testing identifies mutations in RYR2 or CASQ2 genes in the majority of cases.
1. Deep vein thrombosis (DVT) is caused by Virchow's triad of stasis, vessel damage, and hypercoagulability. Prolonged bed rest, major surgery, trauma, pregnancy, and cancer are common risk factors.
2. General anesthesia increases DVT risk compared to epidural anesthesia. Blood type A is also associated with higher risk.
3. DVT diagnosis involves tests like duplex ultrasound, MRI, and blood tests. Treatment includes anticoagulants like heparin and warfarin to prevent clots from worsening. Compression stockings and early mobilization are also used prophylactically.
Anaesthetic management of Abdominal aortic aneurysmsAbhijit Nair
Anesthesia management for abdominal aortic aneurysm (AAA) repair requires careful hemodynamic control. The aortic cross-clamp can cause significant cardiac stress and changes in preload, afterload, and ejection fraction. Agents are needed to manage blood pressure rises during clamping and potential hypotension after removal. Postoperative care focuses on pain control to prevent increases in myocardial oxygen demand, and monitoring for potential renal insufficiency.
The document discusses acute pulmonary embolism (PE). PE is common but difficult to diagnose, with nonspecific symptoms. It describes a case of a 48-year-old woman presenting with sudden dyspnea, tachycardia, and leg swelling who may have PE. Risk factors for PE include recent surgery or trauma, prolonged immobilization, and inherited or acquired hypercoagulable states. Diagnosis involves clinical scoring, D-dimer, imaging like CTPA, and treatment includes anticoagulation with heparin or warfarin.
This document discusses the management of heart disease during pregnancy. It notes that while pregnancy outcomes are generally favorable for women with heart disease, they remain at risk for complications like heart failure, arrhythmia, and stroke. The document outlines the normal cardiovascular changes during pregnancy, physical exam findings, diagnosis of heart conditions, and management of specific diseases like mitral stenosis, aortic stenosis, and mitral valve prolapse. It emphasizes the importance of a multidisciplinary team, monitoring for risk factors, admitting high-risk patients, administering antibiotics during labor, and managing cardiac failure. The goal is early detection and prevention of complications to optimize outcomes for both mother and baby.
This document provides guidelines for preoperative testing to help avoid unnecessary or routine tests. It recommends targeting testing based on a patient's medical history, surgery risk level, and comorbidities. Tests like ECG, chest x-rays, and bloodwork are only recommended for higher-risk patients or those with relevant symptoms or conditions. Routine testing rarely benefits patients and can occasionally cause harm by overinvestigation of abnormal results. The guidelines stratify surgery risk and provide criteria for when different tests may be appropriate based on a patient's American Society of Anesthesiologists physical status classification.
This document summarizes guidelines for antithrombotic therapy for venous thromboembolism from the 10th edition of the CHEST guidelines. It recommends non-vitamin K antagonist oral anticoagulants over warfarin for VTE treatment and prevention in patients without cancer. For patients with cancer, it recommends low molecular weight heparin over other anticoagulants. It provides dosing and monitoring recommendations for the different anticoagulant options. It also addresses duration of therapy, management of recurrent VTE, and specific situations like subsegmental pulmonary embolism.
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Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
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2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
CẬP NHẬT CẮT ĐỐT QUA CATHETER CÁC RỐI LOẠN NHỊP Ở TRẺ EM
1. HƯỚNG DẪN CẮT ĐỐT QUA
CATHETER CÁC RỐI LOẠN NHỊP
Ở TRẺ EM
BS Bùi Thế Dũng
BV Đại học Y Dược – TP. HCM
CẬP NHẬT
2. TÀI LIỆU THAM KHẢO
1. Freidman RA (2002), "NASPE Expert Consensus
Conference: Radiofrequency Catheter Ablation in
Children with and without Congenital Heart
Disease“
2. Cohen MI (2012), "PACES/HRS Expert Consensus
Statement on Asymptomatic Young Patient With
WPW Pattern"
3. Saul JP (2016), "PACES/HRS expert consensus
statement on the use of catheter ablation in children
and patients with congenital heart disease“
3. 3 main issues
1. Safety - Efficacy
2. Procedure:
• laboratory equipment
• personnel
• ablation energy
• catheter choice
• sedation/anesthesia
• pre- and post-ablation procedure management
3. Arrhythmia type
4. SAFETY - EFFICACY
The 2002 consensus: depended on patient age,
typically expressed as “< or > 5 years”
HRS 2014: 2 groups: ≤ 12 years or 12 – 18
years
