Why should we measure endothelial functionEndothelix
This document discusses the importance of measuring endothelial function for cardiovascular risk assessment. It begins with background on cardiovascular disease being the leading cause of death globally and the problems with traditional risk assessment based only on risk factors. It then discusses how endothelial dysfunction underlies many disease states and can serve as an integrated measure of risk. The document reviews different techniques for measuring endothelial function, including flow-mediated dilation of the brachial artery. It argues that a comprehensive cardiovascular risk assessment should include measures of both subclinical disease and endothelial function.
Remote Ischemic Conditioning - Dr. Robert KlonerEndothelix
This document summarizes a presentation on ischemic conditioning and myocardial infarction. It discusses how brief periods of ischemia can protect the heart from subsequent longer periods of ischemia, known as preconditioning. Studies in animal models and clinical trials show remote ischemic conditioning, using brief ischemia in another part of the body like a limb, can protect the heart. Remote ischemic conditioning reduced infarct size and improved outcomes in patients having a heart attack or undergoing procedures like bypass surgery. Ongoing clinical trials are investigating remote ischemic conditioning for other conditions involving ischemia in organs like the brain and kidneys.
Clinical Implications of Ischemic Pre and PostconditioningMohamed Hamoda
This document discusses ischemic preconditioning and postconditioning. It defines preconditioning as brief periods of sublethal ischemia that protect the heart from subsequent ischemia. Postconditioning involves brief coronary occlusions after reperfusion to reduce injury. Mechanisms involve preserving mitochondria and reducing oxidative stress. Human studies show preconditioning reduces infarct size with angina or repeated balloon inflations. Drugs like adenosine may induce preconditioning. Postconditioning involves similar pathways and reduces infarct size in heart attacks. Both techniques aim to reduce cardiac damage from ischemia and reperfusion injury.
This document discusses various strategies for cardioprotection and reducing myocardial injury during ischemia and reperfusion. It introduces ischemic preconditioning, postconditioning, and remote ischemic conditioning as methods to reduce infarct size. Ischemic preconditioning involves brief episodes of ischemia and reperfusion to protect the heart. Postconditioning involves intermittent reperfusion during primary PCI. Remote ischemic conditioning uses brief limb ischemia to protect the heart from afar. The document discusses the signaling pathways and clinical evidence for these conditioning strategies. It also reviews pharmacological approaches like antioxidants, sodium-hydrogen exchange inhibitors, and adenosine to limit reperfusion injury.
This book is an edited collection on the topic of myocardial protection during cardiac surgery. It contains 34 chapters written by experts in the field covering the history and current strategies for protecting the heart during procedures. The editors are Tomas A. Salerno and Marco Ricci from the University of Miami.
This document discusses ischemic preconditioning and postconditioning. It defines ischemic preconditioning as brief episodes of myocardial ischemia that increase the heart's ability to tolerate subsequent prolonged ischemia. Brief periods of ischemia prior to a longer period of ischemia can reduce infarct size and arrhythmias. Ischemic postconditioning involves brief reperfusion/re-occlusion cycles at the end of prolonged ischemia and can also reduce infarct size. The mechanisms of protection involve triggers, transducers, and end effectors at the myocyte level. Clinical studies provide evidence that ischemic preconditioning and postconditioning improve outcomes for patients experiencing myocardial ischemia.
This document is the preface to a book titled "New Solutions for the Heart: An Update in Advanced Perioperative Protection". The preface discusses the motivation for creating the book, which was to provide a comprehensive summary of myocardial protection during cardiac surgery since the topic had not been covered in over 15 years. The editors, Bruno Podesser and David Chambers, recruited leading clinicians and scientists in the field of myocardial protection to contribute chapters on topics ranging from the history of cardioplegia to new technologies and approaches. The preface expresses the hope that the book will stimulate further research in myocardial protection to benefit cardiac surgery patients.
postgraduate education for cardiothoracic anaesthesia and intensive care doctors in cardiac operations on patients with unstable ischemic heart disease
Why should we measure endothelial functionEndothelix
This document discusses the importance of measuring endothelial function for cardiovascular risk assessment. It begins with background on cardiovascular disease being the leading cause of death globally and the problems with traditional risk assessment based only on risk factors. It then discusses how endothelial dysfunction underlies many disease states and can serve as an integrated measure of risk. The document reviews different techniques for measuring endothelial function, including flow-mediated dilation of the brachial artery. It argues that a comprehensive cardiovascular risk assessment should include measures of both subclinical disease and endothelial function.
Remote Ischemic Conditioning - Dr. Robert KlonerEndothelix
This document summarizes a presentation on ischemic conditioning and myocardial infarction. It discusses how brief periods of ischemia can protect the heart from subsequent longer periods of ischemia, known as preconditioning. Studies in animal models and clinical trials show remote ischemic conditioning, using brief ischemia in another part of the body like a limb, can protect the heart. Remote ischemic conditioning reduced infarct size and improved outcomes in patients having a heart attack or undergoing procedures like bypass surgery. Ongoing clinical trials are investigating remote ischemic conditioning for other conditions involving ischemia in organs like the brain and kidneys.
