NT-ProBNP
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An innovative marker to which is used to diagnose cardiac patients. It has longer half life and higher stability than BNP.
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Nt pro BNP
NT-pro BNP is a marker used for both diagnosing and monitoring heart failure. It is more stable than BNP, with a half-life of 120 minutes compared to BNP's 20 minutes. NT-pro BNP levels are not affected by drugs like nesiritide that can impact BNP levels. NT-pro BNP can help distinguish cardiac causes of symptoms like shortness of breath from non-cardiac causes. It also reflects the severity of heart failure and can help monitor the effectiveness of new drugs in decreasing mortality from heart failure.
Brain-type Natriuretic Peptide (BNP) - An Information Resource for Cardiac Ne...
Brain-type Natriuretic Peptide (BNP) - An Information Resource for Cardiac Networks.
Produced by the NHS Heart Improvement Programme, this online document gives a brief overview of available information on Brain-type Natriuretic Peptide (BNP) testing as a ‘rule-out’ measure for echocardiogram when suspecting a diagnosis of heart failure.
(Updated July 2008).
Procalcitonin
Procalcitonin is a peptide marker that is useful for differentiating between bacterial and viral infections. It begins to rise more quickly than C-reactive protein after an inflammatory insult and its levels correlate with the severity of infection or sepsis. Clinical situations where measuring procalcitonin may be helpful include determining the need for and length of antibiotic therapy for respiratory infections, diagnosing and monitoring sepsis, and distinguishing between bacterial and viral causes of meningitis or pneumonia. While elevated in response to bacterial infection, procalcitonin levels may also increase in response to certain non-infectious conditions like trauma or transplantation. It is a more reliable indicator of sepsis than C-reactive protein or other markers.
Biomarker in heart failure
The document discusses various biomarkers used in the diagnosis and management of heart failure. It states that natriuretic peptides like BNP and NT-proBNP are the most widely used biomarkers for heart failure as they are accurate for establishing diagnosis, determining severity, and predicting prognosis. It describes the release and function of these peptides. It also mentions other biomarkers like cardiac troponins, inflammatory markers, neurohormonal factors, and matrix proteins that provide additional information on myocardial injury, inflammation, neurohormonal activation, and remodeling in heart failure. A multimarker approach may help better classify and risk stratify heart failure.
Biomarkers in heart failure
1) Natriuretic peptides like BNP and NT-proBNP are the most extensively studied and used biomarkers in heart failure. They are useful for diagnosis, assessing prognosis, and monitoring response to treatment.
2) Other biomarkers like troponins, ST2, galectin-3, and inflammatory markers can provide additional prognostic information beyond natriuretic peptides.
3) Biomarkers reflect different pathophysiological processes in heart failure like myocyte injury, stress, remodeling, neurohormonal activation, and inflammation. Used together, they can improve risk stratification and guidance of therapy.
Natriuretic peptide in chf and acs,VIRBHAN
Natriuretic peptides like BNP and NT-proBNP are important biomarkers for the diagnosis and management of congestive heart failure (CHF). BNP is released from cardiac ventricles in response to increased wall stress and levels correlate with left ventricular dysfunction. While both BNP and NT-proBNP can help diagnose CHF, NT-proBNP is more stable and its levels better predict mortality and rehospitalization risk in patients with CHF. The diagnostic accuracy of BNP and NT-proBNP can be affected by factors like renal function, obesity, and atrial fibrillation.
Cardiac biomarkers - I
Cardiac biomarkers such as aspartate transaminase, lactate dehydrogenase, creatine kinase, and cardiac troponins are substances that are released when heart muscle is damaged and can help detect and assess heart attacks. While aspartate transaminase and lactate dehydrogenase were earlier markers used, more specific markers like creatine kinase-MB and cardiac troponins T and I are now widely used. No single marker is perfect but used together they can help diagnose chest pain and evaluate heart function.
Heparin Induced Thrombocytopeia (HIT)
This document provides information about heparin-induced thrombocytopenia (HIT). It begins by introducing HIT as an immune-mediated reduction in platelet count that occurs in 3-5% of patients receiving unfractionated heparin for 5 days or more, and less than 1% for low molecular weight heparin. It then describes HIT as characterized by a platelet decrease of over 50% from baseline 5-10 days after starting heparin, along with hypercoagulability and heparin-dependent antibodies. The document outlines the pathogenesis of HIT and differences between type I and type II, reviews potential clinical complications, diagnostic methods, and emphasizes the need to promptly discontinue heparin and
Recommended
Nt pro BNP
NT-pro BNP is a marker used for both diagnosing and monitoring heart failure. It is more stable than BNP, with a half-life of 120 minutes compared to BNP's 20 minutes. NT-pro BNP levels are not affected by drugs like nesiritide that can impact BNP levels. NT-pro BNP can help distinguish cardiac causes of symptoms like shortness of breath from non-cardiac causes. It also reflects the severity of heart failure and can help monitor the effectiveness of new drugs in decreasing mortality from heart failure.
