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- Guidelines for proper ECG acquisition and systematic interpretation.
Ventricular tachycardia are difficult to understand. it is classified in to two types. 1. VT in structurally normal heart, 2. VT in heart with structural diseases. I have tried to simplify the VT in structurally normal heart, which may be helpful to many students and learners.
Ventricular tachycardia are difficult to understand. it is classified in to two types. 1. VT in structurally normal heart, 2. VT in heart with structural diseases. I have tried to simplify the VT in structurally normal heart, which may be helpful to many students and learners.
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
2. 1842- Italian scientist Carlo Matteucci
realizes that electricity is associated with
the heart beat
1876- Irish scientist Marey analyzes the
electric pattern of frog’s heart
1895 - William Einthoven , credited for the
invention of EKG
1906 - using the string electrometer EKG,
William Einthoven diagnoses some heart
problems
3. 1924 - the noble prize for physiology or
medicine is given to William Einthoven for his
work on EKG
1938 -AHA and Cardiac society of great
Britan defined and position of chest leads
1942- Goldberger increased Wilson’s Unipolar
lead voltage by 50% and made Augmented
leads
2005- successful reduction in time of onset of
chest pain and PTCA by wireless
transmission of ECG on his PDA.
4.
5.
6. An electrocardiogram (EKG or ECG) is a
test that checks for problems with the
electrical activity of your heart. An EKG
translates the heart's electrical activity into
line tracings on paper. The spikes and dips
in the line tracings are called waves. The
heart is a muscular pump made up of four
chambers .
8. X- Axis time in seconds
Y-AxisAmplitudeinmillvolts
9. X-Axis represents time - Scale X-Axis – 1 mm = 0.04 sec
Y-Axis represents voltage - Scale Y-Axis – 1 mm = 0.1 mV
One big square on X-Axis = 0.2 sec (big box)
Two big squares on Y-Axis = 1 milli volt (mV)
Each small square is 0.04 sec (1 mm in size)
Each big square on the ECG represents 5 small squares
= 0.04 x 5 = 0.2 seconds
5 such big squares = 0.2 x 5 = 1sec = 25 mm
One second is 25 mm or 5 big squares
One minute is 5 x 60 = 300 big squares
11. P Wave is Atrial contraction – Normal 0.12
sec
PR interval is from the beginning of P wave to
the beginning of QRS – Normal up to 0.2 sec
QRS is Ventricular contraction –Normal 0.08
sec
ST segment – Normal Isoelectic (electric
silence)
QT Interval – From the beginning of QRS to
the end of T wave – Normal – 0.40 sec
RR Interval – One Cardiac cycle 0.80 sec
12.
13. # of
Boxes
DurationThe Wave or Interval
(3)0.12 secP wave : Atrial contraction
(5)0.20 secPR interval – P to begin. of QRS
(2)0.08 secQRS complex - Ventricular
IsoelectricST segment - Electrical silence
(3)0.12 secT wave - repolarization
(2)0.08 secQRS interval – Ventricular cont.
(10)0.40 secQT interval - From Q to T end
(5)0.20 secTP segment - Electrical silence
15. 1. P wave – Atrial contraction = 0.12 sec (3 small
boxes)
2. PR Interval – P + AV delay = 0.20 sec (5 small
boxes)
3. Q wave – Septal = < 3 mm, < 0.04 sec (1 small
box)
4. R wave – Ventricular contraction < 15 mm
5. S wave – complimentary to R < 15 mm
6. ST segment – Isoelectric – decides our fate
7. T wave – ventricular repolarization – friend of ST
8. TP segment – ventricular relaxation – shortened
in tachycardia
16. which measure the difference in electrical
potential between two points
1. Bipolar Leads: Two different points on the
body
2. Unipolar Leads: One point on the body
and a virtual reference point with zero
electrical potential, located in the center of
the heart
18. Standard ECG is recorded in 12 leads
Six Limb leads – L1, L2, L3, aVR, aVL,
aVF
Six Chest Leads – V1 V2 V3 V4 V5 and V6
L1, L2 and L3 are called bipolar leads
L1 between LA and RA
L2 between LF and RA
L3 between LF and LA
20. Standard ECG is recorded in 12 leads
Six Limb leads – L1, L2, L3, aVR, aVL,
aVF
Six Chest Leads – V1 V2 V3 V4 V5 and V6
aVR, aVL, aVF are called unipolar leads
aVR – from Right Arm Positive
aVL – from Left Arm Positive
aVF – from Left Foot Positive
21. The standard EKG has 12 leads:
3 Standard Limb Leads
3 Augmented Limb Leads
6 Precordial Leads
22.
23.
24.
25.
26.
27.
28.
29. Precardial (chest) Lead Position
V1 Fourth ICS, right sternal border
V2 Fourth ICS, left sternal border
V3 Equidistant between V2 and V4
V4 Fifth ICS, left Mid clavicular Line
V5 Fifth ICS Left anterior axillary line
V6 Fifth ICS Left mid axillary line
42. The R wave must grow from V1 to at least V4
The S wave must grow from V1 to at least V3
and disappear in V6
43. The ST segment should start isoelectric
except in V1 and V2 where it may be
elevated
44. The P waves should be upright in I, II, and V2
to V6
45. There should be no Q wave or only a
small q less than 0.04 seconds in width
in I, II, V2 to V6
46. The T wave must be upright in I, II, V2 to
V6
47. Correct Lead placement and good contact
Proper earth connection, avoid other gadgets
Deep inspiration record of L3, aVF
Compare serial ECGs if available
Relate the changes to Age, Sex, Clinical
history
Consider the co-morbidities that may effect
ECG
Make a xerox copy of the record for future
use
Interpret systematically to avoid errors
48.