Clinical Implications of Ischemic Pre and PostconditioningMohamed Hamoda
This document discusses ischemic preconditioning and postconditioning. It defines preconditioning as brief periods of sublethal ischemia that protect the heart from subsequent ischemia. Postconditioning involves brief coronary occlusions after reperfusion to reduce injury. Mechanisms involve preserving mitochondria and reducing oxidative stress. Human studies show preconditioning reduces infarct size with angina or repeated balloon inflations. Drugs like adenosine may induce preconditioning. Postconditioning involves similar pathways and reduces infarct size in heart attacks. Both techniques aim to reduce cardiac damage from ischemia and reperfusion injury.
This document discusses various strategies for cardioprotection and reducing myocardial injury during ischemia and reperfusion. It introduces ischemic preconditioning, postconditioning, and remote ischemic conditioning as methods to reduce infarct size. Ischemic preconditioning involves brief episodes of ischemia and reperfusion to protect the heart. Postconditioning involves intermittent reperfusion during primary PCI. Remote ischemic conditioning uses brief limb ischemia to protect the heart from afar. The document discusses the signaling pathways and clinical evidence for these conditioning strategies. It also reviews pharmacological approaches like antioxidants, sodium-hydrogen exchange inhibitors, and adenosine to limit reperfusion injury.
This book is an edited collection on the topic of myocardial protection during cardiac surgery. It contains 34 chapters written by experts in the field covering the history and current strategies for protecting the heart during procedures. The editors are Tomas A. Salerno and Marco Ricci from the University of Miami.
This document discusses ischemic preconditioning and postconditioning. It defines ischemic preconditioning as brief episodes of myocardial ischemia that increase the heart's ability to tolerate subsequent prolonged ischemia. Brief periods of ischemia prior to a longer period of ischemia can reduce infarct size and arrhythmias. Ischemic postconditioning involves brief reperfusion/re-occlusion cycles at the end of prolonged ischemia and can also reduce infarct size. The mechanisms of protection involve triggers, transducers, and end effectors at the myocyte level. Clinical studies provide evidence that ischemic preconditioning and postconditioning improve outcomes for patients experiencing myocardial ischemia.
This document is the preface to a book titled "New Solutions for the Heart: An Update in Advanced Perioperative Protection". The preface discusses the motivation for creating the book, which was to provide a comprehensive summary of myocardial protection during cardiac surgery since the topic had not been covered in over 15 years. The editors, Bruno Podesser and David Chambers, recruited leading clinicians and scientists in the field of myocardial protection to contribute chapters on topics ranging from the history of cardioplegia to new technologies and approaches. The preface expresses the hope that the book will stimulate further research in myocardial protection to benefit cardiac surgery patients.
postgraduate education for cardiothoracic anaesthesia and intensive care doctors in cardiac operations on patients with unstable ischemic heart disease
Broken Heart Syndrome: Cardiovascular Manifestations of Traumatic Brain InjuryAmit Agrawal
This document summarizes cardiovascular complications that can occur following traumatic brain injury (TBI). Up to 15.7% of patients with severe TBI can develop left ventricular dysfunction and wall motion abnormalities due to increased sympathetic activity and catecholamine release after brain injury. This can cause hypotension, hypertension, arrhythmias, and myocardial injury. ECG changes, echocardiogram abnormalities, and elevated biomarkers of cardiac injury have been documented following TBI. While the exact mechanisms are not fully understood, autonomic dysfunction and systemic inflammation following TBI can directly or indirectly impact cardiovascular function. Treatment involves optimizing hemodynamics and treating the underlying brain injury, as the cardiac abnormalities are often transient.
1) Early revascularization through either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) improves survival rates in patients with cardiogenic shock compared to medical therapy alone.
2) There is ongoing debate about whether culprit vessel-only PCI or multivessel PCI is better for patients with cardiogenic shock and multivessel coronary artery disease. Current guidelines recommend culprit vessel PCI initially except in certain high-risk situations.
3) An integrated approach is needed using early revascularization, inotropic support, and potentially mechanical circulatory support, with involvement of multiple specialists. Cardiogenic shock continues to pose major challenges in acute cardiac care.
A 30-year-old man presented to the emergency department with palpitations and a heart rate over 200 beats per minute. He had a history of similar symptoms previously diagnosed as supraventricular tachycardia. Initial treatments including adenosine, cardioversion, metoprolol, and diltiazem slowed the heart rate but did not terminate the arrhythmia. The patient was diagnosed with idiopathic fascicular left ventricular tachycardia based on changes in QRS morphology and axis compared to sinus rhythm as well as evidence of AV dissociation. Verapamil was recommended as the next treatment as it specifically targets the calcium channels involved in this type of arrhythmia, unlike other treatments tried.
This literature review summarizes the clinical characteristics of myocardial stunning (neurogenic stunned myocardium or NSM) seen in patients after acute ischemic stroke. The review identified 7 case reports/series describing a total of 13 patients with NSM following stroke. Key findings include that NSM after stroke was more common in older females, with involvement of the left ventricle apex. Less than half of cases involved the insular cortex. Troponin levels and left ventricular dysfunction were typically mild. Most patients showed significant left ventricular recovery within 4 weeks, indicating a generally favorable prognosis. However, larger prospective studies are still needed.
