Management of vt vf storm in advanced heart failure
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This document discusses the management of ventricular tachycardia (VT) and ventricular fibrillation (VF) storm in advanced heart failure. It defines VT/VF storm and outlines potential substrate and trigger mechanisms. It recommends beta-blockers and amiodarone as first-line antiarrhythmic therapies. Sedation or general anesthesia may be needed when antiarrhythmic drugs fail. Left ventricular assist devices are preferable to IV inotropes for hemodynamic support. Cardiac sympathetic denervation through thoracic epidural anesthesia or stellate ganglion block/ganglionectomy has also been used successfully in some cases.
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ECHO ASSESSMENT OF ASD FOR DEVICE CLOSURE
preop TEE assessment of atrial septal defect is very important for making decision for device closure, properly assessed adequate rims of ASD will reduce risk of device embolization to almost nil.
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This document provides an overview of cardiac resynchronization therapy (CRT). It discusses how conduction delays can lead to electromechanical dyssynchrony and impair the heart's function. CRT aims to improve this synchrony and thereby improve systolic and diastolic function. The document outlines different types of dyssynchrony and methods to assess it, including echocardiography. Current guidelines recommend CRT for symptomatic heart failure patients with low ejection fraction and wide QRS duration. The implantation procedure involves placing right atrial/ventricular leads and a left ventricular lead via the coronary sinus.
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Although flexible schedules are more common in the workplace these days, it is still important for employees to be mindful of their arrival times.
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The document outlines the essential parts of a business letter, including the heading, inside address, salutation, body, complimentary close, and signature. It describes where each part is positioned on the page and provides guidelines on formatting elements like capitalization, punctuation, and font styles. Various letter formats are also discussed, such as block, semi-block, and hanging indentation forms. Finally, mechanics of writing a professional business letter are covered, like page layout, signature placement, and envelope addressing.
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various theories of emotion
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The History of Timekeeping
Apresentação que eu fiz em 2004 para meu speech, eu cursava inglês no CCAA. Hoje em dia eu olho para trás e vejo que só escolhia temas esquisitos... haha.
O texto do meu trabalho está aqui:
http://www.karensoarele.com.br/wp-content/uploads/2014/04/The-History-of-Timekepeeing.doc
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El documento discute varios temas relacionados con la educación desde una perspectiva crítica. Aborda conceptos como la educación bancaria versus la educación problematizadora de Paulo Freire, así como las ideas de otros pensadores de la pedagogía crítica como Peter McLaren. El documento también explora temas como la función política y económica de la escuela, las formas de conocimiento, y la escuela como espacio de lucha cultural e ideológica.
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Atrial fibrillation is the most common arrhythmia and increases mortality risk. It is classified as paroxysmal, persistent, or permanent based on duration. The CHA2DS2-VASc score is used to assess stroke risk and determine need for anticoagulation. Treatment focuses on rate control with medications like calcium channel blockers or cardioversion for hemodynamic instability. Anticoagulation is recommended for CHA2DS2-VASc score over 2 to prevent stroke.
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1. Wide complex tachycardia (WCT) refers to tachycardias with a heart rate over 100 beats per minute and a QRS duration greater than 0.12 seconds.
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Aortic Valve Stenosis with low EF : TAVR versus Replacement
1) Patients with low ejection fraction (EF < 50%) and severe aortic stenosis who undergo transcatheter aortic valve replacement (TAVI) have similar mortality at 1 year compared to those with higher EF, despite being higher risk.
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The document discusses treatment options for patients with reduced ejection fraction and secondary mitral regurgitation, including the use of minimally invasive mitral valve surgery which can be considered for elderly patients or those with comorbidities. It presents a case study of a 69-year-old male with severe secondary mitral regurgitation who underwent a minimally invasive mitral valve repair which eliminated his mitral regurgitation and improved his symptoms and ejection fraction. Long-term data on isolated mitral valve surgery in patients with reduced ejection fraction shows improvement in mitral regurgitation and functional status with no difference in survival between repair and replacement
When to consider tricuspid valve repair
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Multimodality imaging.
This document discusses the conundrum of managing mitral regurgitation (MR) in patients with heart failure. It highlights the importance of using multimodality imaging to:
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2) Evaluate left ventricular function, dyssynchrony, viability and ischemia to determine indications for cardiac resynchronization therapy or revascularization.
