Pulmonary hypertension
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There is a Little emphasis on Pulmonary hypertension and how it might change the dynamics of investigation interpretations, management, and outcomes at ED. This presentation may be very helpful for EM residents
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Trikat MR is used to treat angina pectoris by protecting heart cells from reduced oxygen supply. It works by inhibiting fatty acid oxidation and increasing glucose oxidation, allowing the heart to function more efficiently during ischemia. The recommended dosage is one 35 mg tablet twice daily with meals. Common side effects include dizziness, headache, and abdominal pain. Trikat MR is contraindicated in patients with movement disorders or severe renal impairment.
Cardiovascular Parameters
This document provides an overview of various cardiovascular parameters and equations, including cardiac output, systemic vascular resistance, mean arterial pressure, stroke volume, preload, afterload, ejection fraction, and shock. It also summarizes different types of shock (hemorrhagic, cardiogenic, septic, neurogenic), embolisms (fat, pulmonary), intra-aortic balloon pumps, receptors, vasoactive drugs, ventilator settings, pulmonary function tests, dead space ventilation, acute respiratory distress syndrome, aspiration, atelectasis, renal failure, and brain death criteria.
Hypertension
This document defines and describes hypertension (HTN). It notes that normal blood pressure is below 130/85 mm Hg and hypertension is sustained blood pressure at or above 140/90 mm Hg. The document discusses types of HTN including essential (primary) HTN which is idiopathic and accounts for 90-95% of cases and secondary HTN which is caused by underlying medical conditions and accounts for 5-10% of cases. Risk factors for HTN include increasing age, black race, obesity, smoking, heavy salt intake, and lack of physical activity. The pathogenesis of HTN involves genetic and environmental factors that can cause increased peripheral resistance and sodium retention leading to increased blood volume and cardiac output over time.
Hypertension slideshare
Hello all, I am Nehal Sharma; owner of this slideshare. I created this slideshare to share my knowledge and experience so i can give wings to all other students aspiring to touch the goal.
Angina pectoris
This document provides an overview of angina pectoris (chest pain). It defines angina as a clinical syndrome caused by transient myocardial ischemia due to an imbalance between oxygen supply and demand in the heart. Angina is common in middle-aged and older adults and can be classified as stable, Prinzmetal's variant, or unstable. It is caused by conditions that limit blood supply to the heart like atherosclerosis or coronary artery spasm. Symptoms include chest pain and shortness of breath. Risk factors include physical exertion, smoking, and hypertension. Treatment involves medications to relieve symptoms and improve blood flow as well as procedures like stents or bypass surgery.
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The document discusses acute myocardial infarction (AMI), including the pathophysiology of AMI, patterns of infarction seen on ECG and microscopy, effects of reperfusion therapy, complications of AMI, and chronic ischemic heart disease. It provides images demonstrating features of AMI such as areas of necrosis, effects of reperfusion, and complications. The goal of reperfusion therapy is to limit infarct size and salvage cardiac muscle.
SITUACION DE LA HIPERTENSION ARTERIAL EN CENTROAMERICA
1) Hypertension and ischemic heart disease are major problems in Central America. Prevention strategies are poor.
2) The approaches used in the US and Europe may not be appropriate for Central America due to the loss of a distinctive Mesoamerican identity.
3) Factors like overweight, obesity, metabolic syndrome, and excessive sugar consumption have contributed to an epidemic of cardiovascular diseases in the region. Improving prevention strategies with a focus on lifestyle is needed.
Inferior myocardial infarction
The document provides information on inferior wall myocardial infarction (MI), including:
1. Definitions, epidemiology, etiology, clinical features, diagnosis, treatment and complications of inferior wall MI are discussed. Worldwide over 7 million people experience STEMIs or NSTEMIs annually.
2. Diagnosis involves ECG, cardiac imaging, cardiac biomarkers like troponin and CK-MB. Reperfusion therapy within 6 hours includes PCI or thrombolysis. General treatment measures include aspirin, clopidogrel, anticoagulants, analgesics, beta-blockers, nitrates and oxygen.