The document describes RIFLE classification of acute kidney injury and discusses risk factors, causes, prediction, prevention and management of AKI after cardiac surgery. It also examines biomarkers used for early diagnosis of AKI and notes that continuous renal replacement therapy is often preferred over other modalities for treating AKI patients in the intensive care unit.
In this ppt, I am going to discuss the role of ICD in the patient with Non-ischemic cardiomyopathy. I am going to discuss all the major trials done in the patient with non-ischemic cardiomyopathy.
Devices and intervention in heart failure.drucsamal
- The document discusses the speaker's receipt of honoraria and research support from numerous pharmaceutical and device companies.
- It summarizes several journal articles and studies related to left ventricular remodeling post-myocardial infarction, baroreflex activation therapy for heart failure, and the effects of bi-ventricular pacing on left ventricular ejection fraction and end-systolic volume.
- Key findings from the PACE trial are highlighted showing improvements in left ventricular ejection fraction and end-systolic volume up to 2 years with bi-ventricular pacing compared to right ventricular pacing alone.
1) A study of 900 older adults found that myocardial fibrosis detected by cardiac magnetic resonance (CMR) imaging was common, with myocardial infarction detected in 211 patients, major non-ischemic fibrosis in 54 patients, and minor non-ischemic fibrosis in 238 patients.
2) Patients with major non-ischemic fibrosis detected by CMR had a poorer prognosis than those without late gadolinium enhancement.
3) A study comparing outcomes of unrecognized myocardial infarction detected by CMR versus recognized myocardial infarction found that all-cause mortality was lower in those with unrecognized infarction for at least 5 years.
Ventricular septal rupture with cardiogenic shock follows by Inferior AMIHan Naung Tun
This document describes the case of a 58-year-old man who presented with chest pain and was diagnosed with an inferoposterior myocardial infarction complicated by ventricular septal rupture and cardiogenic shock. Initial treatment included medications, percutaneous coronary intervention to open the blocked artery, and supportive care. Despite intensive medical management, the patient's condition deteriorated with the development of ventricular septal defect. Surgical repair was considered but the patient expired from cardiogenic shock before a procedure could be performed. The key learning points are the importance of early recognition of pre-shock states, the high mortality of ventricular septal rupture, and the need for a multidisciplinary approach and care at an experienced center to manage such complex cases.
How to assess reversible ischemia in lv dysfunctiondrucsamal
Andres Iñiguez presented on assessing reversible ischemia in left ventricular dysfunction. The optimal treatment for severe coronary artery disease and reduced left ventricular function is controversial, with debate around whether revascularization by CABG or PCI improves survival in patients with left ventricular dysfunction. The STICH trial found no significant difference in mortality between medical therapy alone versus medical therapy plus CABG, though patients with viable myocardium had lower mortality. Complete revascularization is recommended when viable myocardium is present. Worse left ventricular function predicts higher mortality, especially for PCI in STEMI patients, though the impact of dysfunction on mortality is attenuated in elderly patients. New onset congestive heart failure after revascularization is linked to higher mortality rates. Hemodynamic support during
The document discusses several studies related to cardiology. It summarizes the key findings of each study in 1-2 sentences. Some of the studies discussed include:
- A study finding that whole genome sequencing identified genetic risk factors like familial hypercholesterolemia in 1.7% of acute myocardial infarction patients under 55 and a high polygenic risk score in 17% of patients.
- A study finding that plasma levels of the metabolite TMAO were higher in STEMI patients with plaque rupture compared to erosion and may be a novel biomarker for plaque morphology.
- The ALERTS trial which found that an implantable cardiac alert system safely detected rapid ST segment changes but did not meet its
Management of anticoagulation in lvad recipientsdrucsamal
This document discusses management of anticoagulation for patients receiving left ventricular assist devices (LVADs). It notes that thrombosis is a major problem for LVADs. Under-anticoagulation is thought to be a key cause of pump thrombosis. The relationship between activated partial thromboplastin time (aPTT) and anti-Xa levels is poor in LVAD patients on warfarin compared to heart failure patients, indicating aPTT may not accurately reflect anticoagulation levels in LVAD patients. Future directions include further evaluating the role of anti-platelet agents and factors like blood type and hyperco
Suporte circulatório mecânico em ICC em pediatriagisa_legal
This document discusses mechanical circulatory support options for acute cardiac failure in children. It describes:
1) Intra-aortic balloon counterpulsation which provides limited left ventricular support but is limited by high arrhythmia rates in children and inability to support biventricular failure.
2) Extracorporeal membrane oxygenation which can replace both heart and lung function through venoarterial cannulation and has shown survival rates of 30-70% depending on diagnosis.
3) Ventricular assist devices which can replace either or both ventricular functions and avoid the need for prolonged ventilation as with ECMO but are limited to larger children due to device size requirements.
