- The patient presented with new onset AF after recent PCI for NSTEMI. Managing anticoagulation and antiplatelet therapy in such patients is challenging due to risk of bleeding from triple therapy. Shortening triple therapy duration does not significantly reduce bleeding risk. Dual antiplatelet and anticoagulant therapy may reduce bleeding compared to triple therapy.
Percutaneous Transvenous Mitral Commissurotomy in 71 Years Old Woman with Mit...M A Hasnat
AAS Majumder, MA Hasnat, AKMM Islam, M Ullah, MZ Rahman, S Zaman, MM Rahman, MH Alamgir.
Department of Cardiology, NICVD, Dhaka.
(Cardiovasc. j. 2013; 6(1): 68-70)
Noncardiac surgery (NCS) is associated with a considerable risk of adverse cardiac events among individuals with coronary artery or aortic valve disease
Dual antiplatelet therapy duration based on ischemic and bleeding risks after...NAJEEB ULLAH SOFI
The PRECISE-DAPT score is a 5-item bleeding risk prediction model developed to estimate the bleeding risk in patients who receive dual antiplatelet therapy (DAPT) after stent implantation
The categorization of patients based on the PRECISE-DAPT score was shown to be useful to inform decision-making for duration of DAPT in stented patients
It took another 10 years, after a positive response of a different Review Board,before the first alcohol septal ablation (ASA) could be performed at the Royal Brompton Hospital in London 25 years ago.1
The very first patient, after having been informed in great length and meticulous detail about all possible risks,agreed to an experimental procedure, the outcome of which could not be defined.
She had severe left ventricular hypertrophy that created an impressive and highly
symptomatic outflow tract gradient despite pacing and drug treatment; after the ablation on June 18, 1994, she remained asymptomatic for >20 years.
Chronic coronary syndrome (CCS) is a term that defines coronary artery disease as a chronic progressive course. It has been introduced to replace the previous term ‘stable coronary artery disease’.
Percutaneous Transvenous Mitral Commissurotomy in 71 Years Old Woman with Mit...M A Hasnat
AAS Majumder, MA Hasnat, AKMM Islam, M Ullah, MZ Rahman, S Zaman, MM Rahman, MH Alamgir.
Department of Cardiology, NICVD, Dhaka.
(Cardiovasc. j. 2013; 6(1): 68-70)
Noncardiac surgery (NCS) is associated with a considerable risk of adverse cardiac events among individuals with coronary artery or aortic valve disease
Dual antiplatelet therapy duration based on ischemic and bleeding risks after...NAJEEB ULLAH SOFI
The PRECISE-DAPT score is a 5-item bleeding risk prediction model developed to estimate the bleeding risk in patients who receive dual antiplatelet therapy (DAPT) after stent implantation
The categorization of patients based on the PRECISE-DAPT score was shown to be useful to inform decision-making for duration of DAPT in stented patients
It took another 10 years, after a positive response of a different Review Board,before the first alcohol septal ablation (ASA) could be performed at the Royal Brompton Hospital in London 25 years ago.1
The very first patient, after having been informed in great length and meticulous detail about all possible risks,agreed to an experimental procedure, the outcome of which could not be defined.
She had severe left ventricular hypertrophy that created an impressive and highly
symptomatic outflow tract gradient despite pacing and drug treatment; after the ablation on June 18, 1994, she remained asymptomatic for >20 years.
Chronic coronary syndrome (CCS) is a term that defines coronary artery disease as a chronic progressive course. It has been introduced to replace the previous term ‘stable coronary artery disease’.
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.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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.
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
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
3. Mr. KANDASAMY R, 79 years old gentleman presented with complaints of
BREATHLESSNESS ON EXERTION SINCE 1 WEEK.
