Biatrial enlargement is diagnosed when criteria for both right and left atrial enlargement are present on the same ECG.
The diagnosis of biatrial enlargement requires criteria for LAE and RAE to be met in either lead II, lead V1 or a combination of leads.
Biatrial enlargement is diagnosed when criteria for both right and left atrial enlargement are present on the same ECG.
The diagnosis of biatrial enlargement requires criteria for LAE and RAE to be met in either lead II, lead V1 or a combination of leads.
In a myocardial infarction transmural ischemia develops. In the first hours and days after the onset of a myocardial infarction, several changes can be observed on the ECG. First, large peaked T waves (or hyperacute T waves), then ST elevation, then negative T waves and finally pathologic Q waves develop.
ECG Lecture: Sinus arrest, sinoatrial exit block, AV block and escape rhythmsMichael-Joseph Agbayani
Simple ECG lecture about sinus arrest, sinoatrial exit block, AV block and escape rhythms. Slideshow was made with an audience of medical professionals in mind.
In a myocardial infarction transmural ischemia develops. In the first hours and days after the onset of a myocardial infarction, several changes can be observed on the ECG. First, large peaked T waves (or hyperacute T waves), then ST elevation, then negative T waves and finally pathologic Q waves develop.
ECG Lecture: Sinus arrest, sinoatrial exit block, AV block and escape rhythmsMichael-Joseph Agbayani
Simple ECG lecture about sinus arrest, sinoatrial exit block, AV block and escape rhythms. Slideshow was made with an audience of medical professionals in mind.
How to read ECG systematically with practice strips Khaled AlKhodari
This lecture simplifies the steps of reading ECG systematically. It starts with a simple heart anatomy and the logical steps that should be followed to perfect ECG reading without missing any abnormality. Finally, there are some practice ECG strips that include but not only MI, STEMI, Wellens syndrome, Pulmonary embolism, LVH, arrhythmias... and others
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
Telegram: bmksupplier
signal: +85264872720
threema: TUD4A6YC
You can contact me on Telegram or Threema
Communicate promptly and reply
Free of customs clearance, Double Clearance 100% pass delivery to USA, Canada, Spain, Germany, Netherland, Poland, Italy, Sweden, UK, Czech Republic, Australia, Mexico, Russia, Ukraine, Kazakhstan.Door to door service
Hot Selling Organic intermediates
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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.
7. EKG Distributions
• Anteroseptal: V1, V2, V3, V4
• Anterior: V1–V4
• Anterolateral: V4–V6, I, aVL
• Lateral: I and aVL
• Inferior: II, III, and aVF
• Inferolateral: II, III, aVF, and V5 and V6
8. Why perform an ECG?
• It’s part of the admission bundle
• Indicated by the patient’s symptoms
- symptoms of IHD/MI
- symptoms associated with dysrhythmias
• Indicated by the patient’s examination findings
- cardiac murmur
9. ECG Interpretation
• Quality of ECG?
• Rate
• Rhythm
• Axis
• P wave
• PR interval
• QRS duration
• QRS morphology
• Abnormal Q waves
• ST segment
• T wave
• QT interval
10. Quality of the ECG
• Patient name
• Date of the ECG
• Is there any interference?
• Is there electrical activity from all 12 leads?
11. Calibration
• Standard calibration of the ECG is 10mm/mV and normal speed 25mm/sec.
At this calibration, 1 miliVolt calibration signal is expected to produce a
rectangle of 10 mm height and 5 mm width.
• When ECG waves are tall, the R or S waves may extend into the QRS
complexes above or below them. To prevent this superimposition, the whole
ECG may be calibrated at 5mm/mV .
LOW VOLTAGE
Low voltage of the limb leads is present when the amplitude of the QRS
complex in each of the three standard limb leads (I, II, and III) is <5 mm . Low
voltage of all leads is diagnosed when the average voltage in the limb leads is
<5 mm and the average voltage in the chest leads is <10 mm.
12. An example of correct calibration at 10 mm/mV and speed of 25 mm/sec : The
calibration signal is a rectangle making 90 degrees of angles.
