Management chf lecture dr samir tayfour
•Download as PPT, PDF•
4 likes•1,431 views
Dr. Samir Tayfour is a consultant cardiologist in KSA. In treating cardiac dysfunction, he determines the type (systolic or diastolic), etiology, prognosis, and guides therapy. Treatment options include surgery, procedures like bypass, angioplasty, valve replacement, defibrillator implantation, transplantation, and LVAD. Risk factors for heart failure include hypertension, diabetes, hyperlipidemia, inactivity, obesity, alcohol, and smoking.
Report
Share
Report
Share
Recommended
Crestor Presentation
This document discusses several clinical studies that compare the effects of different statin drugs on cardiovascular outcomes and the progression of atherosclerosis. The STELLAR study showed that rosuvastatin more effectively lowered LDL-C and raised HDL-C than other statins. Two real-world studies found that rosuvastatin use was associated with a 28-40% lower risk of cardiovascular events compared to other statins. The METEOR study found that rosuvastatin slowed the progression of atherosclerosis whereas the ENHANCE study found that ezetimibe added to simvastatin provided no benefit.
Treatment strategies in patients with statin intolerance
Statins are among the most prescribed drugs in the world and are first-line therapy in the management of hyperlipidemia.
Their beneficial effects on cardiovascular morbidity and mortality have been demonstrated both in primary and in secondary prevention.
They are generally safe, but in some patients, statin therapy is stopped because of intolerance to the drug that may result in muscle aches and weakness, gastrointestinal symptoms, liver enzyme abnormalities, or other nonspecific discomforts.
The rate of reported statin-related events is about 5% to 10% in randomized, placebo controlled clinical trials.
Old vs new targets april 2015
This document summarizes guidelines for cholesterol treatment and clinical trials evaluating lipid targets. It discusses the ATP III guidelines, major trials after ATP III including TNT, JUPITER, ACCORD-LIPID, and AIM-HIGH. It then reviews the 2013 ACC/AHA cholesterol treatment guidelines, including the 4 groups that benefit from statins, ASCVD risk assessment, and future directions. Clinical cases are used to illustrate guideline recommendations for statin treatment based on a patient's risk factors.
Statins-cornerstone in lipid management
1) Statins are highly effective in reducing LDL-C and cardiovascular risk, playing a cornerstone role in lipid management. They work by inhibiting HMG-CoA reductase.
2) Atorvastatin has been extensively studied in large trials and shown to significantly reduce major cardiovascular events when doses are increased from 10 mg to 80 mg.
3) Studies in India found that high dose atorvastatin (80 mg) was well tolerated and more effective at reducing LDL-C and hs-CRP than lower doses in ACS patients. However, many ACS patients in India were not receiving statins as recommended.
Dyslipidemia management an evidence based approach
How is dyslipidemia managed in clinical practice? Here is a short review on how current guidelines are shaping clinical practice, and how saroglitazar is playing a role in it.
ATP IV Guideline for Blood cholesterol level
The document summarizes new guidelines for treating blood cholesterol to reduce ASCVD risk. It classifies individuals into 4 statin benefit groups based on clinical risk factors like age and cholesterol/diabetes status. The guidelines focus on global ASCVD risk assessment for primary prevention and appropriate statin therapy intensity. Biomarkers and tests can help treatment decisions for those not in the main groups. Safety monitoring and limitations are discussed. Future updates may provide guidance for complex cases and refine risk assessment based on new data.
Statins & primary prevention in women
Statins have a long history dating back to discoveries in the 1970s showing they could block cholesterol synthesis. The first statin was released in 1987. While essential for life, cholesterol comes in both good and bad forms. Whether a 44-year-old woman should be on a statin is unclear given her risk factors of being overweight and a smoker but no family history or other major risks. Clinical trials examine both absolute and relative risk reduction. While statins provide clear benefits, they may modestly increase diabetes risk, especially in certain groups. Larger studies find no increased cognitive risks. Alternative lifestyle approaches like the Mediterranean diet may also help reduce stroke risk.
Statin Wars
- The document discusses guidelines for statin use in primary prevention from the 2014 ACC/AHA, including algorithms for determining statin eligibility based on estimated 10-year risk of atherosclerotic cardiovascular disease (ASCVD).
- It notes that the guidelines lower the risk threshold for statin recommendation from greater than 7.5% 10-year ASCVD risk to greater than 5% for some patients.
- Concerns raised about the guidelines include the selection of studies included in reviews and the lack of consideration of observational data or post-hoc analyses of randomized controlled trials.
Recommended
Crestor Presentation
This document discusses several clinical studies that compare the effects of different statin drugs on cardiovascular outcomes and the progression of atherosclerosis. The STELLAR study showed that rosuvastatin more effectively lowered LDL-C and raised HDL-C than other statins. Two real-world studies found that rosuvastatin use was associated with a 28-40% lower risk of cardiovascular events compared to other statins. The METEOR study found that rosuvastatin slowed the progression of atherosclerosis whereas the ENHANCE study found that ezetimibe added to simvastatin provided no benefit.
Treatment strategies in patients with statin intolerance
Statins are among the most prescribed drugs in the world and are first-line therapy in the management of hyperlipidemia.
Their beneficial effects on cardiovascular morbidity and mortality have been demonstrated both in primary and in secondary prevention.
They are generally safe, but in some patients, statin therapy is stopped because of intolerance to the drug that may result in muscle aches and weakness, gastrointestinal symptoms, liver enzyme abnormalities, or other nonspecific discomforts.
The rate of reported statin-related events is about 5% to 10% in randomized, placebo controlled clinical trials.
Old vs new targets april 2015
This document summarizes guidelines for cholesterol treatment and clinical trials evaluating lipid targets. It discusses the ATP III guidelines, major trials after ATP III including TNT, JUPITER, ACCORD-LIPID, and AIM-HIGH. It then reviews the 2013 ACC/AHA cholesterol treatment guidelines, including the 4 groups that benefit from statins, ASCVD risk assessment, and future directions. Clinical cases are used to illustrate guideline recommendations for statin treatment based on a patient's risk factors.
Statins-cornerstone in lipid management
1) Statins are highly effective in reducing LDL-C and cardiovascular risk, playing a cornerstone role in lipid management. They work by inhibiting HMG-CoA reductase.
2) Atorvastatin has been extensively studied in large trials and shown to significantly reduce major cardiovascular events when doses are increased from 10 mg to 80 mg.
