Hypocalcemia induced camel-hump t-wave, tee-pee sign, and bradycardia in a ca...YasserMohammedHassan1
Rationale: Electrocardiographic is a fundamental tool for a cardiologist, critical care physician, and emergency medicine specialist. The electrolyte imbalance is a very important entity in clinical medicine management. Camel-hump T-wave and the Tee-Pee sign, recently; Wavy triple and Wavy double signs of hypocalcemia (Yasser’s sign) are electrocardiographic findings linked to electrolyte deficiencies. Patient concerns: A middle-aged male car-painter patient presented to the emergency department with atypical severe twisting chest pain, hypocalcemia, hypokalemia, and hypernatremia.
Diagnosis: Hypocalcemia-induced Camel-hump T-wave, Tee Pee sign, Wavy double sign of hypocalcemia (Yasser’s sign), and bradycardia in a car- painter. Interventions: Electrocardiography, arterial blood gases, oxygenation, and echocardiography. Lessons: The dramatic reversal of Camel-hump T-Wave, Tee-Pee sign, Wavy double sign of hypocalcemia (Yasser’s sign) after calcium gluconate injection interpret that these signs were due to hypocalcemia. The twisting chest pain and its limited disappearance immediately after calcium gluconate injection indicate the pain can be named as “chest tetany”. Non-atropine bradycardia response is evidence that the management of the cause of bradycardia sometimes is essential e.g. hypocalcemia in the current case. Outcomes: There was a dramatic response of both clinical and electrocardiography including Camel-hump T-wave, Tee Pee sign, the wavy double sign of hypocalcemia, and bradycardia.
Electrocardiographic passing phenomenon (flying phenomenon or yasser’s phenom...YasserMohammedHassan1
The new “Passing phenomenon” is a transient electrocardiographic change that spontaneously reversed within a few seconds to a few minutes without any medical interventions and apparent hemodynamic impact. Reassurance is immediate therapy. The electrophysiological study is the future advised investigation
Wavy triple an ECG sign (Yasser’s sign) in hypocalcaemia -Cardiology and Eme...YasserMohammedHassan1
The Wavy triple an electrocardiographic sign (Yasser’s sign) is a new diagnostic sign seen in 97.3% (36 cases) of hypocalcemia. Dramatic improvement of both clinical manifestation and the new electrocardiographic sign simultaneously after calcium replacement had happened.
Connected aircraft squadron electrocardiographic sign is a new strong index for monitoring and follows up the tachypneic patients with specific T- waves changes in special leads in several cardiorespiratory patients.
Movable-weaning off an electrocardiographic phenomenon in hypocalcemia (chang...YasserMohammedHassan1
Movable-weaning off an electrocardiographic phenomenon in hypocalcemia (changeable phenomenon or Yasser’s phenomenon of hypocalcemia) is defined according to the author's opinion in the study as a novel electrocardiographic phenomenon characterized by serial dynamic changes in present in all cases of either Wavy triple or double electrocardiographic signs (Yasser signs) of hypocalcemia. Movable-weaning off an electrocardiographic phenomenon is a guide for both Wavy triple or double electrocardiographic signs (Yasser signs) of hypocalcemia. Don’t be angry if the staring electrocardiography or the last one was normal.
Charge syndrome hallmarked with wpws and pda; 20 years post repairing-yasser ...YasserMohammedHassan1
CHARGE syndrome or Hall-Hittner syndrome is a pleiotropic disorder, in which the name is derived from the abbreviation epitomizing its six clinical criteria: ocular coloboma, cardiac defects, choanal atresia, growth or developmental retardation, genital hypoplasia, and ear anomalies or deafness. Wolff-Parkinson-White syndrome is the most frequent pattern of ventricular pre-excitation. Patent ductus arteriosus is one of the most frequent congenital heart diseases due to failure of closure of the ductus arteriosus within 72 hours of birth. CHARGE syndrome, Wolff-Parkinson-White syndrome, and patent ductus arteriosus are so difficult to be present in a single entity.
Calcium dramatically reverse the hypocalcaemia induced qt prolongation in mul...YasserMohammedHassan1
This is the first case that reports these adverse drug reactions with multiple oral drug toxicities. QT prolongation may be drug-induced. Hypocalcemia also is a trigger for QT prolongation. The identification of drug-induced complications is a pivotal step in the diagnosis decision-making of any medical problems. The effects of multiple drug toxicities may be balanced results.
Hypocalcemia induced camel-hump t-wave, tee-pee sign, and bradycardia in a ca...YasserMohammedHassan1
Rationale: Electrocardiographic is a fundamental tool for a cardiologist, critical care physician, and emergency medicine specialist. The electrolyte imbalance is a very important entity in clinical medicine management. Camel-hump T-wave and the Tee-Pee sign, recently; Wavy triple and Wavy double signs of hypocalcemia (Yasser’s sign) are electrocardiographic findings linked to electrolyte deficiencies. Patient concerns: A middle-aged male car-painter patient presented to the emergency department with atypical severe twisting chest pain, hypocalcemia, hypokalemia, and hypernatremia.
Diagnosis: Hypocalcemia-induced Camel-hump T-wave, Tee Pee sign, Wavy double sign of hypocalcemia (Yasser’s sign), and bradycardia in a car- painter. Interventions: Electrocardiography, arterial blood gases, oxygenation, and echocardiography. Lessons: The dramatic reversal of Camel-hump T-Wave, Tee-Pee sign, Wavy double sign of hypocalcemia (Yasser’s sign) after calcium gluconate injection interpret that these signs were due to hypocalcemia. The twisting chest pain and its limited disappearance immediately after calcium gluconate injection indicate the pain can be named as “chest tetany”. Non-atropine bradycardia response is evidence that the management of the cause of bradycardia sometimes is essential e.g. hypocalcemia in the current case. Outcomes: There was a dramatic response of both clinical and electrocardiography including Camel-hump T-wave, Tee Pee sign, the wavy double sign of hypocalcemia, and bradycardia.
Electrocardiographic passing phenomenon (flying phenomenon or yasser’s phenom...YasserMohammedHassan1
The new “Passing phenomenon” is a transient electrocardiographic change that spontaneously reversed within a few seconds to a few minutes without any medical interventions and apparent hemodynamic impact. Reassurance is immediate therapy. The electrophysiological study is the future advised investigation
Wavy triple an ECG sign (Yasser’s sign) in hypocalcaemia -Cardiology and Eme...YasserMohammedHassan1
The Wavy triple an electrocardiographic sign (Yasser’s sign) is a new diagnostic sign seen in 97.3% (36 cases) of hypocalcemia. Dramatic improvement of both clinical manifestation and the new electrocardiographic sign simultaneously after calcium replacement had happened.
Connected aircraft squadron electrocardiographic sign is a new strong index for monitoring and follows up the tachypneic patients with specific T- waves changes in special leads in several cardiorespiratory patients.
