Hypertension, or high blood pressure, is a global health problem that affects nearly 1 billion people worldwide. It is poorly controlled, with less than 25% of cases controlled in developed countries and less than 10% in developing countries. If left untreated, hypertension can lead to heart attacks, heart failure, strokes and kidney disease.
The goals of hypertension treatment are to reduce cardiovascular and renal morbidity and mortality by achieving blood pressure targets. Lifestyle modifications such as weight loss, following a diet low in sodium and high in fruits/vegetables, engaging in physical activity, and quitting smoking can help lower blood pressure. When lifestyle changes are not enough, antihypertensive medications including diuretics, ACE inhibitors,
Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term medical condition in which the blood pressure in the arteries is persistently elevated.
this presentation have various hypertension management guidelines used in the Indian context, hypertension management algorithm, medication used and AYUSH interventions
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Definition of hypertension - prevalence- classification and varieties of hypertension - risk factors - clinical manifestation of hypertension -complication -diagnosis - management - treatment of hypertension and special cases
Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term medical condition in which the blood pressure in the arteries is persistently elevated.
this presentation have various hypertension management guidelines used in the Indian context, hypertension management algorithm, medication used and AYUSH interventions
For More Medicine Free PPT - http://playnever.blogspot.com/
For Health benefits and medicine videos Subscribe youtube channel - https://www.youtube.com/playlist?list=PLKg-H-sMh9G01zEg4YpndngXODW2bq92w
Definition of hypertension - prevalence- classification and varieties of hypertension - risk factors - clinical manifestation of hypertension -complication -diagnosis - management - treatment of hypertension and special cases
Definition of heart failure - causes and types of heart failure - pathophysiology and risky factors for heart failure - Diagnosis clinical manifestations and investigations and classification of heart failure- treatment of chronic heart failure
Also Acute heart failure causes - clinical picture and treatment
Definition of diabetes - introduction - classification of diabetes - etiology of diabetes type 1 and type 2- risk factors for diabetes - diagnosis of diabetes - clinical manifestations of diabetes type 1 and type 2- investigations for diabetes - treatment of diabetes - non-pharmacological treatment and pharmacological treatment - pharmacotherapy of type 1 and type 2 - acute complications of diabetes and treatment
definition of heart failure, classification of heart failure, risk factors for heart failure, clinical features, general physical examination findings in heart failure
Myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops to a part of the heart, causing damage to the heart muscle. The most common symptom is chest pain or discomfort which may travel into the shoulder, arm, back, neck, or jaw.
HYPERTENSION- THE LATEST MANAGEMENT
Dr. Awadhesh kumar sharma is a young, diligent and dynamic interventional cardiologist. He did his graduation from GSVM Medical College Kanpur and MD in Internal Medicine from MLB Medical college jhansi. Then he did his superspecilisation degree DM in Cardiology from PGIMER & DR Ram Manoher Lohia Hospital Delhi. He had excellent academic record with Gold medal in MBBS,MD and first class in DM.He was also awarded chief ministers medal in 2009 for his academic excellence by former chief minister of UP Smt Mayawati in 2009.He is also receiver of GEMS international award.He had many national & international publications.He is also in editorial board of international journal- Journal of clinical medicine & research(JCMR).He is also active member of reviewer board of many journals.He is also trainee fellow of American college of cardiology. He is currently working in NABH Approved Gracian Superspeciality Hospital Mohali as Consultant Cardiologist.
Dr. Sachin Verma is a young, diligent and dynamic physician. He did his graduation from IGMC Shimla and MD in Internal Medicine from GSVM Medical College Kanpur. Then he did his Fellowship in Intensive Care Medicine (FICM) from Apollo Hospital Delhi. He has done fellowship in infectious diseases by Infectious Disease Society of America (IDSA). He has also done FCCS course and is certified Advance Cardiac Life support (ACLS) and Basic Life Support (BLS) provider by American Heart Association. He has also done a course in Cardiology by American College of Cardiology and a course in Diabetology by International Diabetes Centre. He specializes in the management of Infections, Multiorgan Dysfunctions and Critically ill patients and has many publications and presentations in various national conferences under his belt. He is currently working in NABH Approved Ivy super-specialty Hospital Mohali as Consultant Intensivists and Physician.
Definition of heart failure - causes and types of heart failure - pathophysiology and risky factors for heart failure - Diagnosis clinical manifestations and investigations and classification of heart failure- treatment of chronic heart failure
Also Acute heart failure causes - clinical picture and treatment
Definition of diabetes - introduction - classification of diabetes - etiology of diabetes type 1 and type 2- risk factors for diabetes - diagnosis of diabetes - clinical manifestations of diabetes type 1 and type 2- investigations for diabetes - treatment of diabetes - non-pharmacological treatment and pharmacological treatment - pharmacotherapy of type 1 and type 2 - acute complications of diabetes and treatment
definition of heart failure, classification of heart failure, risk factors for heart failure, clinical features, general physical examination findings in heart failure
Myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops to a part of the heart, causing damage to the heart muscle. The most common symptom is chest pain or discomfort which may travel into the shoulder, arm, back, neck, or jaw.
HYPERTENSION- THE LATEST MANAGEMENT
Dr. Awadhesh kumar sharma is a young, diligent and dynamic interventional cardiologist. He did his graduation from GSVM Medical College Kanpur and MD in Internal Medicine from MLB Medical college jhansi. Then he did his superspecilisation degree DM in Cardiology from PGIMER & DR Ram Manoher Lohia Hospital Delhi. He had excellent academic record with Gold medal in MBBS,MD and first class in DM.He was also awarded chief ministers medal in 2009 for his academic excellence by former chief minister of UP Smt Mayawati in 2009.He is also receiver of GEMS international award.He had many national & international publications.He is also in editorial board of international journal- Journal of clinical medicine & research(JCMR).He is also active member of reviewer board of many journals.He is also trainee fellow of American college of cardiology. He is currently working in NABH Approved Gracian Superspeciality Hospital Mohali as Consultant Cardiologist.
