1. Mrs. Maya, a 36-year-old pregnant woman, was admitted for delivery via cesarean section due to her history of valvular heart disease and full term breech pregnancy.
2. On examination, she had a heart murmur, low pulse volume, and was mildly anemic.
3. Her pregnancy had been otherwise uncomplicated except for exertional fatigue and palpitations related to her valvular heart condition.
Heart failure is a clinical syndrome characterized by dyspnea, fatigue, and clinical signs of congestion leading to frequent hospitalizations, poor quality of life, and shortened life expectancy. It is a final common pathway to various cardiac conditions. It is a growing problem worldwide with serious consequences in Sub-Saharan Africa where it occurs at a younger age with limited resources to manage the condition. The incidence and prevalence vary worldwide. In this mini-review, we looked at the definition, classification, and pathophysiology of the condition.
Heart failure Update as per, 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the
Management of Heart Failure and 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure
Heart failure is a clinical syndrome characterized by dyspnea, fatigue, and clinical signs of congestion leading to frequent hospitalizations, poor quality of life, and shortened life expectancy. It is a final common pathway to various cardiac conditions. It is a growing problem worldwide with serious consequences in Sub-Saharan Africa where it occurs at a younger age with limited resources to manage the condition. The incidence and prevalence vary worldwide. In this mini-review, we looked at the definition, classification, and pathophysiology of the condition.
Heart failure Update as per, 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the
Management of Heart Failure and 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure
Mr. AMF 62 years presented with central chest pain on exertion for last 4 monthsHypertension(BP-220/120 mmHg) for last 4 years, taking 4 anti hypertensives.Diabetes for last 5 years (HbA1c-9.3%).Smoking for 8 years.Dyslipedemic for 3 years. H/o 5 times hospital admissions due to heart failure in last 3 years.ECG-Anterior wall ischemiaEF-58%During careful clinical exam- renal bruit on left side.Coronary angiogram done and revealed DVD. Renal angiogram showed significant left renal artery stenosis. Coronary angioplasty and left renal artery angioplasty done.
Mr AMF now have no chest pain on exertion after 3 months of coronary angioplasty.
Now BP is controlled (130/85 mm Hg), taking B blockers and ARB due to intolerance of ACE inhibitors.
No hospital admission during this period.
Diabetes and serum lipids are controlled.
Mr. AMF 62 years presented with central chest pain on exertion for last 4 monthsHypertension(BP-220/120 mmHg) for last 4 years, taking 4 anti hypertensives.Diabetes for last 5 years (HbA1c-9.3%).Smoking for 8 years.Dyslipedemic for 3 years. H/o 5 times hospital admissions due to heart failure in last 3 years.ECG-Anterior wall ischemiaEF-58%During careful clinical exam- renal bruit on left side.Coronary angiogram done and revealed DVD. Renal angiogram showed significant left renal artery stenosis. Coronary angioplasty and left renal artery angioplasty done.
Mr AMF now have no chest pain on exertion after 3 months of coronary angioplasty.
Now BP is controlled (130/85 mm Hg), taking B blockers and ARB due to intolerance of ACE inhibitors.
No hospital admission during this period.
Diabetes and serum lipids are controlled.
Bilateral Pulmonary Hydatid Cysts with Ruptured & Infected Hydatid Cyst of Le...Dharmendra Joshi
Bilateral Pulmonary Hydatid Cysts with Ruptured & Infected Hydatid Cyst of Left Lung - A Case Presentation
Operations:
First Operation:
VATS Enucleation of Hydatid Cyst of Lung (Right side)
Second Operation:
VATS followed by minimally invasive open Enucleation and Capitonnage of Hydatid Cyst of Lung (Left side)
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.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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!
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
4. Particulars of the patient
Name: : Mrs Maya
Age: 36 years
Sex: Female
Religion: Islam
Marital status: Married
Occupation: Housewife
Address: Shahajadpur Sirajgonj
Date of admission: 06th March”21
Date of Examination: 06th March”21
5. PRESENTING COMPLAINTS :
• History of Amenorrhoea for 38 weeks .
• Exertional fatigue and palpitation for several years more marked
during pregnancy period.
6. History of present illness
• According to the statement of the patient, she was amenorrheic for 9
months. She continued her antenatal check-up with an obstetrician
outside the TMSS Medical College & Rafatullah Community Hospital. Her
whole pregnancy period was uneventful except exertional fatigue and
palpitation. This palpitation was not associated with chest pain, heat
intolerance, syncopal attack , increase frequency of micturition and
headache. Her last USG report shows full term pregnancy with breech
presentation . She also mentioned that she was a patient of valvular heart
disease.