Brain-type Natriuretic Peptide (BNP) - An Information Resource for Cardiac Ne...
Brain-type Natriuretic Peptide (BNP) - An Information Resource for Cardiac Networks.
Produced by the NHS Heart Improvement Programme, this online document gives a brief overview of available information on Brain-type Natriuretic Peptide (BNP) testing as a ‘rule-out’ measure for echocardiogram when suspecting a diagnosis of heart failure.
(Updated July 2008).
Procalcitonin
Procalcitonin is a peptide marker that is useful for differentiating between bacterial and viral infections. It begins to rise more quickly than C-reactive protein after an inflammatory insult and its levels correlate with the severity of infection or sepsis. Clinical situations where measuring procalcitonin may be helpful include determining the need for and length of antibiotic therapy for respiratory infections, diagnosing and monitoring sepsis, and distinguishing between bacterial and viral causes of meningitis or pneumonia. While elevated in response to bacterial infection, procalcitonin levels may also increase in response to certain non-infectious conditions like trauma or transplantation. It is a more reliable indicator of sepsis than C-reactive protein or other markers.
Biomarker in heart failure
The document discusses various biomarkers used in the diagnosis and management of heart failure. It states that natriuretic peptides like BNP and NT-proBNP are the most widely used biomarkers for heart failure as they are accurate for establishing diagnosis, determining severity, and predicting prognosis. It describes the release and function of these peptides. It also mentions other biomarkers like cardiac troponins, inflammatory markers, neurohormonal factors, and matrix proteins that provide additional information on myocardial injury, inflammation, neurohormonal activation, and remodeling in heart failure. A multimarker approach may help better classify and risk stratify heart failure.
Biomarkers in heart failure
1) Natriuretic peptides like BNP and NT-proBNP are the most extensively studied and used biomarkers in heart failure. They are useful for diagnosis, assessing prognosis, and monitoring response to treatment.
2) Other biomarkers like troponins, ST2, galectin-3, and inflammatory markers can provide additional prognostic information beyond natriuretic peptides.
3) Biomarkers reflect different pathophysiological processes in heart failure like myocyte injury, stress, remodeling, neurohormonal activation, and inflammation. Used together, they can improve risk stratification and guidance of therapy.
Natriuretic peptide in chf and acs,VIRBHAN
Natriuretic peptides like BNP and NT-proBNP are important biomarkers for the diagnosis and management of congestive heart failure (CHF). BNP is released from cardiac ventricles in response to increased wall stress and levels correlate with left ventricular dysfunction. While both BNP and NT-proBNP can help diagnose CHF, NT-proBNP is more stable and its levels better predict mortality and rehospitalization risk in patients with CHF. The diagnostic accuracy of BNP and NT-proBNP can be affected by factors like renal function, obesity, and atrial fibrillation.
Cardiac biomarkers - I
Cardiac biomarkers such as aspartate transaminase, lactate dehydrogenase, creatine kinase, and cardiac troponins are substances that are released when heart muscle is damaged and can help detect and assess heart attacks. While aspartate transaminase and lactate dehydrogenase were earlier markers used, more specific markers like creatine kinase-MB and cardiac troponins T and I are now widely used. No single marker is perfect but used together they can help diagnose chest pain and evaluate heart function.
Heparin Induced Thrombocytopeia (HIT)
This document provides information about heparin-induced thrombocytopenia (HIT). It begins by introducing HIT as an immune-mediated reduction in platelet count that occurs in 3-5% of patients receiving unfractionated heparin for 5 days or more, and less than 1% for low molecular weight heparin. It then describes HIT as characterized by a platelet decrease of over 50% from baseline 5-10 days after starting heparin, along with hypercoagulability and heparin-dependent antibodies. The document outlines the pathogenesis of HIT and differences between type I and type II, reviews potential clinical complications, diagnostic methods, and emphasizes the need to promptly discontinue heparin and
Transfusion related acute lung injury
Transfusion-related acute lung injury (TRALI) is a potentially fatal syndrome characterized by acute respiratory distress within 6 hours of blood transfusion. It is believed to be caused by anti-leukocyte antibodies in plasma products that cause leukocyte aggregation in the lungs, inflammatory injury, and non-cardiogenic pulmonary edema. TRALI has an incidence of 1 in 5000 transfusions and mortality rate of 5-25%. Risk factors include plasma-rich products, multiparous donors, and underlying patient conditions. Diagnosis involves new pulmonary edema within 6 hours of transfusion in the absence of circulatory overload. Treatment focuses on supportive care, with most patients recovering within 72 hours. Prevention strategies include leukoreduction of blood products
Management of heart failure
This document provides an overview of heart failure, including evaluation and management. It begins with definitions of heart failure and discusses etiology and pathogenesis. It then covers the period of compensation, clinical manifestations, classification of severity, and stages of development. Diagnosis of HFrEF versus HFpEF is explained. Treatment of HFpEF focuses on symptom management while treatment of HFrEF emphasizes guideline directed medical therapy including ACEi/ARB, beta-blockers, ARNi, diuretics, aldosterone antagonists, and SGLT2 inhibitors. Management is aimed at controlling symptoms and congestion through pharmacological optimization and treatment of comorbidities.