Dr. Sachin Verma is a young, diligent and dynamic physician. He did his graduation from IGMC Shimla and MD in Internal Medicine from GSVM Medical College Kanpur. Then he did his Fellowship in Intensive Care Medicine (FICM) from Apollo Hospital Delhi. He has done fellowship in infectious diseases by Infectious Disease Society of America (IDSA). He has also done FCCS course and is certified Advance Cardiac Life support (ACLS) and Basic Life Support (BLS) provider by American Heart Association. He has also done a course in Cardiology by American College of Cardiology and a course in Diabetology by International Diabetes Centre. He specializes in the management of Infections, Multiorgan Dysfunctions and Critically ill patients and has many publications and presentations in various national conferences under his belt. He is currently working in NABH Approved Ivy super-specialty Hospital Mohali as Consultant Intensivists and Physician.
This presentation focus on the accurate method of BP measurement as well as the presentation of the latest clinical trials of hypertension management and their impact on recent guidelies
Desde 1980, la American College of Cardiology (ACC) y American Heart Association (AHA) tienen evidencia cientifica con recomendaciones para la salud cardiovascular.
Basada en la 2017 Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults
This lecture presents the 1-Updated recommendations regarding definition and proper diagnosis of HTN. 2-Updated guidelines for threshold of BP to start treatment and targets of treatment. 3- Updated recommendations on CV risk assessment and management. 4-Hypertension and comorbidities: updated guidelines
Pulmonary hypertension (PH) is a complex and progressive
condition characterised by high blood pressure in the lungs, leading
to significant health challenges. This book is dedicated to unravelling
the intricacies of PH, encompassing its pathophysiology, diagnosis,
management and emerging research trends. It is designed to serve
as a comprehensive guide for clinicians, researchers and students
in the field of cardiology and respiratory medicine, as well as a
valuable resource for patients and their families seeking to deepen
their understanding of this condition.
The chapters of this book are structured to provide a detailed
insight into the various facets of PH. Starting with the basic
pathophysiology and classification systems, I delve into the
clinical presentation, diagnostic criteria and the nuances of
managing this condition, including both pharmacological and
non-pharmacological approaches. Special attention is given to
the unique challenges posed by pediatric PH, PH in pregnancy
and the management of co-morbidities and complications.
Recognizing the rapid advancements in the field, this book also
dedicates a significant portion to discussing current research
trends, future therapeutic targets and evolving diagnostic
techniques. Real-world case studies and patient testimonies are
included to provide a practical perspective, highlighting the
impact of PH on patients’ lives and the importance of a patient-
centered approach to care.
The field of pulmonary hypertension is one of dynamic change
and I growing understanding. Through this book, we aim to
provide a thorough and up-to-date resource that reflects the
current state of knowledge and practice in the field of PH, while
also offering a glimpse into the future directions of research and
treatment. It is my hope that this book will not only enhance the
understanding of PH among healthcare professionals but also offer
support and information to patients and their families navigating
this challenging condition.
I wish to express our heartfelt gratitude to the following
individuals whose unwavering support and contributions have
played a pivotal role in the creation of this book "Innovations in
Cardiology: From Fundamentals to Frontiers – Short Notes in
Cardiology," My sincere thanks go to: Professor Sufia Rahman,
Professor Abdullah Al Shafi Majumder, Professor dr. Abduz
Zaher, Professor Syed Azizul Haque, Professor Dr Nurunnahar
Fatema Begum; Professor Md. Atahar Ali, Professor Dr. Afzalur
Rahman, Professor Fazila- Tun- Nessa Malik, Professor Kh.
Qamrul Islam; Professor Dr. GM Faruque, Professor M.
Maksumul Haq,Professo Dr. Sajal Krisna Banerjee; Professor
Dr. STM Abu Azam; Professor Mir Jamal Uddin, Professor
Mohammad Abdur Rashid, Professor Dr. AKM Fazlur Rahman,
Professor Dr. Abdul Kader Akanda, Professor Dr. AQM Reza,
Professor Dr. Saiful Islam; Dr. Shams Munwar; Professor Dr.
Chaudhury Meshkat Ahmed, Professor Dr. Khaled Mohsin,
Professor Abdul Wadud Chowdhury, Professor Razia Sultana
Mahmud,Professor Dr. M Touhidul Haque; Professor Dr. Md.
Sahabuddin, Professor Prabir Kumar Das, Professor Dr. Baren
Chakraborty, Professor Dr. Amirul Khusru, Dr. Kaiser Nasrullah
Khan, Professor Ashok Dutta, Professor Md. Khalequzzaman,
Dr. Abdullah Al Jamil, Professor Dr. Amal Kumar Choudhury,
Professor Mostafa Zaman Babul, Professor Dr Dipal Krishna
Adhikary, Professor Dr. Dipankar Chandra Nag professor Dr.
Moeen Uddin Ahmed, professor Mir nesar Uddin; Brig. Gen. Dr.
Syeda Aleya Sultana,Professor Dr Syed Nasir Uddin; Professor
Dr Mohsin Hossain; Dr. Sm Shahidul Haque; Professor Dr
Tawfiq Shahriar Huq; Dr. SM Quamrul Haque; Professor Dr.
Mamunur Rashid Sizar, Professor Dr. Mohsin Ahmed, Professor
Dr. Zillur Rahman; Professor Dr. Tanjima Parveen; Professor Dr.
Harisul hoque, Dr. Reyan Anis, Dr. Ashish Dey, Dr. Mohammad
Ullah firoz, Professor Dr. Udoy Shankar Roy; Dr. Nuruddin
Tareq; Dr. Md. Towhiduzzaman, Dr. Kh. Asaduzzaman, Dr.
AKM Monwarul Islam, Dr. Abdul Momen, Dr. Md. Shafiqur
Rahman Patwary, Dr. Md, Zulfiker Ali Lenin; Dr. Mahbub
Mansur, Dr. CM Shaheen Kabir, Dr. Rumi Alam, Dr. Farah
ii
Tasneem Mowmi, Dr. Rashid Ahmed, Dr. Mohammad Anowar
Hossain, Dr. Mohammad Nasimul Gani,Professor Dr abu Tarek
Iqbal, Dr. Husnayen Nanna, Dr. Abdul Malek, Dr, Ajoy Kumar
Datta, Dr. Nur Alam; Dr. Sahela Nasrin; Dr. Haripada sarker, Dr.
Anisul Awal, Dr. Shaila Nabi; Professor Dr. Umme Salma Khan;
Dr SM Ahsan Habib; Professor Dr Solaiman Hossain; Dr. Bijoy
Dutta,Dr. Shahana Zaman; Dr. Ishrat Jahan shimu, Dr. Ibrahim
Khalil. Dr. Chayan Kumar Singha, Dr. Kazi Nazrul Islam, Dr.
