Patent Ductus Arteriosus in Preterm Infants
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The document discusses the management of patent ductus arteriosus (PDA) in preterm infants. PDA occurs in 31% of very low birth weight infants and can be left untreated in some cases. Treatment may include conservative management, pharmacological closure with drugs like indomethacin or ibuprofen, or surgical ligation if drugs fail. Prophylactic drug treatment may help prevent complications in very preterm infants under 25 weeks gestation. The optimal management of PDA in infants under 800g is still debated, as untreated PDA carries risks but interventions also pose dangers.
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Patent Ductus Arteriosus on the Newborn
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Patent Ductus Arteriosus on the Newborn
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Patent ductus arteriosus
Patent ductus arteriosus (PDA) is a congenital disorder in the heart wherein a neonate's ductus arteriosus fails to close after birth. Early symptoms are uncommon, but in the first year of life include increased work of breathing and poor weight gain. With age, the PDA may lead to congestive heart failure if left uncorrected. The ductus arteriosus is a normal fetal blood vessel that closes soon after birth. In a patent ductus arteriosus (PDA) the vessel does not close and remains "patent" (open) resulting in irregular transmission of blood between two of the most important arteries close to the heart, the aorta and the pulmonary artery. PDA is common in neonates with persistent respiratory problems such as hypoxia, and has a high occurrence in premature children. In hypoxic newborns, too little oxygen reaches the lungs to produce sufficient levels of bradykinin and subsequent closing of the DA. Premature children are more likely to be hypoxic and thus have PDA because of their underdeveloped heart and lungs.
A patent ductus arteriosus allows a portion of the oxygenated blood from the left heart to flow back to the lungs by flowing from the aorta (which has higher pressure) to the pulmonary artery. If this shunt is substantial, the neonate becomes short of breath: the additional fluid returning to the lungs increases lung pressure to the point that the neonate has greater difficulty inflating the lungs. This uses more calories than normal and often interferes with feeding in infancy. This condition, as a constellation of findings, is called congestive heart failure.
In some cases, such as in transposition of the great vessels (the pulmonary artery and the aorta), a PDA may need to remain open. In this cardiovascular condition, the PDA is the only way that oxygenated blood can mix with deoxygenated blood. In these cases, prostaglandins are used to keep the patent ductus arteriosus open
PDA
The ductus arteriosus is a normal fetal blood vessel that connects the pulmonary artery to the aorta. It typically closes shortly after birth as pulmonary vascular resistance decreases. A patent ductus arteriosus (PDA) is the failure of the ductus arteriosus to close, allowing blood to shunt from the aorta to the pulmonary artery. PDAs are diagnosed based on history, physical exam findings like a continuous murmur, and imaging like echocardiography. Treatment involves medical closure with drugs or percutaneous device closure for larger PDAs.
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management of shock in neonates
1) Neonatal shock is characterized by an imbalance between oxygen delivery and demand, leading to tissue hypoxia. Myocardial dysfunction, abnormal vasoregulation, and hypovolemia are common causes.
2) Pathophysiology includes an immature myocardium with fewer contractile elements and higher basal contractility, as well as complex vascular smooth muscle tone regulation. Relative adrenal insufficiency also contributes.
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Bleeding neonate
1) A bleeding neonate can have deficiencies in clotting factors or platelets due to various causes such as lack of vitamin K, maternal medication exposure, or inherited conditions.
2) Evaluation involves examining the infant's history and health status to determine if signs point to a systemic problem or isolated clotting issue, and performing lab tests like PT, PTT, and factor assays.
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This document discusses the clinical approach to diagnosing congenital heart disease. It provides statistics on the incidence of CHD and notes it occurs in 6 per 1000 live births for moderate/severe forms. A clinical diagnosis of CHD requires accurate observations and logical inferences. CHD is classified based on whether cyanosis is present, pulmonary blood flow, the side of the heart affected, and whether pulmonary hypertension is present. The diagnosis involves considering the patient's history, physical exam findings, chest x-ray, and ECG.
Neonatal shock
This document describes the case of a 10-day-old infant presenting with signs of shock including tachycardia, poor perfusion, and decreased urine output. Examinations revealed hepatomegaly and other signs suggestive of shock. Investigations showed metabolic acidosis and low blood sugar. The infant did not respond to initial fluid resuscitation and inotropic support. Echocardiogram revealed hypoplastic left heart syndrome. Prostaglandin E1 was started and the infant responded, confirming duct-dependent systemic circulation. The case highlights the importance of early recognition and management of neonatal shock.
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Patent ductus arteriosus
Patent ductus arteriosus (PDA) is a congenital disorder in the heart wherein a neonate's ductus arteriosus fails to close after birth. Early symptoms are uncommon, but in the first year of life include increased work of breathing and poor weight gain. With age, the PDA may lead to congestive heart failure if left uncorrected. The ductus arteriosus is a normal fetal blood vessel that closes soon after birth. In a patent ductus arteriosus (PDA) the vessel does not close and remains "patent" (open) resulting in irregular transmission of blood between two of the most important arteries close to the heart, the aorta and the pulmonary artery. PDA is common in neonates with persistent respiratory problems such as hypoxia, and has a high occurrence in premature children. In hypoxic newborns, too little oxygen reaches the lungs to produce sufficient levels of bradykinin and subsequent closing of the DA. Premature children are more likely to be hypoxic and thus have PDA because of their underdeveloped heart and lungs.