7. Continue.......
She had previously attempted several times for interventional
management for valvular heart disease. But it was not possible due
to some reasons. She also mentioned that she delivered a male
baby 15 years back by normal vaginal delivery without any
complications. In the meantime, she conceived twice which resulted
in miscarriages. After 15 years she conceived accidentally and
continued her pregnancy.
8. Continue.......
By reviewing Ultrasonogram and Echocardiography reports, the
attending physician referred her to higher center(Dhaka) for better
management. But belonging to a lower middle-class family, she was
unable to seek services from Dhaka. So, with great hope she
admitted herself under Unit-1(Green) of Gynecology & Obstetrics
department of TMSS Medical College & Rafatullah Community
Hospital for better management.
9. Historyof past illness:
• She had history of 2 incidents of Miscarriages.
• Rheumatic Valvular Heart Disease for 5 years.
• She had no history of DM, HTN, Bronchial asthma and Thyroid
diseases
Drug history:
She had taken Iron, folic acid and Calcium tablets regularly in her
pregnancy . Betaloc 25mg, Penvik 250mg, Diretic 20/50mg for heart
disease.
10. Family history:
She comes from a lower middle-class family. Both of her parents
are alive. She has one sister & two brothers. All are apparently
healthy.
Menstrual history:
• Menarche: At 13 yrs .
• Menstrual period: 4-5 days.
• Menstrual cycle: Regular
• Menstrual flow: Average
• LMP:16th July 2020
• EDD:8th March 2021
CONTRACEPTIVE HISTORY:
OCP, Barrier Method
11. Obstetrichistory
Married for : 16 years
Para: 2 + 2(miscarriages)
Gravida: 4th
ImmunizationHistory
She was immunized according to EPI schedule and completed Tetanus
vaccine according to schedule.
12. Socio-economichistory:
She came from lower middle-class family.
Personal history:
• She is a housewife. No history of Smoking, Alcohol abuse or
Betel nuts chewing. Her husband is a private job holder.
13. General examination:
• Appearance: Ill looking
• Body built : Average(Weight-56 kg, Height 5 feet 1 Inch)
• Co-operation: Co-operative
• Decubitus: On choice
• Nutrition: Average
• Anemia: Mildly anemic
• Jaundice: Absent
• Cyanosis: Absent
15. General examination(Continue…)
• Blood pressure: 110/70 mm of Hg
• Temperature: 98˚F.
• Respiratory rate: 18 breaths per min
• Neck vein: Not engorged
• Thyroid gland: Not enlarged
• Lymph node: Not enlarged
• Breast examination: Shows normal pregnancy changes
• Skin condition : Normal
17. Cardiovascular System Examination
1. Arterial pulse:
a. Rate: 102 beats/ min
b. Rhythm: Regular
c. Volume & character: Low volume
d. Symmetry: All peripheral pulses are bilaterally symmetrically
palpable.
e. Condition of the vessel wall: Normal
f. No radio-femoral delay
18. Continued:
2. Blood pressure: 110/70 mm of Hg
3. JVP: Not raised.
4. Examination of the precordium:
a)Inspection:
Size & Shape: Normal
Visible pulsation: Apical impulse visible in mitral area. Epigastric
pulsation present
Venous engorgement: Absent
No scar mark, No deformity.
19. Continued:
b) Palpation:
Apex beat: left 5th ICS, 9cm lateral from midline and tapping in
nature.
Thrill: Absent
Left parasternal heave: Present
Pulmonary component of second heart sound: Palpable.
Liver : Not enlarged
20. Continued:
c) Percussion: Not Done
d) Auscultation:
1st heart sound: Loud in mitral area
2nd heart sound: Pulmonary component of 2nd heart sound was
loud.
Murmur: There is a mid diastolic murmur in the mitral area
which is low pitch, localized, rough rumbling which is best heard
in left lateral position breath hold after expiration with the bell of
the stethoscope. Murmur grade is 3/4.
21. Continued:
• Opening snap and presystolic accentuation present.
• An Early Diastolic murmur in the 2nd left intercostal space is
present.
• Another systolic murmur is present in tricuspid area which is best
heard in breath hold after inspiration. Murmur grade is 3/6.
• Bilateral basal crepitation: Absent
22. OBSTETRIC examination
Per-abdominal examination
Inspection:
• Abdomen was enlarged and pyriform in shape.
• Umbilicus was centrally placed and everted .
• Striae gravidarum and Linea nigra present.
23. • Palpation:
Fundal height: 36 weeks in size.
Fundal grip : Smooth, hard and globular structure which signify foetal
head.
Lateral grip : Smooth, curved and resistant structure felt on left side of
the abdomen which signify back of the foetus.
Knob like irregular structure felt on right side of the abdomen, those
directed foetal limbs.
1st Pelvic grip : Broad, soft ,irregular parts seemed as foetal buttock
2nd Pelvic grip: The presenting part was not engaged.
