This document discusses the management of end-stage mitral stenosis. It begins with the anatomy and pathology of mitral stenosis, then covers the clinical presentation, diagnosis, complications and treatment options. Surgical intervention is indicated for symptomatic patients who are not candidates for percutaneous mitral balloon valvuloplasty. The options for surgery include open commissurotomy or valve replacement, with the choice of prosthetic or bioprosthetic valve depending on the patient's characteristics and risk of anticoagulation. Intraoperative echocardiography helps guide surgical decisions. Postoperative management focuses on pulmonary hypertension, heart failure and arrhythmias.
Kindly leave your comment if you found this helpful ;)
Some of the slides, i hide it from my real presentations for my own reference. Download to see all of them.
Aortic insufficiency (AI), also known as aortic regurgitation (AR), is the leaking of the aortic valve of the heart that causes blood to flow in the reverse direction
Kindly leave your comment if you found this helpful ;)
Some of the slides, i hide it from my real presentations for my own reference. Download to see all of them.
Aortic insufficiency (AI), also known as aortic regurgitation (AR), is the leaking of the aortic valve of the heart that causes blood to flow in the reverse direction
Echo assesment of Aortic Stenosis and Regurgitationdrpraveen1986
A simple ppt presentation on echo assesment of AS and AR. Don forget to leave a comment if u find this ppt useful. - Dr. Praveen Babu, Vijaya HOspital, Chennai
Complication on avf play significant number of hospitalization & morbidity. Despite fistula first campaign are still beneficial for most patient, gathering knowlege to prevent complication are important.
simple word for future doctor. writing & drawing in pure white paper is always fun & feels like nothing to loose even if we knew that it will last almost forever
in endo era. aortic is one of the industrial driven medical proedure & one of the most expensive. Its morbidity are quoet acceptable, but......... surgeon if the best deal behind this awsome techno
bentall, and 'old' procedures that still valid until present. Bail out for valve sparring & the patology of indonesian most present were best in this procedures
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
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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!
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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
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
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.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
6. Pathology
Studies of the Mitral Valve: II. Certain Anatomic Features of the
Mitral Valve and Associated Structures in Mitral Stenosis
IAN E. RUSTED, CHARLES H. SCHEIFLEY
7. Studies of the Mitral Valve: II. Certain Anatomic Features of the
Mitral Valve and Associated Structures in Mitral Stenosis
IAN E. RUSTED, CHARLES H. SCHEIFLEY
8.
9. Abnormal Valve Function
• Valve Stenosis
– Obstruction to valve flow during that phase of the cardiac cycle when the
valve is normally open.
– Hemodynamic hallmark -“pressure gradient”
• Valve Regurgitation, Insufficiency, Incompetence
– Inadequate valve closure--- back leakage
• A single valve can be both stenotic and regurgitant; but both
lesions cannot be severe!!
• Combinations of valve lesions can coexist
– Single disease process
– Different disease processes
– One valve lesion may cause another
– Certain combinations are particularly burdensome (AS & MR)
11. Mitral Stenosis
History:
History of acute rheumatic fever,
History of murmur
Effort-induced dyspnea
Most common complaint
Often triggered by exertion, fever, anemia, onset of Afib,
or pregnancy
Orthopnea, which progresses to paroxysmal nocturnal
dyspnea
Effort-induced fatigue
Hemoptysis, due to the ruptures of thin dilated bronchial
veins (late finding)
Chest pain due to right ventricular ischemia,
concomitant coronary atherosclerosis, or a coronary
embolism
Thromboembolism may be the first symptom of MS.
Palpitations
Recumbent cough
Physical: The physical examination findings depend on
the advancement of the disease and the degree of
underlying cardiac decompensation.
Peripheral and facial cyanosis
Jugular venous distention
Respiratory distress, evidence of pulmonary edema (eg,
rales)
Diastolic thrill that is palpable over the apex
A loud S1 followed by an S2 and the opening snap are
best heard at the left sternal border.
This is followed by a low-pitched, rumbling, diastolic
murmur, which is heard best over the apex
while the patient is in the left lateral decubitus position.