HEPARIN INDUCED THROMBOCYTOPENIA
This document discusses heparin-induced thrombocytopenia (HIT). HIT is an immune-mediated reaction to heparin that results in platelet activation and thrombocytopenia. It can lead to thrombotic complications in 20-50% of patients. The document reviews the pathophysiology of HIT, defines its criteria, discusses diagnostic assays and algorithms, and outlines treatment and management approaches including alternative anticoagulants like lepirudin, argatroban, and danaparoid. Early recognition and treatment are important to prevent life-threatening thrombotic events associated with HIT.
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cardiac biomarker
This document discusses cardiac biomarkers, specifically cardiac troponins. It begins by defining biomarkers and different types of biomarkers such as surrogate endpoints and clinical endpoints. It then discusses the history of cardiac biomarkers, including the discovery and use of CK, CK-MB, myoglobin, and troponins. Troponins T and I are now the preferred biomarkers for detecting myocardial injury as they are highly specific and their elevation persists for longer than other markers. High-sensitivity troponin assays can detect even lower levels of troponin and allow for more rapid diagnosis of myocardial infarction. Interpretation of troponin levels is more complex in patients with chronic kidney disease or after procedures like CABG.
Atrial fibrillation
This document provides an overview of atrial fibrillation (AF), including its pathogenesis, types, diagnosis, and management. Some key points:
- AF is the most common cardiac arrhythmia, affecting around 6% of those over 65. It increases the risk of stroke.
- It occurs when the normal sinus rhythm is overridden by disorganized electrical impulses, usually originating in the lungs.
- Types include paroxysmal, persistent, and permanent. Symptoms range from none to palpitations, dyspnea, chest pain, and neurological issues.
- Diagnosis is made via ECG showing irregular rhythm without P waves. Workup evaluates for underlying causes and stroke risk factors.
Aortic dissection nikku ppt
An aortic dissection occurs when blood tears the inner layer of the aorta, separating it from the middle layer. It is classified by location and timing of symptoms. Risk factors include hypertension, connective tissue disorders, and family history. Treatment depends on location but may include surgery, endovascular stent grafting, or medical management of blood pressure. Prognosis depends on type and treatment, with mortality rates declining with advances in surgical and endovascular techniques.
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Acute pulmonary embolism - risk stratification and management
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Ventricular tachycardia
Ventricular tachycardia is a fast heart rhythm originating from the ventricles with a rate over 100 bpm. It is classified based on duration (sustained vs non-sustained), morphology (monomorphic, polymorphic, sinusoidal), and symptoms. Causes include structural heart disease, electrolyte abnormalities, drugs, and prolonged QT interval. Diagnosis involves ECG criteria showing ventricular origin. Treatment depends on hemodynamic stability and may include antiarrhythmic drugs, implantable cardioverter-defibrillator, catheter ablation, or surgery. Recurrent ventricular tachycardia is managed long term with devices, drugs, and treatment of underlying causes.
Procalcitonin
Procalcitonin is a biomarker that is more specific than others for bacterial infection. It rises rapidly within 6 hours of an insult and declines quickly with treatment. It is not impacted by anti-inflammatory states and correlates well with illness severity. Procalcitonin levels can be used to differentiate between bacterial and viral lung infections, diagnose and monitor sepsis and septic shock, monitor antibiotic treatment response, and diagnose secondary infections. Reference values are provided and recommendations include measuring PCT at initiation of suspected conditions and repeating every 2-3 days to guide antibiotic use along with culture and clinical data.
Microalbuminuria
This document discusses microalbuminuria (MA) in a 50-year-old female patient with type 2 diabetes. It defines MA as urinary albumin excretion between 20-200 ug/min or 30-300 mg/24 hours. The document discusses screening, causes, prevalence, and significance of MA. MA is a marker of early kidney damage and predicts increased risk of cardiovascular disease. Tight control of blood pressure, glucose, and lipids is recommended for patients with MA.