On evaluation ECHO done showed SEVERE AS (PG- 59mmHG, MG- 35mmHg), MILD
INCREASE IN GRADIANT ACROSS MV, NORMAL LV FUNCTION, AF WITH CVR. CT
CAG done on 24/11/22 showed PATENT SVG TO LAD, 70-80% MID RCA, 70-80% IN
OSTIOPROXIMAL LEFT RENAL ARTERY.
4. TYPE 2 DIABETES MELLITUS
PARKINSON'S DISEASE (NEWLY DIAGNOSED)
RHEUMATIC HEART DISEASE
CAD - SINGLE VESSEL DISEASE (2012)
S/P CABG SVG TO LAD (2012)
S/P MVR (EDWARDS PERIMOUNT PLUS PERICARDIAL BIOPROSTHETIC VALVE
27mm)-17/10/12
PERMANENT ATRIAL FIBRILLATION
SEVERE SYMPTOMATIC AORTIC STENOSIS
NORMAL LV FUNCTION
S/P TRANSCATHETER AORTIC VALVE IMPLANTATION (TAVI)- 5/12/22 with MYVAL
OCTACOR 24.5MM DONE
POST TAVI ATRIAL FIBRILLATION WITH INTERMITTENT COMPLETE HEART BLOCK
EMERGENCY TPI (7/12/22)
SINGLE CHAMBER PERMANENT PACEMAKER IMPLANTATION (LBBP)- 8/12/22
5.
6.
7.
8.
9. Both SAVR and TAVR are safe for patients with prior CABG surgery at
intermediate operative risk.
Treatment modality influenced the postoperative course, with TAVR
facilitating faster improvement in quality of life and more robust exercise
tolerance, which persisted at 1-year follow-up.
10. Intermediate-risk patients - symptomatic, severe AS and prior CABG surgery, TAVR
using the self-expanding valve and SAVR are both safe.
The rate of all-cause mortality and disabling stroke as well as the individual
components of this primary end point were similar at 30 days and 1 year.
Complications of the procedures differed, with those receiving SAVR having more
transfusions, acute kidney injury, and atrial fibrillation.
Transcatheter aortic valve replacement led to a higher pacemaker rate but also to
significantly better aortic valve area and mean gradient and a more rapid
improvement in symptoms, exercise capacity, and quality of life.
Comparison of Outcomes After Transcatheter vs Surgical Aortic Valve
Replacement Among Patients at Intermediate Operative Risk With a
History of Coronary Artery Bypass Graft SurgeryA Post Hoc Analysis of
the SURTAVI Randomized Clinical Trial
Michael J. Reardon, MD1; Robin H. Heijmen, MD2; Nicolas M. Van
Mieghem, MD, PhD3; et al
11. Reoperation in patients with prior CABG surgery carries increased risk both because
these patients tend to be older and have more comorbidities and because of the risk
of cardiac or graft injury during sternal re-entry.
Previous CABG surgery treated with TAVR or SAVR had similar short-term and long-
term survival, but TAVR resulted in a shorter hospital stay and a greater need for
post procedure pacemakers.
TAVR’s superior hemodynamics may have facilitated increased transvalvular flow
needed for exercise.
Atrial fibrillation increases the risk of all primary and secondary outcomes after
TAVR/TAVI.
Comparison of Outcomes After Transcatheter vs Surgical Aortic Valve Replacement
Among Patients at Intermediate Operative Risk With a History of Coronary Artery
Bypass Graft SurgeryA Post Hoc Analysis of the SURTAVI Randomized Clinical Trial
Michael J. Reardon, MD1; Robin H. Heijmen, MD2; Nicolas M. Van Mieghem, MD, PhD3; et
al
12.
13. A substantial number of patients requiring aortic valve replacement have previous
undergone CABG “because similar risk factors are responsible for the pathogenesis
of coronary artery disease and aortic stenosis”.
The preference for TAVI over surgery in this context is because the “risks of re-
operative surgery are much higher than the initial surgery”. He adds: “The patients
have already had a median sternotomy and are older at the time of the potential
second surgery.
