The document discusses various pericardial diseases including acute pericarditis, constrictive pericarditis, pericardial effusion, and cardiac tamponade. It provides details on the anatomy and functions of the pericardium, pathophysiology, clinical features, diagnostic tests, and management of these conditions. Key points include that pericardial diseases can present with non-specific symptoms, clinical suspicion is important for diagnosis, and treatment depends on underlying etiology and presence of hemodynamic compromise. Differentiating constrictive pericarditis from restrictive cardiomyopathy is important as treatment approaches differ significantly.
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Some of the slides, i hide it from my real presentations for my own reference. Download to see all of them.
Kindly leave your comment if you found this helpful ;)
Some of the slides, i hide it from my real presentations for my own reference. Download to see all of them.
pericardial effusion, cardiac tamponade and myocardial rupturegufuabdikadir96
consists of P.E,cardiac tamponade and myocardial rupture and describes their definitions, pathophysiologies, clinical manifestations, dx, medical-surgical mgt and nursing mgt
for more inquiries/feedback; gufuabdikadir96@gmail.com
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
3. Pericardium is the sac that surrounds the heart
Made up of
- outer fibrous pericardium
- inner serous pericardium (parietal & visceral)
• Pericardial fluid :
– up to 50 ml of clear plasma ultrafiltrate between
the two layers of the serous pericardium
4.
5. Functions
1.Stabilization of the heart within the thoracic cavity by virtue
of its ligamentous attachments -- limiting the heart’s motion.
2. Protection of the heart from mechanical trauma and infection
from adjoining structures.
3. The pericardial fluid functions as a lubricant and decreases
friction of cardiac surface during systole and diastole.
4. Prevention of excessive dilation of heart especially during
sudden rise in intra-cardiac volume (e.g. acute aortic or mitral
regurgitation).
9. Etiological classification
T = Trauma, Tumour
U = Uremia
M = Myocardial infarction (acute, post)
Medications (hydralazine)
O = Other infections (viral,bacterial, fungal, TB)
R = Rheumatoid, autoimmune disorder
Radiation
10. Clinical features
Preceded by fever, malaise and myalgia
Common characteristics of pain
retrosternal or precordial with radiation to the trapezius
ridge, neck, back, left shoulder or arm
Special characteristics of pericardial pain
more likely to be sharp
with coughing, inspiration, swallowing
worse by lying supine, relieved by sitting and leaning
forward
12. Clinical features
• Triphasic friction rub is pathognomonic;
scratching or grating sound; evanescent
• Best heard in the lower LSB with the patient
sitting and leaning forward
Pericardial rub Pleural rub
Can be heard even after
cessation of breathing
Can be heard only during
inspiration and expiration
Heard mostly over the
sternum or sternal borders
Heard mostly over the
lateral parts of the chest
Intensity doesn’t increase
with increased pressure of
the steth
Intensity of rub increases
with increased pressure of
the steth over the chest wall
17. Pericarditis after AMI
Early
Occurs - 1 to 3 days (no more
than a week
due to transmural necrosis
with pericardial inflammation
40% of patients with large, Q-
wave MIs have pericarditis
Benign
aspirin doses (650 mg orally
three or four times per day
for 2 to 5 days) or
acetaminophen is usually
effective
Late (Dresslers Syndrome)
Occurs - 1 week to a few
months after AMI .
autoimmune etiology
3% to 4%.
Polyserositis with pericardial
or pleural effusions
Aspirin , Colchicine .
Prednisone, 40 to 60 mg /d
with a 7- to 10-day taper(If
not responding to treatment
or for recurrent symptoms)
19. Etiology
• Idiopathic or viral — 42 to 49 %
• Post cardiac surgery — 11 to 37 %
• Post radiation therapy — 9 to 31 %
• Connective tissue disorder — 3 to 7 %
• Postinfectious (tuberculous or purulent
pericarditis) — 3 to 6 %
• Miscellaneous causes (malignancy, trauma,
drug-induced, asbestosis, sarcoidosis, uremic
pericarditis) — 1 to 10 %
20. Pathophysiology
• A thickened, fibrotic pericardium forms a non-
compliant shell around the heart (“constricts
it”).