A patent ductus arteriosus allows a portion of the oxygenated blood from the left heart to flow back to the lungs by flowing from the aorta (which has higher pressure) to the pulmonary artery. If this shunt is substantial, the neonate becomes short of breath: the additional fluid returning to the lungs increases lung pressure to the point that the neonate has greater difficulty inflating the lungs. This uses more calories than normal and often interferes with feeding in infancy. This condition, as a constellation of findings, is called congestive heart failure.
In some cases, such as in transposition of the great vessels (the pulmonary artery and the aorta), a PDA may need to remain open. In this cardiovascular condition, the PDA is the only way that oxygenated blood can mix with deoxygenated blood. In these cases, prostaglandins are used to keep the patent ductus arteriosus open
PDA
The ductus arteriosus is a normal fetal blood vessel that connects the pulmonary artery to the aorta. It typically closes shortly after birth as pulmonary vascular resistance decreases. A patent ductus arteriosus (PDA) is the failure of the ductus arteriosus to close, allowing blood to shunt from the aorta to the pulmonary artery. PDAs are diagnosed based on history, physical exam findings like a continuous murmur, and imaging like echocardiography. Treatment involves medical closure with drugs or percutaneous device closure for larger PDAs.
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The document discusses Patent Ductus Arteriosus (PDA), which is the persistence of the ductus arteriosus in newborns beyond the normal closure period of 3-5 days. It affects 5-10% of congenital heart defects and is more common in preterm infants. A PDA causes increased blood flow from the aorta to the pulmonary artery, overloading the lungs and right ventricle. Signs include a machinery murmur and enlarged heart. Treatment involves medical closure with indomethacin in preterm infants or surgical ligation of large defects.
Patent ductus arteriosus
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Pda Part 3 Anatomy Physiology
The patent ductus arteriosus (PDA) is a fetal blood vessel that normally closes after birth. It connects the pulmonary artery to the aorta. During fetal life, it allows most blood to bypass the high-resistance lungs and go to the systemic circulation. After birth, factors like decreased prostaglandins and increased oxygen cause the PDA to contract and close within 3 weeks. A PDA that remains open is called a patent ductus arteriosus. This allows oxygenated blood to shunt from the aorta back to the pulmonary artery, overloading the left heart and lungs. If left untreated, it can cause the pulmonary vascular resistance to rise over time and reverse the shunt to become right-
Management Of PDA
There are three main options to treat a patent ductus arteriosus (PDA): medical management using drugs like indomethacin or ibuprofen, catheter-based procedures to implant occlusion devices, or surgery to ligate and divide the ductus. Medical management aims to treat or prevent heart failure, infective endocarditis, and pulmonary vascular disease. Catheter procedures are usually done after the neonatal period for moderate to large PDAs. Surgery is indicated if medical treatment fails or for treatment of related congenital heart defects, and involves ligating and dividing the ductus via thoracotomy.
Ventricular septal defect (vsd)
Ventricular septal defect (VSD) is a congenital heart defect where there is a hole in the wall separating the two lower chambers of the heart (ventricles). VSDs can range from small to large. Small VSDs often close on their own while large VSDs require medical or surgical treatment. VSDs are diagnosed using tests like echocardiograms, electrocardiograms, and chest x-rays. Treatment may involve medications to manage symptoms or surgery to repair the hole in the ventricle wall. Post-surgery, patients need monitoring and antibiotics to prevent infection.
Pda Part 6 Treatment
The document discusses treatment options for patent ductus arteriosus (PDA) in infants. There are three main options: medical management using drugs like indomethacin or ibuprofen, catheter-based procedures to close the PDA, or surgical intervention. Medical management is usually the first approach using anti-inflammatory drugs and involves balancing treatment against potential renal or gastrointestinal side effects. If medical management fails, catheter or surgical closure may be considered, with catheter procedures preferred if the PDA is suitable due to lower risks. Surgical ligation is an option when other approaches are not viable or have failed.
ASKEP PATEN DUCTUS ARTERIOSUS (PDA)
Patent ductus arteriosus (PDA) adalah tetap terbukanya duktus arteriosus setelah lahir yang menyebabkan dialirkannya darah secara langsung dari aorta ke arteri pulmoner. PDA disebabkan oleh kegagalan penutupan duktus arteriosus pada bayi beberapa minggu pertama. Gejala klinisnya antara lain bising gipson, vibrasi pada sternum kiri, dan gangguan pertukaran gas yang berhubungan dengan ventilasi-perfusi. Pen
Les cardiopathies cyanogènes et non cyanogènes(corrigee)
Cyanotic and acyanotic congeniatl Heart disease in french.