3) Studies in India found that high dose atorvastatin (80 mg) was well tolerated and more effective at reducing LDL-C and hs-CRP than lower doses in ACS patients. However, many ACS patients in India were not receiving statins as recommended.
Dyslipidemia management an evidence based approach
How is dyslipidemia managed in clinical practice? Here is a short review on how current guidelines are shaping clinical practice, and how saroglitazar is playing a role in it.
ATP IV Guideline for Blood cholesterol level
The document summarizes new guidelines for treating blood cholesterol to reduce ASCVD risk. It classifies individuals into 4 statin benefit groups based on clinical risk factors like age and cholesterol/diabetes status. The guidelines focus on global ASCVD risk assessment for primary prevention and appropriate statin therapy intensity. Biomarkers and tests can help treatment decisions for those not in the main groups. Safety monitoring and limitations are discussed. Future updates may provide guidance for complex cases and refine risk assessment based on new data.
Statins & primary prevention in women
Statins have a long history dating back to discoveries in the 1970s showing they could block cholesterol synthesis. The first statin was released in 1987. While essential for life, cholesterol comes in both good and bad forms. Whether a 44-year-old woman should be on a statin is unclear given her risk factors of being overweight and a smoker but no family history or other major risks. Clinical trials examine both absolute and relative risk reduction. While statins provide clear benefits, they may modestly increase diabetes risk, especially in certain groups. Larger studies find no increased cognitive risks. Alternative lifestyle approaches like the Mediterranean diet may also help reduce stroke risk.
Statin Wars
- The document discusses guidelines for statin use in primary prevention from the 2014 ACC/AHA, including algorithms for determining statin eligibility based on estimated 10-year risk of atherosclerotic cardiovascular disease (ASCVD).
- It notes that the guidelines lower the risk threshold for statin recommendation from greater than 7.5% 10-year ASCVD risk to greater than 5% for some patients.
- Concerns raised about the guidelines include the selection of studies included in reviews and the lack of consideration of observational data or post-hoc analyses of randomized controlled trials.
Rosuvastatin
This document discusses cardiovascular disease (CAD) in South Asians and a clinical trial on the use of statins. It contains the following key points:
1) South Asians have a higher prevalence of CAD than other ethnicities due to genetic and environmental/lifestyle factors such as metabolic syndrome and central obesity.
2) The JUPITER trial found that treating individuals with low LDL cholesterol but high C-reactive protein with rosuvastatin reduced cardiovascular events like heart attack and stroke by 44% compared to placebo, showing statins can benefit those not currently eligible for treatment.
3) Rosuvastatin was well-tolerated in JUPITER and showed no increase in side effects even when LDL
Dyslipidemia 2016
The document discusses guidelines for managing dyslipidemia and cardiovascular disease risk, including:
1) It provides risk levels (very high, high, moderate, low) based on calculated cardiovascular risk and clinical factors and recommends LDL-C treatment targets for each level.
2) It discusses statin treatment for different risk levels, recommending the highest tolerated dose to reach LDL-C targets.
3) It summarizes trials comparing different statins and their average LDL-C reduction, finding some are more effective than others at reducing LDL-C.
Review of the New ACC/AHA Cholesterol Guidelines
The ACC/AHA recently released updated cholesterol treatment guidelines. I review them along with what I feel are their limitations. Watch my YouTube video describing these slides: http://youtu.be/2BlUhW6Zu2E
JUPITER (Justification for the Use of Statins in Primary Prevention: An Inter...
- 4-year, double-blind, placebo-controlled, randomized clinical trial
- Population and treatment:
17 802 patients with normal LDL-C (median 108 mg/dL) and elevated CRP (>2.0 mg/L) randomized to rosuvastatin 20 mg/d or placebo
- Primary outcome:
Composite of nonfatal MI, nonfatal stroke, hospitalization for unstable angina, revascularization, and confirmed death from CV causes
See the article at http://www.theheart.org/article/917181.do
Statin-induced Myalgia and Myositis
This document summarizes statin-induced myopathies. It discusses statin mechanisms of action and predisposing factors. It describes different clinical phenotypes including rhabdomyolysis, myalgia with mild CK elevation, self-limited toxic myopathy, and immune-mediated necrotizing myopathy associated with anti-HMGCR antibodies. Immune-mediated necrotizing myopathy is characterized by muscle necrosis, regeneration, and scarce inflammation. Diagnosis involves detecting elevated CK, myopathic EMG findings, and anti-HMGCR antibodies. Treatment depends on severity but may include immunosuppression.
Atorvastatin
The SPARCL trial investigated whether high-dose atorvastatin (80 mg daily) could reduce the risk of fatal or non-fatal stroke in patients who had a stroke or transient ischemic attack 1-6 months prior and no history of coronary heart disease. The double-blind randomized controlled trial assigned 4731 eligible patients to atorvastatin or placebo groups. After a median follow-up of 4.9 years, treatment with atorvastatin reduced the risk of fatal or non-fatal stroke by 2% compared to placebo, with a number needed to treat of 53. Atorvastatin also reduced the risk of major cardiovascular events by 18% compared to placebo.
Role of beta blocker and statin in primary prevention of cardiovascular disease
Role of beta blocker and statin in primary prevention of cardiovascular diseaseLPS Institute of Cardiology Kanpur UP India
This patient is a 37-year-old man with type 2 diabetes, hypertension, dyslipidemia, and a family history of coronary artery disease. Examination found elevated blood pressure and LDL, as well as signs of sympathetic overactivity.
