Pulmonary embolism is a common problem seen in medical practice. This presentation by Dr Vivek Baliga discusses the basic aspects and evidence behind current management.
DIAGNOSIS & MANAGEMENT OF PULMONARY HYPERTENSIONKamal Bharathi
Pulmonary hypertension (PH) is defined by a mean pulmonary artery pressure ≥25 mm Hg at rest, measured during right heart catheterization. There is still insufficient evidence to add an exercise criterion to this definition. The term pulmonary arterial hypertension (PAH) describes a subpopulation of patients with PH characterized hemodynamically by the presence of pre-capillary PH including an end-expiratory pulmonary artery wedge pressure (PAWP) ≤15 mm Hg and a pulmonary vascular resistance >3 Wood units. Right heart catheterization remains essential for a diagnosis of PH or PAH. This procedure requires further standardization, including uniformity of the pressure transducer zero level at the midthoracic line, which is at the level of the left atrium. One of the most common problems in the diagnostic workup of patients with PH is the distinction between PAH and PH due to left heart failure with preserved ejection fraction (HFpEF). A normal PAWP does not rule out the presence of HFpEF. Volume or exercise challenge during right heart catheterization may be useful to unmask the presence of left heart disease, but both tools require further evaluation before their use in general practice can be recommended. Early diagnosis of PAH remains difficult, and screening programs in asymptomatic patients are feasible only in high-risk populations, particularly in patients with systemic sclerosis, for whom recent data suggest that a combination of clinical assessment and pulmonary function testing including diffusion capacity for carbon monoxide, biomarkers, and echocardiography has a higher predictive value than echocardiography alone.
DIAGNOSIS & MANAGEMENT OF PULMONARY HYPERTENSIONKamal Bharathi
Pulmonary hypertension (PH) is defined by a mean pulmonary artery pressure ≥25 mm Hg at rest, measured during right heart catheterization. There is still insufficient evidence to add an exercise criterion to this definition. The term pulmonary arterial hypertension (PAH) describes a subpopulation of patients with PH characterized hemodynamically by the presence of pre-capillary PH including an end-expiratory pulmonary artery wedge pressure (PAWP) ≤15 mm Hg and a pulmonary vascular resistance >3 Wood units. Right heart catheterization remains essential for a diagnosis of PH or PAH. This procedure requires further standardization, including uniformity of the pressure transducer zero level at the midthoracic line, which is at the level of the left atrium. One of the most common problems in the diagnostic workup of patients with PH is the distinction between PAH and PH due to left heart failure with preserved ejection fraction (HFpEF). A normal PAWP does not rule out the presence of HFpEF. Volume or exercise challenge during right heart catheterization may be useful to unmask the presence of left heart disease, but both tools require further evaluation before their use in general practice can be recommended. Early diagnosis of PAH remains difficult, and screening programs in asymptomatic patients are feasible only in high-risk populations, particularly in patients with systemic sclerosis, for whom recent data suggest that a combination of clinical assessment and pulmonary function testing including diffusion capacity for carbon monoxide, biomarkers, and echocardiography has a higher predictive value than echocardiography alone.
Pulmonary edema is often caused by congestive heart failure. When the heart is not able to pump efficiently, blood can back up into the veins that take blood through the lungs. As the pressure in these blood vessels increases, fluid is pushed into the air spaces (alveoli) in the lungs.
Pulmonary edema is often caused by congestive heart failure. When the heart is not able to pump efficiently, blood can back up into the veins that take blood through the lungs. As the pressure in these blood vessels increases, fluid is pushed into the air spaces (alveoli) in the lungs.
PowerPoint presentation about pulmonary embolism -- Teaching at Zagazig university cardiology department ,
Egypt in 2013 by Islam Ghanem , assistant lecturer of cardiology
Dr Vivek Baliga discusses left atrial myxoma for medical students. Lecture includes a link to MCQs in the video. For access to video, please copy and paste this link --> https://youtu.be/JtkWxbVklgA
White Coat Hypertension - Dr Vivek Baliga Patient PresentationDr Vivek Baliga
Dr Vivek Baliga discusses in brief the problem of white coat hypertension - what it means, how it can be a problem and what steps can be taken to lower future risk of hypertension.
Stomach Bloating And Acidity - Tips To Rid Yourself Of It - Dr Vivek Baliga P...Dr Vivek Baliga
Dr Vivek Baliga, physician and internal medicine specialist at Baliga Diagnostics, discusses stomach bloating and how acidity related symptoms can be treated with some simple steps.
Visit his LinkedIn profile here - https://www.linkedin.com/in/dr-vivek-baliga-7b59b0125/
Lower blood pressure without medicines - Dr Vivek Baliga Patient GuideDr Vivek Baliga
Dr Vivek Baliga, physician, discusses simple ways to lower elevated blood pressure naturally using simple lifestyle measures. For more information on Dr Vivek, visit his online profile here - http://baligadiagnostics.com/dr-vivek-baliga/
Consultant Internal Medicine Dr Vivek Baliga reviews a common medical problem - frozen shoulder. It is simple to treat but carries a significant morbidity if ignored. Aimed at medical students.