Patent Ductus Arteriosus
This infant is a 5 day old 25 week preemie with worsening respiratory distress requiring increased oxygen and ventilator support. On exam, the infant has a systolic murmur and signs of increased cardiac output including bounding pulses. An echocardiogram is needed to confirm a diagnosis of a hemodynamically significant patent ductus arteriosus (PDA), which could be contributing to the respiratory distress. Treatment options for a large PDA include supportive care, medications like indomethacin or ibuprofen to close the ductus, or surgery.
Seminar congenital cardiac disorders (pda,TA and AP Window)
Patent ductus arteriosus is a congenital heart disorder where the ductus arteriosus, a blood vessel connecting the pulmonary artery and aorta, fails to close after birth as it normally would. This allows blood to shunt from the aorta to the pulmonary artery, potentially causing heart failure. It can be diagnosed via echocardiogram, electrocardiogram, or chest x-ray and may be treated with medications like indomethacin or surgery.
Dr ranjith mp av canal defect
The document discusses atrioventricular septal defects (AVSDs), which are characterized by the complete absence of the atrioventricular septum. It describes the anatomy, classification, epidemiology, presentation, investigations, and management of AVSDs. Key points include that AVSDs can be partial or complete, account for 4-5% of congenital heart disease, and require surgical repair in early infancy to prevent congestive heart failure and pulmonary hypertension. Left ventricular outflow tract obstruction is a potential postoperative complication.
Atrial septal defect
Atrial septal defect (ASD) is an abnormal opening between the right and left atria that allows blood to pass from the left to the right atrium. There are three main types of ASDs that differ in their location within the atrial septum. Untreated ASDs can lead to volume overload of the right ventricle and elevated pulmonary artery pressures over time. While small defects may be asymptomatic, children with ASDs can experience fatigue, infections, and poor weight gain. Diagnosis involves auscultation, chest X-ray, ECG, echocardiogram and cardiac catheterization. Surgical closure of the defect is usually recommended in childhood to prevent long-term complications like congest
Shock in Neonates
This document discusses shock in neonates and neonatal vasoregulation. It begins by defining blood pressure and its components. It then discusses factors that affect blood pressure and the unique features of the neonatal myocardium. It describes the roles of catecholamines and their receptors in relation to blood pressure. The document clarifies terminology around hypotension and shock. It concludes by discussing clinical methods for monitoring systemic hemodynamics in critically ill newborns such as capillary refill time, central-peripheral temperature difference, and blood pressure measurements.
Atrial septal defect
Atrial Septal Defect (ASD) is a congenital heart defect characterized by an opening in the interatrial septum, causing left-to-right shunting of blood. ASDs range in severity depending on the size of the defect and shunt. While often asymptomatic in children, symptoms of right heart overload can occur as patients age. Diagnosis is typically made through echocardiography or MRI imaging. Treatment options include surgical closure of small to moderate defects and percutaneous catheter closure of defects, both with high success rates.
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Patent Ductus Arteriosus - news and views on diagnosis and management
Patent Ductus Arteriosus - news and views on diagnosis and management
Les cardiopathies cyanogènes et non cyanogènes(corrigee)
Les cardiopathies cyanogènes et non cyanogènes(corrigee)
Seminar congenital cardiac disorders (pda,TA and AP Window)
Seminar congenital cardiac disorders (pda,TA and AP Window)
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This document provides guidelines for contrast reactions and their management from the American College of Radiology (ACR). It discusses various types of intravenous contrast media and their risks. Adverse reactions can range from mild to severe/life-threatening and include contrast-induced nephrotoxicity and nephrogenic systemic fibrosis. The document outlines Boston Medical Center's premedication regime using steroids and antihistamines to reduce reaction risk. It also provides guidance on assessing and treating acute contrast reactions according to their severity per ACR guidelines.
ESC guidelines on Cardiovascular diseases during pregnancy
Pregnancy poses risks for women with cardiac conditions due to physiological changes that increase cardiac output and blood pressure. Careful pre-pregnancy evaluation and individualized management plans are needed to minimize risks which can include arrhythmias, heart failure, and aortic dissection. Medical therapy aims to control symptoms while minimizing risks to both mother and fetus, and mode of delivery depends on maternal cardiac status and obstetric factors.
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Dr ahmed alnakib hd in children
This document discusses factors related to starting dialysis in children with kidney disease. It recommends starting dialysis when a child has an eGFR below 15 ml/min/1.73m2 and symptoms of kidney failure, or an eGFR below 6 ml/min/1.73m2 even without symptoms. Clinical factors like poor growth or neurological issues are also important considerations. The modality options for children are hemodialysis and peritoneal dialysis, with peritoneal dialysis preferred for younger children. Special precautions are needed for hemodialysis in children regarding infection control, vascular access creation and maturation, and dialysis prescriptions tailored to pediatric patients.
Anesthetic complications in pregnancy
This document discusses several anesthetic complications that can occur during pregnancy, including thrombocytopenia/epidural hematoma, aspiration, difficult airways, and neuraxial blockade complications. Key points include: 1) There is no minimum platelet count that absolutely contraindicates neuraxial procedures, but less than 100,000 is often quoted as a threshold. 2) Pregnancy increases the risk of aspiration due to anatomical changes, so all pregnant patients are considered at high risk of aspiration. 3) Airway management can be difficult in pregnancy due to edema and weight gain; facilities should be prepared with multiple airway devices and surgical options. 4) Neuraxial blockade commonly causes hypotension due to sympathetic blockade,
Pediatric Venous Thromboembolism 2012
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Audience: Third year pharmacy students at University of Colorado School of Pharmacy & Oregon State University College of Pharmacy.