Given the patient's sympathetic overactivity, diabetes, hypertension, and family history of CAD, treatment with a beta-blocker and high-intensity statin is recommended. Metoprolol is preferred as it has a short half-life, is excreted through the liver, and does not accumulate in renal impairment. Intensifying the statin dose is also needed given the patient's multiple risk factors to achieve a target LDL lower than 100 mg/dL.Role of statins in secondary prevention in cabg
This document discusses the role of statins in secondary prevention after coronary artery bypass graft (CABG) surgery. It finds that only 60% of vein grafts remain patent 10 years after CABG, putting patients at high risk for subsequent cardiac events. Guidelines recommend statin therapy for all CABG patients to achieve an LDL below 100 mg/dl. Studies show preoperative statin use reduces mortality, stroke, and atrial fibrillation after CABG by limiting inflammation and improving endothelial function. Postoperative aggressive statin therapy further limits graft atherosclerosis and decreases recurrent heart attacks and revascularization through its pleiotropic effects. However, statins remain underutilized after CABG according to one study, highlighting the need to
Hope 3 (stat + antihypertensives) TRIAL
The HOPE-3 trial found that combining treatment with rosuvastatin, candesartan, and hydrochlorothiazide reduced the risk of cardiovascular events by 29% compared to placebo in a population at intermediate cardiovascular risk. The combination therapy lowered LDL cholesterol by 33.7 mg/dL and systolic blood pressure by 6.2 mmHg on average over 5.6 years. It reduced the risk of the primary composite outcome of cardiovascular death, myocardial infarction, or stroke compared to placebo, with numbers needed to treat of 72 and 63 to prevent an event in the primary outcomes. Subgroup analyses suggested greater benefit for those with higher baseline blood pressure.
2013 ACC/AHA guidelines for blood cholesterol management
The 2013 ACC/AHA blood cholesterol treatment guidelines focus on reducing atherosclerotic cardiovascular disease (ASCVD) risk through statin therapy rather than targeting specific LDL-C levels. The guidelines are based on evidence from randomized controlled trials showing consistent ASCVD risk reduction from high- and moderate-intensity statin regimens. They recommend a patient-centered approach and starting statins based on estimated 10-year ASCVD risk rather than using non-HDL or other targets. While lifestyle changes remain important, the guidelines emphasize intensity of statin therapy over addition of nonstatin drugs or targeting specific lipid levels.
Statins
This document summarizes information about statins, including their uses, mechanisms of action, types, interactions, and safety considerations. It discusses how statins are used to prevent heart disease by lowering LDL cholesterol and discusses their four proposed mechanisms of action, including improving endothelial function and maintaining plaque stability. It also provides comparisons of different statin medications and identifies atorvastatin and simvastatin as producing the greatest LDL reduction, as well as pravastatin and fluvastatin as having fewer drug interactions.
New cholesterol treatment guidelines 2013
This document summarizes the 2013 ACC-AHA guidelines for cholesterol treatment. It outlines an algorithm for screening and statin treatment based on cardiovascular risk factors and LDL cholesterol levels. For those between 40-75 years old, it recommends either moderate or high-intensity statin therapy depending on calculated 10-year risk of atherosclerotic cardiovascular disease. High-intensity statin therapy is recommended for those with clinical atherosclerotic CVD or LDL cholesterol over 190 mg/dl. The guidelines also provide definitions of moderate and high-intensity statin regimens and a link to the risk calculator. Limitations noted are that risk factors like family history are not considered and those under 21 or over 75 without disease are not addressed.
Dyslipidemia management an evidence based approach
In this presentation by Dr Vivek Baliga, he discusses the different available statins and how you can choose the right one in different clinical situations. See articles from Dr Baliga on http://drvivekbaliga.net
Management of Dyslipidemia: role of Fenofibrate
The document discusses the management of dyslipidemia and the role of fenofibrate. It summarizes guidelines from the 2016 ESC/EAS and 2017 AACE for treating different lipid abnormalities. Mixed dyslipidemia, characterized by elevated triglycerides and low HDL-C, is common in conditions like obesity, metabolic syndrome, and diabetes. While statins are first-line for lowering LDL-C, combination therapy with fibrates may be considered for mixed dyslipidemia when triglyceride levels are high. Fenofibrate can help address atherogenic dyslipidemias defined by increased cholesterol, triglycerides, small dense LDL, and decreased HDL-C.
Statins and diabetes risk
Statin use is associated with a small increased risk of developing diabetes. However, the cardiovascular benefits of statin therapy still outweigh the diabetes risk. Several studies have found that statin use leads to a 9-13% increased risk of diabetes, but the absolute increased risk is low. The number of patients needed to treat with statins to prevent a cardiovascular event is lower than the number needed to harm in terms of diabetes risk. Therefore, clinical practice for statin therapy for reducing cardiovascular risk should not change.
2013 prevention guidelines cholesterol slide set 4
This document summarizes the 2013 ACC/AHA guidelines for treating blood cholesterol to reduce cardiovascular risk. It provides an overview of the guideline development process, which included a systematic review of randomized controlled trials and development of recommendations based on evidence. The guidelines emphasize adherence to lifestyle changes and identify four statin benefit groups. They also discuss assessing risk and initiating appropriate intensity statin therapy, while noting a lack of evidence for specific cholesterol treatment targets.
Statins for primary prevention in Indians
1) Statins can provide significant benefits for primary prevention of cardiovascular disease in Indians due to their increased risk compared to Caucasians and the effectiveness of statins at low doses in Indians.
2) However, cardiovascular risk scores can over or under estimate risk, especially in younger Indians, so additional testing like coronary artery calcium scoring and apolipoprotein levels may help better identify those most likely to benefit from statin treatment.
3) For Mr. Suresh T, the doctor would recommend using a risk prediction algorithm like JBS3 tailored to Indians, or recalibrating his risk using his family history and lifestyle factors, and discussing the risks and benefits of statin treatment. Further testing could include CAC
Current status & recent advances in dyslipidemia management
The document summarizes recent advances in dyslipidemia treatment, including current and newer hypolipidemic drugs as well as clinical guidelines. It discusses statins, fibrates, bile acid sequestrants, nicotinic acid, and ezetimibe. Major clinical trials such as JUPITER and PROVE-IT established the benefits of intensive statin therapy. However, newer combination therapies with fibrates or nicotinic acid failed to show additional clinical benefits beyond statin treatment alone in trials such as ACCORD and HPS-2 THRIVE.
Lipid lowering trials ppt
1) Several early trials evaluated lipid lowering drugs such as mevastatin and lovastatin, which were isolated from fungi and shown to inhibit HMG CoA reductase. However, mevastatin was not marketed due to toxicity in dogs. Lovastatin was first marketed as Mevacor in 1987.
2) Large primary prevention trials such as WOSCOPS, AFCAPS/TexCAPS, CARDS and JUPITER demonstrated significant reductions in cardiovascular events with statin therapy compared to placebo in various populations with and without known heart disease.