Approach to thrombocytopenia
This document discusses the approach and management of thrombocytopenia and immune thrombocytopenic purpura (ITP). It defines thrombocytopenia and its causes, provides diagnostic criteria for ITP, and outlines treatment approaches including corticosteroids, IVIG, anti-D, thrombopoietin receptor agonists, splenectomy, rituximab, and experimental therapies. It also addresses management of severe bleeding, pregnancy-associated thrombocytopenia, and thrombocytopenia in the settings of HIV and hepatitis C infection.
Supraventricular tachycardias
This document discusses supraventricular tachycardias (SVT). It defines different types of SVT including paroxysmal SVT, which is common in emergency rooms. Quality of life is often poor for those with paroxysmal SVT. The document discusses mechanisms of SVT including reentry circuits, enhanced automaticity, and triggered activity. It provides details on differentiating AV nodal reentrant tachycardia from AV reentrant tachycardia using electrocardiogram findings. Treatment options discussed include carotid sinus massage, adenosine, and catheter ablation.
PSVT
This document discusses paroxysmal supraventricular tachycardia (PSVT), which represents a subset of supraventricular tachycardias (SVTs) characterized by abrupt onset and termination of a regular, rapid tachycardia. The main types of PSVT are atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular reentrant tachycardia (AVRT) involving an accessory pathway. The document provides details on the mechanisms, clinical presentations, evaluations and management of these arrhythmias. Vagal maneuvers and adenosine are first-line treatment options that can terminate the tachycardias by slowing conduction through the at
Secondary hypertension work up
This document provides an overview of secondary hypertension workup. It discusses that secondary hypertension accounts for 5-10% of cases and can be curable. Testing requires a high index of clinical suspicion, such as new onset hypertension under 30 or over 50 years old, or hypertension refractory to 3 or more medications. Routine tests include a urinalysis, blood tests, ECG, and tests for renal, renovascular, adrenal, and thyroid causes. Specific signs or symptoms that should raise suspicion for an underlying secondary cause include hypokalemia without diuretic use, epigastric bruits, differential blood pressures between arms, and episodic hypertension, flushing and palpitations.
Biomarkers in sepsis
This document discusses the potential utility of biomarkers for diagnosing and prognosing sepsis. It begins by explaining why improving diagnostic and prognostic tools for sepsis is important, as it is a leading cause of death in ICU patients. It then discusses how early detection and treatment are paramount but current detection strategies are limited. The document introduces the biomarker paradigm for sepsis, where biomarkers can identify inflammation, coagulation, tissue damage and repair processes to better stratify severity and prognosticate outcomes. Several candidate biomarkers are discussed, such as procalcitonin, cytokines, chemokines, and pentraxin 3. The document considers how biomarkers may help with diagnosis, prognostication, and identifying high-risk patients and treatment response. It concludes the future
Atrial Fibrillation
1) Atrial fibrillation is the most common cardiac arrhythmia characterized by irregular electrical activity in the atria. It increases in prevalence with age and can cause complications like heart failure, stroke, and systemic embolism.
2) Management of atrial fibrillation involves rate or rhythm control as well as long-term anticoagulation to prevent thromboembolism depending on stroke risk factors. The CHA2DS2-VASc score is used to assess this risk.
3) While antiarrhythmic drugs and cardioversion can restore normal sinus rhythm, rate control is preferred for many patients. Newer anticoagulants like dabigatran and rivar
ABG Interpretation
This document provides a summary of an arterial blood gas interpretation presentation. It discusses the objectives, procedure, and precautions for arterial blood gas sampling. It then covers the interpretation of oxygenation status and acid-base status using a six step approach. The six steps include determining if acidemia or alkalemia is present, if the primary disturbance is respiratory or metabolic, if a respiratory disorder is acute or chronic, if compensation is adequate, evaluating the anion gap if metabolic, and identifying the cause of a high anion gap metabolic acidosis.
SUPRAVENTRICULAR TACHYCARDIA - SVT
This document discusses several types of supraventricular tachycardia (SVT), including their definitions, pathophysiology, diagnosis, and treatment. It covers sinus tachycardia, sinus node reentry, atrial flutter, and atrial tachycardia. For each type, it describes the characteristic heart rate, P wave morphology, and mechanisms involving automaticity, reentry, or triggered activity. Treatment options discussed include medications, cardioversion, ablation, and stroke prophylaxis.