Movable-weaning off an electrocardiographic phenomenon in hypocalcemia (chang...YasserMohammedHassan1
Movable-weaning off an electrocardiographic phenomenon in hypocalcemia (changeable phenomenon or Yasser’s phenomenon of hypocalcemia) is defined according to the author's opinion in the study as a novel electrocardiographic phenomenon characterized by serial dynamic changes in present in all cases of either Wavy triple or double electrocardiographic signs (Yasser signs) of hypocalcemia. Movable-weaning off an electrocardiographic phenomenon is a guide for both Wavy triple or double electrocardiographic signs (Yasser signs) of hypocalcemia. Don’t be angry if the staring electrocardiography or the last one was normal.
Charge syndrome hallmarked with wpws and pda; 20 years post repairing-yasser ...YasserMohammedHassan1
CHARGE syndrome or Hall-Hittner syndrome is a pleiotropic disorder, in which the name is derived from the abbreviation epitomizing its six clinical criteria: ocular coloboma, cardiac defects, choanal atresia, growth or developmental retardation, genital hypoplasia, and ear anomalies or deafness. Wolff-Parkinson-White syndrome is the most frequent pattern of ventricular pre-excitation. Patent ductus arteriosus is one of the most frequent congenital heart diseases due to failure of closure of the ductus arteriosus within 72 hours of birth. CHARGE syndrome, Wolff-Parkinson-White syndrome, and patent ductus arteriosus are so difficult to be present in a single entity.
Calcium dramatically reverse the hypocalcaemia induced qt prolongation in mul...YasserMohammedHassan1
This is the first case that reports these adverse drug reactions with multiple oral drug toxicities. QT prolongation may be drug-induced. Hypocalcemia also is a trigger for QT prolongation. The identification of drug-induced complications is a pivotal step in the diagnosis decision-making of any medical problems. The effects of multiple drug toxicities may be balanced results.
Sgarbossa criteria in left bundle branch block in a hypertensive emergency ya...YasserMohammedHassan1
Rationale: Left bundle branch block and hypertensive emergency are very common conditions in clinical cardiovascular and emergency practice. Hypertensive emergency encompasses a spectrum of clinical presentations in which uncontrolled blood pressure leads to progressive end-organ dysfunction. Suspected acute myocardial infarction in the setting of a left bundle branch block presents a unique diagnostic and therapeutic challenge to the clinician. The diagnosis is especially difficult due to electrocardiographic changes caused by altered ventricular depolarization. However, reports on the use of Sgarbossa’s criteria in the management of hypertensive emergency is rare. Patient concerns: A middle-aged married heavy-smoker Egyptian male worker presented to the emergency department with a hypertensive emergency patient with acute chest pain and left bundle branch block. Sgarbossa’s criteria were initially very weak and, over time, became highly suggestive of acute ST-segment elevation myocardial infarction. Interestingly, chest pain increased as Sgarbossa’s diagnostic criteria were met. Thrombolytic therapy was strongly indicated because of a higher development of Sgarbossa criteria scoring. Intervention; Electrocardiography, oxygenation, streptokinase IVI, and echocardiography Diagnosis: Developing acute ST-segment elevation myocardial infarction in the presence of left bundle branch block post- hypertensive emergency. Outcomes: The dramatic response to developing acute myocardial infarction in left bundle branch block with hypertensive emergency to streptokinase. Lessons: The higher Sgarbossa criteria scoring in the case was the only indication for thrombolytic. Therefore, how did Sgarbossa criteria develop during case management to indicate the need for thrombolytic therapy?
Brugada syndrome (BrS) is an inherited cardiac disorder,
characterised by a typical ECG pattern and an increased
risk of arrhythmias and sudden cardiac death (SCD).
BrS is a challenging entity, in regard to diagnosis as
well as arrhythmia risk prediction and management.
Nowadays, asymptomatic patients represent the majority
of newly diagnosed patients with BrS, and its incidence
is expected to rise due to (genetic) family screening.
Progress in our understanding of the genetic and
molecular pathophysiology is limited by the absence
of a true gold standard, with consensus on its clinical
definition changing over time. Nevertheless, novel
insights continue to arise from detailed and in-depth
studies, including the complex genetic and molecular
basis. This includes the increasingly recognised
relevance of an underlying structural substrate. Risk
stratification in patients with BrS remains challenging,
particularly in those who are asymptomatic, but recent
studies have demonstrated the potential usefulness
of risk scores to identify patients at high risk of
arrhythmia and SCD. Development and validation of
a model that incorporates clinical and genetic factors,
comorbidities, age and gender, and environmental
aspects may facilitate improved prediction of disease
expressivity and arrhythmia/SCD risk, and potentially
guide patient management and therapy. This review
provides an update of the diagnosis, pathophysiology
and management of BrS, and discusses its future
perspectives.
The so Called Brugada Syndrome The True HistoryBortolo Martini
The syndrome of sudden Death, right bundle branch block and ST elevation was firstly described by A.Nava and B. Martini in 1988-1989, and only five years later by the Brugada Brothers. The ECG pattern is due to a conduction disturbance of the RVOT, caused by fibrofatty substitution of that structure.
Guillain–Barré syndrome after acute myocardial infarction: A rare presentationApollo Hospitals
The association of acute coronary syndrome with any immunological mediated polyradiculopathy like Guillain–Barré syndrome is very rare. We report such a rare association of acute myocardial infarction and Guillain–Barré syndrome. Our patient underwent primary angioplasty successfully, but developed respiratory failure while in hospital. While the difficulty in weaning off from ventilator a suspicion of neuromuscular disease was made. The further investigations, including nerve conduction study confirmed a diagnosis of Guillain–Barré syndrome. Despite treatment, the patient died secondary to multi-organ dysfunction. Our case is 4th reported in the literature without use of any thrombolytic agent for such association.
Early repolarization (ER), consisting of a J-point elevation, notching or slurring of the terminal portion of the R wave (J wave), and tall/symmetric T wave, is a common finding on the 12-lead electrocardiogram. For decades, it has been considered as benign, barring sporadic case reports and basic electrophysiology research that suggested a critical role of the J wave in the pathogenesis of idiopathic ventricular fibrillation (VF). In 2007-2008, a high prevalence of ER in patients with idiopathic VF was reported and subsequent studies reinforced the results. This PPT describes the current state of knowledge concerning ER syndrome associated with sudden cardiac death.