Background: Provides overview of common causes of pediatric venous thromboembolism & treatment management.
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This document discusses restrictive versus liberal transfusion thresholds in preterm neonates. It summarizes evidence from several clinical trials showing that a restrictive transfusion strategy (lower Hb/Hct thresholds) results in fewer transfusions without increasing mortality or morbidity risks compared to a liberal strategy. The evidence supports using respiratory support level and Hct triggers to guide transfusions. Delaying cord clamping, minimizing phlebotomy losses, and erythropoietin administration can further reduce transfusion needs in preterm neonates.
Snigdha
1) A 32-year-old woman at 33+6 weeks of a twin pregnancy presented with shortness of breath and was found to have peripartum cardiomyopathy with left ventricular ejection fraction of 30-35%.
2) She received treatment including diuretics, beta-blockers, and digoxin and underwent a cesarean section to deliver the twins.
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Hemodialysis in children
Hemodialysis in children has some differences from adults. Dialysis should start when the estimated GFR is below 15 mL/min/1.73m2 with symptoms of uremia, fluid overload, or malnutrition despite medical management, or below 6 mL/min/1.73m2 without symptoms. Clinical factors like growth, development, and nutrition are also important considerations. Hemodialysis facilities for children should be located within 30 minutes of patients' homes and have age-appropriate decorations to create a comfortable environment. Vascular access may include temporary catheters or arteriovenous fistulas created 6-12 months before dialysis. Hemodialysis prescriptions consider factors like dry weight estimation, dial
ibuprofen therapy journal.pptx
This study evaluated the efficacy of a single prophylactic dose of intravenous ibuprofen on the first day of life in closing a patent ductus arteriosus in preterm infants. The study found that a single ibuprofen dose resulted in a higher rate of ductal closure at 24 hours and through the first week compared to infants who did not receive prophylactic treatment. Additionally, infants receiving a single dose had a shorter duration of ventilation and hospitalization with no increase in adverse outcomes. The study concludes that a single ibuprofen dose may effectively close a PDA while avoiding risks associated with multiple dose therapy.
Deep Vein Thrombosis
Deep vein thrombosis (DVT) is a blood clot that forms in the deep veins of the legs or pelvis. Risk factors include prolonged immobility, surgery, cancer, and genetic factors. Symptoms include leg swelling, pain, and warmth. Diagnosis is made through ultrasound or venography. Treatment involves anticoagulants like heparin, low molecular weight heparin, or warfarin to prevent clot extension and pulmonary embolism. Chronic therapy aims to prevent recurrence and typically lasts at least 3-6 months or indefinitely for high-risk patients.
management of hypertension in neonates and infants
This document provides guidance on the management of hypertension in neonates and infants. It discusses evaluating and treating the underlying cause of hypertension, including surgical correction if needed. For pharmacologic treatment, it recommends starting with a single drug such as a calcium channel blocker or beta blocker. Intravenous nicardipine is preferred for severe hypertension due to its rapid onset. Target blood pressures should be less than the 90th percentile. Ongoing monitoring is needed as treatment duration depends on the underlying cause. However, long-term outcomes require further study.
Preterm labour
This document discusses preterm labour, including definitions, incidence, risk factors, causes, prevention, diagnosis, treatment, and management. Some key points:
- Preterm labour is the leading cause of neonatal mortality and morbidity. Risk factors include infections, cervical issues, multiple gestations, and stress.
- Causes include activation of the HPA axis, inflammation, decidual hemorrhage, and uterine overdistention. Progesterone supplements and smoking cessation may help prevent preterm labour.
- Diagnosis relies on regular contractions and cervical changes before 37 weeks. Tocolytics like terbutaline and nifedipine can delay delivery to allow antenatal steroids to improve neonatal outcomes.
Indometacina em pca a termo
1) The study evaluated the effectiveness of indomethacin therapy for patent ductus arteriosus (PDA) in 41 full-term infants with birth weights over 2500g.
2) Indomethacin was administered intravenously in doses of 0.2-0.25 mg/kg every 12-24 hours. 25 infants (61%) responded positively to the treatment, either showing complete ductal closure or improved symptoms.
3) The remaining 16 infants (39%) did not respond to indomethacin therapy and most required surgical ligation of the ductus arteriosus. No severe adverse reactions occurred in any infants from the indomethacin treatment.
Bronchopulmonary dysplasia
Bronchopulmonary dysplasia is a pathologic process leading to signs and symptoms of chronic lung disease that originates in the neonatal period.
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Anesthesiology Information
The document discusses anesthesia considerations for pregnant patients undergoing non-obstetric surgery. It notes that around 1-2.5% of pregnant women require such surgery each year. The risks to the fetus rise with procedures, so evaluation of risks vs benefits is important. The goals of anesthesia management are to maintain maternal oxygenation, cardiac output, oxygen delivery and uterine blood flow. Fetal monitoring may be used after 16 weeks to check for distress.
