This document provides information on chronic heart failure, including its definition, causes, symptoms, diagnostic tests, management, and treatment options. Key points include: heart failure is defined as a clinical syndrome with symptoms caused by structural/functional cardiac issues leading to reduced cardiac output; common causes are coronary artery disease, hypertension, and cardiomyopathy; symptoms include breathlessness, ankle swelling, and fatigue; diagnostic tests include echocardiogram, chest x-ray, and natriuretic peptide levels; management involves treating the underlying cause, reducing exacerbating factors, and pharmacological therapy including ACE inhibitors, beta blockers, diuretics, and device-based therapies for intractable cases.
hypertension is a condition arrising due to increased symphathetic tone so drugs therapies are administered for minimising disease sevearity and further complications. Drug therapy includes drugs like alpha blockers, beta blockers, ACE INHIBITORS, ARBs, vasodilators,direct renin inhibitors, reserpine,prostaglandin analogs, calcium channel blockers for minimising excessive pressure and increased contractility of the heart.
hypertension is a condition arrising due to increased symphathetic tone so drugs therapies are administered for minimising disease sevearity and further complications. Drug therapy includes drugs like alpha blockers, beta blockers, ACE INHIBITORS, ARBs, vasodilators,direct renin inhibitors, reserpine,prostaglandin analogs, calcium channel blockers for minimising excessive pressure and increased contractility of the heart.
This presentation consists of various approaches to treat hypertension depending on severity. It also include treatment according to international guidelines. Classification and brief description of each antihypertensive agent has been mentioned.
Hypertension pharmacotherapy part 2 pptPranatiChavan
First-line medications used in the treatment of hypertension include diuretics, angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), beta-blockers, and calcium channel blockers (CCBs). Some patients will require 2 or more antihypertensive medications to achieve their BP target. As per special consideration, modified treatment is given in the presentation.
hypertension, simplified, jnc 8, treatment and newer modalities to treat. surgical procedures involved for hypertension and jnc 8 versus jnc 7 is compared in this ppt, and also, prevelance and epidemeiology of hypertension is explained. antihypertensives for preffered class and age are explained
Heart Failure (Dr Vosik Presentation) Symposia presented in Milot, Haiti at Hôpital Sacré Coeur.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
Get info on Chronic Heart Failure- NICE guidance. Our chart helps to know Nice Chronic Heart Failure. This guideline covers diagnosing and managing chronic heart failure in people aged 18 and over.
https://www.a4medicine.co.uk/chronic-heart-failure-nice-guidance/
sudden spike in blood pressure to 180/120 or higher
abt how we deal with it
what we need to do immediate action
maintain ASAP blood pressure in order to save the patients
This presentation consists of various approaches to treat hypertension depending on severity. It also include treatment according to international guidelines. Classification and brief description of each antihypertensive agent has been mentioned.
Hypertension pharmacotherapy part 2 pptPranatiChavan
First-line medications used in the treatment of hypertension include diuretics, angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), beta-blockers, and calcium channel blockers (CCBs). Some patients will require 2 or more antihypertensive medications to achieve their BP target. As per special consideration, modified treatment is given in the presentation.
hypertension, simplified, jnc 8, treatment and newer modalities to treat. surgical procedures involved for hypertension and jnc 8 versus jnc 7 is compared in this ppt, and also, prevelance and epidemeiology of hypertension is explained. antihypertensives for preffered class and age are explained
Heart Failure (Dr Vosik Presentation) Symposia presented in Milot, Haiti at Hôpital Sacré Coeur.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
Get info on Chronic Heart Failure- NICE guidance. Our chart helps to know Nice Chronic Heart Failure. This guideline covers diagnosing and managing chronic heart failure in people aged 18 and over.
https://www.a4medicine.co.uk/chronic-heart-failure-nice-guidance/
sudden spike in blood pressure to 180/120 or higher
abt how we deal with it
what we need to do immediate action
maintain ASAP blood pressure in order to save the patients
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
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.