Cardiac Investigation In Heart Failure
This document summarizes guidelines for cardiac investigation and management of heart failure. It addresses:
- When to assess for coronary artery disease in heart failure patients
- Indications for endomyocardial biopsy and BNP testing
- Use of echocardiography and stress testing to evaluate patients
- Screening for rare diseases and comorbidities
- Use of cardiac resynchronization therapy and implantable cardioverter-defibrillators in heart failure
The document provides guidance on the appropriate use of diagnostic tests and treatments based on a patient's symptoms, ejection fraction, QRS duration, and response to medical therapy.
natriureticpeptideinchfandacs-161009093153.pptx
Natriuretic Peptide in CHF &ACS
BNP and NT-pro BNP are useful biomarkers for diagnosing and managing heart failure (HF) and acute coronary syndrome (ACS). Elevated levels indicate increased ventricular wall stress and correlate with worse outcomes. However, factors like obesity, renal function, age and pulmonary disease can affect levels. A BNP <100pg/mL or >500pg/mL has high accuracy to rule-out or rule-in HF, while levels between 100-500pg/mL require considering these factors. Serial measurements also help in monitoring HF therapy responses and predicting mortality risks.
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This document provides an overview of heart failure, including evaluation and management. It begins with definitions of heart failure and discusses etiology and pathogenesis. It then covers the period of compensation, clinical manifestations, classification of severity, and stages of development. Diagnosis of HFrEF versus HFpEF is explained. Treatment of HFpEF focuses on symptom management while treatment of HFrEF emphasizes guideline directed medical therapy including ACEi/ARB, beta-blockers, ARNi, diuretics, aldosterone antagonists, and SGLT2 inhibitors. Management is aimed at controlling symptoms and congestion through pharmacological optimization and treatment of comorbidities.
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This document discusses heparin-induced thrombocytopenia (HIT). HIT is an immune-mediated reaction to heparin that results in platelet activation and thrombocytopenia. It can lead to thrombotic complications in 20-50% of patients. The document reviews the pathophysiology of HIT, defines its criteria, discusses diagnostic assays and algorithms, and outlines treatment and management approaches including alternative anticoagulants like lepirudin, argatroban, and danaparoid. Early recognition and treatment are important to prevent life-threatening thrombotic events associated with HIT.
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This document discusses cardiac biomarkers, specifically cardiac troponins. It begins by defining biomarkers and different types of biomarkers such as surrogate endpoints and clinical endpoints. It then discusses the history of cardiac biomarkers, including the discovery and use of CK, CK-MB, myoglobin, and troponins. Troponins T and I are now the preferred biomarkers for detecting myocardial injury as they are highly specific and their elevation persists for longer than other markers. High-sensitivity troponin assays can detect even lower levels of troponin and allow for more rapid diagnosis of myocardial infarction. Interpretation of troponin levels is more complex in patients with chronic kidney disease or after procedures like CABG.
Atrial fibrillation
This document provides an overview of atrial fibrillation (AF), including its pathogenesis, types, diagnosis, and management. Some key points:
- AF is the most common cardiac arrhythmia, affecting around 6% of those over 65. It increases the risk of stroke.
- It occurs when the normal sinus rhythm is overridden by disorganized electrical impulses, usually originating in the lungs.
- Types include paroxysmal, persistent, and permanent. Symptoms range from none to palpitations, dyspnea, chest pain, and neurological issues.
- Diagnosis is made via ECG showing irregular rhythm without P waves. Workup evaluates for underlying causes and stroke risk factors.
Aortic dissection nikku ppt
An aortic dissection occurs when blood tears the inner layer of the aorta, separating it from the middle layer. It is classified by location and timing of symptoms. Risk factors include hypertension, connective tissue disorders, and family history. Treatment depends on location but may include surgery, endovascular stent grafting, or medical management of blood pressure. Prognosis depends on type and treatment, with mortality rates declining with advances in surgical and endovascular techniques.
SEPSIS BIOMARKERS UPDATES
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SEPSIS BIOMARKERS ARE OUR WEAPON TO EARLY DETECT SEPSIS. WE HAVE TO UNDERSTAND IT WELL
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Ventricular tachycardia
Ventricular tachycardia is a fast heart rhythm originating from the ventricles with a rate over 100 bpm. It is classified based on duration (sustained vs non-sustained), morphology (monomorphic, polymorphic, sinusoidal), and symptoms. Causes include structural heart disease, electrolyte abnormalities, drugs, and prolonged QT interval. Diagnosis involves ECG criteria showing ventricular origin. Treatment depends on hemodynamic stability and may include antiarrhythmic drugs, implantable cardioverter-defibrillator, catheter ablation, or surgery. Recurrent ventricular tachycardia is managed long term with devices, drugs, and treatment of underlying causes.
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Procalcitonin is a biomarker that is more specific than others for bacterial infection. It rises rapidly within 6 hours of an insult and declines quickly with treatment. It is not impacted by anti-inflammatory states and correlates well with illness severity. Procalcitonin levels can be used to differentiate between bacterial and viral lung infections, diagnose and monitor sepsis and septic shock, monitor antibiotic treatment response, and diagnose secondary infections. Reference values are provided and recommendations include measuring PCT at initiation of suspected conditions and repeating every 2-3 days to guide antibiotic use along with culture and clinical data.