Revascularization in heart faliure seminarAnkit Jain
This document discusses revascularization in patients with heart failure due to coronary artery disease and residual left ventricular dysfunction. It provides details on myocardial hibernation and stunning - two states of sustained contractile dysfunction despite viable myocardium. Revascularization can lead to improved survival and reverse remodeling in such patients if a sufficient amount of viable myocardium is present. Techniques to assess myocardial viability include stress echocardiography, nuclear imaging with SPECT or PET, and cardiac magnetic resonance. Revascularization is recommended for patients who have viability in at least 25% of the left ventricular segments.
Angioplasty outcomes in chronic kidney disease - a literature reviewJunhao Koh
1) Chronic kidney disease (CKD) is associated with more severe and diffuse coronary artery disease (CAD) due to increased inflammation and oxidative stress in CKD patients.
2) Outcomes of percutaneous coronary intervention (PCI) are generally worse in CKD patients compared to those without CKD, with higher mortality rates.
3) For stable CAD, PCI may be considered for CKD patients with significant lesions but is associated with higher risk of major adverse cardiac events compared to patients without CKD.
An Integrated Understanding of Pressure and Flow – An Essential PartnershipInsideScientific
A tightly controlled relationship between blood pressure and organ blood flow is vital for matching an organ’s metabolic needs to the delivery of oxygen and nutrients. However, the nature of the pressure-flow relationship is complex and governed by multiple control systems, including local autoregulatory mechanisms at the level of the individual organ, as well as neural and hormonal modulation. To fully understand how pressure-flow relationships operate in health, and may be altered in pathological settings, it is essential to make direct, long-term assessments of blood pressure and blood flow under normal physiological conditions (ie in the conscious state).
In this presentation, Dr. McBryde shares insights from her studies of how the relationship between blood pressure and blood flow is altered in hypertension, to “consumer” organs such as the brain, and to “supply” circulations such as the mesenteric venous pool. She also discusses the variables that go into gathering accurate measurements of these two parameters in a lab setting.
Cabg is superior to pci in heart failure patients with multivessel disease co...drucsamal
PCI is a good alternative to CABG for revascularization in patients with heart failure and viable myocardium. Revascularization of viable myocardium may improve left ventricular function and remodeling, as well as quality of life and survival. While CABG is technically straightforward and evidence-based, PCI has less risk for patients with heart failure despite being technically challenging. More research is still needed comparing PCI to CABG and medical therapy alone for chronic heart failure. Treatment must be individualized based on patient characteristics and local clinical expertise.
FOURIER: estudio de eventos cardiovasculares con evolocumab
30/03/2017 18:30h Casa del Corazón, Madrid
http://evolocumab.secardiologia.es
#evolocumab
Se abordarán los siguientes temas:
Presentación de resultados del estudio FOURIER
Interpretación de los datos en el contexto actual
Traslación clínica y aplicabilidad de los resultados
Coloquio y preguntas del público
A 77-year-old female presented to the emergency department with difficulty breathing and was found to have pulmonary edema and left ventricular hypertrophy. During her hospital stay, a carotid bruit was discovered and Doppler ultrasound revealed 80-99% stenosis of the right carotid artery. She was scheduled for a right carotid endarterectomy to address the high-grade stenosis, a procedure she tolerated well without complications. Medical management has improved for asymptomatic carotid stenosis but intervention may still benefit high-risk patients.
This document summarizes Dicky Aligheri's experience with hybrid procedures for aortic arch involvement between 2013-2014 at the National Cardiac & Vascular Centre Harapan Kita in Jakarta. It describes several case studies of patients who received treatments like total arch replacement, hemi arch replacement, and the frozen elephant trunk procedure. It also reviews literature on debates around the best surgical strategies for aortic arch pathology and the safety and efficacy of hybrid techniques compared to open surgery.
Broken Heart Syndrome: Cardiovascular Manifestations of Traumatic Brain InjuryAmit Agrawal
This document summarizes cardiovascular complications that can occur following traumatic brain injury (TBI). Up to 15.7% of patients with severe TBI can develop left ventricular dysfunction and wall motion abnormalities due to increased sympathetic activity and catecholamine release after brain injury. This can cause hypotension, hypertension, arrhythmias, and myocardial injury. ECG changes, echocardiogram abnormalities, and elevated biomarkers of cardiac injury have been documented following TBI. While the exact mechanisms are not fully understood, autonomic dysfunction and systemic inflammation following TBI can directly or indirectly impact cardiovascular function. Treatment involves optimizing hemodynamics and treating the underlying brain injury, as the cardiac abnormalities are often transient.
1) Early revascularization through either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) improves survival rates in patients with cardiogenic shock compared to medical therapy alone.
2) There is ongoing debate about whether culprit vessel-only PCI or multivessel PCI is better for patients with cardiogenic shock and multivessel coronary artery disease. Current guidelines recommend culprit vessel PCI initially except in certain high-risk situations.
3) An integrated approach is needed using early revascularization, inotropic support, and potentially mechanical circulatory support, with involvement of multiple specialists. Cardiogenic shock continues to pose major challenges in acute cardiac care.