SPM
Steroids are potent drugs used in perinatal medicine to promote lung maturation in preterm infants and treat conditions like chronic lung disease. Antenatal steroids given between 24-34 weeks of gestation reduce the risks of respiratory distress syndrome, intraventricular hemorrhage, and death in preterm infants. Postnatal steroids are used to treat chronic lung disease but have been associated with adverse short and long term effects like gastrointestinal bleeding and cerebral palsy. Steroids are also used to treat conditions like hypotension, hypoglycemia, and surgical conditions such as congenital diaphragmatic hernia in newborns. Further research is still needed to determine the optimal dosage and duration of steroid treatment in
Preterm labour
This document discusses preterm labour, including definitions, incidence, risk factors, causes, prevention, diagnosis, and treatment. It causes can include activation of the HPA axis, inflammation, decidual hemorrhage, and uterine overdistention. Treatments include tocolytics like beta-mimetics and calcium channel blockers, antibiotics, cervical cerclage, progesterone, and antenatal steroids.
approach to Rh Isoimmunization Maternal and neonatal aspects | Dr Habibur Rahim
This document summarizes the approach and management of a baby born to a Rh-negative mother. The baby presented with respiratory distress and signs of Rh isoimmunization. Key points include:
1) The mother's anti-D titer was 1:64 and Doppler ultrasound revealed increased blood flow, indicating Rh isoimmunization.
2) The baby received an exchange transfusion due to signs of hemolysis and hyperbilirubinemia.
3) With oxygen support and treatment, the baby's respiratory distress resolved within 6 hours and the baby improved after exchange transfusion.
preterm.pptx
This document discusses the case of a preterm baby born at 28 weeks and 2 days gestation who experienced respiratory distress syndrome, apnea of prematurity, sepsis, and grade 1 germinal matrix hemorrhage but was eventually discharged home on oxygen and follow up care. The baby was treated with CPAP, caffeine, antibiotics, phototherapy, and other supportive care measures over 38 days in the NICU.
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ESC guidelines on Cardiovascular diseases during pregnancy
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Willens's syndrome.pptx
A 57-year-old woman was admitted to the hospital with chest pain. Electrocardiograms and troponin levels were normal. Intravascular ultrasound was performed before placing a stent in the left main coronary artery and left anterior descending artery to treat a blockage. The minimum lumen area increased to 4.24mm x 4.13mm after stenting.
Intensive care of congenital heart disease.pptx
Congenital defects can put a strain on the heart, causing it to work harder. To stop your heart from getting weaker with this extra work, your doctor may try to treat you with medications. They are aimed at easing the burden on the heart muscle. You need to control your blood pressure if you have any type of heart problem.
Management of Hypetension.pptx
Changing your lifestyle can help control and manage high blood pressure. Your health care provider may recommend that you make lifestyle changes including:
Eating a heart-healthy diet with less salt
Getting regular physical activity
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Limiting alcohol
Not smoking
Getting 7 to 9 hours of sleep daily
CRISPR and cardiovascular diseases.pdf
CRISPR technologies have progressed by leaps and bounds over the past decade, not only having a transformative effect on
biomedical research but also yielding new therapies that are poised to enter the clinic. In this review, I give an overview of (i)
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Pacemaker Pocket Infection After Splenectomy
This case report describes a patient who underwent seven operations over one year to treat recurrent pacemaker pocket infections. The patient had undergone a splenectomy seven years prior due to a splenic rupture from a traffic accident. This left the patient immunocompromised and at higher risk for infection. The patient later required a pacemaker implantation for complete heart block. The pacemaker pocket developed repeated infections, likely due to the patient's asplenic state impairing immunity. The infections were difficult to treat due to multiple complicating factors, including an abandoned pacemaker lead and reuse of a sterilized pacemaker. This highlights the influence of patient factors like asplenia on procedural outcomes like pacemaker implantation.
Piccolo Duct Occluder.pdf
Transcatheter closure of patent ductus arteriosus (PDA) is feasible in low-birth-weight infants. A female baby was born prematurely with a birth weight of 924 g. She had a PDA measuring 3.7 mm. She was dependent on positive pressure ventilation for congestive heart failure in addition to the heart failure medications. She could not be discharged from the hospital even after 79 days of birth, and even though her weight reached 1.9 kg in the neonatal intensive care unit. We attempted to plug the PDA using an Amplatzer Piccolo Occluder, but the device failed to anchor. Then, the PDA was plugged using a 4-6 Amplatzer Duct Occluder using a 6-Fr sheath which was challenging.
MISPLACED ECG LEADS.pptx
Accidental misplacement of the limb lead electrodes is a common cause of ECG abnormality and may simulate pathology such as ectopic atrial rhythm, chamber enlargement or myocardial ischaemia and infarction
A Case of Device Closure of an Eccentric Atrial Septal Defect Using a Large D...