Kamal pasha; professor Dr. Liakat Hossain Tapan, Professor Dr.
Mamun Iqbal, Professor Dr. MG Azam, Dr. Lima Asrin Sayami,
Dr. Smita Kanungo; Dr. Sadequl Islam Shamol; Dr. Swadesh
chakraborty; Dr. Md. Rasul Amin Shepon; Dr. Saqif shahriar;
Your collective wisdom, expertise and commitment to the field
of cardiology have enriched the content of this book. Your
mentorship and guidance have been invaluable in shapi
Definition: Cardiac arrhythmias refer to abnormal heart rhythms, where the heartbeat may be too slow (bradycardia), too fast (tachycardia), or irregular.
These irregularities disrupt the normal electrical signaling in the heart.
In a world where hearts beat free and bold,
A silent foe creeps, its story untold,
Rheumatic whispers, in hushed refrain,
A tale of love's struggle, of heartache and pain.
A childhood song, innocent and sweet,
Takes a tragic turn, hearts skip a beat,
Rheumatic winds blow, fierce and unseen,
Leaving scars on hearts that once danced so keen.
Valves that should open, a rhythmic embrace,
Now bear the weight of this silent chase,
Rheumatic echoes, a haunting refrain,
Leaving imprints of sorrow, of loss and of pain.
But amidst the shadows, there's hope that glows,
A symphony of care, compassion bestows,
With knowledge and love, we stand side by side,
To mend these hearts, to be a healing guide.
Rheumatic battles, we'll face them anew,
A united front, a relentless crew,
For every heart deserves freedom's embrace,
And in the face of rheumatic storms, we'll find grace.
So let's raise our voices, let the world hear,
The fight against rheumatic pain, we hold dear,
With courage and faith, we'll rewrite the verse,
A tale of triumph, of hearts that converse.
"Rheumatic fever reminds us that our body is a delicate symphony, and neglecting even the slightest discord can lead to profound consequences." -
"In the battle against rheumatic fever, awareness and early intervention are our most potent allies."
"Rheumatic fever teaches us the vital lesson that the heart, both physical and emotional, must be nurtured with care and vigilance." -
"Every case of rheumatic fever avoided is a triumph of knowledge, compassion, and the will to protect our most vital instrument, the heart." -
"Rheumatic fever serves as a reminder that even the strongest fortresses need vigilant guardians to shield against the unseen enemies within." -
Case Scenario: You're presenting research findings on hypertension prevalence in
different regions. What Excel chart type would best visualize the variation in
prevalence across regions?
Options: A) Line chart B) Pie chart C) Bar chart D) Scatter plot E) Radar chart Answer:
C) Bar chart
Explanation: A bar chart effectively compares values across different categories,
making it ideal for visualizing the variation in hypertension prevalence across different
regions.
Case Scenario: You're analyzing patient demographics, and you want to find the
most common blood type among your patients. What Excel function would help
you identify the mode of the blood types?
Options: A) MEDIAN B) MODE C) COUNTIF D) AVERAGE E) SUM Answer: B)
MODE
Explanation: The MODE function in Excel helps you find the most frequently occurring
value in a range, making it suitable for identifying the most common blood type among
patients.
Case Scenario: You're conducting a study on the effects of exercise on blood
pressure. What Excel tool would you use to create a summary table showing
average blood pressure before and after exercise?
Options: A) Goal Seek B) PivotTable C) Data Validation D) Filter E) Sort Answer: B)
PivotTable
Explanation: A PivotTable in Excel can summarize data and calculate averages,
making it suitable for creating a summary table showing average blood pressure before
and after exercise.
Case Scenario: You're managing patient records and need to categorize patients
into age groups for analysis. What Excel function would you use to assign each
patient to a specific age category?
Options: A) VLOOKUP B) IF C) COUNTIF D) INDEX E) MATCH Answer: B)
IF
Explanation: The IF function in Excel allows you to apply conditional logic. It's useful
for categorizing patients into age groups based on their ages.
Case Scenario: You're analyzing the effectiveness of a new drug on reducing
cholesterol levels in patients. Which Excel function would you use to calculate
the percentage reduction in cholesterol for each patient?
Options: A) SUMIF B) AVERAGEIF C) MEDIAN D) COUNTIF E) IF Answer: E) IF
Explanation: The IF function in Excel allows you to apply conditional logic. It's useful
for calculating the percentage reduction in cholesterol levels based on the original and
post-treatment values.
Case Scenario: You're preparing a presentation on global prevalence rates of
different heart diseases. What Excel chart type would best display the proportion
of each disease in relation to the whole?
Options: A) Line chart B) Scatter plot C) Bar chart D) Pie chart E) Area chart Answer:
D) Pie chart
Explanation: A pie chart effectively displays proportions and percentages, making it
ideal for showcasing the proportion of each heart disease in relation to the total.
Case Scenario: You're managing a database of medical research papers, including
titles, authors, and publication years. What Excel tool can you use to quickly find
papers published between cert
5. A 5 years old boy presents with fever & swelling of knee and ankle joint for 3 weeks. Write down 3 important D/D. Discuss the treatment of acute rheumatic fever with carditis. (DU-09Ju)
Three important differential diagnoses of a 5-year-old boy presenting with fever and joint swelling for 3 weeks include:
Septic arthritis: This is an acute bacterial infection of a joint that causes similar symptoms to rheumatic fever but is usually monoarticular and associated with more severe pain, redness, and tenderness of the affected joint. Septic arthritis requires urgent drainage and antibiotics.
Juvenile idiopathic arthritis: This is a group of chronic autoimmune disorders that can present with fever, joint swelling, and stiffness. The diagnosis is based on clinical features, laboratory tests, and imaging studies. The treatment may include nonsteroidal anti-inflammatory drugs, disease-modifying antirheumatic drugs, and biologic agents.
Reactive arthritis: This is an inflammatory joint disease that can occur after an infection, especially with certain bacteria such as Chlamydia, Salmonella, or Shigella. Reactive arthritis usually affects the lower limb joints, such as knees, ankles, and feet, and may be associated with skin rash, eye inflammation, or urethritis. The treatment may include antibiotics, nonsteroidal anti-inflammatory drugs, and corticosteroids.