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Imaging provides essential information to optimize treatment strategies for MR in heart failure.
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This document discusses the case of a 76-year-old man presenting with heart failure symptoms and recurrent cough syncope. Testing revealed cardiac amyloidosis due to a TTR gene mutation. For patients with TTR amyloidosis, treatment options include organ transplantation, TTR stabilizers in clinical trials, or enrollment in hospice. Given his age and comorbidities, the man's options included a left ventricular assist device, extended criteria transplant, or a clinical trial for TTR amyloidosis treatment. He was ultimately listed and transplanted, and has since recovered well.
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This document discusses the case of a 76-year-old man presenting with heart failure symptoms and recurrent cough syncope. Testing revealed cardiac amyloidosis due to a TTR gene mutation. For patients with TTR amyloidosis, treatment options include organ transplantation, TTR stabilizers in clinical trials, or enrollment in hospice. Given his age and comorbidities, the man's options included a left ventricular assist device, extended criteria transplant, or a clinical trial for TTR amyloidosis treatment. He was ultimately listed and transplanted within a month, and has since recovered well.
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L.B. is a 62-year-old man with a long history of coronary artery disease and heart failure who has undergone multiple coronary bypass surgeries. He now has an ejection fraction of 25% and intractable ventricular tachycardia despite medical management. Due to the risks of ablation, the team is considering options like hospice care, cardiac transplantation, VAD implantation, or VAD exchange to treat his advanced heart failure. A cardiac catheterization revealed multiple occluded arteries and stenoses. Given his medical history and surgical history, the team must determine the best treatment approach for his condition.
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This document discusses the treatment of mitral regurgitation in patients with heart failure. It describes the mechanisms of functional and ischemic mitral regurgitation. While medical therapy can improve symptoms and survival, cardiac resynchronization therapy may also help reduce mitral regurgitation severity and improve outcomes. Surgery to repair the mitral valve is an option but the risk of recurrence of mitral regurgitation is high, especially with more advanced left ventricular remodeling. Randomized trials are still needed to determine whether surgical correction provides clear benefits over medical therapy alone in high-risk patients. Percutaneous mitral valve repair may be a lower risk option for inoperable patients to reduce symptoms.
Devices and intervention in heart failure.
- The document discusses the speaker's receipt of honoraria and research support from numerous pharmaceutical and device companies.
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Can we afford heart failure management in the future
Heart failure is a major global health problem, affecting 26 million people worldwide. It accounts for 1-3% of hospital admissions in Europe and North America. Hospitalization is the main driver of the high economic costs of heart failure management, which is estimated to rise significantly in the coming decade. To better manage heart failure costs in the future, new models of coordinated and integrated care will need to be implemented, with a focus on preventing hospitalizations and readmissions through improved education, care transitions, and treatment of comorbidities.
The deadly statistics of heart failure.
This document discusses statistics related to heart failure. It summarizes data on outcomes for hospitalized heart failure patients compared to chronic heart failure patients. Hospitalized patients generally have worse outcomes, with high 1-year mortality rates around 25-27%. Chronic heart failure patients have lower but still significant 1-year mortality rates of around 5-6%. The document also reviews real-world data showing high readmission rates after hospitalization for heart failure. It concludes that while treatments for chronic heart failure with reduced ejection fraction have improved outcomes over decades, more efforts are still needed to improve care and outcomes for hospitalized patients and those with preserved ejection fraction.
The heart failure association global awareness programme.
The Global Heart Failure Awareness Programme aims to make the prevention and management of heart failure a global health priority. It is led by the Heart Failure Association of the European Society of Cardiology and supported by educational grants. The programme's objectives are to build a common global approach to raising awareness of heart failure among targeted audiences and to call for heart failure to be a health priority in every country. It plans to achieve this through developing educational content, building advocacy coalitions, and implementing initiatives at the national and local levels between 2015 and 2017.