3) Secondary prevention trials in patients with stable CAD such as 4S, CARE, LIPID and TNT showed that statin therapy reduces
Atorvastatin: Statins in CVD management. Is just lipid lowering enough
This document discusses the benefits of statin drugs beyond their lipid-lowering effects. It summarizes several key studies that show statins reduce cardiovascular events in patients with diabetes or chronic kidney disease, even when baseline lipid levels are normal. The document highlights that atorvastatin and simvastatin have evidence from primary prevention trials of reducing cardiovascular outcomes in diabetes, whereas other statins do not. It also notes that atorvastatin seems to have greater renoprotective effects compared to rosuvastatin in diabetes patients with kidney disease and proteinuria.
Pfizer Talk Final
1) A 43-year-old male presented with chest pain and was diagnosed with an acute inferior STEMI while in normal sinus rhythm. His medical history included atherosclerosis.
2) Atherosclerosis is caused by plaque buildup in arteries and accounts for over 70% of cardiovascular deaths in the US. Elevated LDL cholesterol increases the risk of atherosclerosis and heart disease.
3) Therapeutic lifestyle changes like diet and exercise can modestly lower LDL cholesterol by about 5% on average but response varies between individuals. High fat, low carb diets may improve glycemic control in diabetes without worsening lipids.
Exacerbation of Heart Failure : Thiazolidinediones
The document discusses exacerbation of heart failure with the use of thiazolidinediones, providing an overview of heart failure, insulin resistance, and the mechanisms of fluid retention associated with thiazolidinediones based on case reports and clinical trial data. It also reviews guidelines for managing patients with diabetes and heart failure, and recommends alternative anti-diabetic agents or cautious use of thiazolidinediones.
More Related Content
What's hot
Rosuvastatin
This document discusses cardiovascular disease (CAD) in South Asians and a clinical trial on the use of statins. It contains the following key points:
1) South Asians have a higher prevalence of CAD than other ethnicities due to genetic and environmental/lifestyle factors such as metabolic syndrome and central obesity.
2) The JUPITER trial found that treating individuals with low LDL cholesterol but high C-reactive protein with rosuvastatin reduced cardiovascular events like heart attack and stroke by 44% compared to placebo, showing statins can benefit those not currently eligible for treatment.
3) Rosuvastatin was well-tolerated in JUPITER and showed no increase in side effects even when LDL
Dyslipidemia 2016
The document discusses guidelines for managing dyslipidemia and cardiovascular disease risk, including:
1) It provides risk levels (very high, high, moderate, low) based on calculated cardiovascular risk and clinical factors and recommends LDL-C treatment targets for each level.
2) It discusses statin treatment for different risk levels, recommending the highest tolerated dose to reach LDL-C targets.
3) It summarizes trials comparing different statins and their average LDL-C reduction, finding some are more effective than others at reducing LDL-C.
Review of the New ACC/AHA Cholesterol Guidelines
The ACC/AHA recently released updated cholesterol treatment guidelines. I review them along with what I feel are their limitations. Watch my YouTube video describing these slides: http://youtu.be/2BlUhW6Zu2E
JUPITER (Justification for the Use of Statins in Primary Prevention: An Inter...
- 4-year, double-blind, placebo-controlled, randomized clinical trial
- Population and treatment:
17 802 patients with normal LDL-C (median 108 mg/dL) and elevated CRP (>2.0 mg/L) randomized to rosuvastatin 20 mg/d or placebo
- Primary outcome:
Composite of nonfatal MI, nonfatal stroke, hospitalization for unstable angina, revascularization, and confirmed death from CV causes
See the article at http://www.theheart.org/article/917181.do
Statin-induced Myalgia and Myositis
This document summarizes statin-induced myopathies. It discusses statin mechanisms of action and predisposing factors. It describes different clinical phenotypes including rhabdomyolysis, myalgia with mild CK elevation, self-limited toxic myopathy, and immune-mediated necrotizing myopathy associated with anti-HMGCR antibodies. Immune-mediated necrotizing myopathy is characterized by muscle necrosis, regeneration, and scarce inflammation. Diagnosis involves detecting elevated CK, myopathic EMG findings, and anti-HMGCR antibodies. Treatment depends on severity but may include immunosuppression.
Atorvastatin
The SPARCL trial investigated whether high-dose atorvastatin (80 mg daily) could reduce the risk of fatal or non-fatal stroke in patients who had a stroke or transient ischemic attack 1-6 months prior and no history of coronary heart disease. The double-blind randomized controlled trial assigned 4731 eligible patients to atorvastatin or placebo groups. After a median follow-up of 4.9 years, treatment with atorvastatin reduced the risk of fatal or non-fatal stroke by 2% compared to placebo, with a number needed to treat of 53. Atorvastatin also reduced the risk of major cardiovascular events by 18% compared to placebo.
Role of beta blocker and statin in primary prevention of cardiovascular disease
Role of beta blocker and statin in primary prevention of cardiovascular diseaseLPS Institute of Cardiology Kanpur UP India
This patient is a 37-year-old man with type 2 diabetes, hypertension, dyslipidemia, and a family history of coronary artery disease. Examination found elevated blood pressure and LDL, as well as signs of sympathetic overactivity.
Given the patient's sympathetic overactivity, diabetes, hypertension, and family history of CAD, treatment with a beta-blocker and high-intensity statin is recommended. Metoprolol is preferred as it has a short half-life, is excreted through the liver, and does not accumulate in renal impairment. Intensifying the statin dose is also needed given the patient's multiple risk factors to achieve a target LDL lower than 100 mg/dL.Role of statins in secondary prevention in cabg
This document discusses the role of statins in secondary prevention after coronary artery bypass graft (CABG) surgery. It finds that only 60% of vein grafts remain patent 10 years after CABG, putting patients at high risk for subsequent cardiac events. Guidelines recommend statin therapy for all CABG patients to achieve an LDL below 100 mg/dl. Studies show preoperative statin use reduces mortality, stroke, and atrial fibrillation after CABG by limiting inflammation and improving endothelial function. Postoperative aggressive statin therapy further limits graft atherosclerosis and decreases recurrent heart attacks and revascularization through its pleiotropic effects. However, statins remain underutilized after CABG according to one study, highlighting the need to
Hope 3 (stat + antihypertensives) TRIAL
The HOPE-3 trial found that combining treatment with rosuvastatin, candesartan, and hydrochlorothiazide reduced the risk of cardiovascular events by 29% compared to placebo in a population at intermediate cardiovascular risk. The combination therapy lowered LDL cholesterol by 33.7 mg/dL and systolic blood pressure by 6.2 mmHg on average over 5.6 years. It reduced the risk of the primary composite outcome of cardiovascular death, myocardial infarction, or stroke compared to placebo, with numbers needed to treat of 72 and 63 to prevent an event in the primary outcomes. Subgroup analyses suggested greater benefit for those with higher baseline blood pressure.