Sgarbossa criteria in left bundle branch block in a hypertensive emergency ya...YasserMohammedHassan1
Rationale: Left bundle branch block and hypertensive emergency are very common conditions in clinical cardiovascular and emergency practice. Hypertensive emergency encompasses a spectrum of clinical presentations in which uncontrolled blood pressure leads to progressive end-organ dysfunction. Suspected acute myocardial infarction in the setting of a left bundle branch block presents a unique diagnostic and therapeutic challenge to the clinician. The diagnosis is especially difficult due to electrocardiographic changes caused by altered ventricular depolarization. However, reports on the use of Sgarbossa’s criteria in the management of hypertensive emergency is rare. Patient concerns: A middle-aged married heavy-smoker Egyptian male worker presented to the emergency department with a hypertensive emergency patient with acute chest pain and left bundle branch block. Sgarbossa’s criteria were initially very weak and, over time, became highly suggestive of acute ST-segment elevation myocardial infarction. Interestingly, chest pain increased as Sgarbossa’s diagnostic criteria were met. Thrombolytic therapy was strongly indicated because of a higher development of Sgarbossa criteria scoring. Intervention; Electrocardiography, oxygenation, streptokinase IVI, and echocardiography Diagnosis: Developing acute ST-segment elevation myocardial infarction in the presence of left bundle branch block post- hypertensive emergency. Outcomes: The dramatic response to developing acute myocardial infarction in left bundle branch block with hypertensive emergency to streptokinase. Lessons: The higher Sgarbossa criteria scoring in the case was the only indication for thrombolytic. Therefore, how did Sgarbossa criteria develop during case management to indicate the need for thrombolytic therapy?
Brugada syndrome (BrS) is an inherited cardiac disorder,
characterised by a typical ECG pattern and an increased
risk of arrhythmias and sudden cardiac death (SCD).
BrS is a challenging entity, in regard to diagnosis as
well as arrhythmia risk prediction and management.
Nowadays, asymptomatic patients represent the majority
of newly diagnosed patients with BrS, and its incidence
is expected to rise due to (genetic) family screening.
Progress in our understanding of the genetic and
molecular pathophysiology is limited by the absence
of a true gold standard, with consensus on its clinical
definition changing over time. Nevertheless, novel
insights continue to arise from detailed and in-depth
studies, including the complex genetic and molecular
basis. This includes the increasingly recognised
relevance of an underlying structural substrate. Risk
stratification in patients with BrS remains challenging,
particularly in those who are asymptomatic, but recent
studies have demonstrated the potential usefulness
of risk scores to identify patients at high risk of
arrhythmia and SCD. Development and validation of
a model that incorporates clinical and genetic factors,
comorbidities, age and gender, and environmental
aspects may facilitate improved prediction of disease
expressivity and arrhythmia/SCD risk, and potentially
guide patient management and therapy. This review
provides an update of the diagnosis, pathophysiology
and management of BrS, and discusses its future
perspectives.
The so Called Brugada Syndrome The True HistoryBortolo Martini
The syndrome of sudden Death, right bundle branch block and ST elevation was firstly described by A.Nava and B. Martini in 1988-1989, and only five years later by the Brugada Brothers. The ECG pattern is due to a conduction disturbance of the RVOT, caused by fibrofatty substitution of that structure.
Guillain–Barré syndrome after acute myocardial infarction: A rare presentationApollo Hospitals
The association of acute coronary syndrome with any immunological mediated polyradiculopathy like Guillain–Barré syndrome is very rare. We report such a rare association of acute myocardial infarction and Guillain–Barré syndrome. Our patient underwent primary angioplasty successfully, but developed respiratory failure while in hospital. While the difficulty in weaning off from ventilator a suspicion of neuromuscular disease was made. The further investigations, including nerve conduction study confirmed a diagnosis of Guillain–Barré syndrome. Despite treatment, the patient died secondary to multi-organ dysfunction. Our case is 4th reported in the literature without use of any thrombolytic agent for such association.
Early repolarization (ER), consisting of a J-point elevation, notching or slurring of the terminal portion of the R wave (J wave), and tall/symmetric T wave, is a common finding on the 12-lead electrocardiogram. For decades, it has been considered as benign, barring sporadic case reports and basic electrophysiology research that suggested a critical role of the J wave in the pathogenesis of idiopathic ventricular fibrillation (VF). In 2007-2008, a high prevalence of ER in patients with idiopathic VF was reported and subsequent studies reinforced the results. This PPT describes the current state of knowledge concerning ER syndrome associated with sudden cardiac death.
COVID-19 Pneumonia with Atrial Fibrillation, Coronary Spasm, and Wavy Triple ...YasserMohammedHassan1
Rationale: A novel COVID-19 with severe acute respiratory syndrome had arisen in Wuhan, China in December 2019 Arrhythmias are commonly recognized sequel in COVID-19 patients. Interestingly, the presentation of COVID-19 infection with a newly coronary artery spasm has a risk impact on both morbidity and mortality of COVID-19 patients. Wavy triple an electrocardiographic sign (Yasser Sign) is a new innovated diagnostic sign in hypocalcemia. Patient concerns: An elderly farmer male COVID-19 patient presented to physician outpatient clinic with bilateral pneumonia, atrial fibrillation, evidence of coronary artery spasm, and Wavy triple an electrocardiographic sign (Yasser Sign). Diagnosis: COVID-19 pneumonia with coronary artery spasm and the Wavy triple an electrocardiographic sign (Yasser Sign). Interventions: Chest CT scan, electrocardiography, oxygenation, and echocardiography. Outcomes: Gradual dramatic clinical, electrocardiographic, and radiological improvement had happened. Lessons: The reversal of electrocardiographic ST-segment depressions in a COVID-19 patient after adding oral nitroglycerine is an indicator for the presence of coronary artery spasm. It signifies the role of the anti-infective drugs, anticoagulants, antiplatelet, and steroids in COVID-19 patients with bilateral pneumonia, AF, coronary artery spasm are effective therapies. The disappearance of AF after initial therapy may a guide for a good prognosis in this case study. The evanescence of Wavy triple ECG sign as a hallmark for the existence of the Movable-weaning phenomenon of hypocalcemia is recommended for further wide-study.
Presentazione realizzata dalla dott.ssa Daniela Miani, Unità Scompenso e Trapianto Cardiaco, AOU S. Maria della Misericordia di Udine, nell'ambito del corso "Le malattie neuromuscolari", Udine, 16 dicembre 2013.