Device closure of an eccentric atrial septal defect can be challenging and needs technical modifications to avoid unnecessary complications. Here, we present a case of a 45-year-old woman who underwent device closure of an eccentric defect with a large device. The patient developed pericardial effusion and left-sided pleural effusion due to injury to the junction of right atrium and superior vena cava because of the malalignment of the delivery sheath and left atrial disc before the device was pulled across the eccentric defect despite releasing the left atrial disc in the left atrium in place of the left pulmonary vein. These two serious complications were managed conservatively with close monitoring of the case during and after the procedure.
Arrythmia-IV.pptx
1) Bradycardia can be caused by abnormalities in the conduction system or autonomic nervous system. The conduction system includes the sinus node, AV node, His-Purkinje system and different types of heart block can occur when impulses are blocked at different locations.
2) There are three main types of AV block - first degree, second degree (Mobitz types I and II), and third degree. High grade AV block involves blockage of two or more consecutive impulses.
3) Third degree or complete heart block results in complete dissociation between the atria and ventricles with independent pacemakers. It can occur at the AV node or below in the His-Purkin
Arrythmia-III.pptx
1. Bradycardia is defined as a resting heart rate below 50 beats per minute. It can be physiological or pathological.
2. Sinus bradycardia originates from the sinus node and has a normal P wave morphology with a prolonged PR interval. It can be caused by increased vagal tone, medications, or hypothyroidism.
3. Sick sinus syndrome is characterized by sinus bradycardia, sinus arrest, or combinations of sinus node and AV node dysfunction. It may involve intermittent bradycardia and tachycardia. Pacemaker implantation is usually treatment.
Arrythmia-II.pptx
This document discusses ventricular arrhythmias including their origins, characteristics, classifications, and causes. It provides details on:
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- Characteristics that distinguish SVT from ventricular arrhythmias such as QRS width.
- Classifications of ventricular arrhythmias including premature ventricular complexes, ventricular tachycardia, fibrillation, and electrical storm.
- Causes and characteristics of different types of ventricular tachycardia such as monomorphic VT, polymorphic VT, and torsades de pointes.
- Investigations and treatments for ventricular arrhythmias including cardiac imaging
Arrythmia-I.pptx
This document provides information on supraventricular tachycardia (SVT), including:
- The anatomy and conduction system of the heart that is relevant to SVT.
- The mechanisms that can cause cardiac arrhythmias, including disorders of impulse formation, conduction, and combinations of the two.
- Characteristics used to classify different types of arrhythmias based on rate, rhythm, site of origin, and QRS morphology.
- Specific types of SVT like atrial fibrillation, AV nodal reentry tachycardia, and accessory pathway mediated tachycardias.
- Methods for diagnosing and treating SVT such as electrophysiology studies, catheter ablation
Trio of Rheumatic Mitral Stenosis, Right Posterior Septal Accessory Pathway a...
A 57-year-old male presented with recurrent palpitations. He was diagnosed with rheumatic mitral stenosis, right posterior septal accessory pathway and atrial flutter. An electrophysiological study after percutaneous balloon mitral valvotomy showed that the palpitations were due to atrial flutter with right bundle branch aberrancy. The right posterior septal pathway was a bystander because it had a higher refractory period than the atrioventricular node.
Anticoagulation therapy during pregnancy
This document discusses anticoagulation therapy options during pregnancy for different cardiac conditions. It notes that vitamin K antagonists (VKAs) should be avoided in the first trimester due to risk of embryopathy but can be used in the second and third trimester with risks of 0.7-2% of foetopathy. Unfractionated heparin does not cross the placenta but its use throughout pregnancy is not recommended due to risk of foetopathy. Low molecular weight heparin is considered the safest option for anticoagulation in weeks 6-12 when risk of embryopathy is a concern and has not been associated with risk of foetopathy. Fondaparinux use should be limited
Coronary guidewire
Percutaneous balloon dilatation, first described by
Andreas Gruentzig in 1979, was initially performed
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balloon catheter was developed as a double lumen
catheter (one lumen for pressure monitoring or
distal perfusion, the other lumen for balloon inflation/deflation) with a short fixed and atraumatic
guidewire at the tip. Indeed, initially the technique
involved advancing a rather rigid balloon catheter
freely without much torque control into a coronary
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indications (proximal, short, concentric, noncalcified) were negated.2 Luck was almost as
important as expertise, not only for the operator,
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Simpson who, in 1982, introduced the novelty of
advancing the balloon catheter over a removable
guidewire, which had first been advanced in the
target vessel.3 This major technical improvement
resulted overnight in a notable increase in the procedural success rate. Guidewires have since evolved
into very sophisticated devices.
Intracoronary optical coherence tomography
Optical coherence tomography-guided algorithm for percutaneous coronary intervention. Vessel diameter should be assessed using the external elastic lamina (EEL)-EEL diameter at the reference segments, and rounded down to select interventional devices (balloons, stents). If the EEL cannot be identified, luminal measures are used and rounded up to 0.5 mm larger for selection of the devices. Optical coherence tomography (OCT)-guided optimisation strategies post stent implantation per EEL-based diameter measurement and per lumen-based diameter measurement are shown. For instance, if the distal EEL-EEL diameter measures 3.2 mm×3.1 mm (i.e., the mean EEL-based diameter is 3.15 mm), this number is rounded down to the next available stent size and post-dilation balloon to be used at the distal segment. Thus, a 3.0 mm stent and non-compliant balloon diameter is selected. If the proximal EEL cannot be visualised, the mean lumen diameter should be used for device sizing. For instance, if the mean proximal lumen diameter measures 3.4 mm, this number is rounded up to the next available balloon diameter (within up to 0.5 mm larger) for post-dilation. MLA: minimal lumen area; MSA: minimal stent area;NC: non-compliant
Brugada syndrome
Brugada syndrome (BrS) is an inherited cardiac disorder,
characterised by a typical ECG pattern and an increased
risk of arrhythmias and sudden cardiac death (SCD).