Microalbuminuria
This document discusses microalbuminuria (MA) in a 50-year-old female patient with type 2 diabetes. It defines MA as urinary albumin excretion between 20-200 ug/min or 30-300 mg/24 hours. The document discusses screening, causes, prevalence, and significance of MA. MA is a marker of early kidney damage and predicts increased risk of cardiovascular disease. Tight control of blood pressure, glucose, and lipids is recommended for patients with MA.
Approach to thrombocytopenia
This document discusses the approach and management of thrombocytopenia and immune thrombocytopenic purpura (ITP). It defines thrombocytopenia and its causes, provides diagnostic criteria for ITP, and outlines treatment approaches including corticosteroids, IVIG, anti-D, thrombopoietin receptor agonists, splenectomy, rituximab, and experimental therapies. It also addresses management of severe bleeding, pregnancy-associated thrombocytopenia, and thrombocytopenia in the settings of HIV and hepatitis C infection.
Supraventricular tachycardias
This document discusses supraventricular tachycardias (SVT). It defines different types of SVT including paroxysmal SVT, which is common in emergency rooms. Quality of life is often poor for those with paroxysmal SVT. The document discusses mechanisms of SVT including reentry circuits, enhanced automaticity, and triggered activity. It provides details on differentiating AV nodal reentrant tachycardia from AV reentrant tachycardia using electrocardiogram findings. Treatment options discussed include carotid sinus massage, adenosine, and catheter ablation.
PSVT
This document discusses paroxysmal supraventricular tachycardia (PSVT), which represents a subset of supraventricular tachycardias (SVTs) characterized by abrupt onset and termination of a regular, rapid tachycardia. The main types of PSVT are atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular reentrant tachycardia (AVRT) involving an accessory pathway. The document provides details on the mechanisms, clinical presentations, evaluations and management of these arrhythmias. Vagal maneuvers and adenosine are first-line treatment options that can terminate the tachycardias by slowing conduction through the at
Secondary hypertension work up
This document provides an overview of secondary hypertension workup. It discusses that secondary hypertension accounts for 5-10% of cases and can be curable. Testing requires a high index of clinical suspicion, such as new onset hypertension under 30 or over 50 years old, or hypertension refractory to 3 or more medications. Routine tests include a urinalysis, blood tests, ECG, and tests for renal, renovascular, adrenal, and thyroid causes. Specific signs or symptoms that should raise suspicion for an underlying secondary cause include hypokalemia without diuretic use, epigastric bruits, differential blood pressures between arms, and episodic hypertension, flushing and palpitations.
Biomarkers in sepsis
This document discusses the potential utility of biomarkers for diagnosing and prognosing sepsis. It begins by explaining why improving diagnostic and prognostic tools for sepsis is important, as it is a leading cause of death in ICU patients. It then discusses how early detection and treatment are paramount but current detection strategies are limited. The document introduces the biomarker paradigm for sepsis, where biomarkers can identify inflammation, coagulation, tissue damage and repair processes to better stratify severity and prognosticate outcomes. Several candidate biomarkers are discussed, such as procalcitonin, cytokines, chemokines, and pentraxin 3. The document considers how biomarkers may help with diagnosis, prognostication, and identifying high-risk patients and treatment response. It concludes the future
Atrial Fibrillation
1) Atrial fibrillation is the most common cardiac arrhythmia characterized by irregular electrical activity in the atria. It increases in prevalence with age and can cause complications like heart failure, stroke, and systemic embolism.
2) Management of atrial fibrillation involves rate or rhythm control as well as long-term anticoagulation to prevent thromboembolism depending on stroke risk factors. The CHA2DS2-VASc score is used to assess this risk.
3) While antiarrhythmic drugs and cardioversion can restore normal sinus rhythm, rate control is preferred for many patients. Newer anticoagulants like dabigatran and rivar
ABG Interpretation
This document provides a summary of an arterial blood gas interpretation presentation. It discusses the objectives, procedure, and precautions for arterial blood gas sampling. It then covers the interpretation of oxygenation status and acid-base status using a six step approach. The six steps include determining if acidemia or alkalemia is present, if the primary disturbance is respiratory or metabolic, if a respiratory disorder is acute or chronic, if compensation is adequate, evaluating the anion gap if metabolic, and identifying the cause of a high anion gap metabolic acidosis.
SUPRAVENTRICULAR TACHYCARDIA - SVT
This document discusses several types of supraventricular tachycardia (SVT), including their definitions, pathophysiology, diagnosis, and treatment. It covers sinus tachycardia, sinus node reentry, atrial flutter, and atrial tachycardia. For each type, it describes the characteristic heart rate, P wave morphology, and mechanisms involving automaticity, reentry, or triggered activity. Treatment options discussed include medications, cardioversion, ablation, and stroke prophylaxis.