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
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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.
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
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
2. Definition of Heart Failure (ESC )
Heart failure is a clinical syndrome characterized by
typical symptoms (e.g., breathlessness, ankle swelling
and fatigue)
accompanied by signs (e.g., elevated jugular venous
pressure, pulmonary crackles and peripheral oedema)
caused by structural and/or functional cardiac
abnormality
resulting in a reduced cardiac output and/or elevated
intra-cardiac pressure at rest or during stress.
4. Causes of Heart Failure
Endocrine Diabetes Mellitus
Hypo/Hyperthyroidism,
Cushing syndrome, Adrenal insufficiency
Phaeochromocytoma
Nutritional Deficiency of thiamine, selenium
Obesity, Cachexia
Infiltrative Sarcoidosis, amyloidosis, haemochromatosis
connective tissue disease
Others Chagas disease
HIV infection
Peripartum cardiomyopathy
End stage renal disease
5. Symptoms and Signs of Heart Failure
Symptoms
Typical
Breathlessness
Orthopnoea
Paroxysmal nocturnal
dyspnoea
Reduced exercise
tolerance
Fatigue, tiredness,
increased time to
recover after exercise
Ankle swelling
Signs
More specific
Elevated jugular venous
pressure
Hepatojugular reflux
Third heart sound
(gallop rhythm)
Laterally displaced
apical impulse
6. New York classification of Heart Failure
(NYHA)
I - Heart disease present, but no undue dyspnoea
from ordinary activity
II - Comfortable at rest; dyspnoea during ordinary
activities
III - Less than ordinary activity causes dyspnoea,
which is limiting
IV - Dyspnoea present at rest; all activities causes
discomfort
7. Definition of Heart Failure with
reduced, mid-range and preserved ejection fraction
( can be performed at tertiary center )
Type
of HF
HFrEF HFmrEF HFpEF
CRITERIA
1 Symptoms
±Signs
Symptoms ±Signs Symptoms ±Signs
2 LVEF <40
%
LVEF 40-49 % LVEF ≥ 50 %
3 1. Elevated levels of
natriuretic peptides
2. At least one additional
criterion:
a. relevant structural
heart disease (LVH
and/or LAE)
b. diastolic dysfunction
1. Elevated levels of
natriuretic peptides
2. At least one additional
criterion:
a. relevant structural heart
disease (LVH and/or LAE)
b. diastolic dysfunction
8. Diagnostic tests in initial assessment of patients
with newly diagnosed heart failure
Haemoglobin and WBC
Urea & electrolytes, creatinine (with estimated GFR)
Liver function tests (Bilirubin, AST, ALT, GGT)
Glucose, Haemoglobin A1C
Lipid profile
TSH
Ferritin, Transferrin saturation, Total iron binding capacity
(optional )
12-lead ECG
Chest X-ray
Echocardiogram ( if available )
9. CXR in left ventricular failure
A - Alveolar oedema
(perihilar bat’s wing
appearance)
B - Kerley B lines
C - Cardiomegaly
D - Dilated prominent
upper lobe veins (upper
lobe diversion)
E - Pleural Effusion
11. Patient with Suspected
HF (non-acute onset)
ASSESSMENT OF HF PROBABILITY
1. Clinical history:
History of CAD (MI, revascularization)
History of arterial hypertension
Exposition to cardiotoxic drug/radiation
Use of diuretics
Orthopnoea/paroxysmal nocternal dyspnoea
2. Physical examination:
Rales
Bilateral ankle oedema
Heart murmur
Jugular venous dilatation
Laterally displaced/broadened apical beat
3. ECG
Any abnormality
12. ASSESSMENT OF HF PROBABILITY
NATRIURETIC PEPTIDES
• NT-proBNP ≥ 125 pg/mL
• BNP ≥ 35 pg/mL
Assessment of
natriuretic