Murmur may diminish in intensity as the stenosis
increases.
The duration, but
mitral narrowing.
holosystolic murmur
Digital clubbing
Systemic embolization
Signs of right heart failure
pulmonary hypertension
second sound; and a
Graham Steell murmur).
12. Mitral Stenosis
• History
– Asymtomatic Symptmatic
– History of past illness
– Heart Failure
• Physical
– Heart mur-mur
– Heart failure
17. Mitral Stenosis- Clinical Symptoms
• Symptoms related to severity of
MVA reduction-
• Symptoms unrelated to severity of
MS-
– Atrial fibrillation
– Systemic thromboembolism
• Symptoms due to Pulmonary HTN
and RV failure-
– Fatigue, low output state
– Peripheral edema and hepato-
splenomegaly
25. Surgery
for Mitral Stenosis
Class III
1. not indicated for patients with mild MS.
2. Closed commissurotomy should not be
performed in patients undergoing MV
repair; open commissurotomy is the
preferred approach.
Class I
1. symptomatic (NYHA functional class
III–IV) moderate or severe MS* when 1)
percutaneous mitral balloon valvotomy is
unavailable, 2) percutaneous mitral balloon
valvotomy is contraindicated because of left atrial
thrombus despite anticoagulation or because
concomitant moderate to severe MR is present, or
3) the valve morphology is not favorable for
percutaneous mitral balloon valvotomy in a
patient with acceptable operative risk.
2. Symptomatic patients with moderate to severe
MS* who also have moderate to severe MR should
receive MV replacement, unless valve repair is
possible at the time of surgery.
Class IIb
asymptomatic patients with moderate
or severe MS* who have had
recurrent embolic events while
receiving adequate anticoagulation
and who have valve morphology
favorable for repair.
Class IIa
Severe MS* and severe pulmonary hypertension
(pulmonary artery systolic pressure greater than
60) with NYHA functional class I–II symptoms
who are not considered candidates for
ercutaneous mitral balloon valvotomy or surgical
MV repair
26. • I
– Symptomatic (NYHC),not BMV candidates
• IIa
– Symptomatic (PH), not BMV candidates
• IIb
– Asymtomatic, thrombus / embolic (+)
– Valve morphology
• III
– Mild MS
– Percutaneus Commissurotomy
Surgery
for Mitral Stenosis
27.
28. Class I
Percutaneous or surgical MV commissurotomy
is indicated when anatomically possible for
treatment of severe MS, when clinically
indicated.
Rheumatic Heart Disease
29. Class IIa
1. A mechanical prosthesis is reasonable
for MV replacement in patients under
65 years of age with long-standing atrial
fibrillation.
2. A bioprosthesis is reasonable for MV
replacement in patients 65 years of age
or older.
3. A bioprosthesis is reasonable for MV
replacement in patients under 65 years
of age in sinus rhythm who elect to
receive this valve for lifestyle
considerations after detailed discussions
of the risks of anticoagulation versus
the likelihood that a second MV
replacement may be necessary in the
future.
Selection of an Mitral Valve Prosthesis
Class I
A bioprosthesis is indicated for MV
replacement in a patient who will not
take warfarin, is incapable of taking
warfarin, or has a clear contraindication
to warfarin therapy
30. Class I
1. Intraoperative transesophageal echocardiography
is recommended for valve repair surgery.
2. Intraoperative transesophageal echocardiography
is recommended for valve replacement surgery
with a stentless xenograft, homograft, or autograft
valve.
3. Intraoperative transesophageal chocardiography
is recommended for valve surgery for infective
endocarditis.
INTRAOPERATIVE ASSESSMENT
Class IIa
Intraoperative transesophageal
echocardiography is reasonable for all
patients undergoing cardiac valve surgery.
31. End Stage MS
• LV failure
• Arythmias
• Pulmonary Hypertension
Posterior Chordal Preservation
Maze
BMV
32.
33. • PVD may occur in 5-10% of patients with untreated Septal Defect
• it does not appear to be caused solely by the magnitude of the shunt
persisting for decades.