Per maggiori informazioni: http://malattierare.aou.udine.it/
CHARGE syndrome hallmarked with Wolff-Parkinson-White syndrome and patent duc...YasserMohammedHassan1
Abstract
Rationale: CHARGE syndrome or Hall-Hittner syndrome is a pleiotropic disorder, in which the name is derived from the abbreviation epitomizing its six clinical criteria: ocular coloboma, cardiac defects, choanal atresia, growth or developmental retardation, genital hypoplasia, and ear anomalies or deafness. Wolff-Parkinson-White syndrome is the most frequent pattern of ventricular pre-excitation. Patent ductus arteriosus is one of the most frequent congenital heart diseases due to failure of closure of the ductus arteriosus within 72 hours of birth. CHARGE syndrome, Wolff-Parkinson-White syndrome, and patent ductus arteriosus are so difficult to be present in a single entity. Patient concerns: A young female girl patient presented to the physician outpatient clinic with acute confusion status with a past repaired patent ductus arteriosus. Diagnosis: CHARGE syndrome hallmarked with Wolff-Parkinson-White syndrome and patent ductus arteriosus; 20 years post-repairing. Interventions: Plain chest x-ray, electrocardiography, oxygenation, and echocardiography. Outcomes: A dramatic clinical improvement post-oxygenation had happened. Lessons: CHARGE syndrome with Wolff-Parkinson-White syndrome and repaired patent ductus arteriosus is an extreme combination. The existence of infantile electrocardiographic Tee-Pee sign of hypocalcemia and adult low ionized calcium with CHARGE syndrome is highly suggestive of associated DiGeorge phenotype syndrome. An absence of tachycardia post- repairing of patent ductus arteriosus from 11 mo until the 20th-year-old is a good prognostic sign. The presence of an infantile T-wave alternance will strengthen both the risk of serious arrhythmia and the efficacy of patent ductus arteriosus repairing.
A woman in her late 40s with a history of hypertension presented to the emergency department after multiple episodes of palpitations with near syncope. While in the
emergency department, she developed monomorphic ventricular tachycardia (VT) with hemodynamic instability and was successfully cardioverted. She continued to have nonsustained monomorphic VT, so intravenous amiodarone and oral metoprolol were initiated. She was admitted for further evaluation. Results of tests of electrolyte levels and coronary angiography were normal. Cardiac magnetic resonance imaging with
gadolinium contrast revealed normal-sized cardiac chambers and normal biventricular
function without delayed enhancement. The presenting electrocardiogram (ECG)
is shown in Figure 1.
A presentation which looks at a case study of a young patient presenting with stroke, and then looks at some of the potential causes of this in the younger population.
Acute myocardial infarction associated with right bundle branch block and cha...YasserMohammedHassan1
Acute myocardial infarction may be associated right bundle branch block.
Accompanied trifascicular heart block had pre-streptokinase left anterior fascicular block
with left axis deviation and post-streptokinase left posterior fascicular block with right axis
deviation.
Three and One Method (Yasser’s Method) to Overcome Streptokinase-Induced Hypo...YasserMohammedHassan1
Aim of the study: The study aimed to clarify how to overcome streptokinase-induced hypotension during acute myocardial infarction intravenous infusion? Background: Streptokinase is the cheapest approved thrombolytic agent. Streptokinase is commonly associated with hypotension. The delay in giving a thrombolytic agent for acute myocardial infarction may be hazardous. Method of study and patients: My study was an observational-retrospective twenty-case report series. The study was conducted in Fraskour Central Hospital and Kafr El-Bateekh Central Hospital. The author reported twenty cases of confirmed acute myocardial infarction with indications for thrombolytic over about 34 months, starting on October 5, 2018, ended on July 25, 2021. Testing for the probability of hypotension during infusion of streptokinase was done for all cases. Three and One Method (Yasser’s Method) was only applied in the cases of hypotension during streptokinase intravenous infusion. Results: The mean age in the current study is; 60.6 with male sex predominance (85%). Acute inferior myocardial infarction is the most common (55%) infarction. Pre-testing for the probability of hypotension during infusion of streptokinase was only applied in (50%) with equal positive probability and negative probability test was (50%). Yasser’s Methods was applied in (75%) in response in (100%). Conclusions: Three and One Method (Yasser’s Method) is an innovative clinical and therapeutic method in cardiovascular science. The method is used in cases of acute myocardial infarction. It is indicated in the cases of hypotension during the intravenous infusion of streptokinase. Three and One Method (Yasser’s Method) is effective, safe, and time saving for cases of acute myocardial infarction.
Similar to Graded phenomenon (Yasser’s phenomenon) international conference on heart and cardiovascular diseases july 19, 2021 (20)
- يعتبر تقييم نتائج غازات الدم الشرياني (ABG) مصدر إزعاج للعديد من الطلاب والأطباء المبتدئين حيث يتم تعلمها بشكل سيئ أو يتم تدريسها بشكل سيء.
- تحليل غازات الدم هو أداة تساعد على التشخيص، وليست تشخيصية، وهي شائعة الاستخدام لتقييم الضغوط الجزئية للغاز في الدم ومحتوى القاعدة الحمضية.
- يتيح فهم تحليل غازات الدم واستخدامه لمقدمي الخدمات تفسير اضطرابات الجهاز التنفسي والدورة الدموية والتمثيل الغذائي.
- يمكن إجراء "تحليل غازات الدم" على الدم المأخوذ من أي مكان في الدورة الدموية (الشريان أو الوريد أو الشعيرات الدموية).
- ارتباط تفسير نتائج غازات الدم الشرياني (ABG) مرتبط ارتباطا وثيقا بالحالة الاكلينيكية للمريض ولا يمكن فصلهما بحال.
- اختبار غازات الدم الشرياني (ABG) بشكل صريح للدم المأخوذ من الشريان. يقيم تحليل ABG ضغط المريض الجزئي للأكسجين (PaO2) وثاني أكسيد الكربون (PaCO2). يوفر PaO2 معلومات عن حالة الأوكسجين ، ويقدم PaCO2 معلومات عن حالة التهوية (فشل تنفسي مزمن أو حاد) يتأثر PaCO2 بفرط التنفس (التنفس السريع أو العميق) ، ونقص التهوية (التنفس البطيء أو الضحل)، وحالة القاعدة الحمضية. على الرغم من أنه يمكن تقييم الأكسجين والتهوية بطريقة غير جراحية عن طريق قياس التأكسج النبضي ومراقبة ثاني أكسيد الكربون في نهاية المد ، على التوالي ، فإن تحليل ABG هو المعيار.
- فمن المثير ألا ينزعج الطبيب أو الممرضة اذا وجد صعوبة في تفسير بعض النتائج لغازات الدم.