Assuming the diagnosis of acute rheumatic fever with carditis, the treatment usually involves a combination of antibiotics and anti-inflammatory drugs. The antibiotics aim to eradicate the streptococcal infection and prevent further rheumatic fever recurrences, while the anti-inflammatory drugs aim to reduce the inflammation and symptoms of carditis. The specific regimen may vary depending on the severity of carditis, the presence of other complications, and the patient's age and weight. In general, the following principles apply:
Antibiotics: A 10-day course of oral or intramuscular penicillin is the first-line antibiotic for acute rheumatic fever, as it is effective against most strains of streptococci and has low toxicity. Alternative antibiotics may be used for patients who are allergic to penicillin or have recurrent rheumatic fever despite adequate penicillin therapy. Long-term prophylaxis with penicillin is recommended to prevent recurrences, usually until the age of 21 years or for 10 years after the last episode of rheumatic fever, whichever is longer.
Anti-inflammatory drugs: High-dose aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen are usually given for the first 2-3 weeks of acute rheumatic fever to control fever, pain, and inflammation. Corticosteroids such as prednisone or methylprednisolone may be used in severe cases of carditis or when other therapies are not effective or contraindicated. The duration and dose of anti-inflammatory drugs should be tailored to the patient's response and adverse effects, such as gastric
The Cardiovascular System: Life's Vital Transport System
The cardiovascular system, comprising the heart, blood vessels, and blood, is a fundamental physiological network in the body.
It facilitates the circulation of oxygen, nutrients, hormones, and immune cells while eliminating waste products.
Essential for maintaining tissue function, energy production, and overall homeostasis.
Defining the Cardiovascular System
The cardiovascular system, also known as the circulatory system, is a complex network responsible for circulating vital substances throughout the body.
Components of the Cardiovascular System
Heart: A muscular organ that pumps blood, generating the force required to propel blood through the blood vessels.
Blood Vessels: A network of tubes that carry blood to and from various body tissues.
Blood: A specialized fluid containing red and white blood cells, platelets, and plasma, essential for nutrient and gas exchange.
Exploring Applied Physiology of the Cardiovascular System
The cardiovascular system is a cornerstone of human health, regulating the circulation of vital nutrients, oxygen, and waste products throughout the body.
Understanding the applied physiology of this system is essential for healthcare professionals to provide effective medical care and interventions.
Importance of Applied Cardiovascular Physiology
Effective healthcare requires a deep comprehension of how the cardiovascular system functions under various conditions.
Applied physiology knowledge empowers healthcare practitioners to make informed decisions, diagnose disorders, and formulate targeted treatment plans.
Focus on Practical Applications in Healthcare
This presentation delves into the practical aspects of cardiovascular physiology that directly impact clinical practice.
We will explore how physiological concepts are translated into real-world medical scenarios and interventions.
By grasping the applied physiology of the cardiovascular system, healthcare providers can optimize patient care, enhance diagnostics, and improve treatment outcomes.
Throughout this presentation, we'll bridge the gap between theoretical understanding and its practical implications in the field of healthcare.
Understanding the Components
The cardiovascular system comprises three crucial components: the heart, blood vessels, and blood.
Heart: A muscular organ that pumps blood, ensuring a continuous flow throughout the body.
Blood Vessels: A network of tubes that transport blood to and from various tissues.
Blood: A specialized fluid that carries nutrients, oxygen, hormones, and removes waste products.
Role in Oxygen and Nutrient Delivery
Oxygen from the lungs and nutrients from the digestive system are transported to body tissues through the bloodstream.
These essential components are required for cellular metabolism and energy production.
Peripartum cardiomyopathy (PPCM) is a type of heart disease that affects women during the last month of pregnancy or in the first few months after delivery. It is characterized by a weakened and enlarged heart muscle, which makes it difficult for the heart to pump blood efficiently to the rest of the body. The exact cause of PPCM is unknown, but it is believed to be related to the hormonal changes and increased demands on the heart that occur during pregnancy. Symptoms of PPCM can include shortness of breath, fatigue, chest pain, swelling in the legs and feet, and palpitations. Treatment for PPCM usually involves medications to improve heart function and supportive care to manage symptoms. In severe cases, advanced treatments such as implantable devices or heart transplantation may be necessary. With early diagnosis and treatment, most women with PPCM can recover completely and go on to lead healthy lives.during pregnancy.
The diagnosis of PPCM is based on clinical symptoms, such as shortness of breath, fatigue, chest pain, and edema, along with imaging studies, such as echocardiography. Treatment for PPCM usually involves medications to improve heart function and supportive care to manage symptoms. These medications can include beta-blockers, ACE inhibitors, diuretics, and inotropic agents. In severe cases, advanced treatments such as mechanical circulatory support or heart transplantation may be necessary.
The prognosis for PPCM varies depending on the severity of the disease and the presence of underlying comorbidities. However, with early diagnosis and appropriate treatment, most women with PPCM can recover completely and go on to lead healthy lives. The recurrence rate of PPCM in subsequent pregnancies is approximately 20%, and women who have had PPCM are advised to avoid future pregnancies or undergo careful monitoring and management during pregnancy.
There are still many unanswered questions about PPCM, including its exact cause, optimal diagnostic and treatment strategies, and long-term outcomes. Further research is needed to better understand this complex and potentially life-threatening condition.
In conclusion, PPCM is a rare but serious form of heart disease that can occur during or after pregnancy. Early recognition and management of this condition are critical in preventing complications and improving outcomes for both the mother and the baby. Future research will continue to shed light on the pathophysiology and optimal management of PPCM.
Cardiac rehabilitation is a comprehensive program that aims to improve the health and quality of life of individuals with cardiovascular disease. This review article provides an overview of current evidence-based practices and the benefits of cardiac rehabilitation. The article discusses the components of cardiac rehabilitation, including medical evaluation, physical activity and exercise training, nutrition counseling and education, psycho social support and counseling, cardiac risk factor management, medication management, and tobacco cessation counseling. The article also discusses the effectiveness of cardiac rehabilitation in reducing mortality rates, improving functional capacity, and reducing the risk of future cardiovascular events. Additionally, the article explores the future directions of cardiac rehabilitation, including personalized medicine, technology integration, home-based programs, expanded target populations, and a multidisciplinary approach. Healthcare providers play a crucial role in encouraging and referring eligible patients to cardiac rehabilitation programs as part of their treatment plan. The review concludes that cardiac rehabilitation is an essential aspect of the management of cardiovascular disease and highlights the need for further research and development in this dynamic field.