• Ventricles are like a fixed cavity; encased by
the thick pericardium
• This shell prevents the heart from expanding
when blood enters it.
• So it interferes with ventricular filling
21. Pathophysiology
• In early diastole the ventricle relaxes (expands) to
a certain extent and stops abruptly because it
cannot expand any more
• Almost all of the ventricular filling occurs in
early diastole; very little filling in late diastole
because the ventricle cannot expand any more
• CP restriction of filling in late diastole
• Filling of one ventricle occurs at the expense of
the other ventricle
22.
23.
24. Consequence of impaired ventricular filling
causes fatigue, muscle wasting, and weight loss
Reduced cardiac output :
Hepatic congestion, peripheral edema, ascites , anasarca, and
cardiac cirrhosis.
Systemic > pulmonary venous congestion
Pericardium – Rigid and Scarred
26. Physical examination
BP, HR JVP
ascites, edema, hepatomegaly
early diastolic “knock”
after S2
sudden cessation of ventricular diastolic filling imposed
by rigid pericardial sac
Kussmaul’s sign
inspiratory increase in JVP
27. Kussmaul’s sign
• In Inspiration :
– Normal :
• RV Volume increases without increase in RA pressure.
– In Constrictive pericarditis :
• RV volume increases , as the RV cannot expand due to
thickened pericardium ,this results in increase in RA
pressure which causes Elevated JVP in inspiration.
28. Diagnosis
• Clinical suspicion followed by confirmation
with certain diagnostic tests
( many patients are initially seen for abdominal
symptoms)
• ECG : AF in 1/3rd of patients
flattened or inverted T waves
30. • Echocardiogram
- pericardial thickening
- septal bounce : abrupt displacement of IVS
during early diastole
- restrictive filling pattern
- >25% increase in mitral E velocity during expiration
compared with inspiration
31.
32.
33. CP vs RCM (echo)
Constriction
2 D
• Pericardial thickening
• Normal chamber wall
thickness
• Septal bounce
Doppler
• > 25% ↓ in mitral E velocity
with inspiration
• ↑ tricuspid flow with insp
• ↑HV diastolic flow reversal
with inspiration
• Tissue doppler E’ : > 8 cm /sec
Restriction
2D
• Increased wall thickness
• Thickened valves
• Atrial enlargement
• Speckling
Doppler
• MR, TR
• ↑ HV diastolic diastolic flow
reversal with expiration
• Tissue doppler E’ : < 8
cm/sec
35. Management
Cautious diuretics and salt restriction
Sinus tachycardia is a compensatory mechanism,
BB and CCB that slow the HR should be avoided.
In patients with AF with FVR , digoxin is
recommended as initial treatment to slow the
ventricular rate before resorting to beta blockers
or calcium antagonists.
In general, the rate should not be allowed to drop
80 -90 / min
• Definitive treatment : surgical pericardiectomy
37. • Accumulation of fluid between the visceral and
parietal layers of serous pericardium
• Serous
– Transudative – CHF , Renal failure
• Suppurative
– Pyogenic infection
• Hemorrhagic
– occurs with any type of pericarditis
– especially with infections and malignancies
38. Etiology
1. Inflammation from infection, immunologic process.
2. Trauma causing bleeding in pericardial space.
3. Noninfectious conditions such as:
a. increase in hydrostatic pressure e.g. congestive
heart failure.
b. increase in capillary permeability e.g. hypothyroidism
c. decrease in plasma oncotic pressure e.g. cirrhosis.
4. Decreased drainage of pericardial fluid due to obstruction of
thoracic duct as a result of malignancy or damage during surgery.