A 30-year-old man presented to the emergency department with palpitations and a heart rate over 200 beats per minute. He had a history of similar symptoms previously diagnosed as supraventricular tachycardia. Initial treatments including adenosine, cardioversion, metoprolol, and diltiazem slowed the heart rate but did not terminate the arrhythmia. The patient was diagnosed with idiopathic fascicular left ventricular tachycardia based on changes in QRS morphology and axis compared to sinus rhythm as well as evidence of AV dissociation. Verapamil was recommended as the next treatment as it specifically targets the calcium channels involved in this type of arrhythmia, unlike other treatments tried.
This literature review summarizes the clinical characteristics of myocardial stunning (neurogenic stunned myocardium or NSM) seen in patients after acute ischemic stroke. The review identified 7 case reports/series describing a total of 13 patients with NSM following stroke. Key findings include that NSM after stroke was more common in older females, with involvement of the left ventricle apex. Less than half of cases involved the insular cortex. Troponin levels and left ventricular dysfunction were typically mild. Most patients showed significant left ventricular recovery within 4 weeks, indicating a generally favorable prognosis. However, larger prospective studies are still needed.
The document describes RIFLE classification of acute kidney injury and discusses risk factors, causes, prediction, prevention and management of AKI after cardiac surgery. It also examines biomarkers used for early diagnosis of AKI and notes that continuous renal replacement therapy is often preferred over other modalities for treating AKI patients in the intensive care unit.
In this ppt, I am going to discuss the role of ICD in the patient with Non-ischemic cardiomyopathy. I am going to discuss all the major trials done in the patient with non-ischemic cardiomyopathy.
Devices and intervention in heart failure.drucsamal
- The document discusses the speaker's receipt of honoraria and research support from numerous pharmaceutical and device companies.
- It summarizes several journal articles and studies related to left ventricular remodeling post-myocardial infarction, baroreflex activation therapy for heart failure, and the effects of bi-ventricular pacing on left ventricular ejection fraction and end-systolic volume.
- Key findings from the PACE trial are highlighted showing improvements in left ventricular ejection fraction and end-systolic volume up to 2 years with bi-ventricular pacing compared to right ventricular pacing alone.
1) A study of 900 older adults found that myocardial fibrosis detected by cardiac magnetic resonance (CMR) imaging was common, with myocardial infarction detected in 211 patients, major non-ischemic fibrosis in 54 patients, and minor non-ischemic fibrosis in 238 patients.
2) Patients with major non-ischemic fibrosis detected by CMR had a poorer prognosis than those without late gadolinium enhancement.
3) A study comparing outcomes of unrecognized myocardial infarction detected by CMR versus recognized myocardial infarction found that all-cause mortality was lower in those with unrecognized infarction for at least 5 years.
Ventricular septal rupture with cardiogenic shock follows by Inferior AMIHan Naung Tun
This document describes the case of a 58-year-old man who presented with chest pain and was diagnosed with an inferoposterior myocardial infarction complicated by ventricular septal rupture and cardiogenic shock. Initial treatment included medications, percutaneous coronary intervention to open the blocked artery, and supportive care. Despite intensive medical management, the patient's condition deteriorated with the development of ventricular septal defect. Surgical repair was considered but the patient expired from cardiogenic shock before a procedure could be performed. The key learning points are the importance of early recognition of pre-shock states, the high mortality of ventricular septal rupture, and the need for a multidisciplinary approach and care at an experienced center to manage such complex cases.
How to assess reversible ischemia in lv dysfunctiondrucsamal
Andres Iñiguez presented on assessing reversible ischemia in left ventricular dysfunction. The optimal treatment for severe coronary artery disease and reduced left ventricular function is controversial, with debate around whether revascularization by CABG or PCI improves survival in patients with left ventricular dysfunction. The STICH trial found no significant difference in mortality between medical therapy alone versus medical therapy plus CABG, though patients with viable myocardium had lower mortality. Complete revascularization is recommended when viable myocardium is present. Worse left ventricular function predicts higher mortality, especially for PCI in STEMI patients, though the impact of dysfunction on mortality is attenuated in elderly patients. New onset congestive heart failure after revascularization is linked to higher mortality rates. Hemodynamic support during
The document discusses several studies related to cardiology. It summarizes the key findings of each study in 1-2 sentences. Some of the studies discussed include:
- A study finding that whole genome sequencing identified genetic risk factors like familial hypercholesterolemia in 1.7% of acute myocardial infarction patients under 55 and a high polygenic risk score in 17% of patients.
- A study finding that plasma levels of the metabolite TMAO were higher in STEMI patients with plaque rupture compared to erosion and may be a novel biomarker for plaque morphology.