Outline of CPR manual
I. Introduction
A. Definition of CPR
1. Explanation of what CPR stands for
2. Definition of CPR as a life-saving technique
B. Importance of CPR
1. Statistics on cardiac arrest and survival rates
2. Explanation of why CPR is crucial for saving lives
C. Objective of the manual
1. Explanation of what readers will learn from the manual
2. Statement of the manual's purpose
II. Getting Started with CPR
A. Assessing the situation
1. Importance of assessing the situation before starting CPR
2. Factors to consider when assessing the situation
B. Checking for responsiveness
1. Explanation of how to check for responsiveness
2. Importance of checking for responsiveness
C. Activating the emergency response system
1. Explanation of when to activate the emergency response system
2. Step-by-step guide to activating the emergency response system
III. Basic Life Support Techniques
A. Key components of basic life support
1. Explanation of the components of basic life support
2. Importance of each component
B. The ABCs of CPR
1. Explanation of the ABCs of CPR
2. Importance of each step in the ABCs of CPR
C. Performing chest compressions
1. Explanation of how to perform chest compressions
2. Importance of proper chest compression technique
D. Delivering rescue breaths
1. Explanation of how to deliver rescue breaths
2. Importance of proper rescue breath technique
E. Utilizing an automated external defibrillator (AED)
1. Explanation of what an AED is and how it works
2. Step-by-step guide to using an AED
F. Administering medications during CPR
1. Explanation of medications used during CPR
2. Dosages and administration guidelines for each medication
IV. Advanced Life Support Techniques
A. Advanced airway management
1. Explanation of advanced airway management techniques
2. Importance of advanced airway management in CPR
B. Advanced monitoring techniques
1. Explanation of advanced monitoring techniques
2. Importance of advanced monitoring in CPR
C. Invasive interventions
1. Explanation of invasive interventions
2. Importance of invasive interventions in CPR
D. Extracorporeal membrane oxygenation (ECMO)
1. Explanation of ECMO
2. Importance of ECMO in CPR
V. Improving Outcomes in CPR
A. Factors influencing CPR outcomes
1. Explanation of factors that influence CPR outcomes
2. Importance of understanding these factors
B. Strategies for improving CPR outcomes
1. Explanation of strategies for improving CPR outcomes
2. Importance of implementing these strategies
C. The role of high-quality CPR in improving outcomes
1. Explanation of what high-quality CPR is
2. Importance of performing high-quality CPR
VI. Special Considerations in CPR
A. CPR in special populations
1. Explanation of special populations that require unique CPR techniques
2. Importance of understanding these unique CPR techniques
B. CPR in special settings
1. Explanation of special settings that require unique CPR techniques
2. Importance of understanding these unique CPR techniques
C.
I. Introduction
A. Brief explanation of World Hypertension Day
B. Importance of addressing hypertension as a global health issue
C. Overview of the objectives of the presentation
II. Understanding Hypertension
A. Definition and classification of hypertension
B. Prevalence and global burden of hypertension
C. Risk factors and causes of hypertension
D. Health implications and complications associated with hypertension
III. World Hypertension Day 2023
A. Background and significance of World Hypertension Day
B. Theme and key messages for World Hypertension Day 2023
C. Activities and events organized worldwide to raise awareness
IV. Goals and Objectives
A. Key goals set for World Hypertension Day 2023
B. Promoting prevention and early detection of hypertension
C. Encouraging healthy lifestyle modifications
D. Enhancing public knowledge about hypertension management
V. Initiatives and Campaigns
A. Overview of global initiatives and campaigns
B. Collaborations with international organizations, NGOs, and healthcare professionals
C. Campaign materials and resources available for public use
VI. Strategies for Hypertension Prevention and Control
A. Implementing population-level interventions
B. Screening and diagnosis strategies
C. Lifestyle modifications (diet, physical activity, stress management)
D. Pharmacological management and treatment guidelines
VII. Public Awareness and Education
A. Importance of raising public awareness about hypertension
B. Educational campaigns and resources for the general public
C. Role of healthcare professionals in educating patients
VIII. Impact and Achievements
A. Highlighting the impact of previous World Hypertension Day campaigns
B. Success stories and achievements in hypertension prevention and control
C. Lessons learned and areas for improvement
IX. Conclusion
A. Recap of the key points discussed
B. Call to action for individuals, communities, and policymakers
C. Encouragement to spread awareness and take steps towards hypertension prevention
. Introduction
A. Definition and prevalence of hypertension in the elderly
B. Importance of managing hypertension in this population
II. Risk Factors and Complications
A. Common risk factors for hypertension in the elderly
B. Potential complications associated with uncontrolled hypertension
III. Diagnostic Process
A. Blood pressure measurement techniques and guidelines
B. Target blood pressure goals for elderly patients
C. Identification of secondary causes of hypertension
IV. Non-Pharmacological Management
A. Lifestyle modifications
1. Dietary recommendations (e.g., DASH diet, sodium reduction)
2. Weight management and physical activity
3. Smoking cessation and alcohol moderation
B. Stress management and relaxation techniques
V. Pharmacological Management
A. First-line antihypertensive medications
B. Considerations for drug selection in the elderly
1. Drug interactions and comorbidities
2. Adverse effects and tolerability
C. Individualized treatment approach based on patient characteristics
VI. Monitoring and Follow-Up
A. Frequency of blood pressure monitoring
B. Importance of medication adherence
C. Adjusting treatment based on patient response
D. Collaborative care and involvement of healthcare professionals
VII. Special Considerations
A. Polypharmacy and medication management
B. Management of hypertension in frail and institutionalized elderly
C. Cognitive impairment and medication adherence
VIII. Controversies and Challenges
