The role of the primary care physician (PCP) in the management of acute myocardial infarction (MI) is important. As usually the first medical contact, the PCP's roles include identifying and diagnosing STEMI based on ECG, ordering necessary investigations, providing initial management including medications, preventing complications, maintaining patient records, and educating patients. Timely reperfusion therapy such as thrombolysis or percutaneous coronary intervention is crucial, as irreversible heart muscle damage occurs rapidly after a STEMI. The PCP helps determine whether thrombolysis or transfer for angiography is most appropriate based on factors like symptoms, ECG changes, and distance to facilities.
DANISH is a major breakthrough trial published in NEJM on 29/09/2016 regarding Defibrillator Implantation in Patients with Nonischemic Systolic Heart Failure. All content of this slide is Copy right of NEJM.
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Renal artery stenosis is the leading cause of secondary hypertension and may lead to :
Resistant (refractory) hypertension,
Progressive decline in renal function, and
Cardiac destabilization syndromes (Flash pulmonary edema, recurrent heart failure, or acute coronary syndromes)
This presentation covers various aspects of OHCA scenarios, including incidence, outcome, challenges, solutions, hen to initiate CPR, protocols, Termination, ECPR, and other issues are covering in details. Explore regional experiences in training and OHCA results as well.
Renal artery stenosis is the leading cause of secondary hypertension and may lead to :
Resistant (refractory) hypertension,
Progressive decline in renal function, and
Cardiac destabilization syndromes (Flash pulmonary edema, recurrent heart failure, or acute coronary syndromes)
This presentation covers various aspects of OHCA scenarios, including incidence, outcome, challenges, solutions, hen to initiate CPR, protocols, Termination, ECPR, and other issues are covering in details. Explore regional experiences in training and OHCA results as well.
Dr Ashling Lillis, National Director's Clinical Fellow Macmillan Support, final year trainee in Acute Oncology
Dr Clare Philliskirk, Trainee in Acute Medicine, West Midlands
Dr Sarbit Clare, Acute Medical Consultant, Sandwell and West Birmingham Hospitals
Dr Avinash.KM is a Neurosurgeon with advanced training in Interventional vascular Neurosurgery(FINR) from Zurich, Switzerland, and FMINS-Fellowship in minimally invasive and Endoscopic Neurosurgery from Germany.
He is presently working in Columbia asia hospitals, Bangalore.
His main areas of interest are Vascular Neurosurgery, Stroke specialist, interventional neuroradiology, Endovascular Neurosurgery, Endoscopic and minimally invasive Neurosurgery, Endoscopic spine surgery.He has advanced training in both Brain Aneurysm coiling and clipping, Brain AVM embolizations and its surgical removal, carotid artery stenting and carotid endarterectomy. Since he is trained both in open microvascular Neurosurgery and in Interventional Neurosurgery he helps patients in choosing the right treatment options for brain vascular diseases with out any bias of one treatment over the other.
Seminar on critical Congenital heart disease Dr Habibur Rahim | Dr Faria YasminDr. Habibur Rahim
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Duct-dependent systemic circulations
Critical aortic stenosis
Coarctation of the aorta
Interruption of aortic arch
Hypoplastic left heart syndrome
Duct-dependent pulmonary circulations
Pulmonary atresia Critical pulmonary stenosis
Tricuspid atresia
Tetralogy of Fallot
Ebstein’s anomaly
Parallel non-mixing circulation
Transposition of great arteries
Other
Total anomalous pulmonary venous connection (TAPVC)
Double outlet right ventricle
Single ventricle
Truncus arteriosus
Atrioventricular blocks are related to delay in conduction of the AV node..
Their recognition is primarily by ECG, anatomical correlation is by EP study.