• patients should be considered to have Eisenmenger syndrome when Septal
Defects are large and unrestrictive and when there is resting cyanosis.
• smaller Septal Defect is present in a patient with pulmonary hypertension,
other causes should be sought.
• There have been case reports of such patients being managed with
intravenous epoprostenol or oral bosentan with such success that Septal
Defects closure subsequently became possible.
Septal Defects in the Adult: Recent Progress and Overview
Gary Webb and Michael A. Gatzoulis
Circulation 2006;114;1645-1653
35. Risk of
Pulmonary Hypertension
• PreOperative Risk
– Elevated PVR
– Increase PBF
– Parenchimal Lung disease
• IntraOperative Risk
– CPB
• Post Operative Risk
– Pre & Intra Operative Risk
– Metabolic / Physical stress
36. Symptoms
Dyspnea
Fatigue
Leg swelling
Weakness
Palpitations
Abdominal fullness
Angina
Syncope and presyncope
Signs
Normal to low blood pressure
Jugular venous distention
Lung findings
Right ventricular lift
Pulmonic ejection click,
Systolic ejection murmur at LICS 2/3
Increased split of second heart sound
Systolic murmur at LICS 4 increasing with
inspiration (tricuspid insufficiency)
Soft diastolic decrescendo murmur of
pulmonic regurgitation in LICS 3
Hepatomegaly
Ascites
Peripheral edema
Clubbing
Cyanosis
37. Diagnosis and Treatment of Pulmonary Hypertensio
TRENTON D. NAUSER, M.D., and STEVEN W. STITES, M.D.
University of Kansas Medical Center, Kansas City, Kansas,2004
50. Evidence-Based Treatment AlgorithmEvidence-Based Treatment Algorithm
World Symposium on PAH, Venice, Italy, June 23 – 25, 2003World Symposium on PAH, Venice, Italy, June 23 – 25, 2003
Combination?
ACCP Evidence-based Clinical Practice Guidelines
Euro Heart J 2004; 25: 2243 – 2278 and Chest 2004; 126: 35S – 62S
51. Evaluation of
Suspected
Pulmonary Hypertension
Diagnosis and Treatment
of Pulmonary Hypertension
TRENTON D. NAUSER, M.D., and
STEVEN W. STITES, M.D.
University of Kansas Medical Center
F:JOBxDiagnosis and Treatment of Pulmonary Hypertension
May 1, 2001 - American Family Physician.htm
52.
53. Strategies
to treat acute PH
• Reduce Sympathetic Stimulation
– Analgesia & sedation
– Muscle relaxant
– Treat hypo & hyperthermia
– Low doses of vasoconstrictive agent if
possible
• Lower PVR
– Gas exchange
• Increase alveolar O2 tension
• Treat acidosis
• Hypocapnia
– Mechanical Ventilation
• Avoid hyper/hypo inflation
• Low intra thoracic pressure
– Vasodilating drugs
• Spesific : NO
• Non specific :
– Nitroprusside
– Glycerol trinitrate
– PDE3 inhibitor
– Isoproterenol
– Prostacyclin I2
– Prostaglandin E1
54.
55. Atrial hypertrophy and dilatation may be
either a cause or a consequence of
persistent AF,
- Hemodynamic Consq
- Thrombus formation
- Risk for Ischemic Stroke
-Prev stroke/TIA
-Hypertension
-CHF
-Advanced age
-DM
-CAD
Decreased HRV in mitral stenosis patients with sinus rhythm suggests increased
sympathetic activity in patients prone to atrial fibrillation. The evaluation of HRV
may be a useful tool for the identification of patients predisposed to AF.
Ann Saudi Med 2002;22(3-4):143-148.
HEART RATE VARIABILITY IN PATIENTS WITH MITRAL
STENOSIS: A STUDY OF 20 CASES FROM KING
ABDULAZIZ UNIVERSITY HOSPITAL
Awdah Al-Hazimi, PhD; Nabil Al-Ama, MRCP; Moustafa Marouf, PhD