A. Blood pressure targets and guidelines in the elderly
B. Conflicting evidence on specific antihypertensive agents
C. Adherence issues and barriers to effective management
IX. Conclusion
A. Summary of key points discussed
B. Importance of comprehensive management in elderly patients
C. Future directions in hypertension management for the elderly
I. Introduction
A. Definition of CPR
1. Explanation of what CPR stands for
2. Definition of CPR as a life-saving technique
B. Importance of CPR
1. Statistics on cardiac arrest and survival rates
2. Explanation of why CPR is crucial for saving lives
C. Objective of the manual
1. Explanation of what readers will learn from the manual
2. Statement of the manual's purpose
II. Getting Started with CPR
A. Assessing the situation
1. Importance of assessing the situation before starting CPR
2. Factors to consider when assessing the situation
B. Checking for responsiveness
1. Explanation of how to check for responsiveness
2. Importance of checking for responsiveness
C. Activating the emergency response system
1. Explanation of when to activate the emergency response system
2. Step-by-step guide to activating the emergency response system
III. Basic Life Support Techniques
A. Key components of basic life support
1. Explanation of the components of basic life support
2. Importance of each component
B. The ABCs of CPR
1. Explanation of the ABCs of CPR
2. Importance of each step in the ABCs of CPR
C. Performing chest compressions
1. Explanation of how to perform chest compressions
2. Importance of proper chest compression technique
D. Delivering rescue breaths
1. Explanation of how to deliver rescue breaths
2. Importance of proper rescue breath technique
E. Utilizing an automated external defibrillator (AED)
1. Explanation of what an AED is and how it works
2. Step-by-step guide to using an AED
F. Administering medications during CPR
1. Explanation of medications used during CPR
2. Dosages and administration guidelines for each medication
IV. Advanced Life Support Techniques
A. Advanced airway management
1. Explanation of advanced airway management techniques
2. Importance of advanced airway management in CPR
B. Advanced monitoring techniques
1. Explanation of advanced monitoring techniques
2. Importance of advanced monitoring in CPR
C. Invasive interventions
1. Explanation of invasive interventions
2. Importance of invasive interventions in CPR
D. Extracorporeal membrane oxygenation (ECMO)
1. Explanation of ECMO
2. Importance of ECMO in CPR
V. Improving Outcomes in CPR
A. Factors influencing CPR outcomes
1. Explanation of factors that influence CPR outcomes
2. Importance of understanding these factors
B. Strategies for improving CPR outcomes
1. Explanation of strategies for improving CPR outcomes
2. Importance of implementing these strategies
C. The role of high-quality CPR in improving outcomes
1. Explanation of what high-quality CPR is
2. Importance of performing high-quality CPR
VI. Special Considerations in CPR
A. CPR in special populations
1. Explanation of special populations that require unique CPR techniques
2. Importance of understanding these unique CPR techniques
B. CPR in special settings
1. Explanation of special settings that require unique CPR techniques
2. Importance of understanding these unique CPR techniques
C. CPR during a pandemic
1
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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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!
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.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
1. HYPERTENSIONHYPERTENSION
AND ITSAND ITS
MANAGEMENTMANAGEMENT
Dr. Md.Toufiqur Rahman
MBBS, FCPS, MD,FACC, FESC, FRCP, FSCAI,FAPSIC,
FAPSC, FCCP
Associate Professor of Cardiology
National Institute of Cardiovascular Diseases
Sher-e-Bangla Nagar, Dhaka-1207
Consultant, Medinova,
Malbagh branch.
2. Hypertension
A World Wide Epidemic
Nearly 1 billion hypertensive in the world
Hypertension is poorly controlled, with less than
25% controlled in developed countries and less
than 10% in developing countries.
Hypertension which is responsible for 3 million
death annually.
May 14th
is World Hypertension Day
4. Hypertension is a hemodynamic disorder
A well accepted definition of hypertension was
suggested by Evans and Rose:
“Hypertension should be defined in the terms of blood
pressure level above which investigation and treatment
do good more than harm”
A patient is said to be hypertensive when his SBP≥
140 mm Hg & DBP ≥ 90 mm Hg provided that the
patient is not on antihypertensive drugs.
Hypertension: DefinitionHypertension: Definition
5. Varieties OF HTNVarieties OF HTN
Labile HTN
Isolated diastolic hypertension
Isolated systolic hypertension
Malignant or accelerated Hypertension
Refractory/ Resistant hypertension
Hypertensive emergencies/ urgencies
6. Classification of BP for AdultsClassification of BP for Adults
JNC-VI;1997JNC-VI;1997
BP Classification Systolic BP Diastolic BP
Optimal <120 and <80
Normal <130 and <85
High Normal 130-139 or 85-89
Stage 1 HT 140-159 or 90-99
Stage 2 HT 160-179 or 100-109
Stage 3 HT ≥ 180 or ≥ 110
BP Classification Systolic BP Diastolic BP
Normal <120 and <80
Prehypertension 120-139 or 80-89
Stage 1 HT 140-159 or 90-99
Stage 2 HT ≥ 160 or ≥ 100
JNC-VII;2003JNC-VII;2003
7. Classification of BP LevelsClassification of BP Levels
ESH-ESC Guidelines, 2003
BP Classification
Optimal
Normal
High Normal
Grade 1 HT (mild)
Grade 2 HT (moderate)
Grade 3 (severe)
Isolated systolic HT
Systolic BP
<120
120-129
130-139
140-159
160-179
>180
>140
Diastolic BP
<80
80-84
85-89
90-99
100-109
>110
<90
9. Haemodynamic Pattern inHaemodynamic Pattern in
HypertensionHypertension
Young : ↑ BP = ↑CO X TPR
Middle Aged : ↑ BP = CO X TPR
Elderly : ↑ BP = ↓ CO X ↑ ↑ TPR
10. Aetiology of SystemicAetiology of Systemic
HypertensionHypertension
A) Essential or Primary HTN (95%)
A. ↑ Age
B. Genetic • Both parents (45%)
• Single (25%)
C. Environment • Diet Fat
Salt
alcohol
• Obesity
• Physical inactivity
• Stress
• Smoking
D. Hormonal
12. C) Others
Coarctation of the aorta
Pregnancy Induced HTN (Pre-eclampsia)
Sleep Apnea Syndrome.
Aetiology of SystemicAetiology of Systemic
HypertensionHypertension
13. Clinical ManifestationClinical Manifestation
• Asymptomatic in the majority of patients. Can
remain undetected for many years
• Headache may occur when SBP rises above
200mmHg or when blood pressure is rapidly
elevated.