ST elevation is not always due to STEMI. Other causes to be kept in mind to prevent the undue complications of thrombolysis. wrong patient and wrong management
The electrocardiogram, a basic tool in cardiology has been developed two centuries ago. It was recorded by a giant machine at that time, which is now being recorded on a mobile. Such is the advancement in ECG, which is still the gold standard in diagnosis of VT .
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Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
Model Attribute Check Company Auto PropertyCeline George
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3. Introduction
• Of the cardiovascular diseases (CVDs), the leading cause of death globally,
Ischemic Heart Disease (IHD) accounts for the majority of the deaths.
• Sudden occlusion of the coronary artery due to thrombus, is an emergency and
clinically manifests as ST segment elevation myocardial infarction (STEMI)
• Opening an occluded artery is main motto either by balloon or by drug.
• Biggest Hurdle in management of STEMI is time duration from First Medical
Contact (FMC) to management.
• Despite the management, some patients have detrimental course based on their
initial presentation.
4. Epidemiology
• India accounts for one fifth of the deaths worldwide especially in younger
population (WHO).
• The Indians have CVDs a decade earlier than the western population.
• The conventional risk factors fail to explain this increased risk.
• In 2016, CVDs contributed to 28.1% of total deaths and 14.1% of total disability
adjusted life years (DALYs) compared with 15.2% and 6.9%, respectively in 1990
(Almost double).
5. Time is Muscle
• Introduced by Eugene Braunwald
• “….the more time a heart-related issue goes untreated, the more damage the
heart may endure.”
• Almost half of the STEMI patients die before reaching the hospital.
• When not intervened either medically or percutaneously, another half
would die in the first 24 hours.
• Timely identification and management aimed at salvaging the myocardium
decides the further course of STEMI.
7. Unique risk factors
• High homocysteine levels
• Ambient air pollution
• Psychosocial factors
• Mental health and
• Higher high sensitivity C reactive protein (hs CRP) levels
indicating chronic infection and inflammation.
8. Role of PCP
• Usually the FMC
• 1.Identification
• 2.Diagnosis based on ECG
• 3.Necessary Investigations
• 4.Management
• 5.Preventive aspects
• 6.Maintaining the patient records
18. Management
• Loading doses of
• Antiplatelets and Statins
• Soluble Aspirin 325 mg
• Clopidogrel 300 mg
• Atorvastatin 80mg stat
• Injection UFH 5000 IU IV stat.
• Check whether can be sent to nearby PPCI or Not < 120 minutes.
• If not there, check whether TLT can be done or not.
• If TLT. Monitor after 90min of TLT
• Check for clinical signs
• Send to nearby cathlab.
25. CHECK LIST OF THE MEDICATIONS IN A PATIENT WITH ACUTE MI
Not applicable to all, contraindications to be kept in mind.
Nitrates and betablockers contraindicated in complicate IWMI and RVMI
26. Education
• Healthy lifestyle
• Timely assessment of risk factors in presence of premature
CAD.
• Exercise for 30minutes for atleast five days in a week
• Meditation
• Yoga
• Sleep
28. Pre hospital thrombolysis
• In 108 ambulance
• Patient with chest pain, ECG will be taken in ambulance and
send to physician and confirm diagnosis of STEMI.
• Loading doses will be given.
• Vitals will be checked.
• Based on time duration, TLT will be done.
• Tenecteplase is the drug used.
• Shifted to nearby PCI center.
• STREAM Trial showed positive results.
29. STEMI INDIA
• Pharmacoinvasive strategy.
• Initiated in Goa and
subsequently in southern
states of India.
• SPOKE AND HUB MODEL
• Early diagnosis
• Timely TLT
• And later on PCI with effective
results.
41. Take home message
• The STEMI, when timely managed we can salvage the myocardium
from necrosis.
• Fibrin specific thrombolytics are more efficacious in retaining the
patency of the occluded artery.
• Pharmacoinvasive strategy is of uprising trend in India.
• Identifying false STEMI cases is also of equal importance.
• Educating the public regarding the prevention is of utmost importance.