13. ECG interpretation
• Quality of ECG?
• Rate
• Rhythm
• Axis
• P wave
• PR interval
• QRS duration
• QRS morphology
• Abnormal Q waves
• ST segment
• T wave
• QT interval
14. Rate
• The 6 Second Rule: All but very slow heart rates can be determined by counting
the number of cycles that occur within 6 seconds, and then multiplying that
number by 10.
• The rule of 300 : 300/number of big squares between R waves
• Rate is either:
- Normal
– Bradycardia – HR < 40bpm
– Tachycardia HR > 120bpm
16. Rhythm
• Look for:
• Are there P waves?
• Are they regular?
• Does one precede every QRS complex?
Rythm could either be of sinus or non sinus in origin . Having P wave is sinus origin.
Without P wave or buried with preceeding T wave is either Venticular or Supraventricular
origin.
17. Axis
Definition:
the mean direction of electrical forces in the frontal plane ( limb leads) as measured
from the zero reference point (lead 1)
Normal values
P wave: 0 to 75 degrees
QRS complex: -30 to 90 degress
T wave: QRS-T angle <45 degrees frontal or <60 degrees precordial
19. Axis
Positive in I and II
= NORMAL
Positive in I and
negative in II = LAD
Negative in I and
positive in II = RAD
20. D/D of Right Axis Deviation (RAD)
• Differential diagnosis Right Ventricular Hypertrophy (RVH) — most common
• Left Posterior Fascicular Block (LPFB) — diagnosis of exclusion
• Lateral and apical MI
• Acute Right Heart Strain, e.g. acute lung disease such as pulmonary embolus
• Chronic lung disease, e.g. COPD
• Dextrocardia
• Ventricular pre-excitation (WPW) — LV free wall accessory pathway
• Ventricular ectopy
• Hyperkalemia
• Sodium-channel blockade, e.g. tricyclic toxicity
• Normal in infants and children
• Normal young or slender adults with a horizontally positioned heart can also
demonstrate a rightward QRS axis on the ECG.
21. D/D ofLeft Axis Deviation (LAD)
• left ventricular hypertrophy (LVH)
• Left Anterior Fascicular Block (LAFB) — diagnosis
of exclusion
• LBBB
• inferior MI
• ventricular ectopy
• paced beats
• Ventricular pre-excitation (WPW)
22. ECG interpretation
• Quality of ECG?
• Rate
• Rhythm
• Axis
• P wave
• PR interval
• QRS duration
• QRS morphology
• Abnormal Q waves
• ST segment
• T wave
• QT interval
23. P wave
• The P wave is the first positive deflection on the ECG
• It represents atrial depolarisation
Characteristics of the Normal Sinus P Wave
• Morphology
• Smooth contour
• Monophasic in lead II
• Biphasic in V1
• Axis
• Normal P wave axis is between 0° and +75°
• P waves should be upright in leads I and II, inverted in aVR
• Duration
• < 120 ms
• Amplitude
• < 2.5 mm in the limb leads,
• < 1.5 mm in the precordial leads
24. P wave abnormalities
Common P wave abnormalities include:
• P mitrale (bifid P waves), seen with left atrial
enlargement.
• P pulmonale (peaked P waves), seen with right atrial
enlargement.
• P wave inversion, seen with ectopic atrial and
junctional rhythms.
• Variable P wave morphology, seen in multifocal atrial
rhythms.
28. PR interval
• The PR interval is the time from the onset of the P wave to the
start of the QRS complex.
• It reflects conduction through the AV node.
• Start of P wave to start of QRS complex
• Normal = 0.12 - 0.2 seconds (3-5 small squares)
• Decreased = can indicate an accessory pathway
• Increased = indicates AV block (1st
/2nd
/3rd
)
29. ECG interpretation
• Quality of ECG?
• Rate
• Rhythm
• Axis
• P wave
• PR interval
• QRS duration
• QRS morphology
• Abnormal Q waves
• ST segment
• T wave
• QT interval
30. QRS complex
Main Features to Consider
• Width of the complexes: Narrow versus broad.