26. Examination of Respiratory System
• Respiratory rate: 18 breaths per min
• 1. Inspection :
• Size & Shape of the chest: Normal
• Movement of the chest : Symmetrical
• Visible pulsation: Apical impulse visible in mitral area.
• Intercostal indrawing: Absent
• Subcostal recession: Absent
• No deformity.
• No scar mark.
27. Continue
2. Palpation :
• Position of the trachea : Central
• Apex beat: left 5th ICS, 9cm lateral from midline and tapping in nature.
• Chest expansion: Symmetrical on both side
• Chest expansibility: 3 cm.
• Vocal fremitus : Normal
29. Alimentary System Examination
• Lips, gums, teeth, tongue, oral cavity- Normal
• Abdomen
• Inspection
• Abdomen was enlarged and pyriform in shape.
• Umbilicus was centrally placed and everted .
• Striae gravidarum and Linea nigra present.
30. • Palpation & Percussion was not done due advanced pregnancy.
• Auscultation
• Bowel Sound-Normal
• Foetal Heart Sound- 140 beats/ min
31. Examination of Nervous system
• Higher psychic function :
• Orientation : Oriented
• Intelligence : Normal
• Speech : Normal
• Consciousness : Conscious
• Memory : Intact
• Cranial nerves : Yields no abnormality
32. CONTINUE
Cerebellar function : Yields no abnormality
Motor function :
Bulk of the muscle : Normal
Tone of the muscle : Normal
Co-ordination of movement : Normal
Reflexes : Superficial & deep reflexes are normal
Involuntary movements : Absent
Sensory function : Intact
33. CONTINUE
• Signs of meningeal irritation :
• Neck rigidity : Absent
• Kernigs sign : Absent
• Brudzinski’s sign : Absent
Other systemic examination revealed normal findings.
34. Salient features:
Mrs. Maya, 36yrs, 4th gravida , para 2+2(miscarriages), non-diabetic,
normotensive patient, was admitted at her 38th weeks of pregnancy
with the plan to have delivery via caesarean section. She continued
her antenatal check-up with an obstetrician outside the TMSS Medical
College & Rafatullah Community Hospital. Her whole pregnancy
period was uneventful except exertional fatigue and palpitation. This
palpitation was not associated with chest pain, heat intolerance,
syncopal attack , increase frequency of micturition and headache. She
mentioned that she was a patient of valvular heart disease.
35. ContinueD.......
She also mentioned, she delivered a male baby 15 years back by
normal vaginal delivery without any complications. Her last USG
report shows full term pregnancy with breech presentation. By
seeing all the reports, the attending physician referred her higher
center (Dhaka). But she admitted herself under Unit-1(Green) of
Gynecology and Obstetric department of TMSS Medical College &
Rafatullah Community Hospital.
36. ContinueD.......
On General Examination she was mildly anaemic , her pulse was
102 bpm, regular, low volume. B.P was 110/70 mm of Hg, JVP not
raised. On examination of CVS- visible pulsation present in mitral
and epigastric areas, apex beat in left 5th ICS, 9cm lateral from
midline and tapping in nature, left parasternal heave present,
pulmonary component of second heart sound was palpable.
37. ContinueD.......
On Auscultation, 1st heart sound was loud in mitral area.
Pulmonary component of 2nd heart sound was also loud. There
was a mid diastolic murmur in the mitral area which is low pitched,
localized, rough rumbling, best heard in left lateral position breath
hold after expiration with the bell of the stethoscope. Murmur
grade was 3/4.
38. Continued…
Opening snap and presystolic accentuation was present. An early
diastolic murmur in the 2nd left intercostal space was present.
Another systolic murmur was present in tricuspid area which was
best heard in breath hold after inspiration. Murmur grade was 3/6.
Bilateral basal crepitation absent.
39. Continued…
On Obstetric examination -Abdomen was enlarged and pyriform in
shape. Umbilicus was centrally placed and everted. Striae
gravidarum and Linea nigra present. Fundal height of 36 weeks in
size. Fundal grip was Smooth, hard and globular structure which
signify foetal head. Lateral grip was Smooth, curved and resistant
structure felt on left side of abdomen which signify back of the
foetus. Small knob like irregular structure felt on right side of
abdomen those directed foetal limbs.1st Pelvic grip was broad, soft
and irregular part seemed as foetal buttock. 2nd pelvic grip: The
presenting part was not engaged.
45. ECHOCARDIOGRAPHY
Echo- 2D:
• Thickening, fibrosis and calcification of mitral
leaflets
• Diastolic doming of Anterior Mitral Leaflet (AML)
• Both commissure are fused.
• LA seems to be dilated.
