This document provides information on heart failure including its physiology, definition, classification, etiology, risk factors, pathophysiology, clinical manifestation, diagnosis, treatment, and differential diagnosis. It discusses the anatomy of the heart and mediastinum. It defines left heart failure with systolic and diastolic types, right heart failure, and high output heart failure. Risk factors for heart failure include aging, family history, unhealthy lifestyle, and underlying heart/lung conditions. Clinical exams may reveal jugular venous distension, lung crackles, edema. Diagnostic tests include BNP, ECG, echocardiogram, and chest x-ray. Treatment involves drugs like ACE inhibitors, ARBs, beta-blockers, di
It includes emergency situations related to the cardiovascular aspect of humans. it focuses on the critical care aspect to manage certain emergencies. Nursing care is also included thus, fosters a better aspect of nursing individuals to manage a cardiovascular emergency.
Heart failure , systolic and diastolic dysfunction, management of acute heart...ErumZubair3
heart failure is a chronic condition of the heart in which heart is unable to pump sufficient amount of blood to meet requirements of the metabolic tissues.
Cardiac myopathy is a heart-related disorder. many types are there in cardiomyopathy .4 types of CMP is hypertrophic CMP, dilated CMP, restrictive CMP, stress CMP. causes of this are node related problem,ischemic condion of the heart .symptoms to this is chest pain breathlessness, edema like cardiacfailure will happen at last . manage mesvn t like betablockers , ace inhibitors doamine .dobutamine, and diuretics should be given to the patient .surgical manage meant is septal ablation, and heart transplantation should be given to the patient
It includes emergency situations related to the cardiovascular aspect of humans. it focuses on the critical care aspect to manage certain emergencies. Nursing care is also included thus, fosters a better aspect of nursing individuals to manage a cardiovascular emergency.
Heart failure , systolic and diastolic dysfunction, management of acute heart...ErumZubair3
heart failure is a chronic condition of the heart in which heart is unable to pump sufficient amount of blood to meet requirements of the metabolic tissues.
Cardiac myopathy is a heart-related disorder. many types are there in cardiomyopathy .4 types of CMP is hypertrophic CMP, dilated CMP, restrictive CMP, stress CMP. causes of this are node related problem,ischemic condion of the heart .symptoms to this is chest pain breathlessness, edema like cardiacfailure will happen at last . manage mesvn t like betablockers , ace inhibitors doamine .dobutamine, and diuretics should be given to the patient .surgical manage meant is septal ablation, and heart transplantation should be given to the patient
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
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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.
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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
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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
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.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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
2. Table of content
Physiology of heart
and defenition of HF
03
Classification of HF
Etiology, risk factor,
patohysiology of HF
Diagnosis and Clinical
Manifestation
3. Table of content
Treatment of HF
07
Diffrential diagnosis
of HF
Defenition, etiology,
pathophysiology RHD
Diagnosis for RHD
6. ANATOMY - Mediastinum
Mediastinum is central, midline thoracic cavity, which is surrounded anteriorly by
sternum, posteriorly by 12 thoracic vertebrae & laterally by pleural cavity.
Mediastinum is divided into superior mediastinum & inferior mediastinum.
• Superior mediastinum
• Above the plane of sternal angle (above 2 nd rib)
• Contains superior vena cava, aortic arch & its branches, trachea,
oesophagus, thoracic duct, vagus and phrenic nerve.
• Inferior mediastinum
• Below the plane of sternal angle
• Further divided into 3 parts - anterior, middle & posterior mediastinum.
• Anterior mediastinum is anterior to the heart
• Middle mediastinum contains the heart and great vessels
• Posterior mediastinum contains everything that is below the posterior
margin of heart i.e. thoracic aorta
9. CARDIAC TERRITORIES
FRONTAL VIEW
• Right border is formed by
right atrium.
• Laterally to right atrium on
left side is right ventricle
(covers most of the anterior
surface of heart)
• Left border - Mainly formed
by left ventricle
• Posterior border is where
most part of left atrium is
located.
• The apex of heart is formed
by left ventricle
Image courtesy - University of Auckland
10. CONDUCTION PATHWAY
• Speed of conduction -
Purkinje > Atria >
Ventricles > AV node
• Pacemakers rhythm
generation - SA (60-
100/min) > AV (40-
60/min) > bundle of
His/Purkinje (20-40/min).