Three and One Method (Yasser’s Method) to Overcome Streptokinase-Induced Hypo...YasserMohammedHassan1
Aim of the study: The study aimed to clarify how to overcome streptokinase-induced hypotension during acute myocardial infarction intravenous infusion? Background: Streptokinase is the cheapest approved thrombolytic agent. Streptokinase is commonly associated with hypotension. The delay in giving a thrombolytic agent for acute myocardial infarction may be hazardous. Method of study and patients: My study was an observational-retrospective twenty-case report series. The study was conducted in Fraskour Central Hospital and Kafr El-Bateekh Central Hospital. The author reported twenty cases of confirmed acute myocardial infarction with indications for thrombolytic over about 34 months, starting on October 5, 2018, ended on July 25, 2021. Testing for the probability of hypotension during infusion of streptokinase was done for all cases. Three and One Method (Yasser’s Method) was only applied in the cases of hypotension during streptokinase intravenous infusion. Results: The mean age in the current study is; 60.6 with male sex predominance (85%). Acute inferior myocardial infarction is the most common (55%) infarction. Pre-testing for the probability of hypotension during infusion of streptokinase was only applied in (50%) with equal positive probability and negative probability test was (50%). Yasser’s Methods was applied in (75%) in response in (100%). Conclusions: Three and One Method (Yasser’s Method) is an innovative clinical and therapeutic method in cardiovascular science. The method is used in cases of acute myocardial infarction. It is indicated in the cases of hypotension during the intravenous infusion of streptokinase. Three and One Method (Yasser’s Method) is effective, safe, and time saving for cases of acute myocardial infarction.
Mimic HL MI in chest tetany with mirror ECG change, Movable phenomenon (Yasse...YasserMohammedHassan1
The reversal of mirror electrocardiographic change, reversal of ST-segment depression coronary artery spasm, and normalization of Movable phenomenon (Yasser’s phenomenon) after oxygenation. It signifies the role of oxygen in both coronary artery spasm and tetany. Mirror local electrocardiographic change is a novel described expression that may reflect the myocardial polarity in this chest tetany.
Sgarbossa Criteria in Left Bundle Branch Block in a Hypertensive Emergency, a...YasserMohammedHassan1
Left bundle branch block and hypertensive emergency are very often to occur in the clinical practice. But, developing of Sgarbossa criteria in left bundle branch block throughout the course of hypertensive emergency was an extremely rare. My current case is a hypertensive emergency patient with acute chest pain and left bundle branch block. Sgarbossa criteria were initially very weak but, became highly suggestive for acute ST-segment elevation myocardial infarction with time. With strong collective data for the case, the chance for thrombolytic therapy was strictly indicated. So why was the case developed an acute ST-segment elevation myocardial infarction to received thrombolytic therapy?.
Oxygen Reversal of Coronary Artery Spasm with Modification of International S...YasserMohammedHassan1
Abstract Aim of the study: the study aims to clear the initial effect of non-baric oxygen inhalation on the coronary artery spasm. Background: Coronary artery spasm (CAS) is a cardiovascular disorder that plays an important role in the pathogenesis of stable angina, unstable angina, myocardial infarction, and sudden cardiac death. Nitrate, calcium channel blockers, and statins are known established medications in the reversal of coronary artery spasms. Oxygen safety versus adverse effects of nitrate, calcium channel blockers, and statins are comparable. Method of study and patients: My case study was an observational-retrospective seventeen case report series. The study was conducted in Fraskour Central Hospital, Kafr El-Bateekh Central Hospital, and physician outpatient. The author reported the seventeen cases of acute angina with rest chest pain over about 38-months, starting on December 15, 2018, ended on February 7, 2022. Results: The mean age is; 43.2 with the female sex predominance (64.71%). Housewife (29.41%) and students (23.53%) are the most affected occupations. The main complaint is chest pain (64.71%). The most common associated risk factors are female sex (64.71%) and stress (23.53%). Drug-induced (23.53%), hyperventilation syndrome-induced (23.53%), and CO toxicity-induced coronary artery spasm (17.65%) are common diagnoses. The dose of inhaled O2 dose that achieved the reversal of CAS varied from 5 to 12 liter. A maximal dose (12 minutes) was given for CO toxicity. The duration of inhaled O2 dose that achieved the reversal CAS varied from 15 to 80 minutes. Maximal duration (80 minutes) was given in CO toxicity. The complete response had happened in 94.12%. Conclusions: Dramatic clinical reliving and reversal response of electrocardiographic ST-segment depression after oxygen inhalation is an indication for its initial use in coronary artery spasm. Yasser's Modification or Oxygen test for the past "international standards for the diagnostic criteria of coronary vasomotor disorders" improves patient safety and decreases the hazards of nitrate and other medications.
Sgarbossa Criteria in Left Bundle Branch Block in a Hypertensive Emergency, a...YasserMohammedHassan1
ABSTRACT
Rationale: Left bundle branch block and hypertensive emergency are very common conditions in clinical cardiovascular and emergency practice. Hypertensive emergency encompasses a spectrum of clinical presentations in which uncontrolled blood pressure leads to progressive end-organ dysfunction. Suspected acute myocardial infarction in the setting of a left bundle branch block presents a unique diagnostic and therapeutic challenge to the clinician. The diagnosis is especially difficult due to electrocardiographic changes caused by altered ventricular depolarization. However, reports on the use of Sgarbossa’s criteria in the management of hypertensive emergencies are rare. Patient concerns: A middle-aged married heavy-smoker Egyptian male worker presented to the emergency department with a hypertensive emergency patient with acute chest pain and left bundle branch block. Sgarbossa’s criteria were initially very weak and, over time, became highly suggestive of acute ST-segment elevation myocardial infarction. Interestingly, chest pain increased as Sgarbossa’s diagnostic criteria were met. Thrombolytic therapy was strongly indicated because of a higher development of Sgarbossa criteria scoring. Intervention; Electrocardiography, oxygenation, streptokinase IVI, and echocardiography Diagnosis: Developing acute ST-segment elevation myocardial infarction in the presence of
left bundle branch block post hypertensive emergency. Outcomes: The dramatic response to developing acute myocardial infarction in the left bundle branch block with hypertensive emergency to streptokinase. Lessons: The higher Sgarbossa criteria scoring in the case was the only indication for thrombolytic. Therefore, how did Sgarbossa's criteria develop during case management to indicate the need for thrombolytic therapy?
Oxygen Reversal of Coronary Artery Spasm with Modification of International S...YasserMohammedHassan1
Abstract
Aim of the study: the study aims to clear the initial effect of non-baric oxygen inhalation on the coronary artery spasm. Background: Coronary artery spasm (CAS) is a cardiovascular disorder that plays an important role in the pathogenesis of stable angina, unstable angina, myocardial infarction, and sudden cardiac death. Nitrate, calcium channel blockers, and statins are known established medications in the reversal of coronary artery spasms. Oxygen safety versus adverse effects of nitrate, calcium channel blockers, and statins are comparable. Method of study and patients: My case study was an observational-retrospective seventeen case report series. The study was conducted in Fraskour Central Hospital, Kafr El-Bateekh Central Hospital, and physician outpatient. The author reported seventeen cases of acute angina with rest chest pain over about 38 months; starting on December 15, 2018, ended on February 7, 2022. Results: The mean age is 43.2 with the female sex predominance (64.71%). Housewives (29.41%) and students (23.53%) are the most affected occupations. The main complaint is chest pain (64.71%). The most common associated risk factors are female sex (64.71%) and stress (23.53%). Drug-induced (23.53%); hyperventilation syndrome-induced (23.53%); and CO toxicity-induced coronary artery spasm (17.65%) are common diagnoses. The dose of inhaled O2 dose that achieved the reversal of CAS varied from 5 to 12 liter. A maximal dose (12 minutes) was given for CO toxicity. The duration of inhaled O2 dose that achieved the reversal CAS varied from 15 to 80 minutes. Maximal duration (80 minutes) was given in CO toxicity. The complete response had happened in 94.12%. Conclusion: Dramatic clinical reliving and reversal response of electrocardiographic ST-segment depression after oxygen inhalation is an indication of its initial use in coronary artery spasms. Yasser’s Modification or Oxygen test for the past “international standards for the diagnostic criteria of coronary vasomotor disorders” improves patient safety and decreases the hazards of nitrate and other medications.