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6快递给客户（国内顺丰国外DHLUPS等快读邮寄）。头贼脑的倒也逗人喜爱日上三竿时山娃总爱窜进自家瓜棚里跟小伙伴们坐着聊天聊着聊着便忍不住往瓜田里逡巡一番抱起一只硕大的西瓜用石刀劈开抑或用拳头砸开每人抱起一大块就啃啃得满嘴满脸猴屁股般的红艳大家一个劲地指着对方吃吃地笑瓜裂得古怪奇形怪状却丝毫不影响瓜味甜丝丝的满嘴生津遍地都是瓜横七竖八的活像掷满了一地的大石块摘走二三只爷爷是断然发现不了的即便发现爷爷也不恼反而教山娃辨认孰熟孰嫩孰甜孰淡名义上是护瓜吃
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NURSING MANAGEMENT OF PATIENT WITH EMPHYSEMA .PPT
Prepared by Prof. BLESSY THOMAS, VICE PRINCIPAL, FNCON, SPN.
Emphysema is a disease condition of respiratory system.
Emphysema is an abnormal permanent enlargement of the air spaces distal to terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis.
Emphysema of lung is defined as hyper inflation of the lung ais spaces due to obstruction of non respiratory bronchioles as due to loss of elasticity of alveoli.
It is a type of chronic obstructive
pulmonary disease.
It is a progressive disease of lungs.
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PrudentRx enhances healthcare by educating patients and ensuring effective medication management in a complex, evolving landscape.
CHAPTER 1 SEMESTER V COMMUNICATION TECHNIQUES FOR CHILDREN.pdf
Here are some key objectives of communication with children:
Build Trust and Security:
Establish a safe and supportive environment where children feel comfortable expressing themselves.
Encourage Expression:
Enable children to articulate their thoughts, feelings, and experiences.
Promote Emotional Understanding:
Help children identify and understand their own emotions and the emotions of others.
Enhance Listening Skills:
Develop children’s ability to listen attentively and respond appropriately.
Foster Positive Relationships:
Strengthen the bond between children and caregivers, peers, and other adults.
Support Learning and Development:
Aid cognitive and language development through engaging and meaningful conversations.
Teach Social Skills:
Encourage polite, respectful, and empathetic interactions with others.
Resolve Conflicts:
Provide tools and guidance for children to handle disagreements constructively.
Encourage Independence:
Support children in making decisions and solving problems on their own.
Provide Reassurance and Comfort:
Offer comfort and understanding during times of distress or uncertainty.
Reinforce Positive Behavior:
Acknowledge and encourage positive actions and behaviors.
Guide and Educate:
Offer clear instructions and explanations to help children understand expectations and learn new concepts.
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1比1制作(uofm毕业证书)美国密歇根大学毕业证学位证书原版一模一样
原版定制【微信:bwp0011】《(uofm毕业证书)美国密歇根大学毕业证学位证书》【微信:bwp0011】成绩单 、雅思、外壳、留信学历认证永久存档查询，采用学校原版纸张、特殊工艺完全按照原版一比一制作（包括：隐形水印，阴影底纹，钢印LOGO烫金烫银，LOGO烫金烫银复合重叠，文字图案浮雕，激光镭射，紫外荧光，温感，复印防伪）行业标杆！精益求精，诚心合作，真诚制作！多年品质 ,按需精细制作，24小时接单,全套进口原装设备，十五年致力于帮助留学生解决难题，业务范围有加拿大、英国、澳洲、韩国、美国、新加坡，新西兰等学历材料，包您满意。
【业务选择办理准则】
一、工作未确定，回国需先给父母、亲戚朋友看下文凭的情况，办理一份就读学校的毕业证【微信bwp0011】文凭即可
二、回国进私企、外企、自己做生意的情况，这些单位是不查询毕业证真伪的，而且国内没有渠道去查询国外文凭的真假，也不需要提供真实教育部认证。鉴于此，办理一份毕业证【微信bwp0011】即可
三、进国企，银行，事业单位，考公务员等等，这些单位是必需要提供真实教育部认证的，办理教育部认证所需资料众多且烦琐，所有材料您都必须提供原件，我们凭借丰富的经验，快捷的绿色通道帮您快速整合材料，让您少走弯路。
留信网认证的作用:
1:该专业认证可证明留学生真实身份
2:同时对留学生所学专业登记给予评定
3:国家专业人才认证中心颁发入库证书
4:这个认证书并且可以归档倒地方
5:凡事获得留信网入网的信息将会逐步更新到个人身份内，将在公安局网内查询个人身份证信息后，同步读取人才网入库信息
6:个人职称评审加20分
7:个人信誉贷款加10分
8:在国家人才网主办的国家网络招聘大会中纳入资料，供国家高端企业选择人才
【关于价格问题（保证一手价格）】
我们所定的价格是非常合理的，而且我们现在做得单子大多数都是代理和回头客户介绍的所以一般现在有新的单子 我给客户的都是第一手的代理价格，因为我想坦诚对待大家 不想跟大家在价格方面浪费时间