peptides not
routinely done
in clinical
practice
ECHOCARDIOGRAPHY
≥ 1 present
Yes
If HF confirmed (based on all available data):
Determine aetiology and start appropriate treatment
HF unlikely:
Consider other
diagnosis
All absent
No
Normal
13. Management of chronic heart failure
1. General measures
Stop smoking
Stop drinking alcohol
Eat less salt
Optimize weight and nutrition
2. Treat the cause
Dysrhythmias
Valve disease
3. Treat exacerbating factors
Anaemia
Thyroid disease
Infection
High blood pressure
17. Drugs : Diuretics
Loop diuretics
To relieve symptoms
PO Furosemide 40 mg/ 24 hour (increase dose
as necessary)
Side effects: hypokalaemia, renal impairment
Monitor: Urea and electrolytes
18. Drugs : Diuretics
Potassium sparing diuretics
PO Spironolactone 25 mg/24 hour
Risk of hyperkalaemia in patients with CKD,
patients taking ACEI
Monitor : Urea and electrolytes
Thiazide diuretics
If refractory oedema
PO Metolazone 5-20 mg/ 24 hour
19. Drugs:
Angiotensin converting enzyme inhibitor (ACEI)
ACEI
Improves symptoms and prolong life in patients with left
ventricular systolic dysfunction.
E.g., Enalapril, Lisinopril, Ramipril
Start at low dose and increase gradually to maximum target
dose
Regular monitoring of renal function (serum potassium
and Creatinine)
21. Drugs: Angiotensin receptor blocker (ARB)
ARB
If patient has intolerable ACEI induced cough
E.g., Candesartan, Valsartan
Side effects: Hyperkalaemia
Monitor : Serum potassium, creatinine
22. Drugs : Beta Blockers
Reduce mortality in heart failure
Use with caution: Start low, go slow in the absence
of fluid retention
Wait ≥ 2 weeks between each dose increment
E.g., Carvedilol, Bisoprolol, Nebivolol, Metoprolol
succinate (CR, XL)
23. Drugs: Mineralocorticoid receptor Antagonists
Spironolactone
PO 25 mg / 24 hour
In patients still symptomatic despite optimal therapy
Post MI patients with LV systolic dysfunction
Side effect : hyperkalaemia
Monitor : Electrolytes
Eplerenone
If spironolactone is not tolerated
24. Drugs : Digoxin
In patients with
Sinus rhythm, left ventricular systolic dysfunction, signs
and symptoms of heart failure while receiving standard
therapy with ACEI and beta blocker
AF : to slow the rapid ventricular rate
Dose : 125 mcg/24 hour (if sinus rhythm)
Monitor: Urea and electrolytes ( maintain serum potassium
at 4-5 mmol/l)
25. Other drugs
Combination of hydralazine and isosorbide dinitrate
If intolerant of ACEI and ARB
ARNI (Angiotensin Receptor-Neprilysin Inhibitor)
Sacubitril / Valsartan
If channel blocker
Ivabradine ( need to monitor heart rate / benefit in AF
???? )
27. Intractable heart failure
Reassess the cause & precipitating factors like NSAID
Drug compliance? At maximum dose ?
In patient management :
Minimal exertion
Sodium and fluid restriction (1.5 L/ 24 hour PO)
IV Furosemide 40-80 mg slowly
Opiates and IV nitrates (may relieve symptoms)
Weigh daily (aim reduction of 0.5 kg/day)
Monitoring of renal function ( beware of hypokalaemia)
DVT prophylaxis : Heparin + TED stockings
28. Device therapy for heart failure
Considered for intractable heart failure
Aim : resynchronization therapy
Prevent worsening heart failure and prevent sudden cardiac
death
Available devices :
Implantable cardioverter defibrillator (ICD)
Cardiac resynchronization therapy (CRTP and CRTD)
Assessment at tertiary centre (refer to tertiary centre)
For recommendation of device therapy
For implantation of device
For follow-up after device implantation