Dr Vivek Baliga Review - Case Of A Rash On The HipsDr Vivek Baliga
This is an interesting case and one for medical students to be used as a review. Starts with a case and followed by Dr Vivek Baliga's review on the diagnosis with references.
Losing Weight For Unexplained Reasons - Dr Vivek Baliga Patient PresentationDr Vivek Baliga
Weight loss is a serious problem, especially if it happens without any effort. Here are some common reasons why it might be happening. Full text article - http://heartsense.in/losing-weight-for-no-reason-heres-why/
Combination Therapy In Hypertension - Dr Vivek Baliga PresentationDr Vivek Baliga
Dr Vivek Baliga of Baliga Diagnostics, Bangalore, discusses the common combination therapies used in the management of hypertension in clinical practice.
Newer Oral Anticoagulants In Atrial Fibrillation - Dr Vivek BaligaDr Vivek Baliga
In this presentation, Dr Vivek Baliga, Baliga Diagnostics Bangalore, discusses the role of new oral anticoagulants in the management of non-valvular atrial fibrillation.
Author Profile - http://baligadiagnostics.com/dr-vivek-baliga/
In this presentation, Dr Vivek Baliga discusses some of the common cardiac conditions that are seen in post menopausal women.
Dr VIvek Baliga discusses the management of irritable bowel syndrome in the second part of this presentation. For more information on health and heart disease, visit http://heartsense.in/author/dr-vivek-baliga-b/
ECG In Ischemic Heart Disease - Dr Vivek Baliga ReviewDr Vivek Baliga
Dr Vivek Baliga Presentation on the role of ECG in the diagnosis of ischemic heart disease. Here, he covers the very basics in ECG diagnosis of heart disease. Suitable for medical students and physicians alike. For more health articles for patients, visit http://baligadiagnostics.com/category/dr-vivek-baliga/
Link to article - http://heartsense.in/what-enlarged-prostate-gland/
Dr Vivek Baliga discusses why the prostate gland enlarges, what it means and how it can be managed. Patient presentation.
For academic articles, visit http://drvivekbaliga.net
Irritable Bowel Syndrome Part 1 - Dr Vivek BaligaDr Vivek Baliga
In this presentation, Dr Vivek Baliga discusses the important aspects of irritable bowel syndrome - a common medical problem in clinical practice. For more articles, visit http://baligadiagnostics.com/author/drbvb/
Post viral pericarditis - Dr Vivek Baliga presentationDr Vivek Baliga
Dr Vivek Baliga Academic Summaries - http://drvivekbaliga.net
Patient articles - http://heartsense.in/author/dr-vivek-baliga-b/
In this presentation, you will learn about post viral pericarditis in brief.
Dr Vivek Baliga - Diastolic heart failure - A complete overviewDr Vivek Baliga
In this presentation, Dr Vivek Baliga, Consultant Internal Medicine, discusses a common problem in medical practice that often confuses many - diastolic heart failure. Now a misnomer, it is referred to as heart failure with preserved ejection fraction. For patient articles - http://heartsense.in/author/dr-vivek-baliga-b/ . LinkedIn - https://www.linkedin.com/in/dr-vivek-baliga-7b59b0125
Dr Vivek Baliga - Chronic Disease Management In Heart Failure And DiabetesDr Vivek Baliga
Dr Vivek Baliga, Consultant Internal Medicine at Baliga Diagnostics discusses the management of 2 common problems in medical practice - heart failure and type 2 diabetes, including the link between the two. For more articles for patients, visit http://heartsense.in/author/dr-vivek-baliga-b/. For scientific articles and short reviews, visit http://drvivekbaliga.net/
Dyslipidemia management an evidence based approachDr Vivek Baliga
In this presentation by Dr Vivek Baliga, he discusses the different available statins and how you can choose the right one in different clinical situations. See articles from Dr Baliga on http://drvivekbaliga.net
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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
2. Background
Common and potentially lethal disease
The diagnosis is often missed because
patients with PE present with
nonspecific signs and symptoms
If left untreated, approximately one third
of patients who survive an initial PE
subsequently die from a future embolic
episode
3. Risk Factors
Immobilization
Venous stasis
Hypercoagulable states – Factor V
leiden mutation
Surgery and trauma
account for 15% of all postoperative deaths
hip, pelvic, and spinal surgery are
associated with the highest risk.
4. Risk Factors
Malignancy
Malignancy has been identified in 17% of patients
with venous thromboembolism
neoplasms most commonly associated with PE, in
descending order of frequency, are pancreatic
carcinoma; bronchogenic carcinoma; and
carcinoma of the genitourinary tract, colon,
stomach, and breast.
Pregnancy
Oral contraceptives
5. Clinical features
Categorized into 4 classes based on
the acuity and severity of pulmonary
arterial occlusion:
Massive PE
Acute pulmonary infarction
Acute embolism without infarction
Multiple pulmonary emboli
6. Clinical features
Massive PE
Large emboli compromise pulmonary
circulation to produce circulatory collapse
and shock
The patient has hypotension; appears
weak, pale, sweaty, and oliguric; and
develops impaired mentation
7. Clinical features
Acute pulmonary infarction
10% of patients have peripheral occlusion
of a pulmonary artery causing parenchymal
infarction.