14. The rate of in-hospital mortality was similar between TAVI and surgery patients.
Furthermore, the lower incidence of myocardial infarction, stroke, bleeding, and
acute kidney injury were all lower in the TAVI patients.
However, the need for a permanent pacemaker was almost two-fold higher in TAVI
patients
TAVI procedure may be ‘an attractive option in the population of high-risk patients
with aortic stenosis and previous CABG’.
Patients with previous heart surgery often present with reduced left ventricular
function.
Paravalvular insufficiency will influence their late mortality.
16. MRS VASANTHA, 72 Year old came with chest pain on exertion which was retrosternal
compressive type (GRADE-II) subsides with rest and non radiating,
TYPE 2 DIABETES MELLITUS
SYSTEMIC HYPERTENSION
DYSLIPIDEMIA
DEGENERATIVE MODERATE CALCIFIC AORTIC STENOSIS
MILD AR
CAD-ACS-NSTEMI
CAG (O7/12/2022): TRIPLE VESSEL DISEASE
NORMAL LV FUNCTION WITH LVEF-62%
SUCCESSFUL OCT GUIDED PCI TO RCA DONE WITH 2 DES AND PCI TO LCX WITH
2 DES AND FFR TO LAD DONE(BORDERLINE)
17. Discharged on 9/12/22
T ECOSPRIN 75MG 1-0-0
T BRILINTA 90MG 1-0-1
T ROZAVEL 40MG 0-0-1
T CONCOR 5MG 1-0-0
T CILACAR 10MG 1-0-1
T TAZLOC CT 80MG 0-0-1
T MINIPRESS XL 2.5MG 1-0-1
T PAN 40MG 1-0-0 TO CONTINUE BEFORE FOOD
CAP.HAEMUP 1CAP 1-0-0
Readmitted on 11/12/22 with complaints of chest pain radiating to arm, ECG showed AF with FVR.
18. The management of atrial fibrillation in patients who have undergone percutaneous coronary
intervention (PCI) for the treatment of coronary-artery disease is a common and difficult
challenge.
In patients with atrial fibrillation, oral anticoagulation is administered to reduce the risk of
stroke. In patients who have undergone PCI, dual antiplatelet therapy is administered to
prevent major adverse cardiovascular events and stent thrombosis.
One in four older patients with atrial fibrillation who have had an acute myocardial infarction
receives triple therapy.
A risk of intracranial hemorrhage that is two times as high as the risk with dual antiplatelet
therapy.
19. Shortening the course of triple therapy does not substantially reduce the bleeding risk.
Triple therapy may prevent ischemic events, it also has the potential to cause considerable
harm in many patients.
In the PIONEER AF-PCI trial, dual therapy with rivaroxaban was associated with lower risks
of Thrombolysis in Myocardial Infarction (TIMI) major and minor bleeding than was triple
therapy with warfarin.
Duration of triple therapy and the anticoagulants used in each study (warfarin in the WOEST
trial, rivaroxaban in the PIONEER AF-PCI trial, and dabigatran in the RE-DUAL PCI trial)
20.
21. Clinical Significance of Atrial Fibrillation Status in Patients
With Percutaneous Coronary Intervention
Approximately 5%-10% of patients who underwent percutaneous coronary intervention (PCI)
or had acute coronary syndrome (ACS) have concomitant AF.
Concomitant AF is associated not only with hemodynamic compromise, but also other
multifactor comorbidities.
these patients typically require both anticoagulation and antiplatelet therapies.
22. Kinjo et al. assessed the prognostic significant of AF and atrial flutter in patients with acute MI
that had been treated with PCI. In their study, patients with AF were older, were in higher
Killip classes, had higher rates of previous MI and previous cerebrovascular accident, had
systolic blood pressures of < 100 mmHg and heart rates ≥ 100 beats/min, were less likely to
smoke, and had higher prevalence of multivessel disease and poorer reperfusion of infarct-
related artery than those without AF.