• Pacemaker - Uses calcium
to generate action
potential. Atrial and
ventricular muscle
depolarization is sodium
dependent
Image courtesy : Hole’s human anatomy and physiology , 7 th
edition by Shier
11. CORONARY ARTERIES
• The left coronary artery is
further divided into left
circumflex artery and left
anterior descending artery
aka anterior
interventricular branch
• The right coronary artery
is further divided into
marginal arteries, nodal
arteries & posterior
interventricular branch.
12. CONCEPTS OF PRELOAD, EJECTION FRACTION & CARDIAC OUTPUT
PRELOAD
• Preload is the load on ventricular
muscles at the end of diastole. It
is determined mainly by left
ventricular end diastolic volume &
left ventricular end diastolic
pressure, in other words - by
venous return.
• Increase in preload results in
increase in contractility that in
turn increases stroke volume &
thus increase in ejection fraction
• Chronic increase in preload is
responsible for dilated
cardiomyopathy
13. CONCEPTS OF PRELOAD, EJECTION FRACTION & CARDIAC OUTPUT
STROKE VOLUME
• Stroke volume is the amount of blood that heart pump out with each beat. It is
affected by contractility, afterload & preload
• SV = EDV (End Diastolic Volume) – ESV (End Systolic Volume)
EJECTION FRACTION
• Is the fraction of blood that heart pump out during 1 contraction which
is usually 60- 70% in healthy normal adult
• Ejection Fraction = Stroke volume/End diastolic volume; therefore, EF =
EDV – ESV/EDV
CARDIAC OUTPUT
• Is the amount of blood that heart pump out during 1 minute
• Cardiac output is calculated as: CO = Heart rate * Stroke volume.
14. CONCEPTS OF PRELOAD, EJECTION FRACTION & CARDIAC OUTPUT
AFTERLOAD
• Afterload is the pressure against which heart will work. It is
determined by peripheral arterial resistance
• Chronic increase in afterload (e.g. hypertension, increasing age) will
lead to left ventricular hypertrophy
• Peripheral resistance is calculated as - Blood flow = Pressure /
Resistance (Q=P/R), therefore R = P/Q
19. HEART FAILURE
Basically classified into 3 types
• Left Heart Failure
• Systolic Heart Failure (SHF)
• Diastolic Heart Failure (DHF)
• Right Heart Failure
• Due to increase in resistance to blood flow out
of the right ventricle.
• High Output Heart Failure
• Failure of heart due to persistent high cardiac
output (high stroke volume)
23. RIGHT HEART FAILURE
Due to increase in resistance to blood flow out of the right
ventricle.
Etiology
• Left heart failure (is most common cause).
• Idiopathic pulmonary hypertension (BMPR2 mutation leading to
pulmonary vasoconstriction)
• Pulmonary stenosis or embolization (give thrombolytic to break
embolus in hemodynamically unstable patient)
• Right ventricular infarction (clear lungs, hypotension, JVD
elevation)
• Restrictive cardiomyopathy, Tricuspid or Pulmonary
regurgitation
24. HIGH OUTPUT HEART FAILURE
Failure of heart due to persistent high cardiac output (high stroke
volume)
Etiology
• Hyperthyroidism
• Severe anemia
• Thiamine deficiency (wet beri beri)
• Septic shock
• Arteriovenous fistula (trauma, shunt, Paget disease of bone)
• Obesity
26. What raises my risk for heart failure?
• Aging can weaken and stiffen your heart. People 65 years or
older have a higher risk of heart failure. Older adults are also
more likely to have other health conditions that cause heart
failure.
• Family history of heart failure makes your risk of heart failure
higher. Genetics may also play a role. Certain changes, or
mutations, to genes can make your heart tissue weaker or less
flexible.
• Unhealthy lifestyle habits, such as an unhealthy diet, smoking,
using cocaine or other illegal drugs, heavy alcohol use, and lack
of physical activity, increase your risk of heart failure.