2013 ACC/AHA guidelines for blood cholesterol management
The 2013 ACC/AHA blood cholesterol treatment guidelines focus on reducing atherosclerotic cardiovascular disease (ASCVD) risk through statin therapy rather than targeting specific LDL-C levels. The guidelines are based on evidence from randomized controlled trials showing consistent ASCVD risk reduction from high- and moderate-intensity statin regimens. They recommend a patient-centered approach and starting statins based on estimated 10-year ASCVD risk rather than using non-HDL or other targets. While lifestyle changes remain important, the guidelines emphasize intensity of statin therapy over addition of nonstatin drugs or targeting specific lipid levels.
Statins
This document summarizes information about statins, including their uses, mechanisms of action, types, interactions, and safety considerations. It discusses how statins are used to prevent heart disease by lowering LDL cholesterol and discusses their four proposed mechanisms of action, including improving endothelial function and maintaining plaque stability. It also provides comparisons of different statin medications and identifies atorvastatin and simvastatin as producing the greatest LDL reduction, as well as pravastatin and fluvastatin as having fewer drug interactions.
New cholesterol treatment guidelines 2013
This document summarizes the 2013 ACC-AHA guidelines for cholesterol treatment. It outlines an algorithm for screening and statin treatment based on cardiovascular risk factors and LDL cholesterol levels. For those between 40-75 years old, it recommends either moderate or high-intensity statin therapy depending on calculated 10-year risk of atherosclerotic cardiovascular disease. High-intensity statin therapy is recommended for those with clinical atherosclerotic CVD or LDL cholesterol over 190 mg/dl. The guidelines also provide definitions of moderate and high-intensity statin regimens and a link to the risk calculator. Limitations noted are that risk factors like family history are not considered and those under 21 or over 75 without disease are not addressed.
Dyslipidemia management an evidence based approach
In this presentation by Dr Vivek Baliga, he discusses the different available statins and how you can choose the right one in different clinical situations. See articles from Dr Baliga on http://drvivekbaliga.net
Management of Dyslipidemia: role of Fenofibrate
The document discusses the management of dyslipidemia and the role of fenofibrate. It summarizes guidelines from the 2016 ESC/EAS and 2017 AACE for treating different lipid abnormalities. Mixed dyslipidemia, characterized by elevated triglycerides and low HDL-C, is common in conditions like obesity, metabolic syndrome, and diabetes. While statins are first-line for lowering LDL-C, combination therapy with fibrates may be considered for mixed dyslipidemia when triglyceride levels are high. Fenofibrate can help address atherogenic dyslipidemias defined by increased cholesterol, triglycerides, small dense LDL, and decreased HDL-C.
Statins and diabetes risk
Statin use is associated with a small increased risk of developing diabetes. However, the cardiovascular benefits of statin therapy still outweigh the diabetes risk. Several studies have found that statin use leads to a 9-13% increased risk of diabetes, but the absolute increased risk is low. The number of patients needed to treat with statins to prevent a cardiovascular event is lower than the number needed to harm in terms of diabetes risk. Therefore, clinical practice for statin therapy for reducing cardiovascular risk should not change.
2013 prevention guidelines cholesterol slide set 4
This document summarizes the 2013 ACC/AHA guidelines for treating blood cholesterol to reduce cardiovascular risk. It provides an overview of the guideline development process, which included a systematic review of randomized controlled trials and development of recommendations based on evidence. The guidelines emphasize adherence to lifestyle changes and identify four statin benefit groups. They also discuss assessing risk and initiating appropriate intensity statin therapy, while noting a lack of evidence for specific cholesterol treatment targets.
Statins for primary prevention in Indians
1) Statins can provide significant benefits for primary prevention of cardiovascular disease in Indians due to their increased risk compared to Caucasians and the effectiveness of statins at low doses in Indians.
2) However, cardiovascular risk scores can over or under estimate risk, especially in younger Indians, so additional testing like coronary artery calcium scoring and apolipoprotein levels may help better identify those most likely to benefit from statin treatment.
3) For Mr. Suresh T, the doctor would recommend using a risk prediction algorithm like JBS3 tailored to Indians, or recalibrating his risk using his family history and lifestyle factors, and discussing the risks and benefits of statin treatment. Further testing could include CAC
Current status & recent advances in dyslipidemia management
The document summarizes recent advances in dyslipidemia treatment, including current and newer hypolipidemic drugs as well as clinical guidelines. It discusses statins, fibrates, bile acid sequestrants, nicotinic acid, and ezetimibe. Major clinical trials such as JUPITER and PROVE-IT established the benefits of intensive statin therapy. However, newer combination therapies with fibrates or nicotinic acid failed to show additional clinical benefits beyond statin treatment alone in trials such as ACCORD and HPS-2 THRIVE.
Lipid lowering trials ppt
1) Several early trials evaluated lipid lowering drugs such as mevastatin and lovastatin, which were isolated from fungi and shown to inhibit HMG CoA reductase. However, mevastatin was not marketed due to toxicity in dogs. Lovastatin was first marketed as Mevacor in 1987.
2) Large primary prevention trials such as WOSCOPS, AFCAPS/TexCAPS, CARDS and JUPITER demonstrated significant reductions in cardiovascular events with statin therapy compared to placebo in various populations with and without known heart disease.
3) Secondary prevention trials in patients with stable CAD such as 4S, CARE, LIPID and TNT showed that statin therapy reduces
Atorvastatin: Statins in CVD management. Is just lipid lowering enough
This document discusses the benefits of statin drugs beyond their lipid-lowering effects. It summarizes several key studies that show statins reduce cardiovascular events in patients with diabetes or chronic kidney disease, even when baseline lipid levels are normal. The document highlights that atorvastatin and simvastatin have evidence from primary prevention trials of reducing cardiovascular outcomes in diabetes, whereas other statins do not. It also notes that atorvastatin seems to have greater renoprotective effects compared to rosuvastatin in diabetes patients with kidney disease and proteinuria.
What's hot (20)
JUPITER (Justification for the Use of Statins in Primary Prevention: An Inter...
JUPITER (Justification for the Use of Statins in Primary Prevention: An Inter...