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Similar to NT-ProBNP
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- Indications for endomyocardial biopsy and BNP testing
- Use of echocardiography and stress testing to evaluate patients
- Screening for rare diseases and comorbidities
- Use of cardiac resynchronization therapy and implantable cardioverter-defibrillators in heart failure
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BNP and NT-pro BNP are useful biomarkers for diagnosing and managing heart failure (HF) and acute coronary syndrome (ACS). Elevated levels indicate increased ventricular wall stress and correlate with worse outcomes. However, factors like obesity, renal function, age and pulmonary disease can affect levels. A BNP <100pg/mL or >500pg/mL has high accuracy to rule-out or rule-in HF, while levels between 100-500pg/mL require considering these factors. Serial measurements also help in monitoring HF therapy responses and predicting mortality risks.
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This document discusses biomarkers for the diagnosis of heart failure, specifically B-type natriuretic peptide (BNP) and N-terminal pro BNP. BNP is released mainly from the heart in response to increased wall stress and its levels correlate with the severity of heart failure. Studies have shown N-terminal pro BNP to have similar diagnostic accuracy to BNP for heart failure in emergency room settings and for investigating dyspnea. The levels of these natriuretic peptides are increased in certain conditions like aging, acute coronary syndrome, and renal failure, and decreased in others such as obesity and burnt out cardiomyopathy. Their interpretation requires consideration of clinical history and features in addition to renal function and obesity.
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1) Significant reductions in NT-proBNP levels occurred within 2 weeks of starting ARNI and correlated with improvements in cardiac structure and function at 12 months including increased LVEF and reduced LV volumes.
2) Reverse cardiac remodeling occurred in all patient subgroups including those with new-onset HF, those who were ACEI/ARB naïve, and those who did not reach target ARNI doses.
3) Patients with the
cardiac biomarker.pptx
Cardiac biomarkers NT-proBNP and hs-cTn are used for diagnosis, risk stratification, and monitoring treatment responses in heart failure and myocardial injury. NT-proBNP is cleared by the kidneys and its cut-off values are adjusted for renal dysfunction and BMI. Hs-cTn assays have high sensitivity and optimized thresholds can safely rule out myocardial infarction. Both biomarkers provide prognostic information, with elevated levels indicating higher mortality risk. The 2022 ACC guidelines recommend hs-cTnT and hs-cTnI for evaluation of possible acute coronary syndrome.
Role of plasma N-terminal proB-type natriuretic peptide (NT-proBNP) level in ...
Cardioembolic stroke generally results in more severe disability, since it typically has a larger ischemic area than the other types of ischemic stroke. The correct identification of a stroke etiology as cardioembolic is important as it has been shown that these patients benefit from anticoagulation. However, it is difficult to differentiate cardioembolic strokes from non-cardioembolic strokes (atherothrombotic stroke and lacunar stroke). NT-proBNP is a well recognized biochemical marker of congestive heart failure. Recent studies suggest that NT-proBNP may be used as a marker of cardioembolic stroke.
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The document summarizes the natriuretic peptide system, focusing on B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP). It discusses their role in heart failure (HF), including use of BNP levels to diagnose HF. Elevated BNP correlates with HF severity and prognosis. While useful for evaluating dyspnea, BNP levels may be normal in some HF patients. NT-proBNP also correlates with HF and prognosis. Limited evidence suggests NT-proBNP may have greater prognostic value than BNP. Randomized trials on using BNP-guided therapy for HF have shown mixed results.
Assessing Congestion in HF : Natriuretic Peptides
1) Natriuretic peptides (BNP, NT-proBNP) provide a quantitative measure of myocardial wall stress that correlates with heart failure symptoms and prognosis.
2) Elevated BNP/NT-proBNP levels strongly support the diagnosis of acute or chronic heart failure. Serial measurements can track changes in disease severity over time.
3) Patients with higher BNP/NT-proBNP levels or less reduction in levels following treatment have worse outcomes, including increased risk of death and heart failure hospitalization. Natriuretic peptide levels may help guide therapy adjustments.
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Sacubitril-valsartan (angiotensin receptor-neprilysin inhibitor or ARNI) provides a novel dual approach for managing heart failure by inhibiting neprilysin to increase natriuretic peptides while blocking the renin-angiotensin-aldosterone system through angiotensin receptor blockade. The PARADIGM-HF trial found ARNI significantly reduced cardiovascular death, all-cause death, and heart failure hospitalizations compared to enalapril in patients with heart failure with reduced ejection fraction. Current guidelines recommend ARNI as a replacement for ACE inhibitors or ARBs in such patients based on the benefits demonstrated in PARADIGM-HF.