27. What raises my risk for heart failure?
• Heart or blood vessel conditions, serious lung disease, or
infections such as HIV or SARS-CoV-2 raise your risk. This is also
true for long-term health conditions such as obesity, high blood
pressure, diabetes, sleep apnea, chronic kidney disease, anemia,
thyroid disease, or iron overload.
• Black and African American people are more likely to have heart
failure than people of other races, often have more serious
cases of heart failure and experience heart failure at a younger
age
33. LEFT HEART FAILURE
Symptoms
• Poor exercise tolerance, easy fatigability
• Jugulovenous distension, Peripheral swelling (ankle)
• Inspiratory rales, Shortness of breath, Dyspnea - because fluid in
interstitium prevents expansion of lung. edema can narrow the
airways, which produces wheezes during expiration; this
phenomenon is called as Cardiac Asthma.
• Paroxysmal Nocturnal Dyspnea – Difficulty in breathing on laying
down due to increase in venous return. Usually patient
complains of using 2-3 pillows for sleeping. Standing up relieves
symptoms.
• Confusion
34. LEFT HEART FAILURE
Findings
• Cardiomegaly, Jugular venous distension, S3 in SHF (rapid filling
of ventricles), S4 in DHF (atrial contract against stiffened
ventricles).
• Congested lungs, Pulmonary edema (transudate fluid due to
increase in pulmonary capillary hydrostatic pressure).
• If pulmonary capillary rupture then heart failure cells in alveoli
(alveolar macrophage containing hemosiderin)
35. New York Heart Association functional classification based on severity of symptoms and physical activity
36. INVESTIGATIONS
• BNP level – Use in emergent situation when you are not clear about
CHF.
• BNP level – Use in emergent situation when you are not
clear about CHF.
• High level cannot differentiate SHF versus DHF and so
do transthoracic echocardiography
• If the BNP levels remain high after treatment – sign of bad prognosis.
• If BNP is < 100 pg/mL – Heart failure is highly unlikely.
• If BNP is 100-500 pg/mL - Results are uncertain but
suspicious
• If BNP is > 500 pg/ml - Heart failure is highly likely.
37. INVESTIGATIONS
• On X-Ray: Cardiomegaly, Kerley B lines (septal edema), pulmonary
vasculature congestion, air bronchogram
• On ECG - Left ventricular hypertrophy (S wave in V1 + R in V5 or V6 >
35 mm, > 7 large squares).
• ECG might show ischemic heart disease, arrhythmias and ventricular
hypertrophy.
38. RIGHT HEART FAILURE
PHYSICAL FINDINGS
• Jugulovenous distension, Peripheral edema (in ankle)
• Tricuspid valve regurgitation +/-, S3-S4 sound on right side
• No crackles (if RHF is not due to LHF)
• Hepatosplenomegaly (zone 3 – central zone is affected most,
ascites)
• Cyanosis due to decrease in oxygen saturation
39. HIGH OUTPUT HEART FAILURE
SIGNS AND SYMPTOMS
• Breathlessness at rest or on exertion
• Exercise intolerance
• Fatigue
• The signs of typical heart failure may be present including
tachycardia, tachypnea, raised jugular venous pressure,
pulmonary rales, pleural effusion and peripheral edema
• In high output heart failure, patients are likely to have warm
rather than cold peripheries due to low systemic vascular
resistance and peripheral vasodilatation.
50. Laki-laki usia 61 tahun datang ke poli dengan Riwayat DM
lama. Minum glibenclamid fan metformin. Tidak ada obat
lain. Sudah seminggu ini sesak napas saat aktifitas sehari-
hari. Tidur harus setengah duduk 3 hari ini. Kaki pernah
bengkak. Diberi furosemide dan berkurang. Ronki minimal di
basal. Td 100/60
67. • Low-grade fever does not
require specific treatment
• Fever alone, or fever with
mild arthralgia or arthritis,
may not require NSAIDs but
can instead be treated with
paracetamol
69. Laki-laki usia 61 tahun datang ke poli dengan Riwayat DM
lama. Minum glibenclamid fan metformin. Tidak ada obat
lain. Sudah seminggu ini sesak napas saat aktifitas sehari-
hari. Tidur harus setengah duduk 3 hari ini. Kaki pernah
bengkak. Diberi furosemide dan berkurang. Ronki minimal di
basal. Td 100/60