BrS is a challenging entity, in regard to diagnosis as
well as arrhythmia risk prediction and management.
Nowadays, asymptomatic patients represent the majority
of newly diagnosed patients with BrS, and its incidence
is expected to rise due to (genetic) family screening.
Progress in our understanding of the genetic and
molecular pathophysiology is limited by the absence
of a true gold standard, with consensus on its clinical
definition changing over time. Nevertheless, novel
insights continue to arise from detailed and in-depth
studies, including the complex genetic and molecular
basis. This includes the increasingly recognised
relevance of an underlying structural substrate. Risk
stratification in patients with BrS remains challenging,
particularly in those who are asymptomatic, but recent
studies have demonstrated the potential usefulness
of risk scores to identify patients at high risk of
arrhythmia and SCD. Development and validation of
a model that incorporates clinical and genetic factors,
comorbidities, age and gender, and environmental
aspects may facilitate improved prediction of disease
expressivity and arrhythmia/SCD risk, and potentially
guide patient management and therapy. This review
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A roadmap for the human development
The Human Developmental Cell Atlas (HDCA) initiative, which is part of the Human Cell Atlas, aims to create a comprehensive reference map of cells during development. This will be critical to understanding normal organogenesis, the effect of mutations, environmental factors and infectious agents on human development, congenital and childhood disorders, and the cellular basis of ageing, cancer and regenerative medicine. Here we outline the HDCA initiative and the challenges of mapping and modelling human development using state-of-the-art technologies to create a reference atlas across gestation. Similar to the Human Genome Project, the HDCA will integrate the output from a growing community of scientists who are mapping human development into a unified atlas. We describe the early milestones that have been achieved and the use of human stem-cell-derived cultures, organoids and animal models to inform the HDCA, especially for prenatal tissues that are hard to acquire. Finally, we provide a roadmap towards a complete atlas of human development.
Intra aortic balloon pump
The treatment of patients with advanced acute heart failure is still challenging.
Intra-aortic balloon pump (IABP) has widely been used in the management of
patients with cardiogenic shock. However, according to international guidelines, its
routinary use in patients with cardiogenic shock is not recommended. This recommendation is derived from the results of the IABP-SHOCK II trial, which demonstrated
that IABP does not reduce all-cause mortality in patients with acute myocardial infarction and cardiogenic shock. The present position paper, released by the Italian
Association of Hospital Cardiologists, reviews the available data derived from clinical
studies. It also provides practical recommendations for the optimal use of IABP in
the treatment of cardiogenic shock and advanced acute heart failure.
Left ventricular false tendons
Left ventricular false tendons (LVFTs) are fibromuscular
structures, connecting the left ventricular
free wall or papillary muscle and the ventricular
septum.
There is some discussion about safety issues during
intense exercise in athletes with LVFTs, as these
bands have been associated with ventricular arrhythmias
and abnormal cardiac remodelling. However,
presence of LVFTs appears to be much more common
than previously noted as imaging techniques
have improved and the association between LVFTs
and abnormal remodelling could very well be explained
by better visibility in a dilated left ventricular
lumen.
Although LVFTsmay result in electrocardiographic abnormalities
and could form a substrate for ventricular
arrhythmias, it should be considered as a normal
anatomic variant. Persons with LVFTs do not appear
to have increased risk for ventricular arrhythmias or
sudden cardiac death.