Role of beta blocker and statin in primary prevention of cardiovascular disease
Role of beta blocker and statin in primary prevention of cardiovascular disease
2013 ACC/AHA guidelines for blood cholesterol management
2013 ACC/AHA guidelines for blood cholesterol management
Dyslipidemia management an evidence based approach
Dyslipidemia management an evidence based approach
2013 prevention guidelines cholesterol slide set 4
2013 prevention guidelines cholesterol slide set 4
Current status & recent advances in dyslipidemia management
Current status & recent advances in dyslipidemia management
Atorvastatin: Statins in CVD management. Is just lipid lowering enough
Atorvastatin: Statins in CVD management. Is just lipid lowering enough
Similar to Management chf lecture dr samir tayfour
Pfizer Talk Final
1) A 43-year-old male presented with chest pain and was diagnosed with an acute inferior STEMI while in normal sinus rhythm. His medical history included atherosclerosis.
2) Atherosclerosis is caused by plaque buildup in arteries and accounts for over 70% of cardiovascular deaths in the US. Elevated LDL cholesterol increases the risk of atherosclerosis and heart disease.
3) Therapeutic lifestyle changes like diet and exercise can modestly lower LDL cholesterol by about 5% on average but response varies between individuals. High fat, low carb diets may improve glycemic control in diabetes without worsening lipids.
Exacerbation of Heart Failure : Thiazolidinediones
The document discusses exacerbation of heart failure with the use of thiazolidinediones, providing an overview of heart failure, insulin resistance, and the mechanisms of fluid retention associated with thiazolidinediones based on case reports and clinical trial data. It also reviews guidelines for managing patients with diabetes and heart failure, and recommends alternative anti-diabetic agents or cautious use of thiazolidinediones.
Cvd risk in dm
1) Patients with diabetes have more than double the risk of major adverse cardiovascular events like myocardial infarction, stroke, and heart failure compared to those without diabetes.
2) Lifestyle changes like diet, exercise, and not smoking along with controlling blood pressure and lipids through medication are more important for reducing cardiovascular risk than glycemic control alone.
3) Cardiovascular disease risk is significantly increased in those with diabetes, with women seeing higher relative risks than men. Multiple factors contribute to diabetes being a major risk factor for cardiovascular disease.
Guidelines for prevention of stroke Guidelines for prevention of stroke
The guidelines provide recommendations for the secondary prevention of stroke in patients with previous ischemic stroke or transient ischemic attack (TIA). Key recommendations include: aggressively treating hypertension, diabetes, dyslipidemia and other vascular risk factors; initiating antiplatelet therapy; and considering carotid endarterectomy for severe carotid stenosis. Lifestyle modifications such as smoking cessation, weight control, diet and exercise are also encouraged. The guidelines were updated from 1999 based on new clinical trial evidence.
past presnt and futer of dyslidema ttt.pdf
Dr. Greg Searles presented on the past, present, and future of lipid management. He discussed current lipid management guidelines, which recommend statin treatment and LDL-C targets based on risk level. For high-risk patients, the guidelines recommend an LDL-C target of <2.0 mmol/L or >50% reduction from baseline. Dr. Searles reviewed evidence from landmark statin trials demonstrating their efficacy in reducing cardiovascular events. He also discussed current combination therapy options for further LDL-C lowering when targets are not met with statins alone, focusing on the modest additional benefit shown for ezetimibe in the IMPROVE-IT trial.
The past, present and future of lipid management
This document summarizes a presentation on lipid management given by Dr. Greg Searles. The presentation covered current lipid guidelines, LDL and other lipid profiles, dietary and pharmacological lipid-lowering therapies including statins, cholesterol absorption inhibitors, and PCSK9 inhibitors. It discussed landmark statin trials that demonstrated reductions in cardiovascular outcomes and the additional benefit seen when adding ezetimibe to statin therapy as shown in the IMPROVE-IT trial. The presentation aimed to provide an overview of the past, present, and future of lipid management.
Drug Prescription in hypertension
This document provides guidelines for drug prescription in the treatment of hypertension (HTN). It recommends the following:
- First-line drugs for HTN include thiazide diuretics, calcium channel blockers (CCBs), and ACE inhibitors/ARBs. Patients under 55 should generally receive ACE inhibitors/ARBs, while those over 55 or black patients receive CCBs.
- Treatment goals for blood pressure are tailored based on a patient's estimated 10-year risk of atherosclerotic cardiovascular disease. Generally, those at lower risk aim for 140/90 mmHg while higher risk patients including those with diabetes or kidney disease aim for 130/80 mmHg.
- Non-pharmac
Dyslipidaemia presentation
This document outlines guidelines for screening and treating dyslipidemia. It discusses lipid handling in the body and pathophysiology of atherosclerosis. Current drug treatments include statins as first-line therapy, with bile acid sequestrants, nicotinic acid, fibrates, ezetimibe, and omega-3 fatty acids as alternatives. Newer drugs that inhibit PCSK9 are also mentioned. Treatment goals depend on risk level, with lifestyle changes recommended initially before adding drug therapy for higher risk patients.
Dyslpidemia Cme Com 25 May09
This presentation was presented by me in one of the CME programs, held in Comilla, Bangladesh on the 25th. May 2009.
PHARMACOTHERAPY POINTERS FOR ATHEROSCLEROSIS [MALAYSIAN CPGs].pdf
This document discusses various drug therapies for treating atherosclerosis and lowering cholesterol, including statins, cholesterol absorption inhibitors, PCSK9 inhibitors, fibrates, bile acid sequestrants, and niacin. It provides details on the mechanisms of action, recommended dosages, monitoring, and combination therapies for these drugs. The major goals of treatment are to lower LDL cholesterol and reduce cardiovascular risk, especially through high-intensity statin therapy. Drug selection and monitoring are important to effectively manage dyslipidemia and treat atherosclerosis.
Chronic stable angina
Trimetazidine is an effective treatment for chronic stable angina. It works by shifting cardiac energy production from fatty acid oxidation to glucose oxidation, thereby reducing ischemia and improving cardiac efficiency. The document outlines the definition, grading, pathophysiology, and treatment goals for chronic stable angina. It describes the mechanisms of action and benefits of trimetazidine, including reduced angina attacks, increased exercise capacity, improved left ventricular function, and reduced mortality risk. Trimetazidine is recommended in international guidelines as an effective second-line treatment for chronic stable angina.
abc presentation
- Each year 3.2 million people die from diabetes complications, with up to 1 in 4 deaths in adults aged 35-64 in high-incidence countries due to the disease.