46. • Parasternal Long Axis View
thickening, fibrosis &
Calcification of both anterior
and posterior mitral leaflets
48. • Parasternal short axis view
showing planimetry of mitral
valve. Mitral valve is reduced
which is about 0.928 cm2
49. • This is color flow map of a
stenotic mitral valve from
apical 4 chamber view
showing a candle-flame
like jet.
50. Continued
Echo- M mode:
• There is dilatation of left atrium (56mm)
• Dilated RA and RV
• Reduced EF slope.
• Mitral valve area is 0.93 cm2
• TAPSE 17 mm
Echo- CD:
• Color flow mosaic passing from LA to
LV.
• Color flow mosaic passing from RV to
RA.
52. USG of pregnancy profile
• Single live pregnancy of about 37 weeks and 2 days with breech
presentation.
53. Confirmed diagnosis:
4th Gravida of 38th weeks Pregnancy and Severe Mitral Stenosis
with Severe Tricuspid Regurgitation with Severe Pulmonary
Hypertension.
56. Continue
After initial treatment gynecology and obstetrics department
promptly sought cardiac consultation. Cardiology department visited
the patient, reviewed the case carefully made a preoperative risk
assessment by CARPREG score which was 1 that correspond to
cardiac risk 27%. After that a thorough discussion with patient`s
husband about the risks & benefits of patient was done. Then
cardiology department gave an opinion for cesarean section after
three days of preoperative patient preparation, under G/A and
with the presence of Cardiologist, Anesthesiologist and
Obstetrician.
57. Pre-Operative Patient preparation
• Inj. Fusid 20 mg: 2 ample IV bid at 8 am and 4 pm for 3 days.
• Tab. Spirocard 100 mg: once daily
• Tab. Betaloc 25 mg:1+0+1
• Tab. Penvik 250 mg:1+0+1
• Inj. Pantonix 40mg: 1 vial bid before meal
• Judicious fluid volume was maintained preoperatively(1ml/kg/hr)
• Inj. Ceftron 1gm:1 vial I/V was given just before operative
procedure.
• An informed written consent was taken before surgery.
58. Per operative
• Elective LSCS was done under General Anesthesia on
09.03.21 during office time with presence of Cardiologist,
Anesthesiologist and Pediatrician. Cesarean section
took 23 mins. There was no complications during
procedure. Fetal expulsion occurred within 2 mins. A male
baby was born weighing 2.44kg and the APGAR score
was 8/10 .
• IV fluid was given@1ml/kg/hr.
• Advised to collect 1 units of fresh human whole blood .
59. Post-operative
• Inf. Hartsol 500 ml+ 2 amp LINDA DS was given @ 15 drop/min in 12 hours
• Inj. Fusid 20 mg: 2 ample IV bid at 8 am and 4 pm for 3 days then converted
to oral fusid 40 mg bid
• Inj. Cardinex 40 mg: S/C x 12 hourly for 3 days
• Inj. Ceftron 1gm:12 hourly for 5 days
• Inj Filmet 500 mg..1 bottle I/V x 8 hourly upto 3rd POD
• Inj. Anadol100 mg: 12 hourly upto 2nd POD then oral.
• Inj. Pantonix 40mg:1 vial I/V bid
• Tab. Spirocard 100 mg :once daily
• Tab. Betaloc 25 mg: 1+0+1
• Tab. Penvik 250 mg: 1+0+1
60. Discharge and Advice
She was discharged on 20th March 2021 with following medications
and advice:
• Tab. Cef-3 DS 1+0+1 for 7 days.
• Tab. Napa Extend 1+1+1 for 3days.
• Tab. Pantonix 20 mg. 1+0+1 before meal for 15 days.
• Tab. Deflux 10mg 1+1+1 before meal for 10 days.
• Tab. Penvik 250mg: 1+0+1 continue
• Tab. Betaloc 25 mg: 1+0+1 continue
• Tab. Edeloss (20/50): 0+1+0 continue
61. Advice for mother
• Avoid heavy exertion.
• Avoid extra salt.
• Keep water intake to 1.5 L/day.
• Avoid coitus for 6 weeks.
• Avoid oestrogen containing preparation such OCP, Injection,
sub dermal patch, Norplant.
• Use Barrier method.
• Strictly forbidden for further conception.
• Advice for follow up after 14 days both in Cardiology and
Gynae & Obs OPD.
62. Advice for Baby
• Exclusive breast feeding for 6 months.
• Give the baby vaccination according to EPI schedule .
• Advised for follow up after 14 days in Pediatric OPD.
63. Take Home Message
• Rheumatic mitral stenosis complicating pregnancy is still a
frequent cause of death in a developing country. Patient with
severe mitral stenosis tolerate pregnancy poorly & should be
advised against pregnancy until correction of their mitral valve is
done
• But for those patient who find themselves in such unfortunate
situation like Mrs Maya, they should be treated in a
multidisciplinary approach to reduce mortality and morbidity.