AF was a common complication in patients with MI who were treated with PCI and
independently influenced 1-year mortality.
Cardiogenic shock, congestive heart failure, cardiac rupture, ventricular tachycardia and/or
ventricular fibrillation, and stroke occurred more often in patients with AF than in those
without AF
23. Patients with AF had a greater incidence of death due to pump failure than those without AF.
A higher risk of mortality; a deterioration in haemodynamics due to increased heart rate, loss of
atrioventricular synchrony, and progressive dysfunction of the left atrium and left ventricle;
and stroke and other embolic events resulting from atrial thrombi.
Several kind of arrhythmias, especially ventricular arrhythmias and conduction disturbances,
can occur during PCI. These arrhythmias may result from excess catheter manipulation,
intracoronary dye injection, new ischaemic events, or reperfusion injury. Lethal ventricular
arrhythmias, including serious ventricular tachycardia and ventricular fibrillation, have been
reported to occur in 1.5–4.4% of patients undergoing coronary angioplasty.
24. The frequency of these arrhythmias after primary PCI was analyzed in a study of
3065 patients.
Ventricular arrhythmias occurred in 133 patients (4.3%).
Smoking, lack of pre-procedural beta-blockers, shorter time from symptom onset to
emergency room arrival, initial TIMI flow grade 0, and infarct of the right coronary
artery were variables independently associated with a risk of serious ventricular
arrhythmias
25.
26.
27.
28. Both prevalent AF and incident AF were associated with worse crude outcomes and
complications during hospitalization.
AF is increasing as the society ages and is associated with numerous risk factors, such as
smoking, alcohol consumption, obesity, hypertension, diabetes, and history of heart failure or
myocardial infarction. Therefore, AF was common in patients who underwent PCI, including
those with ACS, who represented a high-risk group.
Patients with PCI were identified and classified into 3 groups according to AF status: no AF,
prevalent AF before admission, and incident AF after admission.
30. Mr. GUNAPANDIYAN V, 44 years old gentleman, Now admitted for CAG + PCI TO LAD/
LCX AND OM.
31. TYPE 2 DIABETES MELLITUS – 7 years
SYSTEMIC HYPERTENSION - 7 years
RHD
SEVERE MS WITH PHT
S/P MVR(2013)- SJM MECHANICAL (27MM)
RECENT NSTEMI
S/P CAG (2/12/2021)- TRIPLE VESSEL DISEASE.
CAD- S/P PCI TO CULPRIT LAD WITH RESOLUTE ONYX STENT/ POBA TO RAMUS AND
DISTAL LAD
MILD LV DYSFUNCTION, EF- 50%
CAG (10/12/22)- TRIPLE VESSEL DISEASE WITH 90% TSR ND LAD STENT, DISTAL CTO
OF CAD WITH TOTAL OCCLUSION.
ADHOC PCI (10/12/22)- WITH 3.0MM X 28MM XIENCE ALPINE DES TO LAD, 2.0MM X
28MM XIENCE ALPINE DES TO OM2 AND WITH 2.75MM X 18MM XIENCE ALPINE DES TO
LCX.
33. Triple therapy (TT) indications:
Atrial fibrillation at moderate to high thromboembolic risk, mechanical heart valves, previous
cardiogenic thromboembolism and recent deep vein thrombosis or pulmonary embolism
Owing to the superior efficacy of VKA compared to dual antiplatelet therapy (DAPT)
TT with VKA, aspirin and clopidogrel is regarded as the optimal antithrombotic regimen in
patients with an indication for VKA undergoing PCI-S.
TT is associated with the lowest incidence of stroke compared to DAPT or the combination of
VKA and a single antiplatelet agent.
34. Drug-eluting stents are generally not implanted, owing to the need for prolonged clopidogrel,
and hence TT, administration.
When drug-eluting stent implantation is clinically necessary, the use of newer generation drug-
eluting stents (especially polymer-free) that exhibit accelerated re endothelization is preferred