Mimic high lateral myocardial infarction in chest tetany with mirror electroc...YasserMohammedHassan1
The reversal of mirror electrocardiographic change, reversal of ST-segment depression coronary artery spasm, and normalization of Movable phenomenon (Yasser’s phenomenon) after oxygenation. It signifies the role of oxygen in both coronary artery spasm and tetany. Mirror local electrocardiographic change is a novel described expression that may reflect the myocardial polarity in this chest tetany.
Zavras-Kounis syndrome simultaneously with reactional myoclonus post-streptok...YasserMohammedHassan1
Rationale: Drug-associated adverse effects are one of the most important entities in clinical medicine. Involuntary movements may have a dynamic serious impact on myocardial muscle. Myoclonus is well as abnormal involuntary movements with a distinct description. Myoclonus is a physical trauma and stress for coronary arteries. Physical and mechanical stress may be causing coronary artery spasm. Drug-inducing allergic angina, allergic coronary artery spasm, and allergic myocardial infarction are renowned as Zavras-Kounis syndrome. Streptokinase is a still-known effective thrombolytic in myocardial infarction. There is a correlation between COVID-19 infection and myocardial infarction. Patient concerns: A 70-year-old married, farmer, smoker, Egyptian male patient was admitted to the critical care unit with acute inferior myocardial infarction and suspected COVID-19 pneumonia. An interlacing generalized myoclonus and allergic coronary artery spasm occurred. Diagnosis: Reactional myoclonus with allergic coronary artery spasm post-streptokinase in COVID-19 inducing myocardial infarction. Interventions: Electrocardiography, oxygenation, streptokinase intravenous infusion, and echocardiography. Outcomes: Reactional generalized myoclonus with coronary artery spasm had happened during-streptokinase infusion but the dramatic response was the result. Lessons: Dramatic clinical and electrocardiographic response after using the traditional anti-allergic signifying its role and suggest the diagnosis of Zavras-Kounis syndrome. The presence of continuing generalized myoclonus movements with the disappearance of coronary artery spasm after stoppage may be directed to the myoclonus cause. Streptokinase causing generalized myoclonus movements previously unknown, so it is a new recording adverse effect finding. The presence of involuntary movements, COVID-19 pneumonia, myocardial infarction, elderly, and cigarette smoking are prognostic factors for the severity of the disease.
Café Au Lait Spot is A Marker for Pheochromocytoma in Hypertensive Crisis Wit...YasserMohammedHassan1
Café au lait Spot is a marker for pheochromocytoma in hypertensive crisis but with a wide-differential diagnosis. Labetalol may be chosen in hypertensive crisis due to pheochromocytoma.
Wavy Triple Sign of Hypocalcemia or Yasser’s Sign-in Diabetic Ketoacidosis-Dr...YasserMohammedHassan1
The wavy triple an electrocardiographic sign (Yasser’s sign) and hypocalcemia are commonly seen in diabetic ketoacidosis. Dramatic spontaneous improvement of both wavy triple an electrocardiographic sign (Yasser’s sign) and hypocalcemia simultaneously after the management of diabetic ketoacidosis in most cases.
الأدوية الخطرة بالعناية والطوارئ-Dr. Yasser Mohammed Hassanain Elsayed.pptxYasserMohammedHassan1
• هنالك العديد من الأدوية الخطرة التي طالما نستخدمها بالمستشفيات، خاصة بأقسام الطوارىء أو الرعاية الحرجة.
• البعض منها يكون في أقسام الطوارئ، والبعض الأخر يكون في أقسام الرعاية الحرجة، وأحيانا تكون في الأقسام الداخلية للمستشفيات.
• ربما تتصدر مشكلات كبيرة عن استخدام هذه الأدوية، هذا فضلا عن الصغيرة منها، مثل:
- توقف القلب وربما الموت المفاجيء.
- الزيادة الخطرة بضربات القلب
- حدوث ذبحة صدرية
- أو حدوث جلطة دموية في القلب
- حدوث ألم شديد بالصدر
- حدوث فشل تنفسي أو إثارته.
- حدوث فشل كبدي أو إثارته.
- حدوث ضعف حاد بعضلة القلب أو إثارته.
- الى غير ذلك من صور وأشكال عديدة، من المضاعفات.
ألم الصدر التشخيص- وكيفية التعامل معه-Dr. Yasser Mohammed Hassanain Elsayed.pptxYasserMohammedHassan1
• يعتمد تشخيص وعلاج ألم الصدر على السبب.
فقد تتنوع أسباب ألم الصدر من مشكلات صغيرة، مثل:
- حرقة المعدة
- الضغط النفسي
- حالات الطوارئ الطبية الخطيرة مثل النوبة القلبية
- أو تكوُّن جلطة دموية في الرئتين (الإنصمام الرئوي).
• يأخذ ألم الصدر صورا وأشكالا عديدة، وتتراوح حدته بين الشعور بطعنات حادة وحتى الألم الخفيف. وفي بعض الأحيان، يكون ألم الصدر ساحقًا أو حارقًا. وفي حالات أخرى، ينتقل الألم صعودًا إلى الرقبة وإلى داخل الفك، ثم ينتشر للخلف أو للأسفل لتشعر به في أحد الذراعين أو في الذراعين معًا.
Introduce the Research-Welcome Keys-Dr. Yasser Mohammed Hassanain Elsayed.pptxYasserMohammedHassan1
• The term, research, is much stricter in science than in everyday life.
• It revolves around using the scientific method to generate hypotheses and provide analyzable results.
Rationale: Coronary artery spasm is common ischemic heart disease. It is a serious clinical cardiovascular issue. Nitrates such as nitroglycerine have a pivotal role in the management of coronary artery disease.
Patient concerns: A 45-year-old married, officer, heavy smoker, Egyptian male patient presented with acute excruciating severe chest pain and combined electrocardiographic ST-segment coronary artery spasms.
Diagnosis: Combined ST-segment coronary artery spasms of ST-segment elevations and ST-depressions were the most probable diagnosis.