The 2016 consensus: patient weight was more
important than age – chose cutoff “15 kg”
Succes rate of RFCA:
1991 – 1995 (Early Era, n=4193): 90.4%
1996 – 1999 (Late Era, n=3407): 95.2%
5. SAFETY - EFFICACY
2000 – 2002 (n=2761, 41 centers):
Succes rate of RFCA: 93% SVT, 78% VT
Recurrence at 12 months: 24.6% right septal
APs, 15.8% right freewall APs; 9.3% left free
wall APs, 4.8% left septal APs; 4.8% AVNRT
Complications:
1991 – 1995: 4.2%
1996 – 1999: 3%
6. Complications
Death and major complications:
congenital heart disease
lower patient weight
greater number of RF applications
left-sided procedures
Three most common serious complications:
AV block: 0.89 – 0.56%
Perforation or pericardial effusion: 0.69 – 0.53%
thrombi or emboli: 0.37 – 0.19%
7. Fluoroscopy Exposure
Deterministic effects
(threshold level is 2 Gy)
Stochastic effects
(dose independent)
Skin erythema Malignancies: 0.02% – 0.03%
Epilation Hereditary defects
Cataracts
Retarded bone growth
Sterility
Decreased white blood cell
Organ atrophy
Fibrosis
8. Techniques to Reduce
Procedure-Based Radiation
1. As Low as Reasonably Achievable (ALARA)
• Pulsed fluoroscopy
• Lower frame rate
• Adjusting collimators to decrease field view
• Limiting the use of magnification
• “store fluoro” function instead of cineangiography
• Alternating between two views rather than a single
imaging view to minimize site exposure
2. Nonfluoroscopic systems
• 3-D imaging systems + TEE or ICE
9. Anesthesia and Sedation
Aims: improve patient comfort, reduce movement, and
have minimal effect on the arrhythmia substrate
Personnel:
• Pts > 12 years: nurse anesthetist
• Pts ≤ 12 years: nurse anesthetist + anesthesiologist
General anesthesia with endotracheal intubation or
laryngeal mask: age ≤ 12 years, significant CHD;
ventricular dysfunction; pulmonary hypertension;
hemodynamic instability; prolonged procedure; the need
for complete immobility and patient or parent choice.
10. Safety Recommendations
Class I
In-house pediatric cardiovascular surgical support for
patients < 15 kg
A pediatric (or congenital) cardiovascular surgical
program at the same institution where the ablation is
performed for patients ≤ 12 years of ages
Age-appropriate cardiovascular surgical program and
back-up at the same institution where the ablation is
performed for patients from 12 to 18 years of ages
11. Safety Recommendations
Class I
For patients ≤ 12 years of and/or with moderate or
complex CHD, the procedure staff should have a
pediatric and/or CHD pts anesthesiologist
Fluoroscopy use should be as low as possible
Anticoagulation with unfractionated heparin: When
the procedure will take place in the left atrium or
ventricle, or there is a known or potential right-to-left
shunt to prevent systemic embolization (ACT: 250 –
300 s during procedures)
12. Safety Recommendations
Class IIa
Cryoablation is useful for septal substrates and
proximity to smaller coronary arteries
Class IIb
Cryoablation can be useful for pts < 15 kg
Class III
Ablation is not recommended for patients with
an intracardiac thrombus
13. Procedural Recommendations
Class I
EP lab and postprocedure recovery unit should be
suitable for the care of pediatric and CHD pts
Ablation for patients with moderate or complex CHD
or complex arrhythmias should be performed by an
electrophysiologist with the appropriate expertise
3D mapping system should be available and strongly
considered for mapping and ablation of postoperative
arrhythmias in patients with moderate or complex CHD
14. Procedural Recommendations
Class IIa
Irrigated or large electrode-tip RF catheters
can be useful for the ablation of postoperative
arrhythmias in patients with CHD
Nonfluoroscopic imaging can be useful to
reduce radiation exposure
Cryoablation can be useful for slow pathway
modification in pediatric patients with AVNRT
16. Indications for SVT Ablation
Class I
Documented SVT, recurrent or persistent associated
with ventricular dysfunction in pts > 15 kg
Documented SVT, recurrent or persistent when
medical therapy is either not effective or is intolerant
Documented SVT, recurrent or persistent when the
family wishes to avoid chronic drugs in pts > 15 kg
Recurrent hemodynamic compromise (hypotension or
syncope) from SVT in pts > 15 kg
Recurrent SVT requiring emergency medical care or
electrical cardioversion for termination in pts > 15 kg
17. Indications for SVT Ablation
Class II a
Recurrent symptoms clearly consistent with
PSVT in pts > 15 kg, and one of the following:
evidence of AP involvement; inducible SVT
Slow pathway modification in pts > 15 kg with
documented SVT, when SVT is not inducible
at EP testing, but evidence for dual AV nodal
physiology. Cryotherapy should be considered
18. Indications for SVT Ablation
Class II b
Recurrent symptoms clearly consistent with
PSVT in pts < 15 kg, and one of the following:
evidence of AP; inducible SVT.