Acute onset of pleuritic chest pain,
breathlessness, and hemoptysis
Normal electrocardiogram findings and no
response to GTN rules out cardiac cause.
8. Clinical features
Acute embolism without infarction
nonspecific symptoms of unexplained
dyspnea and/or substernal discomfort.
9. Clinical features
Multiple pulmonary emboli
First subset has repeated documented episodes
of pulmonary emboli over years, eventually
presenting with signs and symptoms of pulmonary
hypertension and cor pulmonale.
Second subset has no previously documented
pulmonary emboli but have widespread
obstruction of the pulmonary circulation with clot.
They present with gradually progressive
dyspnoea, intermittent exertional chest pain, and,
eventually, features of pulmonary hypertension
and cor pulmonale
10. Clinical features
Most patients with PE have no obvious
symptoms at presentation
In contrast, patients with symptomatic
deep vein thrombosis (DVT) commonly
have PE confirmed on diagnostic
studies in the absence of pulmonary
symptoms.
11. Clinical features
Most common symptoms of PE in the
Prospective Investigation of Pulmonary
Embolism Diagnosis (PIOPED) study
were:
Dyspnoea (73%)
Pleuritic chest pain (66%)
Cough (37%)
Hemoptysis (13%).
12. Investigations
Arterial blood gases
hypoxemia, hypocapnia, and respiratory
alkalosis
predictive value of hypoxemia is quite low
D-dimer
misses 10% of patients with PE
only 30% of patients with positive D-dimer
findings have a confirmatory diagnosis of
PE
13. Investigations
Chest radiograph
Initially, normal
later stages :
Westermark sign (dilatation of pulmonary
vessels and a sharp cutoff)
atelectasis
small pleural effusion
elevated diaphragm
14.
15. Investigations
CT Pulmonary angiography
Gold standard for the diagnosis of PE
Positive results consist of a filling defect or
sharp cutoff of the affected artery
Ventilation-perfusion (V/Q) scanning
Normal V/Q scan findings indicate an
absence of any perfusion defects
4% of these patients still may have PE
16. Investigations
Echocardiography
sensitivity and specificity for central and
peripheral PE is 59% and 77%
Electrocardiogram
Tachycardia and nonspecific ST-T wave
abnormalities
S1-Q3-T3 pattern is observed in only 20%
of patients with proven PE
17. Treatment
Oxygen
Full anticoagulation is mandatory
Thrombolytic therapy
hemodynamically unstable
patients who have right-heart strain
high-risk patients with underlying poor
cardiopulmonary reserve
18. Thrombolytic Therapy
Alteplase is recommended
Streptokinase and Reteplase may also
be used
Although most studies demonstrate
superiority of thrombolytic therapy with
respect to resolution of radiographic and
hemodynamic abnormalities within the first
24 hours, this advantage disappears 7
days after treatment
19. Thrombolytic Therapy
The role of thrombolytic therapy in the
management of acute PE remains
controversial
Currently accepted indications for
thrombolytic therapy include
hemodynamic instability or right
ventricular dysfunction demonstrated on
echocardiography.
20. Thrombolytic Therapy
Konstantinides and colleagues
"submassive" pulmonary embolism,
defined as right ventriculardysfunction
but preserved systemic arterial
pressure
256 patients with acute PE and right
ventricular dysfunction or pulmonary
hypertension but with no systemic
hypotension.
21. Thrombolytic Therapy
The primary endpoint (in-hospital death
or clinical deterioration that required
escalation of treatment) occurred
significantly less often in the alteplase
group than in the placebo group (11%
vs. 25%).
Thrombolytic therapy for submassive
PE did not reduce mortality
22. Anticoagulation
LMW Heparin
Warfarin for 6 months if no risk factors
identified
Warfarin for longer if concurrent risk
factors such as malignancy, immobility
etc
23. IVC Filters
Greenfield filter
Indicated in the following settings
Patients with acute venous thromboembolism who
have an absolute contraindication to anticoagulant
therapy, eg, recent surgery, hemorrhagic stroke,
or significant active or recent bleeding
Massive PE who survived but in whom recurrent
embolism will be invariably fatal
Documented recurrent venous thromboembolism,
adequate anticoagulant therapy notwithstanding
24. IVC Filters
One large trial has shown that during
the first 12 days after insertion of IVC
filters, significantly fewer patients had
recurrent PE
Following a 2-year follow-up, no
significant differences in survival rates
existed between the 2 groups
27. Prognosis
Most patients treated with anticoagulants do
not develop long-term sequelae upon follow-
up evaluation
Mortality rate in patients with undiagnosed PE
is 30%
At 5 days of anticoagulant therapy, 36% of
lung scan defects are resolved; at 2 weeks,
52% are resolved; at 3 months, 73% are
resolved.
28. Further studies?
Organizing trials of thrombolysis for
pulmonary embolism ischallenging
the illness is difficult todetect
public awareness of this major
cardiopulmonary illness is unacceptably
low.