Definition, classification, epidemiology, etiology, diagnosis, prognosis of DCM, HOCM, LVNC
Also review of acute myocarditis in children
R/v of heart failure management
Definition, classification, epidemiology, etiology, diagnosis, prognosis of DCM, HOCM, LVNC
Also review of acute myocarditis in children
R/v of heart failure management
Most people with supraventricular tachycardia don't need activity restrictions or treatment. For others, lifestyle changes, medication and heart procedures may be needed to control or eliminate the rapid heartbeats and related symptoms.
Types
Supraventricular tachycardia (SVT) falls into three main groups:
Atrioventricular nodal reentrant tachycardia (AVNRT). This is the most common type of supraventricular tachycardia.
Atrioventricular reciprocating tachycardia (AVRT). AVRT is the second most common type of supraventricular tachycardia. It's most commonly diagnosed in younger people.
Atrial tachycardia. This type of SVT is more commonly diagnosed in people who have heart disease. Atrial tachycardia doesn't involve the AV node.
Other types of supraventricular tachycardia include:
Sinus tachycardia
Sinus nodal reentrant tachycardia (SNRT)
Inappropriate sinus tachycardia (IST)
Multifocal atrial tachycardia (MAT)
Junctional ectopic tachycardia (JET)
Nonparoxysmal junctional tachycardia (NPJT)
Symptoms
The main symptom of supraventricular tachycardia (SVT) is a very fast heartbeat (100 beats a minute or more) that may last for a few minutes to a few days. The fast heartbeat may come and go suddenly, with stretches of typical heart rates in between.
Some people with SVT have no signs or symptoms.
Signs and symptoms of supraventricular tachycardia may include:
Very fast (rapid) heartbeat
A fluttering or pounding in the chest (palpitations)
A pounding sensation in the neck
Weakness or feeling very tired (fatigue)
Chest pain
Shortness of breath
Lightheadedness or dizziness
Sweating
Fainting (syncope) or near fainting
In infants and very young children, signs and symptoms of SVT may be difficult to identify. They include sweating, poor feeding, pale skin and a rapid pulse. If your infant or young child has any of these symptoms, ask your child's care provider about SVT screening.
When to see a doctor
Supraventricular tachycardia (SVT) is generally not life-threatening unless you have heart damage or other heart conditions. However, in extreme cases, an episode of SVT may cause unconsciousness or cardiac arrest.
Call your health care provider if you have an episode of a very fast heartbeat for the first time or if an irregular heartbeat lasts longer than a few seconds.
Some signs and symptoms of SVT may be related to a serious health condition. Call 911 or your local emergency number if you have an episode of SVT that lasts for more than a few minutes or if you have an episode with any of the following symptoms:
Chest pain
Shortness of breath
Weakness
Dizziness
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Causes
For some people, a supraventricular tachycardia (SVT
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Salient features of the book are -
- The book provides a shortcut to understand and remember certain specific formulae and points you require to interpret the 12-lead ECG.
- Treatment protocols (in green boxes) for most of the important conditions are also included.
- View sample ECGs as you read along the topics.
- The content is explained in a very simple language to provide good conceptions, written from a student’s point of view.
- People can gain their belief in the book after going through sample ECGs which would be available at www.themedicalpost.net/ecg
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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.
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1. Murmurs
Dr. Kalpana Malla
MBBS MD (Pediatrics)
Manipal Teaching Hospital
Download more documents and slide shows on The Medical Post [ www.themedicalpost.net ]
3. Murmurs
• Turbulence in blood flow at or near valve -
flow murmur
• An abnormal communication within heart –
shunt murmur
• Heart murmurs may be present without any
heart disease
5. INNOCENT MURMURS:
Also known as flow, benign, non pathologic,
functional, inorganic physiologic
Occur in up to - 77% of neonates
- 66% of children
- 90% with exercise
6. What are Innocent Murmurs?
- Due to physiological turbulence of blood within
normal anatomical heart
- No structural cardiac Ds
- No hemodynamic abnormalities
- Become prominent – fever, anxiety, anemia,
infections
7. Character of IM
• Systolic soft grade 2 ** exception venous hum
– continuous murmur
• No thrill
• Intensity variable – change with posture
• Normal pulse
• Normal S2
• Normal CXR & ECG
10. Systolic Murmurs
2. Ejection systolic (Midsystolic)
- Innocent M
- Flow M – all flow M in VSD,ASD,PDA
- Aortic valve sclerosis
- Aortic outflow obstruction - Aortic stenosis
3. Late systolic M
- MV prolapse
- TV prolapse
11. Diastolic murmurs
• Early diastolic M
- Aortic Regurgitation
- Pulmonary R
• Mid – Diastolic M
– MS
– TS
– Artial myxoma
– ↑ flow across AV valve
– Austin Flint M
– Carey- Coombs M
17. Vibratory Still’s Murmur
Most common innocent murmur of
childhood
Age — 2 to 6 years, rare in teens
Etiology—unknown, may be associated
with LV ejection
18. Still’s Murmur
Location—max at LLSB, LMSB
Character—vibratory, groaning, musical
Radiation— apex,
Timing—mid-systole
Intensity—grade I-II
Pitch—mid to low
19. Still’s Murmur ……
Variation—
Loudest - supine, after exercise, with
fever, anemia, or excitement
Disappears or localizes to LLSB when upright
Normal ECG
20. 2. Pulmonary Systolic Murmur:
Age — common 8-14 years
Etiology—normal ejection vibrations
,turbulence through PV
Intensity— mid systolic grade I-III
Location - ULSB
Pitch—mid to high-pitched
Character—soft, blowing, somewhat
grating, diamond-shaped
22. Physiological Pulmonary flow
murmur of neonate
Age —newborns. May last 3 – 6 months
Etiology— turbulence and relative
obstruction at PA bifurcation due to acute
angle at birth
23. Physiological Pulmonary flow murmur
of neonate
Location—LUSB
Radiation—LMSB, bilateral axillae, mid-
back
Timing—early to mid-systole
25. 4. Carotid Bruit
• Bruit is French for “noise”
• Age range—children and young adults
• Etiology— turbulence at take off of carotid
or brachiocephalic vessels
26. Carotid Bruit (Characteristics):
Location—neck - suprasternal
notch, supraclavicular areas
Radiation—carotids, below clavicles
Timing—early to mid-systole (grade I-III)
Character—may be slightly harsh
Arise in carotid or subclavian arteries
28. 5. Venous Hum:
Second most common innocent murmur
Etiology—turbulence in jugular and subclavian
venous return meeting in SVC
Age - pre-school
Adololescents - can be + w/ increased blood
flow states e.g. anemia, pregnancy,
thyrotoxicosis
29. Venous Hum
Location—anterior neck to mid-infraclavicular
area, R side > L side
Radiation—may go to LMSB
Intensity—grade I-III
Pitch—mid to low
Character— continuous ,soft, whispering,
roaring, or blowing
30. Venous Hum
Variation—
Disappears - supine position,
- with gentle manual compression
of jugular vein
- with head turn AWAY from the side
31. Thank you
Download more documents and slide shows on The Medical Post
[ www.themedicalpost.net ]