14. Measuring Blood PressureMeasuring Blood Pressure
• Patient seated quietly for at least
5minutes in a chair, with feet on the
floor and arm supported at heart level
•An appropriate-sized cuff (cuff bladder encircling at
least 80% of the arm)
•At least 2 measurements
Continue…
15. Measuring Blood PressureMeasuring Blood Pressure
• Systolic Blood Pressure is the point at which the
first of 2 or more sounds is heard
• Diastolic Blood Pressure is the point of
disappearance of the sounds (Korotkoff 5th)
Continue…
16. Measuring Blood PressureMeasuring Blood Pressure
• Ambulatory BP Monitoring - information about BP
during daily activities and sleep.
• Correlates better than office measurements with
target-organ injury.
Continue…
18. The scope of the problemThe scope of the problem
– Heart Attack (MI)
– Heart Failure
– Stroke
– Kidney Disease
THEREFORE EARLY DIAGNOSIS IS ESSENTIAL TO
MINIMISE CARDIOVASCULAR RISK AND DAMAGE
TO TARGET ORGANS
19. Hypertension even today is aHypertension even today is a
triple paradox which is :triple paradox which is :
Easy to diagnose OFTEN remains undetected
Simple to treat OFTEN remains untreated
Despite availability of potent drugs, treatment
all too OFTEN is ineffective
20. The "Rule of Halves" inThe "Rule of Halves" in
HypertensionHypertension
Only 1/2 have been
diagnosed
Only 1/2 of those
diagnosed have been
treated
Only 1/2 of those treated
are adequately controlled
Only 12.5% overall are adequately controlled
Not
diagnosed
Not treated
Not
controlled
Controlled
21. Evaluation of hypertensive patientsEvaluation of hypertensive patients
Objectives:
To know accurate and representative
measurement of BP
To identity any known cause of Hypertension
To assess presence or absence of TOD
To assess response to therapy
To identity cardiovascular risks factor
To know concomitant disorders
Continue….
22. Evaluation of hypertensive patientsEvaluation of hypertensive patients
Evaluation by
Medical history
Physical Examination
Laboratory investigation
Routine tests
Optional tests.
23. Effects of Antihypertensive Drug Treatment onEffects of Antihypertensive Drug Treatment on
CV Mortality and MorbidityCV Mortality and Morbidity
Combined result from 17 randomized, placebo-controlled treatment trials; decreased in events-treated
compared to control
Arch Intern Med.1993;153: 578-581and JACC,1996; 27:121478
-52%
-38%
-35%
-25%
-16%
-60%
-50%
-40%
-30%
-20%
-10%
0%
CHF Strokes
(fatal/nonfatal)
LVF CVD Deaths CVD events
(fatal/nonfatal
Management of HTNManagement of HTN
24. 140
120
100
80
60
40
20
0
50
40
30
20
10
0
Historical Lessons About HypertensionHistorical Lessons About Hypertension
Hypertension
Increases Morbidity
and Mortality
Men Women
CHDIncidenceRate/1000
personsperyear
THE FRAMINGHAM STUDY
Cumulativefatal&
NonfatalEndpoints
Treatment Decreases
Morbidity and
Mortality
Men Women Placebo Active
Treatment
THE VET.ADM. STUDY II
Ann Inter Med. 1961; 55:33-50 JAMA. 1970;213:1143-1152
Normotension
Hypertension
25. Implication of reduction in Diastolic BP forImplication of reduction in Diastolic BP for
Primary PreventionPrimary Prevention
30
20
%Reduction
Change in DBP
0
-10
-20
-30
-40
-50
7.5 mm Hg 5-6 mm Hg 2 mm Hg
-21
-46
-16
-38
-6
-15
CHD
Stroke
Cook, et al. Arch Int med. 1995; 155:711-109
26. Millimeters Matter……Millimeters Matter……
“ A 2-mm Hg reduction in DBP would
result in…
a 6% reduction in the risk of CHD and a 15%
reduction
in the risk of stroke and TIAs”
Cook, et al. Arch Int med. 1995; 155:711-109
27. Impact of High Normal BP on CVImpact of High Normal BP on CV
Disease Risk in MenDisease Risk in Men
High Normal
130-139/ 85-89 mm Hg
Normal
120-129/ 80-84 mm Hg
Optimal
<120/ 80 mm Hg
CumulativeIncidence(%)
Time (Years) N Engl J Med. 2001;345:1291-97
28. Benefits of Lowering BPBenefits of Lowering BP
Average percent
reduction
Stroke reduction 35-40%
Myocardial infarction 20-25%
Heart failure 50%
29. Goals of TherapyGoals of Therapy
• Reduction of cardiovascular and renal
morbidity and mortality. 1
• The primary focus should be on achieving the systolic
BP goal.
• Systolic BP and diastolic BP to targets < 140/90
mmHg = decrease in CVD complications.
• In patients with hypertension with diabetes or renal
disease, the BP goal is < 130/80 mmHg 1
1
JNC - VII Report, JAMA , 2003;289:2560-2572
30. JNC VII Algorithm for Treatment of
Hypertension
JNC - VII Report, JAMA , 2003;289:2560-2572
Lifestyle
Modifications
Not at Goal BP
(< 140/90 mmHg or < 130/80 mmHg
for Those with Diabetes or Chronic
Kidney Disease
Initial Drug Choices
31. Lifestyle Modification: 1Lifestyle Modification: 1
⇒ Socioeconomic condition in the world suggest that
prevention through Lifestyle Modifications is the
universal “vaccine” against Hypertension
⇒Weight Reduction
– Maintain normal body weight
• BMI: 18.5 – 24.9
• BP reduction: 5-20 mmHg/10 kg loss
⇒DASH Eating Plan
– Dietary Approaches to Stop Hypertension
• Fruits, Vegetables, Low-fat dairy
• Reduce saturated and total fat
• 8-14 mmHg BP reduction
33. Lifestyle Modification: 3Lifestyle Modification: 3
⇒Smoking Cessation
•Any independent chronic effect of smoking on BP is small
•Smoking cessation does not decrease BP
•BUT total cardiovascular risk is increased by smoking.