Cryotherapy should be considered
Recurrent hypotension or syncope from SVT
in pts < 15 kg
Intermittent symptomatic SVT which is
nonsustained (less than 30s) in pts > 15kg
19. Indications for SVT Ablation
Class III
SVT controlled with medical therapy without
intolerable adverse effects in pts < 15 kg
Clinical symptoms consistent with SVT, but no
inducible SVT, and no evidence for dual AV
nodal physiology during EP testing
Slow pathway modification when dual AV
node physiology is demonstrated after ablation
of a different arrhythmia substrate (such as an
AP when there is no inducible AVNRT
20. Indications for WPW pattern Ablation
Class I
WPW pattern following cardiac arrest
WPW pattern with syncope when there are
predictors of high risk for cardiac arrest (The
shortest preexcited RR interval during AF, or
during incremental atrial pacing ≤ 250 ms;
Multiple accessory pathways)
21. Indications for WPW pattern Ablation
Class II a
WPW pattern with ventricular dysfunction in pts
> 15 kg, or when medical therapy is either not
effective or intolerant in pts < 15 kg
WPW pattern with predictors of high risk for
cardiac arrest in pts > 15 kg
WPW pattern with syncope, without predictors of
high risk for cardiac arrest in pts > 15 kg
Asymtomatic WPW pattern in pts > 15 kg when
the absence of WPW pattern is a prerequisite for
participation in personal or professional activities
22. Indications for WPW pattern Ablation
Class II b
Asymtomatic WPW pattern in pts > 15 kg
without high risk for cardiac arrest because of
a patient or family choice
Class III
WPW pattern caused by a fasciculoventricular
accessory pathway
WPW pattern without symptoms in pts < 15 kg
23. Indications for ablation of
ventricular arrhythmias without CHD
Class I
VPCs or VT caused ventricular dysfunction, when
medical therapy is either not effective or intolerant, or
as an alternative to medical therapy in pts > 15 kg
Recurrent or persistent symptomatic verapamil –
sensitive VT, idiopathic outflow tract VT, or VT with
hemodynamic compromise, when medical therapy is
either not effective or intolerant, or as an alternative
to medical therapy in pts > 15 kg (LOVT-VT was a
Class IIa indication in the prior pediatric guidelines)
24. Indications for ablation of
ventricular arrhythmias without CHD
Class II a
VPCs with correlated symptoms in pts > 15 kg
Class II b
Accelerated idioventricular rhythm with
correlated symptoms in pts > 15 kg
(Class IIa in the prior pediatric guidelines)
Recurrent/frequent polymorphic ventricular
arrhythmia when there is a suspected triggering
focus, arrhythmia, or substrate that can be
targeted
25. Indications for ablation of
ventricular arrhythmias without CHD
Class III
VT in pts < 15 kg controlled medically, or is
well tolerated without ventricular dysfunction
Acc. idioventricular rhythm in pts < 15kg
Asymptomatic VPCs, VT, or accelerated
idioventricular rhythm that is not suspected of
causing or leading to ventricular dysfunction
VPCs, VT due to transient reversible causes
26. Indications for ablations
in patients with CHD
Class I
Recurrent or persistent AT, SVT related to AP or
twin AV nodes in patients with CHD when
medical therapy is either not effective or
intolerant. Ablation is also recommended as an
alternative to medical therapy for pts > 15 kg
WPW pattern and high-risk, commonly in
Ebstein’s anomaly, in pts > 15 kg
Ablation as adjunctive therapy to an ICD in pts
with recurrent monomorphic VT, a VT storm, or
multiple appropriate shocks that are not
manageable by device reprogramming or drug
27. Indications for ablations
in patients with CHD
Class II a
• Sustained monomorphic VT causing symptoms
or hypotension, when drug therapy is not
effective or intolerant. Ablation is an alternative
to medical therapy in pts > 15 kg
• AVNRT when medical therapy is either not
effective or intolerant in pts > 15 kg with
moderate or complex CHD
28. Class I Indications for Ablation for
Infants and Patients <15 kg
Pediatric cardiovascular surgical support should be
available in-house during ablation procedures
Documented SVT, when medical therapy is either not
effective or intolerant
WPW pattern following resuscitated cardiac arrest
WPW pattern with syncope when there are predictors
of high risk for cardiac arrest
Idiopathic JET, or congenital JET associated with
ventricular dysfunction, when medical therapy is either
not effective or intolerant (cryotherapy is preferred)
29. Class I Indications for Ablation for
Infants and Patients <15 kg
VPC or VT with ventricular dysfunction, when
medical therapy is not effective or intolerant
SVT related to accessory AV connections or twin
AV nodes in patients with CHD when medical
therapy is either not effective or intolerant
Symptomatic AT occurring outside the early
postoperative phase (less than 3 – 6 months) in
patients with CHD, when medical therapy is
either not effective or intolerant
30. Summary
The important roles of advancements in imaging
technologies and ablation energy sources
• nonfluoroscopic systems
• higher-energy RF sources
• cryoenergy
Patient weight was more important than age
High succes rate and safety if follow guideline