3. The history of pioneers in cardiology and development of techniques like echocardi
Recommended
Trimetazidine
Trikat MR is used to treat angina pectoris by protecting heart cells from reduced oxygen supply. It works by inhibiting fatty acid oxidation and increasing glucose oxidation, allowing the heart to function more efficiently during ischemia. The recommended dosage is one 35 mg tablet twice daily with meals. Common side effects include dizziness, headache, and abdominal pain. Trikat MR is contraindicated in patients with movement disorders or severe renal impairment.
Cardiovascular Parameters
This document provides an overview of various cardiovascular parameters and equations, including cardiac output, systemic vascular resistance, mean arterial pressure, stroke volume, preload, afterload, ejection fraction, and shock. It also summarizes different types of shock (hemorrhagic, cardiogenic, septic, neurogenic), embolisms (fat, pulmonary), intra-aortic balloon pumps, receptors, vasoactive drugs, ventilator settings, pulmonary function tests, dead space ventilation, acute respiratory distress syndrome, aspiration, atelectasis, renal failure, and brain death criteria.
Hypertension
This document defines and describes hypertension (HTN). It notes that normal blood pressure is below 130/85 mm Hg and hypertension is sustained blood pressure at or above 140/90 mm Hg. The document discusses types of HTN including essential (primary) HTN which is idiopathic and accounts for 90-95% of cases and secondary HTN which is caused by underlying medical conditions and accounts for 5-10% of cases. Risk factors for HTN include increasing age, black race, obesity, smoking, heavy salt intake, and lack of physical activity. The pathogenesis of HTN involves genetic and environmental factors that can cause increased peripheral resistance and sodium retention leading to increased blood volume and cardiac output over time.
Hypertension slideshare
Hello all, I am Nehal Sharma; owner of this slideshare. I created this slideshare to share my knowledge and experience so i can give wings to all other students aspiring to touch the goal.
Angina pectoris
This document provides an overview of angina pectoris (chest pain). It defines angina as a clinical syndrome caused by transient myocardial ischemia due to an imbalance between oxygen supply and demand in the heart. Angina is common in middle-aged and older adults and can be classified as stable, Prinzmetal's variant, or unstable. It is caused by conditions that limit blood supply to the heart like atherosclerosis or coronary artery spasm. Symptoms include chest pain and shortness of breath. Risk factors include physical exertion, smoking, and hypertension. Treatment involves medications to relieve symptoms and improve blood flow as well as procedures like stents or bypass surgery.
Cvs lab dxami-csbrp
The document discusses acute myocardial infarction (AMI), including the pathophysiology of AMI, patterns of infarction seen on ECG and microscopy, effects of reperfusion therapy, complications of AMI, and chronic ischemic heart disease. It provides images demonstrating features of AMI such as areas of necrosis, effects of reperfusion, and complications. The goal of reperfusion therapy is to limit infarct size and salvage cardiac muscle.
SITUACION DE LA HIPERTENSION ARTERIAL EN CENTROAMERICA
1) Hypertension and ischemic heart disease are major problems in Central America. Prevention strategies are poor.
2) The approaches used in the US and Europe may not be appropriate for Central America due to the loss of a distinctive Mesoamerican identity.
3) Factors like overweight, obesity, metabolic syndrome, and excessive sugar consumption have contributed to an epidemic of cardiovascular diseases in the region. Improving prevention strategies with a focus on lifestyle is needed.
Inferior myocardial infarction
The document provides information on inferior wall myocardial infarction (MI), including:
1. Definitions, epidemiology, etiology, clinical features, diagnosis, treatment and complications of inferior wall MI are discussed. Worldwide over 7 million people experience STEMIs or NSTEMIs annually.
2. Diagnosis involves ECG, cardiac imaging, cardiac biomarkers like troponin and CK-MB. Reperfusion therapy within 6 hours includes PCI or thrombolysis. General treatment measures include aspirin, clopidogrel, anticoagulants, analgesics, beta-blockers, nitrates and oxygen.