Therefore hypertensives who smoke
should be counselled on smoking
cessation
36. JNC VII Algorithm for
Treatment of Hypertension
Hypertension without
compelling indications
Hypertension with
compelling indication
(Systolic Bp 140-159
mmHg
or Diastolic BP 90-99
mmHg)
Thiazide-Type
Diuretics for Most
May Consider ACE
inhibitor, ARB, ß-
blocker, CCB or
combination
Systolic Bp >160
mmHg
or Diastolic BP > 100
mmHg)
2- Drug Combination
for Most
(Usually Thiazide -
Type Diuretic and
ACE Inhibitor or ARB
or ß-blocker, CCB)
Drug (s) for the
Compelling
Indications
Other
Anithypertensive
Drugs
(Diuretics, ACE
inhibitor, ARB, ß-
blocker, CCB) as
Initial Drug Choices
37. ChoiceChoice of antihypertensiveof antihypertensive
• Diuretics, beta-blockers, calcium antagonists, ACE-inhibitors,
angiotensin receptor antagonists) are suitable for the initiation and
maintenance of therapy
• Choice:
→ Previous experience of the patient
→ Cost
→ Risk profile, target organ damage, clinical cardiovascular or renal
disease or diabetes or lung disorder
→ Patient’s preference
• Long acting preparations providing 24-h efficacy on a once daily
basis
(2003 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension. Journal of Hypertension 2003 vol21 no6 p1011-1063).
38. Special ConsiderationsSpecial Considerations
Guideline Basis for Compelling Indications for
Individual Drug Classes
High Risk Conditions
With Compelling
Indication
Heart failure
Post-myocardial
infarction
High coronary disease
risk
Diabetes
Chronic Kidney Disease
Recurrent stroke
prevention
Recommended Drugs
Diuretic β-blocker ACE inhibitor ARB CCB Aldosterone Antagonist
JNC - VII Report, JAMA , 2003;289:2560-2572
40. Possible Combination ofPossible Combination of
Antihypertensive AgentsAntihypertensive Agents
Diuretics
Beta
Blocker
∝-Blocker
ACE inhibitor
CCBs
ARBs
EHS-ESC Guidelines, 2003;
41. Indications and Contraindications forIndications and Contraindications for
the Major Classes of Antihypertensiuethe Major Classes of Antihypertensiue
DrugsDrugs
Class Conditions favouring
the use
Compelling
contraindications
Possible
contraindications
ACEIs CHF
LV dysfunction
Post-MI
Nondiabetic nephropathy
Type 1 diabetic nephropathy
Protienuria
Pregnancy
Hyperkalaemia
Bilateral RAS
ARBs Type 2 diabetic nephropathy
Diabetic microalbuminuria
Proteinuria
LVH
ACE inhibitor cough
Pregnancy
Hyperkalaemia
Bilateral RAS
a-Blockers Prostatic hyperplasia (BPH)
Hyperlipidaemia
Orthostatic
hypotension
CHF
EHS-ESC Guidelines, 2003;
42. EVOLUTION OF HYPERTENSIONEVOLUTION OF HYPERTENSION
MANAGEMENTMANAGEMENT
JNC I
1977
JNC II
1980
JNC III
1984
JNC IV
1988
JNC V
1993
JNC VI
1997
JNC VII
2003
High
Dose
diuretic
High
Dose
diuretic
Lower
Dose
diuretic
Or
β-blocker
Lower
Dose
diuretic
Or
β-blocker
Or
ACEI
Or
CCB
Lower
Dose
diuretic
Or
β-blocker
Or
ACEI
Or
CCB
α-blocker
Or
α / β blocker
•
Individulised
Therapy
•Single-agent
titration
preferred
•Loe-dose
combo
therapy as a
secondary
option
•Focus on
Systolic
BP Control
•Thiazide-
type
diuretics
preferred
as initial
drug
treatment
•Emphasis
on
combinatio
n therapy
High-dose Monotherapy Low-dose Combination
43. Management of HTN in SpecialManagement of HTN in Special
SituationSituation
1. Hypertension Crises
Hypertension Emergencies
Hypertension Urgencies
2. Refractory/ Resistant hypertension
3. HTN in Pregnancy
4. HTN with coexisting Cardiovascular & other disorders
4. Management of Secondary HTN
44.
45. Resistant Hypertension
• Not uncommon : 15-20%
• Persistence of elevated systo-diastolic pressure in
spite of at 3 anti-hypertensive drugs ( including
diuretics)
• Pre-requisites: Exclusion of pseudo-hypertension;
white-coat hypertension,use of not-appropriate
cuffs.
47. Therapeutic intervention
• Exclude undiagnosed secondary
hypertension
• Compliance of drugs
• Adherence to life style changes
• Consider use of 3 or more anti-hypertensive
drugs
• Consider the use of drugs such as
spironolactone
48. Failure of reduction of DBP<90 mm Hg
despite the use of three or more drugs
which include a diuretic
Resistant hypertension
Braunwald’s Heart Disease, 2005
49. Volume overload & pseudotolerance
“White coat”
Pseudohypertension in the elderly
Excess sodium intake
Inadequate diuretic therapy
Volume retention
Drug related
Dosage too low
Inappropriate combination
Drug interaction
Associated conditions
Smoking
Obesity
Excess alcohol
Sleep apnea
Secondary hypertension
Resistant hypertension
Causes:
Braunwald’s Heart Disease, 2005
50. Current recommendations for primary
prevention of hypertension involve:
a population based approach, and
an intensive targeted strategy focused on
individuals at high risk for hypertension.
Primary Prevention of Hypertension
Hypertension Primer, AHA, 2004
51. Conclusion
• Hypertension is easy to diagnose and easy to treat
• Aim of the management is to save the target organ from
the deleterious effect
• Pharmacological armament of antihypertensive drugs so
rich that we have wide range of options. And this makes
the physicians comfortable in varied situations.
Conversely one needs to be judicious regarding the
choice of the drug
• Besides pharmacology we have other choices and one
has to be acquainted with that choice
• Primary prevention of hypertension should be highlighted
and it should get more priority than it is getting now.
52. Hypertension - a worldwide epidemic
It’s a disease which is responsible for 3 million death annually
About 15-20% of Bangladeshi population is suffering from Hypertension
HTN is very poorly controlled - < 25% in developed & < 10% in developing
countries
Early diagnosis & management can prevent end organ damage from HTN
Target goal of BP in hypertensive patients:-
< 140/90 mm Hg
< 130/80 mm Hg for patients with DM & renal disease
Lifestyle modification is the universal “Vaccine” against Hypertension
ConclusionConclusion