- Type 2 diabetes is a major cause of premature death mainly through increased cardiovascular disease risk. Controlling individual risk factors like blood pressure, cholesterol, and blood glucose can prevent and slow cardiovascular disease in people with diabetes.
- Treatment goals for diabetes include an A1C under 7%, blood pressure under 140/80 mmHg, and LDL cholesterol under 100 mg/dL to reduce risks of complications like heart disease, stroke, and kidney disease.
Congestive heart failure
This document provides an overview of heart failure, including its definition, epidemiology, etiology, pathophysiology, classification, signs and symptoms, diagnosis, and treatment. Heart failure is defined as when the heart is unable to pump enough blood to meet the body's needs. It affects about 3-20 cases per 1000 people and is increasing in prevalence. Causes include intrinsic pump failure, increased workload on the heart, and impaired filling of cardiac chambers. Treatment involves pharmacological therapies like ACE inhibitors, beta blockers, diuretics, as well as non-pharmacological approaches like diet modification and exercise.
Diabetic dyslipidemia
The document discusses cardiovascular disease (CVD) risk factors and outcomes in patients with diabetes. It finds that CVD is responsible for 60-75% of mortality in type 2 diabetes (T2DM) patients. CVD prevalence increases with both age and duration of T2DM. Patients can develop CVD even in the first few years after being diagnosed with diabetes. Intensive control of blood sugar, blood pressure, and cholesterol is important for reducing CVD risk in T2DM patients.
Diabetic dyslipidemia
This document provides an overview of diabetic dyslipidemia and lipid management recommendations for patients with diabetes. It discusses that excess fat contributes to atherosclerosis and mortality in diabetes. It outlines traditional and non-traditional risk factors for cardiovascular disease. The spectrum of diabetic dyslipidemia includes quantitative changes like high triglycerides and qualitative changes in lipoprotein composition. Lifestyle modifications and statin therapy are recommended to improve lipid profiles and reduce cardiovascular risk according to guidelines. The appropriate screening, interpretation of results, and intensity of statin therapy depends on individual patient risk factors and characteristics.
Chronic Stable Angina.pptx
Trimetazidine is a newer anti-anginal drug that acts as a metabolic modulator. It works by shifting energy production in cardiac cells from fatty acid oxidation to glucose oxidation. This protects cells during ischemia. Trimetazidine reduces angina attacks, increases exercise tolerance, and improves outcomes like cardiac function and survival in patients with ischemic heart disease. It has fewer side effects than other anti-anginal drugs and is recommended as a second-line treatment option when first-line therapies are inadequate or not tolerated. However, not all trimetazidine formulations are equivalent, as generic copies may have reduced efficacy compared to the original research brand Vastarel MR.
0900 0920 Antiplatelet and Anticoaulation Therapy Aleti FINAL(1).pptx
This document provides guidelines for antiplatelet and anticoagulation therapy. It discusses:
1) Current practice guidelines for managing antiplatelet therapy in CAD patients, including the selection of different antiplatelet medications and optimal durations of dual antiplatelet therapy.
2) Evidence for aspirin, clopidogrel, prasugrel, and ticagrelor in primary and secondary prevention. It finds prasugrel and ticagrelor reduce ischemic events compared to clopidogrel but with potential for higher bleeding risks.
3) Guidelines for dual antiplatelet therapy duration after stent implantation, recommending at least 1 year for most patients but shorter durations for those at high bleeding risk
Common Risk Factors for Heart Disease Dr. Ranjit Jagtap.pdf
As per Dr. Ranjit Jagtap News By making positive lifestyle changes and working closely with your healthcare provider to manage any underlying conditions, you can significantly reduce your risk of heart disease. Remember that prevention is key, and the choices you make today can have a profound impact on your heart health in the years to come. So, take the necessary steps to prioritise your heart’s well-being and live a longer, healthier life.
Dyslipidemia
This document discusses dyslipidemia, which refers to abnormal levels of lipids in the blood such as elevated cholesterol, triglycerides, and low HDL. It causes by the accumulation of LDL cholesterol and leads to atherosclerosis and increased risk of heart disease. Treatment involves lifestyle modifications like diet, exercise, weight loss to lower lipid levels as well as lipid-lowering medications like statins which work by inhibiting cholesterol production in the liver. The goals of treatment are to lower LDL cholesterol and reduce risk of heart attacks and other cardiovascular events.
Prevention of stroke - Dự phòng đột quỵ não
This document provides guidelines for preventing stroke in patients who have had a stroke or transient ischemic attack. It discusses controlling risk factors such as hypertension, dyslipidemia, diabetes, obesity, and atrial fibrillation. It recommends treating hypertension to a target blood pressure under 140/90 mmHg. It suggests statin therapy for patients with atherosclerotic ischemic stroke or TIA. It also recommends screening post-stroke patients for diabetes and obesity. For carotid artery disease, it supports carotid endarterectomy for severe stenosis, and optimal medical therapy for mild-moderate stenosis. The document provides guidance on anticoagulation and antiplatelet therapies for atrial fibrillation and general stroke prevention respectively.
Similar to Management chf lecture dr samir tayfour (20)
Exacerbation of Heart Failure : Thiazolidinediones
Exacerbation of Heart Failure : Thiazolidinediones
Guidelines for prevention of stroke Guidelines for prevention of stroke
Guidelines for prevention of stroke Guidelines for prevention of stroke
PHARMACOTHERAPY POINTERS FOR ATHEROSCLEROSIS [MALAYSIAN CPGs].pdf
PHARMACOTHERAPY POINTERS FOR ATHEROSCLEROSIS [MALAYSIAN CPGs].pdf
0900 0920 Antiplatelet and Anticoaulation Therapy Aleti FINAL(1).pptx
0900 0920 Antiplatelet and Anticoaulation Therapy Aleti FINAL(1).pptx
Common Risk Factors for Heart Disease Dr. Ranjit Jagtap.pdf
Common Risk Factors for Heart Disease Dr. Ranjit Jagtap.pdf
Recently uploaded
NARCOTICS- POLICY AND PROCEDURES FOR ITS USE
This document outlines policies and procedures for handling narcotic and controlled drugs in NABH accredited hospitals.