3. The history of pioneers in cardiology and development of techniques like echocardi
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The document discusses acute pulmonary edema and acute respiratory distress syndrome (ARDS). It provides definitions, pathophysiology, clinical features, diagnostic criteria and management principles for both conditions. For acute pulmonary edema, treatments aim to decrease preload and afterload through medications like nitrates, diuretics, ACE inhibitors and non-invasive ventilation. For ARDS, the 1994 consensus criteria define it as acute diffuse lung injury leading to pulmonary edema and hypoxemia. Management focuses on supportive care and treating underlying causes.
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This document is a quiz about hypertension (high blood pressure). It contains 20 multiple choice questions that test understanding of what hypertension is, normal blood pressure values, risk factors, symptoms, health problems associated with uncontrolled hypertension, lifestyle changes and medications for treatment. The key points covered are:
- Hypertension refers to high blood pressure caused by increased force of blood flow in arteries.
- Normal blood pressure is a reading between 90/60mmHg to 120/80mmHg.
- Risk factors include age, family history, obesity, smoking, physical inactivity, diabetes and excess alcohol.
- Hypertension often has no noticeable symptoms and is called the "silent killer".
- Uncontrolled hypertension can lead to
Blood pressure
Blood pressure is regulated through short term and long term mechanisms. Short term regulation involves the sympathetic nervous system (SNS) and vascular endothelium. The SNS activates baroreceptor and chemoreceptor reflexes to constrict blood vessels and increase heart rate. The vascular endothelium releases vasoconstrictors and vasodilators. Long term regulation is controlled by the renal system and endocrine system. The renal system regulates blood volume and pressure through mechanisms like the renin-angiotensin-aldosterone system (RAAS) and natriuretic peptides. The endocrine system releases hormones like epinephrine, aldosterone, and antidiuretic hormone (ADH) which increase blood volume and
Angina pectoris
Angina pectoris is a clinical syndrome characterized by episodes of chest pain or pressure due to coronary artery disease. It occurs when myocardial oxygen demand exceeds supply. The document discusses the pathophysiology, risk factors, types, diagnosis and management of angina pectoris. Nursing interventions focus on treating episodes, reducing anxiety, and educating patients on prevention through lifestyle modifications and medication adherence. The goals are prompt relief of pain, decreased anxiety, avoidance of complications, and adherence to a self-care program.
Hypertension
This document discusses the physiological regulation of blood pressure and drug treatment of hypertension. It begins by defining key terms like blood pressure, systolic and diastolic pressure, and mean arterial pressure. It then covers the cardiac and vascular mechanisms that regulate blood pressure, including factors like stroke volume, cardiac output, peripheral resistance, and vascular volume. Local and systemic regulators of blood pressure are also outlined, such as substances secreted by the endothelium, hormones, and the autonomic nervous system. The document concludes by defining hypertension and discussing drug classes used to treat it, including diuretics, beta blockers, ACE inhibitors, and others.
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This document discusses the pharmacologic management of hypertension and congestive heart failure. It begins by defining cardiac output and its relationship to heart rate and stroke volume. It then discusses factors that affect blood pressure such as total peripheral resistance, cardiac output, and blood volume. The document reviews treatment for both chronic hypertension through lifestyle modifications and medication, as well as treatment for hypertensive emergencies and urgencies through rapid-acting parenteral and oral antihypertensive agents. The goal of therapy is to reduce blood pressure by no more than 25% over 1-2 hours to prevent target organ damage.
Angina pectoris
Angina pectoris is a type of chest pain or discomfort that occurs when the heart muscle does not receive enough oxygen-rich blood. It is caused by an imbalance between the heart's oxygen supply and demand. There are several types of angina including stable angina, unstable angina, and variant angina. Risk factors that can trigger angina include atherosclerosis, coronary artery spasm, increased cardiac output from exercise or stress, and damaged heart muscle. Diagnosis involves taking a medical history, physical exam, ECG, blood tests, imaging tests like angiography, and exercise testing. Treatment focuses on lifestyle changes, medications like nitroglycerin, beta blockers, and calcium channel blockers, and procedures like
Renin angiotensin system
This document discusses drugs that inhibit the renin-angiotensin system for treating hypertension and other conditions. It describes how ACE inhibitors work by inhibiting the angiotensin converting enzyme and decreasing angiotensin II formation, while also increasing bradykinin levels. Angiotensin receptor blockers competitively block the angiotensin II receptor. Both classes lower blood pressure by vasodilation and reduced sodium retention. They are used to treat hypertension, heart failure, diabetic nephropathy, and myocardial infarction. Adverse effects include hypotension, hyperkalemia, and cough with ACE inhibitors.