Interventions: Electrocardiogram, echocardiography, and nitroglycerine intravenous infusion.
Outcomes: Dramatic response of both clinical and electrocardiographic combined ST-segment coronary artery spasms to nitroglycerine.
Lessons: A combined ST-segment coronary artery spasms including ST-segment elevation and ST-depression may be present in the same ECG. The dramatic efficacy of later using nitroglycerine in the management of combined ST-segment coronary artery spasms.
Yasser's covid 19 discrepancy phenomenon-dr. yasser mohammed hassanain elsayedYasserMohammedHassan1
Yasser’s COVID-19 Discrepancy phenomenon is a novel descriptive phenomenon that is always seen in all COVID-19 pneumonia. Initial dramatic improvement of the clinical status of COVID-19 pneumonic patient, not a simultaneously after the management, not a coincide with laboratory, radiological, and electrocardiographic workup. Further larger studies for the study medical regimen with considering of “Yasser’s COVID-19 Discrepancy phenomenon” is recommended.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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.
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
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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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
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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
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
2. Dr. Yasser Mohammed
Hassanain Elsayed
MB Bch, PGDip Cardiology
(Middlesex University, RILA)
Researcher and author
Critical Care Unit
Work: Egyptian Ministry of Health
(MOH)
5. Learning objectives
• Discovery and historical bit
• Know the definition
• Understanding the hints on varieties
• Understanding of GP
• The risk
• How to deal with it? (Management)
• Conclusion and Recommendations
6. Table 1- showing remarks of the study
method and data.
Issue Definition
Title Graded phenomenon (Yasser's phenomenon); A novel
Electrocardiographic phenomenon change the arrhythmia
directory
Estimated Enrollment 30 participants
Study Type Observational
Observational Model Case-only
Time Retrospective
Study Start Date January 13, 2016
Estimated Study Completion Date February 9, 2020
Analytic method Comparative using percentage %
8. 1. History
Either
• Over about 5 years of subsequent
immediate serial ECG tracings.
or
• Subsequent changes, but in the
same ECG tracing.
9. 2. principle of the “Graded
phenomenon”
• It is based on catching the
graded changes in the serial ECG
tracings.
• Or even the same ECG tracing
regarding the arrhythmias.
13. 1. “GP” Variant I Classification:
According to the extension direction for arrhythmia:
1. The up-grading phenomenon with the right to the left
extension.
2. The up-grading phenomenon with the left to the right
extension.
3. Up-grading bidirectional sectors of tachycardia (BSOT).
4. Intermittent Wandering pacing rhythm with the left to the
right extension.
14. 2. “GP” Variant II Classification:
According to the grading and conversion of arrhythmia of
GP:
1. Up-grading.
2. Down-grading.
3. Fixed–change.
4. Spontaneously changed to normal sinus rhythm.
5. Spontaneously changed to another arrhythmia.
6. Therapeutic reversal.
15. 3. “GP” Variant III Classification:
According to the risk of arrhythmia of GP:
1. High risk.
2. Non-risk.
3. Still-risk.
18. A 60-year-old married, housewife, Egyptian
female, presented to the Emergency Room
(ER) with orthopnea of progressive course.
The patient was admitted and managed in
the intensive care unite (ICU) as chronic
heart failure (CHF) with hypertensive crises
(HC). She gave a history of diabetes and
calcular cholecystitis.
19. “Upgrading GP with the right to left extension”; started in V1-6 leads (A-tracing), II, III, and aVF with V1-6 Leads (B-tracing), to all
ECG leads (C-tracing) Randomly mixture of bigeminy PVCs and trigeminy PVCs. (D-tracing) Runs of VT (3 Subsequent PVCs) (E-
tracing) disappearance of the previous changes after NTG with evidence of old silent inferior-anterior MI (F-tracing).
21. A 58-year-old married Egyptian housewife
female patient presented to the POC with
dizziness, dyspnea, and palpitations. The
patient gave a history of psycho-familial
troubles. Clinically, she had appeared
myxedematos. There was sub-clinical
hypothyroidism and congestive heart failure
(CHF).
22. “Upgrading GP with the right to left extension”; started in V1-6 leads (A-tracing), II, III, and aVF with V1-6 Leads (B-tracing),
to all ECG leads (C-tracing) Randomly mixture of bigeminy PVCs and trigeminy PVCs. (D-tracing) Runs of VT (3 Subsequent
PVCs) (E-tracing) disappearance of the previous changes after NTG with evidence of old silent inferior-anterior MI (F-tracing).
24. A 75-year-old married Egyptian housewife
female patient presented to the POC with
chest pain, dyspnea, and palpitations. The
patient was initially diagnosed as
hypertensive crises with junctional
tachycardia.
25. GP + an interesting progressive bidirectional sectors of tachycardia (BSOT) started with NSR in between until becoming total tachycardia in all
ECG tracing. BSOT initially started in the first part of I, II, and III, aVR, aVL, and aVF leads (A tracing; blue color) extended to the last part of I, II,
III, and aVR, aVL, and aVF and the first part of, aVR, aVL, aVF, and V1-3 leads (B tracing; green color) the first part of I, II, III, the middle part of
aVR, aVL, aVF and V1-3, and last part of I, II, III, and V4-6 leads (C tracing; gold color) extend to last part of aVR, aVL, and aVF, and all V1-6 leads
(D tracing; green color) lastly it includes all ECG leads (E tracing; turquoise color).
27. An 11-year-old Egyptian boy student patient
presented to the POC with pleuritic chest pain.
There was no history of heart disease.
28. Intermittent Wandering pacing rhythm with a progressive left to the right extension.
It progresses from partial junctional rhythm becoming total junctional rhythm in all ECG tracing except lead I and aVL spontaneously
normalized. WPR initially started in I, II, and the first part of III, aVR, aVL, and aVF leads (green arrows and color) sinus bradycardia in
the remaining part of aVR, aVL, and aVF leads (black and blue arrows, and color) junctional rhythm in part of V1-3 (green arrows and
color) sinus bradycardia in the remaining part of V-3, and all V4-6 leads (black and blue arrows, and color) (A. ECG tracing) JR
including all ECG tracing except lead I and aVL (B. ECG tracing) spontaneously normalized (C. ECG tracing)
30. A 37-year-old married Egyptian housewife
female patient presented to the POC with
irritable bowel syndrome with chest tightness,
and palpitations. She gave a history of anxiety
due to delayed infertility. The patient initially
diagnosed as anxiety with a junctional rhythm.
31. Junctional rhythm (JR) with progressive right to left extension with a NSR in between until becoming total JR in all ECG
tracings
JR initially started in V1-6 leads (green arrows and color) + the remaining are NSR (blue arrows and color) (A. ECG tracing),
extended to all ECG leads except AVL(brown arrows and color) (B. ECG tracing) spontaneously normalized in all ECG leads
(C. ECG tracing;).