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Nano-gold for Cancer Therapy chemistry investigatory project
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The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
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Breast cancer: Post menopausal endocrine therapy
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
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Patent Ductus Arteriosus in Preterm Infants
- 1. Patent Ductus Arteriosus in Preterm Infants http://www.youtube.com/watch?feature=player_embedded&v=MvbIhb 63brk
- 2. Incidence most common form of congenital cardiac abnormality in newborn Frequency of 31% in very low birth weight (VLBW) infants
- 3. Best left untreated Therapeutic interventions for PDA have significant complications If PDA is left untreated in preterm infants, there is a high likelihood of spontaneous closure Treat when required
- 4. Significant size PDA:Bedside to Echo Lab Blood-stained endotracheal aspirates Pulmonary oedema Bounding pulses with widened pulse pressure Hyperdynamic precordium Continuous murmur Cardiomegaly pulmonary Congestion
- 5. ECHO CRITERIA OF SIGNIFICANT PDA A left atrium to aortic root dimension ratio of more than 1:1.4 A ductal diameter of more than 1.4 mm/kg body weight Left ventricular enlargement Diastolic flow reversal B-type natriuretic peptide (BNP) and N-terminal Pro-BNP level rise
- 6. MANAGEMENT STRATEGIES Prophylactic pharmacologic treatment (COX inhibitors) Pre-symptomatic pharmacologic treatment of PDA Conservative management Pharmacological closure of the demand Surgical ligation
- 7. WHEN DOES PDA REQUIRE INTERVENTION Infants with a birth weight <800 g 1.Significant morbidity and mortality from 2. PDA and the natural course in this group is uncertain 3.Treat PDA : symptomatic/on Mechanical ventilation 4.Identified by echocardiography at 24-30 hours of age 5.A large PDA can be treated with COX inhibitors 6.Infants with a small-to-moderate PDA 1. could be managed conservatively 2.Rx could be deferred for 7-14 days for spontaneous PDA closure Infants weighing >800g 1.Rx when ventilator-dependent/ CHF/renal failure 2.Clinician’s discretion
- 8. WHEN DOES PDA REQUIRE INTERVENTION Infants born at 23-25 wk gestation 1)No antenatal steroid exposure 2) Highest risk of PDA-related morbidities 3)Prophylactic low-dose indomethacin works & prevents intra ventricular haemorrhage (IVH) 4)Please exclude duct-dependent CHD
- 9. Prophylactic Pharmacotherapy COX inhibitors (indomethacin or ibuprofen) to preterm infants within the first 24h of life irrespective of the diagnosis of PDA Dose and interval of indomethacin is 0.1mg/kg at 12h intervals or 0.2 mg/kg at 24h intervals 3 doses were used starting at 6-12h of age Ibuprofen:3 doses starting from 2 to 6 h of age (1st dose was 10 mg/kg, followed by the 2nd and 3rd doses of 5 mg/kg at 24h intervals) Not recomonded
- 10. Pre-symptomatic Pharmacologic Rx Not demonstrated any advantage in terms of death, ROP, NEC or Broncho pulmonary dysplasia (BPD) Not enough evidence
- 11. Conservative Management Fluid restriction to <130 mL/kg/d of more than 4 days of age High positive end-expiratory pressure and low inspiratory time (0.35s) Devoid of side effects of medication or surgical ligation Reasonable Infants born at 23 to 25 wk gestation were found to have a lower likelihood of spontaneous PDA closure and a higher risk of treatment failure with ibuprofen. In this subgroup of infants with significant PDA, treatment with a COX inhibitor would be acceptable to most clinicians after 48-72 h of life
- 12. Pharmacological Closure The mainstay of treatment if conservative measures fail Indomethacin, ibuprofen and mefenamic acid Indomethacin and ibuprofen have been extensively studied Indomethacin is of proven efficacy in the management of PDA Short-course regimens (≤3 doses) of indomethacin to treat PDA A prolonged course has been shown to increase the incidence of NEC Doses of indomethacin are lower when used for the prevention of IVH (0.1mg/kg/dose intravenously at 6-12h of postnatal age and at 24h intervals for 2 additional doses) Due to concerns about the adverse effects of indomethacin, Ibuprofen has received the most attention: ibuprofen lysine and ibuprofen THAM………contd
- 13. Contd… Data support the use of either drug for the treatment of PDA VLBW infants has shown that oral ibuprofen is as good as intravenous ibuprofen in terms of ductal closure, and is associated with fewer side effects paracetamol is in Q
- 14. Surgical Ligation Surgical ligation is contemplated only when pharmacological closure is ineffective or is contraindicated in a preterm infant who is hemodynamically unstable due to PDA surgery is associated with increased incidence of neurodevelop- mental impairment and BPD Secondary surgical closure (indomethacin treatment followed by ligation) was associated with decreased death death
- 15. NOVEL A novel approach by Sperandio et al. is of escalating the dose of indomethacin stepwise every 12h to reach a maximum single dose of 1mg/kg has shown an overall closure rate of 98.5%. Adverse effects were comparable to initial non-responders. Study results were limited due to the retrospective nature of the study and lack of long term follow up Endoscopic and catheter closure Video-assisted thoracic surgery Transcatheter management of PDA in VLBW is still a dark
- 16. RESEARCH ISSUES • The most compelling question in the management of significant PDA in preterm infants is the outcome of untreated or conservatively managed infants with a birth weight <800 g compared to outcome with pharmacological and/or surgical closure • RCT may help looking into all the five approaches in detail with head to head collision, to choose the best : A very difficult task and of ethical concern
- 17. CONCLUSION Infants with a birth weight of <800g are at risk of significant morbidity and mortality from PDA, and it would be reasonable to treat the PDA in such infants when they are clinically symptomatic and require positive pressure ventilatory support However, infants born at a gestational age of 23-25 wk without antenatal steroid exposure are at a higher risk of PDA-related morbidities and would benefit from prophylactic low-dose indomethacin for prevention of IVH Preterm infants with a birth weight >800g are unlikely to need treatment for PDA unless they are ventilator-dependent and showing evidence of congestive heart failure or renal impairment
- 18. http://www.indianpediatrics.net/apr2014/2 89.pdf Marriage is not always that funny as it looks Especially if the Preterm has cursed with large PDA