CHF Hosp. San Lucas interno new
Congestive heart failure is the most common cause of hospital admission in the United States. It occurs when the heart is unable to pump sufficiently, leading to poor oxygen delivery and fluid accumulation in the lungs. There are two main types: systolic dysfunction with reduced ejection fraction and diastolic dysfunction with impaired relaxation. Common causes of systolic dysfunction include hypertension, myocardial infarction, and valvular heart disease. Treatment focuses on ACE inhibitors, beta blockers, diuretics, and devices like implantable defibrillators for severe cases. While treatments are available for systolic dysfunction, there are no proven therapies yet for diastolic dysfunction beyond diuretics and beta blockers.
Ace inhibitors from basic science to therapeutic agents
Pulmonary angiotensin converting enzyme (ACE), First ACE inhibitor (Capoten), therapeutic uses of ACE inhibitors since 1981
Pulmonary Hypertension
1) Pulmonary hypertension is defined as a mean pulmonary arterial pressure exceeding 25% of systemic levels.
2) It is classified as primary, which has no known cause but some cases are hereditary, or secondary due to structural abnormalities in the heart or lungs.
3) The pathology involves thickening of the walls of small pulmonary arteries and intimal fibrosis, most prominently in arteries 40-300 micrometers in diameter.
Congestive Heart Failure
This document discusses treatment options for congestive heart failure. It describes several classes of drugs used including inotropic drugs like digoxin to increase heart contraction; diuretics like furosemide and thiazide to reduce fluid overload; ACE inhibitors like captopril and enalapril to reduce afterload and preload; vasodilators to reduce preload and afterload; beta blockers like bisoprolol and carvedilol which are preferred to improve ventricular function; and aldosterone antagonists like spironolactone to prevent sodium reabsorption. The mechanisms of action and side effects of each drug class are explained in detail. Non-drug treatments like reducing salt intake and exercise
Fetal and perinatal circulation
Educative ppt for students and trainees in Paediatrics, Paediatric Critical care , Neonatology , DCH, DNB Paediatrics
Acute myocardial infarction
Myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops to a part of the heart, causing damage to the heart muscle. Find a good presentation on Acute myocardial infarction here.
Cardiac medications
ACE inhibitors (ACEi) and angiotensin II receptor blockers (ARB)
Drugs
ACEi include enalapril, ramipril, and lisinopril.
ARBs include losartan and candesartan.
Mechanism
Reduce levels (ACEi) or effects (ARB) of angiotensin II.
Angiotensin II increases BP via systemic vasoconstriction, sodium retention, and aldosterone and ADH release.
Lower efficacy in black patients, so not 1st line in this group.
The medicos PDF app was used to collect this information. I stumbled discovered this amazing app when searching for various slides and books and decided to share it with you all. The Google Play Store has a free version of the app.
Antianginal drug
Anti-anginal agents are used to treat angina pectoris, which is characterized by chest pain due to insufficient oxygen supply to the heart. There are several classes of anti-anginal agents that work by different mechanisms: nitrates increase oxygen supply by dilating coronary arteries and reducing blood pressure; beta blockers decrease oxygen demand by lowering heart rate and blood pressure; calcium channel blockers increase oxygen supply and decrease demand by dilating arteries and relaxing smooth muscle. Organic nitrates are commonly used anti-anginal agents that work by dilating coronary arteries and veins to increase blood flow and decrease workload, thereby relieving chest pain.
M of angina & ami
1. Stable angina is caused by fixed stenosis, while unstable angina involves dynamic obstruction from plaque rupture and thrombosis. Acute myocardial infarction results from acute coronary artery occlusion and necrosis.
2. Management involves controlling risk factors, treating symptoms, and improving prognosis. Symptomatic treatment includes nitrates, beta blockers, or calcium channel blockers. Prognostic treatment consists of aspirin, other antiplatelets, and statins. Invasive options are percutaneous coronary intervention or coronary artery bypass grafting.