33. A 50-year-old married Egyptian male teacher
patient presented to the POC with dizziness
and palpitations. The patient appeared
anxious. There was a recent history of
psychological stress. There was a history of old
MI.
34. Fixed trigeminal PVCs in anxiety and old IMI
A-C tracings showing fixed trigeminy PVCs.
35. 7. Up-grading PVCs in
suspected of acute
pulmonary embolism
( thrombophilia)
36. An 88-year-old married, worker, Egyptian male
patient presented in the ER with tachypnea
and palpitations. The patient gave a recent
history of bilateral LL swelling. The patient has
a history of hypertension, AF, recurrent
cerebrovascular strokes with bulbar palsy. At
home, the patient missed his warfarin (3 mg).
He was admitted to the ICU as suspected of
acute pulmonary embolism.
37. Up-grading PVCs in suspected pulmonary embolism ( thrombophilia)
AF, sinus arrest (A. tracing) polymorphic VT (B. tracing) multifocal PVCs(C+D tracings) runs of VT(E+F tracings).
38. 8. Fixed graded PVCs in CHF;
Hexagimeny-trigimeny-
trigimeny hexagimeny
39. An 87-year-old married Egyptian male
farmer presented to the POC with
palpitations. There was a history of
compensated CHF and cirrhotic liver
disease.
42. A 75-year-old married Egyptian female
housewife presented to the POC with
dizziness. There was a history of
compensated chronic heart failure (CHF)
and obstructive sleep apnea (OSA).
45. A 70-year-old married Egyptian male carpenter
presented to ER with chest pain, dyspnea, and
dizziness. He gave a recent history of ingested
3 tablets of oral tramadol (100 mg). There was
a history of urinary bladder carcinoma.
(Toxicity case).
48. A 66-year-old married Egyptian male
carpenter presented to the ED with
orthopnea. The patient had a recent history
of CHF. He was admitted to the ICU as a
CHF with AMI.
54. A 60-year-old married Egyptian female
housewife presented to the ER with dizziness.
There was a history of compensated chronic
renal failure (CRF) on regular hemodialysis.
She was admitted to ICU with symptomatic
bradycardia.
57. A 66-year-old married Egyptian male
electrician presented to the ER with
orthopnea. The patient had a recent history of
CHF. He was admitted to the ICU as a CHF.
63. A 43-year-old married Egyptian male worker
presented to the ER with palpitations and
headaches. He was a heavy cigarette smoker.
He was admitted to the ICU as PSVT with
HCC.
66. A 44-year-old married, driver, heavy
cigarette smoker, Egyptian male patient
presented in the ER with acute severe chest
pain and palpitations. The chest pain was
anginal The patient gave a recent history of
using substance abuse. He was admitted to
the ICU and managed in the ICU as unstable
angina.
69. Table-2 Summery mechanisms of cardiac
arrhythmias.
No.
Disorders in impulse figuration Disorders in impulse conduction
1.
2.
A. Automaticity
1. Altered normal automaticity
2. Abnormal automaticity
B. Triggered activity
1. Delayed after-depolarization
2. Early after-depolarization
(EADs)
A. Reentry
1. Anatomic reentry
2. Functional reentry
Modified from Gaztan L et al (2012)
83. • Up-grading: It is meaning that the change either from low serious arrhythmia
to higher serious arrhythmia, or more extension for the current serious
arrhythmia, or ending to serious arrhythmia or just extension for a benign
arrhythmia e.g. case No. 1. Up-grading may be included an up-grading type of
arrhythmia as in case No. 7.
• Down-grading: It is meaning that the change either from higher serious
arrhythmia to low serious arrhythmia, or less extension for the current serious
arrhythmia, or ending to the benign or non-serious arrhythmia e.g. case No. 15.
• Fixed–change: It is meaning that the current arrhythmia is constant in the
serial ECG or even the single ECG tracing e.g. case No. 6.
• Spontaneously changed to normal sinus rhythm: It is meaning that the
current arrhythmia is spontaneously changed to normal sinus rhythm with no
uses of medications or therapeutic maneuvers like DCC and Valsalva’s e.g. case
No. 16 and17.
84. • Spontaneously changed to another arrhythmia e.g. sinus tachycardia e.g.
case No. 19.
and atrial fibrillation e.g. case No. 18.
• Therapeutic reversal: It is meaning that there is a new arrhythmic change
after using the traditional antiarrhythmic e.g. case No. 14.
86. • The up-grading phenomenon with the right to left extension: It
is meaning that the arrhythmic change starting from the right side
of ECG tracing directed toward its left side e.g. case No. 1.
• The up-grading phenomenon with the left to right extension: It
is meaning that the arrhythmic change starting from the left side
of ECG tracing directed toward its right side e.g. case No. 2.
• Up-grading bidirectional sectors of tachycardia (BSOT): It is
meaning that the arrhythmic change starting as sectors of
tachycardia then gradually extend to both left and right side of
ECG tracing until becoming complete tachycardia e.g. case No. 3.
• Intermittent Wandering pacing rhythm with the left to right
extension: It is meaning that the change occurring intermittent
manner then extends from left to right e.g. case No. 4.
88. • High: This is meaning that there will be possible serious outcomes like;
sudden cardiac deaths congestive heart failure, Torsades de pointes, and VT
ventricular tachycardia e.g. case No. 1, 2, and 7.
• Non-risk: This is meaning that there will no be possible serious outcomes e.g.
case No. 4, 5, and 14.
• Still-risk: This is meaning that there are no current possible serious outcomes
but maybe with passing the time e.g. case No. 18, 24, and 26.
90. • Essential points are considered in the management of GP
• Serial ECG tracings
• The risk
• The course
• The clinical status
• GP can be treated as a case by case according to the above considerations.
• Multidisciplinary subspecialty teams are advised for further understanding of GP
• The recommended multidisciplinary subspecialty teams will be including;
• Cell biologist
• Electro-physiologist
• Cardiologist
• Pathophysiologist.
92. • Graded phenomenon (Yasser's phenomenon) is a novel
electrocardiographic phenomenon change the arrhythmia directory.
• It is a crucial step for understanding arrhythmia.
• The phenomenon is a new strong guide for monitoring and follows up
arrhythmic patients in cardiovascular patients.
• There are interlacing correlations between the “passing phenomenon”
and the current “Graded phenomenon” especially in cases of arrhythmia that
is spontaneously changed to normal sinus rhythm with no uses of medications
or therapeutic maneuvers like DCC and Valsalva’s e.g. case No. 16 and 17.
• Electrophysiology studies (EPS) is recommended for more future study and
understanding the “Graded phenomenon”
• Physiological study for the cellular biology may be advised future options
for the “Graded phenomenon”.