49. Standardization – 10 mm (2 boxes) = 1 mV
Double and half standardization if required
Sinus Rhythm – Each P followed by QRS, R-R
constant
P waves – always examine for in L2, V1, L1
QRS positive in L1, L2, L3, aVF and aVL. – Neg in
aVR
QRS is < 0.08 narrow, Q in V5, V6 < 0.04, < 3 mm
R wave progression from V1 to V6, QT interval <
0.4
Axis normal – L1, L3, and aVF all will be positive
ST Isoelectric, T waves ↑, Normal T↓ in aVR,V1,
V2
50. Normal Resting ECG – cannot exclude disease
Ischemia may be covert – supply / demand equation
Changes of MI take some time to develop in ECG
Mild Ventricular hypertrophy - not detectable in ECG
Some of the ECG abnormalities are non specific
Single ECG cannot give progress – Need serial
ECGs
ECG changes not always correlate with Angio
results
Paroxysmal events will be missed in single ECG
51. May have slight left axis due to rotation of
heart
May have high voltage QRS – simulating LVH
Mild slurring of QRS but duration < 0.09
J point depression, early repolarization
T inversions in V2, V3 and V4 – Juvenile T ↓
Similarly in women also T↓
Low voltages in obese women and men
Non cardiac causes of ECG changes may
occur
52. Always positive in lead I and II
Always negative in lead aVR
< 3 small squares in duration
< 2.5 small squares in amplitude
Commonly biphasic in lead V1
Best seen in leads II
58. Nonpathological Q waves may present in I,
III, aVL, V5, and V6
R wave in lead V6 is smaller than V5
Depth of the S wave, should not exceed 30
mm
Pathological Q wave > 2mm deep and > 1mm
wide or > 25% amplitude of the subsequent R
wave
59.
60. Sokolow & Lyon
Criteria
S in V1+ R in V5 or
V6 > 35 mm
An R wave of 11 to 13
mm (1.1 to 1.3 mV) or
more in lead aVL is
another sign of LVH
61. ST Segment is flat (isoelectric)
Elevation or depression of ST segment by
1 mm or more
“J” (Junction) point is the point between
QRS and ST segment
62.
63. Normal T wave is asymmetrical, first half
having a gradual slope than the second
Should be at least 1/8 but less than 2/3 of the
amplitude of the R
T wave amplitude rarely exceeds 10 mm
Abnormal T waves are symmetrical, tall,
peaked, biphasic or inverted.
T wave follows the direction of the QRS
deflection.
64.
65. 1. Total duration of Depolarization and
Repolarization
2. QT interval decreases when heart rate
increases
3. For HR = 70 bpm, QT<0.40 sec.
4. QT interval should be 0.35 0.45 s,
5. Should not be more than half of the
interval between adjacent R waves (RR
interval).
78. Is a Coronary artery disease is most commonly caused by
obstructive atherosclerosis of epicardial coronary arteries.
This leads to an inadequate perfusion of the myocardium and
causes an imbalance between myocardial tissue oxygen
supply and demand (myocardial ischemia).
Ischaemic (or ischemic) heart disease is a disease
characterized by reduced blood supply to the heart.
It is the most common cause of death in most western
countries.
Ischaemia means a "reduced blood supply".
The coronary arteries supply blood to the heart muscle and no
alternative blood supply exists, so a blockage in the coronary
arteries reduces the supply of blood to heart muscle.
79. Most ischaemic heart disease is caused by atherosclerosis,
usually present even when the artery lumens appear normal
by angiography.
Initially there is sudden severe narrowing or closure of either
the large coronary arteries and/or of coronary artery end
branches by debris showering downstream in the flowing
blood.
It is usually felt as angina, especially if a large area is affected.
The narrowing or closure is predominantly caused by the
covering of atheromatous plaques within the wall of the artery
rupturing, in turn leading to a heart attack (Heart attacks
caused by just artery narrowing are rare).
A heart attack causes damage to heart muscle by cutting off
its blood supply.
80. 1.Poor R wave progression :
Loss of gradual progression (increase) in
amplitude of R waves in chest leads from
V1V6 if this gradual increase is lost this
is sign of IHD .
2.Q waves:
Presence of deep Q waves in related
leads (inferior , antoroseptal and lateral )
donates old MI.
81. 3. T wave inversion in related leads MAY
BE a sign of IHD . Other causes :
- LVH
- stroke
-pericardaities
-normal in V1,V2 (in female)
82. 4. ST segment :
Elevation :-
- acute MI .
- acute percardities .
-early repolarization pattern in young age
Depression :-
-horizontal depression IHD(angina).
-down sloping depression IHD(angina).
83. 5. Lost of R wave progression :
Ischemic cardiomyopathy .
84. 1.LA:
a) Wide P wave in limb leads .
b) Biphasic P wave in V1: -ve component
deeper than +ve component .
2.LV:
a) R amplitude in aVL >13mm.
b) Tallest R wave + deepest >35mm .
c) R wave or S wave > 25mm .
85. 3. RA:
tall peaked P wave in limb leads.
4. RV:
tall R waves in V1 , V2 .