40. Clinical features
• Usually asymptomatic
• Can have signs of compression
- dyspnoea, dysphagia, hoarseness of voice,
hiccoughs, nausea
• Signs : muffled heart sounds
paradoxically reduced intensity of rub
41. Chest x ray
– usually requires >
200 ml of fluid
– cannot distinguish
between pericardial
effusion and
cardiomegaly
44. Management
• Depends on the etiology , presence of
hemodynamic compromise and the volume of
fluid.
• No role for diuretics
• Pericardiocentesis is not always necessary.
• Pericardiocentesis if
Malignancy or Purulent pericarditis is suspected
Hemodynamic compromise present
46. What is Tamponade ?
• Accumulation of fluid in the pericardial space
causing increase in pressure with subsequent
cardiac compression.
• Pericardial pressures > intracardiac pressures
• Most common causes :
– Malignancy
– Idiopathic pericarditis
– Renal failure.
– Bleeding following cardiac Sx and trauma , TB &
Hemopericardium
47.
48.
49.
50. Pathophysiology
– Most critical point occurs when an effusion
reduces the volume of the cardiac chambers such
that cardiac output begins to decline
– Mainly by impeding right-sided heart filling, with
much of the effect on the left side of the heart
due to secondary under filling.
51. Pathophysiology
• A ) Modest amounts of
rapidly accumulating fluid
can have major effects on
cardiac function.
• B) Large, slowly
accumulating effusions
are often well tolerated,
presumably because of
chronic changes in the
pericardial pressure-
volume relation described
earlier.
52. Cardiac Tamponade -- Pathophysiology
Accumulation of fluid under high pressure:
compresses cardiac chambers & impairs
diastolic filling of both ventricles
SV venous pressures
CO systemic
Hypotension/shock JVP
Reflex tachycardia hepatomegaly
ascites
peripheral edema
53. Clinical features
• Symptoms
acute : confusion / agitation
• Signs ( Becks triad)
- hypotension
- elevated JVP
- muffled heart sounds
Pulsus paradoxus : insp drop in SBP > 10 mmhg
Pulsus paradoxus also seen in CP, COPD, asthma
54. Pulsus Paradoxus
• When severe, it may be detected by palpating
weakness or disappearance of the arterial pulse
during inspiration.
• Measured by noting the difference between the
systolic pressure at which the Korotkoff sounds
are first heard (during expiration) and the systolic
pressure at which the Korotkoff sounds are heard
with each beat, independent of respiratory phase
• Between these two pressures, the sounds are
heard only intermittently (during expiration).
55. • Since both ventricles share
a tight incompressible
covering, the inspiratory
enlargement of the RV
compresses and reduces LV
volume; leftward bulging
of the IVS further reduces
the LV cavity as the RV
enlarges during inspiration
• The normal inspiratory
augmentation of RV
volume causes an
exaggerated reciprocal
reduction in LV volume.
60. Echocardiogram
• Dilated IVC with minimal
or no collapse
• Restrictive filling pattern
• Significant respiratory
variation in filling pattern
• Tamponade : equal and
continuous restriction
throughout diastole
• CP : Restriction to filling
in late diastole
63. Take aways…
• Symptoms may be non cardiac
• CP and PE will mimic right heart failure
• In any RHF symptoms rule out pericardial disease
• Because treatment is completely different
(diuretics,digoxin)
• Clinical suspicion is essential for diagnosis
• Correct diagnosis is imperative
• Potential for permanent cure
64.
65. ECG
ECG in MI
ST elevations are convex,
Restricted to arterial territory
Reciprocal depression - More
prominent
QRS changes occur( Q waves,
as well as notching and loss of
R-wave amplitude)
T-wave inversions are usually
seen within hours before the
ST segments have become
isoelectric.
ECG in pericarditis
• ST Elevations are concave.
• Not restricted to arterial
territory.
• Reciprocal ST depression in
avR /V1
• T wave inversions after ST
segment becomes isoelectric.
• elevated ST segments return
to normal within hours