- The ALERTS trial which found that an implantable cardiac alert system safely detected rapid ST segment changes but did not meet its
Management of anticoagulation in lvad recipientsdrucsamal
This document discusses management of anticoagulation for patients receiving left ventricular assist devices (LVADs). It notes that thrombosis is a major problem for LVADs. Under-anticoagulation is thought to be a key cause of pump thrombosis. The relationship between activated partial thromboplastin time (aPTT) and anti-Xa levels is poor in LVAD patients on warfarin compared to heart failure patients, indicating aPTT may not accurately reflect anticoagulation levels in LVAD patients. Future directions include further evaluating the role of anti-platelet agents and factors like blood type and hyperco
Suporte circulatório mecânico em ICC em pediatriagisa_legal
This document discusses mechanical circulatory support options for acute cardiac failure in children. It describes:
1) Intra-aortic balloon counterpulsation which provides limited left ventricular support but is limited by high arrhythmia rates in children and inability to support biventricular failure.
2) Extracorporeal membrane oxygenation which can replace both heart and lung function through venoarterial cannulation and has shown survival rates of 30-70% depending on diagnosis.
3) Ventricular assist devices which can replace either or both ventricular functions and avoid the need for prolonged ventilation as with ECMO but are limited to larger children due to device size requirements.
Revascularization in heart faliure seminarAnkit Jain
This document discusses revascularization in patients with heart failure due to coronary artery disease and residual left ventricular dysfunction. It provides details on myocardial hibernation and stunning - two states of sustained contractile dysfunction despite viable myocardium. Revascularization can lead to improved survival and reverse remodeling in such patients if a sufficient amount of viable myocardium is present. Techniques to assess myocardial viability include stress echocardiography, nuclear imaging with SPECT or PET, and cardiac magnetic resonance. Revascularization is recommended for patients who have viability in at least 25% of the left ventricular segments.
Angioplasty outcomes in chronic kidney disease - a literature reviewJunhao Koh
1) Chronic kidney disease (CKD) is associated with more severe and diffuse coronary artery disease (CAD) due to increased inflammation and oxidative stress in CKD patients.
2) Outcomes of percutaneous coronary intervention (PCI) are generally worse in CKD patients compared to those without CKD, with higher mortality rates.
3) For stable CAD, PCI may be considered for CKD patients with significant lesions but is associated with higher risk of major adverse cardiac events compared to patients without CKD.
An Integrated Understanding of Pressure and Flow – An Essential PartnershipInsideScientific
A tightly controlled relationship between blood pressure and organ blood flow is vital for matching an organ’s metabolic needs to the delivery of oxygen and nutrients. However, the nature of the pressure-flow relationship is complex and governed by multiple control systems, including local autoregulatory mechanisms at the level of the individual organ, as well as neural and hormonal modulation. To fully understand how pressure-flow relationships operate in health, and may be altered in pathological settings, it is essential to make direct, long-term assessments of blood pressure and blood flow under normal physiological conditions (ie in the conscious state).
In this presentation, Dr. McBryde shares insights from her studies of how the relationship between blood pressure and blood flow is altered in hypertension, to “consumer” organs such as the brain, and to “supply” circulations such as the mesenteric venous pool. She also discusses the variables that go into gathering accurate measurements of these two parameters in a lab setting.
Cabg is superior to pci in heart failure patients with multivessel disease co...drucsamal
PCI is a good alternative to CABG for revascularization in patients with heart failure and viable myocardium. Revascularization of viable myocardium may improve left ventricular function and remodeling, as well as quality of life and survival. While CABG is technically straightforward and evidence-based, PCI has less risk for patients with heart failure despite being technically challenging. More research is still needed comparing PCI to CABG and medical therapy alone for chronic heart failure. Treatment must be individualized based on patient characteristics and local clinical expertise.
FOURIER: estudio de eventos cardiovasculares con evolocumab
30/03/2017 18:30h Casa del Corazón, Madrid
http://evolocumab.secardiologia.es
#evolocumab
Se abordarán los siguientes temas:
Presentación de resultados del estudio FOURIER
Interpretación de los datos en el contexto actual
Traslación clínica y aplicabilidad de los resultados
Coloquio y preguntas del público
A 77-year-old female presented to the emergency department with difficulty breathing and was found to have pulmonary edema and left ventricular hypertrophy. During her hospital stay, a carotid bruit was discovered and Doppler ultrasound revealed 80-99% stenosis of the right carotid artery. She was scheduled for a right carotid endarterectomy to address the high-grade stenosis, a procedure she tolerated well without complications. Medical management has improved for asymptomatic carotid stenosis but intervention may still benefit high-risk patients.
This document summarizes Dicky Aligheri's experience with hybrid procedures for aortic arch involvement between 2013-2014 at the National Cardiac & Vascular Centre Harapan Kita in Jakarta. It describes several case studies of patients who received treatments like total arch replacement, hemi arch replacement, and the frozen elephant trunk procedure. It also reviews literature on debates around the best surgical strategies for aortic arch pathology and the safety and efficacy of hybrid techniques compared to open surgery.
This patient is a 74-year-old Thai woman who presented with worsening low back pain and fever. MRI showed discitis and spondylitis at L2-L3 with an epidural abscess, psoas abscess, and paravertebral abscesses. Culture of pus from the psoas abscess grew Streptococcus constellatus. She underwent laminectomy and abscess drainage. Her symptoms improved with long-term antibiotic treatment.