• Voltage (height) of the complexes.
• Spot diagnoses: Specific morphology patterns that are important to
recognise.
• Normal = <0.12 seconds
• Narrow complexes (QRS < 100 ms) are supraventricular in origin.
• Broad complexes (QRS > 100 ms) may be either ventricular in origin, or
may be due to aberrant conduction of supraventricular complexes (e.g.
due to bundle branch block, hyperkalaemia or sodium-channel blockade)
31. Low Voltage QRS
• Low Voltage
• The QRS is said to be low voltage when:
• The amplitudes of all the QRS complexes in
the limb leads are < 5 mm; or
• The amplitudes of all the QRS complexes in
the precordial leads are < 10 mm
32. QRS complex
• Is there LVH?
• Probably the most commonly used are the Sokolov-Lyon criteria (S wave
depth in V1 + tallest R wave height in V5-V6 > 35 mm).
>35mm is suggestive of LVH
33. Q waves
• Q waves are allowed in V1, aVR & III
• Pathological Q waves can indicate previous MI
34. ECG interpretation
• Quality of ECG?
• Rate
• Rhythm
• Axis
• P wave
• PR interval
• QRS duration
• QRS morphology
• Abnormal Q waves
• ST segment
• T wave
• QT interval
35. ST segment
• The ST segment is the flat, isoelectric section of the ECG between the end of the S
wave and the beginning of the T wave.
• It represents the interval between ventricular depolarisation and repolarisation.
• The most important cause of ST segment abnormality (elevation or depression) is
myocardial ischaemia / infarction.
• ST depression (upsloping, horizontal and downsloping)
- downsloping or horizontal = ABNORMAL
• ST elevation
- infarction
- pericarditis (widespread)
38. T wave
• Small = hypokalaemia
• Tall = hyperkalaemia
• Inverted/biphasic = ischaemia/previous infarct
• Hyperkalemia: Potassium reduces myocardial excitability, with
depression of pacemaking and conducting tissues.
• K+ >5.5 meq/l is a/w repolarization abnormalities causing peaked T waves
(earliest sign of hyperkalemia)
• K+>6.5 a/w progressive paralysis of artia , ECG shows wide and flat P
wave, incerase PR and P wave eventually dissapear.
• K+ more than 7 causes conduction abnormalities and bradycardia and
eventually asystole.
44. Blocks
AV blocks
First degree block
PR interval fixed and > 0.2 sec
Second degree block, Mobitz type 1
PR gradually lengthened, then drop QRS
Second degree block, Mobitz type 2
PR fixed, but drop QRS randomly
Type 3 block
PR and QRS dissociated
49. Left Bundle Branch Block
Monophasic R wave in I and V6, QRS > 0.12 sec
Loss of R wave in precordial leads
QRS T wave discordance I, V1, V6
Consider cardiac ischemia if a new finding
50. Right Bundle Branch Block
V1: RSR prime pattern with inverted T wave
V6: Wide deep slurred S wave
51. First Degree Heart Block, Mobitz Type I (Wenckebach)
PR progressively lengthens until QRS drops
53. Right Ventricular Myocardial Infarction
Found in 1/3 of patients with inferior MI
Increased morbidity and mortality
ST elevation in V4-V6 of Right-sided EKG
It’s vital to have a system in place to interpret the ECG.
Small square 0.04s; Large square 0.2s
It’s vital to have a system in place to interpret the ECG.
Can use lead II
The normal axis is around 60 degrees.
It’s vital to have a system in place to interpret the ECG.
Not very useful signs.
Short PR interval can be accessory pathway or can be normal
It’s vital to have a system in place to interpret the ECG.
It’s vital to have a system in place to interpret the ECG.
Tall = can be normal young man
T wave more than 10mm size= hyperkalemia
Long QT syndrome. Amiodarone, sotalol.
Long QT syndrome is associated with Torsades de pointes
Resiprocal: Reciprocal changes are simple the opposite deflection in an opposing lead, for example a posterior infarction causing ST depression in the anterior leads.