Dr. harman vasopeptidase inhibition
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The Relevance of Natriuretic Peptide in Medical Laboratory Diagnosis
Natriuretic peptides (NPs) are hormones that regulate blood pressure, cardiovascular homeostasis, and long bone growth. They are hormones which are mainly secreted from cardiac organ and have important natriuretic and kaliuretic characteristics. It is classified into four including; atrial NP, Brain-type NP (BNP), C-type NP and dendroaspis NP, a D-type NP, each with its own characteristic roles. The NP system involves three ligands and three receptors and result in situations such as diuresis, natriuresis, vasodilation, and inhibition of aldosterone synthesis and renin secretion as a circulating hormone The N-terminal part of the prohormone of BNP is produced alongside BNP. This has indeed play a diagnostic value in cardiac attack. NPs or their fragments have been subjected to scientific observation for their diagnostic value.
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NT-ProBNP
- 1. Hafij Ali (MSc in Genetic Engineering & Biotechnology, SUST) Product Executive (PMD) Labaid Hospital & Diagnostic NT-ProBNP
- 2. Heart Failure Heart failure (HF) is a global health problem associated with high morbidity and mortality Detection in its early stages and appropriate treatment are key to improving quality of life Patients with HF – especially with mild symptoms – are often not diagnosed
- 3. PrePro-BNP When heart failure develops or worsens, the ventricles or lower chambers of the heart produce a substance called PrePro-BNP. PreproBNP is 134 amino acids peptide. Cleaved into proBNP (108 amino acids) and a signal peptide of 26 amino acids. ProBNP is subsequently cleaved into BNP (32 amino acids) and the inactive N- terminal proBNP peptide (NT-proBNP; 76 amino acids).
- 6. NT-ProBNP Innovative marker to improve clinical decisions Produced from heart muscle cells, mainly in the left ventricular myocardium but also in the atrial myocardium, as a pro-hormone BNP.
- 7. Why Is a NT-ProBNP Blood Test Needed? NT-ProBNP levels help to determine - Heart failure Determine heart failure worsened condition Other treatments are needed Need to be hospitalized Determine prognosis
- 8. Testing may be performed A person has symptoms such as swelling in the legs (Edema) Difficulty breathing Shortness of breath Fatigue It can be used, along with other cardiac biomarker tests, to detect heart stress and damage and/or along with lung function tests to distinguish between causes of shortness of breath. Chest X-rays and an ultrasound test called echocardiography may also be performed.
- 9. What does the test result mean? Higher-than-normal results suggest that a person has some degree of heart failure, and the level of BNP or NT-proBNP in the blood is related to its severity. Higher levels of BNP or NT-proBNP are often associated with a worse outlook (prognosis) for the person. Normal results indicate that the person's symptoms are likely due to something other than heart failure.
- 10. Why NT-ProBNP but Not BNP? Both tests have similar diagnostic accuracy for detecting CHF in patients with depressed left ventricular ejection fraction (LVEF), but NT-proBNP has greater sensitivity for detecting CHF in patients with preserved LVEF Both tests can be used to screen a general population of asymptomatic subjects for depressed LVEF (≤ 40%), although for this population NT- proBNP yields more accurate results than BNP (p=.01) NT-proBNP has a circulating half-life of ~120 minutes, available for measurement longer than BNP Longer half-life reduces the possibility of false negative result NT-ProBNP’s stability increases early detection
- 11. Conti… NT-ProBNP has less laboratory variation (Biosite BNP: CV=9.9-12.0%; NT-proBNP: CV=2.9-6.1% - data supplied by Roche Diagnostics). NT-ProBNP has higher stability than BNP. In response to myocardial stress (e.g., increased ventricular stretch, ischemia), the rise in NT-proBNP is often several orders of magnitude higher than BNP. CV=Coefficient of Variation
- 12. BNP < 100 pg/mL - HF unlikely >400 pg/mL - HF likely 100-400 pg/mL - Use clinical judgment NT-proBNP < 300 pg/mL - HF unlikely Age < 50 years, NT-proBNP >450 pg/mL - HF likely Age 50-75 years, NT-proBNP >900 pg/mL – HF likely Age >75 years, NT-proBNP >1800 – HF likely Cut-off Level
- 13. Raised NTproBNP • If NTproBNP is above the cut off levels but below 2000pg/ml – refer routinely for echocardiography and specialist opinion • If > 2000pg/ml – refer urgently for echocardiography and specialist opinion
- 14. Price NT-ProBNP Labaid: 3,000/= BNP IBNSINA: 3200 (Without Discount) Popular: 3,000/= Square: 4,200/= Apollo: 4,950/=
- 15. Information About Test Collection Specimen: Blood - 4ml (Lithium heparin tube) Test Perform from Plasma : 50 µl Machine: Immulite - 2000, USA, Siemens Test Performing Time: 35min
- 16. Thank you….