Although large efforts are spent for creating fistula as the primary access, use of Hemodialysis Vascular catheters are still the major access on the first Hemodialysis session and after 4 month whether we would like it or not.
"USRDS 2013"
Perioperative evaluation of difficult clinical scenarios which prompted to delay of surgery:
- Undiagnosed aortic regurgitation
- Pleural effusion with suspected TB
Innovations in Percutaneous Intervention, 1977-2007. Slides created by Simon H. Stertzer, MD, FACC, FAHA, Professor Emeritus, Stanford University School of Medicine.
2016: National Acute Stroke Protocol Standard of Care and Emerging Technology...SDGWEP
1. The document outlines the national acute stroke protocol presented by Dr. Thomas Osborne.
2. It discusses evaluating patients based on symptoms and history, administering tPA within 3 hours of onset based on CT exclusion criteria, and using imaging to identify tissue at risk of infarction.
3. Advanced technologies like perfusion imaging are helping shift from a time-based to physiology-based approach by identifying the ischemic core and penumbra.
This editorial discusses cardiac resynchronization therapy (CRT) and the appropriate patient population for this treatment. It summarizes a recent randomized trial that studied CRT in patients with narrow QRS complexes (<120 ms). The editorial concludes that CRT is not an effective treatment for patients with narrow QRS, as large randomized controlled trials have shown benefit of CRT only in patients with left bundle branch block and QRS duration >150 ms. The appropriate substrate for CRT is left ventricular dyssynchrony due to prolonged QRS duration, especially left bundle branch block.
This document discusses a potential new treatment for hypoplastic left heart syndrome (HLHS) using human umbilical cord blood mononuclear stem cells. The authors hypothesize that HLHS is caused by heterogeneous mutations affecting cardiac myocyte development and growth. They propose that an intramyocardial injection of mononuclear stem cells derived from human umbilical cord blood could safely and effectively treat HLHS by altering gene expression and reversing the genetic mutations. Studies in animal models show this stem cell therapy improves heart function without safety issues, offering a less invasive alternative to current surgical treatments.
1) The document discusses various echocardiography techniques to assess fluid responsiveness in critically ill patients, including measuring changes in stroke volume, velocity time integral, and inferior vena cava diameter and collapsibility in response to passive leg raises or mini-fluid boluses.
2) Key techniques mentioned are measuring stroke volume variation (SVV) or pulse pressure variation (PPV), which can predict fluid responsiveness if above 12%, and observing changes in velocity time integral during end-expiratory and end-inspiratory occlusion tests, with a change over 13% predicting a fluid response.
3) Measuring inferior vena cava collapsibility or distensibility is also discussed, with values
John N. Hill is a cardiologist who has over 30 years of experience. He obtained his medical degree in 1983 and completed fellowships in cardiology and cardiac electrophysiology. He has held numerous academic and clinical positions including Director of Clinical Cardiac Pacing and Electrophysiology. He has extensive teaching experience and has published over 20 papers. His interests include tennis, cars, and aircraft.
This document summarizes two studies on percutaneous left ventricular assist devices (LVADs) and coronary artery fistulas.
The first study investigated the ability of a percutaneous LVAD to deliver blood to the systemic circulation during cardiac arrest in pigs. The LVAD maintained blood flow and preferentially perfused vital organs like the brain. Intensified fluid loading further improved LVAD performance.
The second study evaluated the microvascular effects of ultrasound contrast (Definity) in hamsters with conditions like ischemia-reperfusion, diabetes, and sepsis. Inflammatory responses were higher in diabetes with ischemia and sepsis groups, independent of contrast use. Contrast did not alter hemodynamics or reology.
1. A study of 6,856 patients who received intravenous thrombolysis for acute ischemic stroke from 10 European centers found that treatment within 90 minutes of symptom onset was independently associated with excellent 3-month outcome in patients with moderate (NIHSS 7-12) and mild (NIHSS 0-6) stroke severity.
2. For patients with NIHSS 7-12, treatment within 90 minutes was associated with a 37% higher likelihood of excellent outcome compared to later treatment.
3. For patients with mild symptoms (NIHSS 0-6), treatment within 90 minutes was associated with a 51% higher likelihood of full recovery (mRS=0) to overcome the ceiling effect of spontaneous good recovery
This review article discusses microvascular and macrovascular disease in systemic hypertension. It summarizes that:
1) Cardiac imaging plays a crucial role in risk stratifying hypertensive patients and identifying management strategies by properly diagnosing microvascular and coronary artery disease.
2) The nitric oxide synthase (eNOS) G298 gene allele may be a marker for microvascular angina in hypertensive patients, as studies have found it to be more prevalent in hypertensive patients with chest pain and reversible myocardial defects but normal coronary arteries.