对于老客户或者被老客户介绍过来的朋友，我们都会适当给一些优惠。
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Management of vt vf storm in advanced heart failure
- 1. Management of VT/VF Storm in Advanced Heart Failure: What to Think About, What Works? What Doesn’t Work? Owen Obel, MD VA North Texas Healthcare System, UT Southwestern Medical Center Dallas, Texas
- 2. Disclosures Speaker: Medtronic, Biotronik, Boston Scientific Advisory: Medtronic, Biotronik
- 3. Definition of VT/VF Storm • Diverse arrhythmic mechanisms, broad definition • Frequent episodes of VT/VF requiring cardioversion • Management guidelines rely on anecdotal evidence • Most trials define >2 episodes/24h. Episodes usually more frequent 6 minute recording
- 4. SUBSTRATE Scar Myopathy Hypertrophy Valve/congenital Ischemia Channelopathy Monomorphic VT Polymorphic VT Ventricular Fibrillation VT/VF Storm Mechanisms TRIGGER Unknown / 1st shock Sympathetic hyperactivation HF decompensation Ischemia/infarction Electrolyte (K+ and Mg++) Ectopy Special situations
- 5. VS ACLS Guidelines Group 2Group 1 OR VT/VF Storm in Advanced Heart Failure Beta-Blockade 12 patients received all 3 Lidocaine (22) Procainamide (16) Bretylium (18) 1 week mortality: 22% group 1 vs. 82% group 2 1 year mortality: 33% group 1 vs. 95% group 2 Nadamanee Circulation 2000 IV beta- blockers (21) Left stellate ganglion block (6)
- 6. • 342 patients with recurrent VT/VF (BP<80, shock) • Refractory to/intolerant of: lidocaine/procainamide/bretylium • IV Amiodarone: 125mg/24 hr 500mg/24 hr 1000mg/24 hr • Supplemental infusions for breakthrough VT IV Amio Multicenter Trial Group Circulation 1995 VT/VF Storm in Advanced Heart Failure Amiodarone P=0.067 Amiodarone and beta-blockade are synergistic Beta-blockers should always be co-administered at maximum tolerated doses
- 7. Beta-blockade Amiodarone Dofetilide Lidocaine/Mexilitene ✔ Procainamide Sotalol Dronedarone Flecainide Propafenone Verapamil/Diltiazem ✗ VT/VF Storm in Advanced Heart Failure
- 8. • IV Sedation is used very early in treatment path • General anesthesia is a highly effective measure • Propofol reduces sympathetic tone by inhibiting central sympathetic discharge • Patients may require >48 hours of full anesthesia Sedation / General Anesthesia VT/VF Storm in Advanced Heart Failure When AADs Fail LV Assist Devices Cardiac Sympathetic Denervation
- 9. VT/VF Storm in Advanced Heart Failure LV Assist Devices IV inotropes for hemodynamic support are proarrhythmic LVADs should be used instead LVADs have a powerful independent anti-arrhythmic effect (even in DCM)
- 10. VT/VF Storm in Advanced Heart Failure Cardiac Sympathetic Denervation Thoracic epidural anesthesia Stellate ganglion block/ ganglionectomy • Both TEA and CSD have been used with success in VT/VF storm • Patients with advanced heart failure have been included in case series • TEA has more of an immediate effect • Neither procedure is reported to cause hemodynamic compromise Vashegi HRJ 2014
- 11. VT/VF Storm in Advanced Heart Failure CRT-induced Proarrhythmia
- 12. Conclusions • VT/VF storm is not uncommon in patients with advanced heart failure, precipitant often not known • Beta-blockade and amiodarone are the cornerstone AADs • Sedation (often) or general anesthesia (sometimes) required • IV inotropes exacerbate ventricular arrhythmias • LV assist devices can be of great benefit • Cardiac sympathetic denervation has been successfully used