5 Effective Homeopathic Medicines for Irregular Periods
Discover the benefits of homeopathic medicine for irregular periods with our guide on 5 common remedies. Learn how these natural treatments can help regulate menstrual cycles and improve overall menstrual health.
Visit Us: https://drdeepikashomeopathy.com/service/irregular-periods-treatment/
How to choose the best dermatologists in Indore.
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
Nano-gold for Cancer Therapy chemistry investigatory project
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...Université de Montréal
“Psychiatry and the Humanities”: An Innovative Course at the University of Montreal Expanding the medical model to embrace the humanities. Link: https://www.psychiatrictimes.com/view/-psychiatry-and-the-humanities-an-innovative-course-at-the-university-of-montrealPune Call Girls 7339748667 AVAILABLE HOT GIRLS AUNTY BOOK NOW
Pune Call Girls 7339748667 AVAILABLE HOT GIRLS AUNTY BOOK NOW
June 2024 Oncology Cartoons By Dr Kanhu Charan Patro
une 2024 Oncology Cartoons By Dr Kanhu Charan Patro
What is Obesity? How to overcome Obesity?
Obesity is a chronic complex disease defined by excessive fat deposits that can impair health.
Foundation of Yoga, YCB Level-3, Unit-1
Unit -1 of Yoga certification board, level 3, all topics covered. An exam conducted by ministry of Ayush for yoga enthusiastic students.
Top Travel Vaccinations in Manchester
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
How to Control Your Asthma Tips by gokuldas hospital.
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
Pollen and Fungal allergy: aeroallergy.pdf
Pollen and Fungal allergy: aeroallergy.pdfChulalongkorn Allergy and Clinical Immunology Research Group
Pollen and Fungal allergy
Presented by Chaloemchai Chumsaengchotsakul, MD.
June 14, 2024Medical Quiz ( Online Quiz for API Meet 2024 ).pdf
This quiz was conducted as a promotional event for the 2024 Annual Meet of Kerala Chapter of API.
More than 20 participants took part everyday !
Artificial Intelligence Symposium (THAIS)
Artificial Intelligence Symposium (THAIS). Parc Taulí. Sabadell
Breast cancer: Post menopausal endocrine therapy
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
Recently uploaded (20)
5 Effective Homeopathic Medicines for Irregular Periods
5 Effective Homeopathic Medicines for Irregular Periods
Nano-gold for Cancer Therapy chemistry investigatory project
Nano-gold for Cancer Therapy chemistry investigatory project
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...
Pune Call Girls 7339748667 AVAILABLE HOT GIRLS AUNTY BOOK NOW
Pune Call Girls 7339748667 AVAILABLE HOT GIRLS AUNTY BOOK NOW
Tele Optometry (kunj'sppt) / Basics of tele optometry.
Tele Optometry (kunj'sppt) / Basics of tele optometry.
June 2024 Oncology Cartoons By Dr Kanhu Charan Patro
June 2024 Oncology Cartoons By Dr Kanhu Charan Patro
How to Control Your Asthma Tips by gokuldas hospital.
How to Control Your Asthma Tips by gokuldas hospital.
Medical Quiz ( Online Quiz for API Meet 2024 ).pdf
Medical Quiz ( Online Quiz for API Meet 2024 ).pdf
Management chf lecture dr samir tayfour
- 1. Dr SAMIR TAYFOUR CONSULTANT CARDIOLOGIST KSA
- 9. Determine the type of cardiac dysfunction (systolic vs. diastolic) Determine Etiology Define prognosis Guide therapy
- 11. Lifestyles, Fitness and Rehabilitation Treatment options Surgery and other Medical Procedures Not often used in heart failure unless there is a correctable problem Coronary artery bypass Angioplasty Valve replacement Defibrillator implantation Heart transplantation Left ventricular assist device (LVAD)
- 23. Risk Factor Goal Hypertension Generally < 130/80 Diabetes See ADA guidelines1 Hyperlipidemia See NCEP guidelines2 Inactivity 20-30 min. aerobic 3-5 x wk. Obesity Weight reduction < 30 BMI Alcohol Men ≤ 2 drinks/day, women ≤ 1 Smoking Cessation Dietary Sodium Maximum 2-3 g/day Diabetes Care 2006; 29: S4-S42 1 JAMA 2001; 285:2486-97 2 Adapted from:
- 28. Cardiac glycosides in clinical use are: Digoxin, Digitoxin Ouabain.
- 39. Figure 1. Agonist activation and coupling/signaling properties of β-adrenergic receptor subtypes. Lohse M J et al. Circulation Research 2003;93:896-906 Copyright © American Heart Association
- 40. Figure 2. Calcium cycling in cardiac myocytes and regulation by PKA. AC indicates adenylyl cyclase; RyR, ryanodine receptor; PLB, phospholamban; SERCA, sarcoplasmic reticulum calcium ATPase; CaM, calmodulin; CaMK, calmodulin-dependent kinase; CaN, calcineur... Lohse M J et al. Circulation Research 2003;93:896-906 Copyright © American Heart Association
- 49. Heart Zones
Editor's Notes
- All patients presenting with heart failure should undergo diagnostic evaluation that: Determines the type of cardiac dysfunction (systolic vs. diastolic) Uncovers the etiology and if it is reversible Defines the prognosis, and Guides therapy
- The June 2006 AHA guide regarding exercise, “Making healthy food and lifestyle choices: Our guide for American adults,” recommends 30 minutes or more of aerobic exercise every day. The recommendations and a free brochure are available at www.americanheart.org or 1-800-AHA-USA1.
- Figure 1. Agonist activation and coupling/signaling properties of β-adrenergic receptor subtypes. GRK indicates G protein–coupled receptor kinase; βArr, β-arrestin; PDE, phosphodiesterase; PI3K, phosphatidylinositol 3-kinase; and AC, adenylyl cyclase. Data from Hoffmann et al.184
- Figure 2. Calcium cycling in cardiac myocytes and regulation by PKA. AC indicates adenylyl cyclase; RyR, ryanodine receptor; PLB, phospholamban; SERCA, sarcoplasmic reticulum calcium ATPase; CaM, calmodulin; CaMK, calmodulin-dependent kinase; CaN, calcineurin; GRK, G protein–coupled receptor kinase; NCX, sodium-calcium exchanger; NHE, sodium-proton exchanger; and PP, protein phosphatase.