3) Both structural changes like capillary rarefaction and functional changes like endothelial dysfunction can cause microvascular dysfunction and angina in hypertensive individuals in the absence of
Future Inoroivement in Cardiac Regenerative MedicineBudi Pikir
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Similar to Ischemic Conditioning Therapy - A New Path for Treatment of Endothelial Dysfunction and CVD (20)
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Ischemic Conditioning Therapy - A New Path for Treatment of Endothelial Dysfunction and CVD
1. Ischemic Conditioning Therapy:
A New Path for Treatment of
Endothelial Dysfunction
and CVD
Thursday, December 8, 2016, 2PM PST
Co-Presenter:
Morteza Naghavi, M.D.
Chairman of Scientific Advisory Board
16. 40 min occlusion plus 4 hours reperfusion in anesthetized rabbit; Left = control; Right = preconditioned with two 5 min occlusions plus 5 min reperfusion
before the long occlusion. Hale SL, Kloner RA Coronary Artery Disease 1992;3:133-140
17. Michael Rahbek Schmidt, Steen Buus
Kristiansen and Hans Erik Bøtker
Circulation Research. 2013;113:1278-1280
18. Philippe Kolh, M.D., Ph.D.
Service de Cardiochirurgie, CHU Sart
Tilman, B 35 Sart Tilman, Liege 4000,
Belgium
19. Exercise is a natural form of ischemic
conditioning. In other words, ischemic
conditioning is a medical form of exercise.
20. Arterioscler Thromb Vasc Biol. 2007 Jun;27(6)
Repetition of ischemic preconditioning
augments endothelium-pendent vasodilation
in humans: role of endothelium-derived
nitric oxide and endothelial progenitor cells.
Kimura M1, Ueda K, Goto C, Jitsuiki D, Nishioka K, Umemura T, Noma
K, Yoshizumi M, Chayama K, Higashi Y.
Department of Medicine and Molecular Science, Graduate School of Biomedical Sciences,
Hiroshima University, 1-2-3 Kasumi, Mimami-ku, Hiroshima 734-8551, Japan.
21.
22.
23. Figure 1. Comparison of forearm blood flow (FBF) responses to acetylcholine (ACh) at 0
weeks and 4 weeks of follow-up in the control group (A) and in the ischemic preconditioning
untrained (contralateral) arm group (B) and ischemic preconditioning arm group (C).
Masashi Kimura et al. Arterioscler Thromb Vasc Biol.
2007;27:1403-1410
24. Figure 4. Measurement of the number of endothelial progenitor cells by flow cytometry at 0
weeks and 4 weeks of ischemic preconditioning stimuli (top).
Masashi Kimura et al. Arterioscler Thromb Vasc Biol.
2007;27:1403-1410
25. Figure 5. Correlation between maximal forearm blood flow (FBF) response to acetylcholine
(ACh) and number of endothelial progenitor cells at 0 weeks and 4 weeks of ischemic
preconditioning stimuli.
Masashi Kimura et al. Arterioscler Thromb Vasc Biol.
2007;27:1403-1410
26. Atherosclerosis. 2011 Dec;219(2):750-2. doi:
10.1016/j.atherosclerosis.2011.08.046. Epub 2011 Sep 7.
Effect of local and remote isc
hemic preconditioning on
endothelial function in young
people and healthy or
hypertensive elderly people.
Moro L, Pedone C, Mondì A, Nunziata E, Antonelli Incalzi R.
Area di Geriatria, Università Campus Biomedico, Roma, Italy.
27. Moro L, Pedone C, Mondì A, Nunziata E, Antonelli Incalzi R.
37. "We emphasize the critical need to take into account the
presence of cardiovascular risk factors and concomitant
medications when designing preclinical studies for the
identification and validation of cardioprotective drug targets and
clinical studies. This will hopefully maximize the success rate of
developing rational approaches to effective cardioprotective
therapies for the majority of patients with multiple risk factors."
38. The challenge of translating
ischemic conditioning from animal
models to humans: the role of
comorbidities
Kieran McCafferty,§, Suzanne
Forbes*, Christoph Thiemermann
and Muhammad M. Yaqoob
Disease Models & Mechanisms (2014) 7, 1321-1333
39. The rate of tissue deoxygenation differs between individuals.
Near-infrared
Spectroscopy (NIRS)
40. The rate of tissue deoxygenation differs between individuals.
41.
42.
43.
44. Over 4000 articles published since
1986 on Ischemic Conditioning and
its potential benefits
44
Figure 1. Comparison of forearm blood flow (FBF) responses to acetylcholine (ACh) at 0 weeks and 4 weeks of follow-up in the control group (A) and in the ischemic preconditioning untrained (contralateral) arm group (B) and ischemic preconditioning arm group (C).
Figure 4. Measurement of the number of endothelial progenitor cells by flow cytometry at 0 weeks and 4 weeks of ischemic preconditioning stimuli (top). Comparison of the number of endothelial progenitor cells at 0 weeks and 4 weeks of follow-up in the control group and in the ischemic preconditioning untrained (contralateral) arm group and ischemic preconditioning arm group. *P<0.05 vs 0 weeks in the preconditioning group.
Figure 5. Correlation between maximal forearm blood flow (FBF) response to acetylcholine (ACh) and number of endothelial progenitor cells at 0 weeks and 4 weeks of ischemic preconditioning stimuli.