3. For acute myocardial infarction, treatment focuses on reperfusion through thrombolysis or angioplasty, pain management, and prevention of complications. Long-term management emphasizes secondary prevention with
Mi and angina
Coronary artery disease and its resulting conditions of angina pectoris and myocardial infarction are discussed. Coronary artery disease occurs when plaque builds up in the coronary arteries, limiting blood flow to the heart. Angina pectoris, commonly known as chest pain, occurs when oxygen demand of the heart exceeds supply and has types including stable, unstable, and variant angina. Myocardial infarction, or heart attack, happens when an area of heart muscle dies due to lack of oxygen from a blockage of one of the coronary arteries. Nursing care focuses on pain management, preventing complications, health education, and cardiac rehabilitation.
Chronic chf
This document provides information on chronic congestive heart failure (CHF), including its definition, stages of evolution, pathophysiology, treatment objectives and options. It discusses the effects and uses of various drug classes for CHF treatment, including diuretics, digoxin, inotropic agents, vasodilators and neurohormonal antagonists. It describes the mechanisms of action, effects, benefits, risks and guidelines for use of these drug classes in managing CHF.
Myocardial infarction
This document defines acute myocardial infarction (AMI or heart attack) and discusses its causes, risk factors, signs and symptoms, diagnostic testing, treatment options, and long-term management. An AMI occurs when blood flow to the heart is reduced, damaging heart muscle. The main causes are blockages in the coronary arteries, often due to blood clots forming on top of plaques. Risk factors include age, family history, smoking, diabetes, high blood pressure, high cholesterol, obesity, and physical inactivity. Treatment focuses on restoring blood flow through medications, angioplasty, or bypass surgery, along with long-term lifestyle changes and medications to prevent future issues.
Pulmonary hypertension and the Intensivist
This document discusses pulmonary hypertension (PH), including its definition, classification, pathophysiology, diagnosis, and management in intensive care patients. It defines PH as a mean pulmonary artery pressure >25 mmHg and outlines the various causes classified under five groups. The pathophysiology of PH involves vasoconstriction, vascular remodeling, thrombosis and endothelial dysfunction. Diagnosis involves history, physical exam, imaging like chest X-ray and ECG, as well as right heart catheterization. Management focuses on treating the underlying cause, using vasodilators, inotropes to support the right ventricle, diuretics, oxygen therapy and potentially surgery in refractory cases. PH increases mortality and deteriorations can be rapid
Pulmonary hypertension
Pulmonary hypertension is defined as a mean pulmonary arterial pressure of at least 25 mm Hg. It can be caused by various conditions and is classified accordingly. Idiopathic pulmonary hypertension has no known cause. It presents with dyspnea and right heart failure. Diagnosis involves right heart catheterization showing elevated pulmonary pressures. Treatment includes diuretics, vasodilators like calcium channel blockers, endothelin receptor antagonists, phosphodiesterase inhibitors, prostanoids, and sometimes atrial septostomy or lung transplantation for severe cases refractory to medical therapy. Prognosis depends on factors like functional status, hemodynamics, and response to treatment.
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The document discusses acute pulmonary edema and acute respiratory distress syndrome (ARDS). It provides definitions, pathophysiology, clinical features, diagnostic criteria and management principles for both conditions. For acute pulmonary edema, treatments aim to decrease preload and afterload through medications like nitrates, diuretics, ACE inhibitors and non-invasive ventilation. For ARDS, the 1994 consensus criteria define it as acute diffuse lung injury leading to pulmonary edema and hypoxemia. Management focuses on supportive care and treating underlying causes.
Hypertension quiz
This document is a quiz about hypertension (high blood pressure). It contains 20 multiple choice questions that test understanding of what hypertension is, normal blood pressure values, risk factors, symptoms, health problems associated with uncontrolled hypertension, lifestyle changes and medications for treatment. The key points covered are:
- Hypertension refers to high blood pressure caused by increased force of blood flow in arteries.
- Normal blood pressure is a reading between 90/60mmHg to 120/80mmHg.
- Risk factors include age, family history, obesity, smoking, physical inactivity, diabetes and excess alcohol.
- Hypertension often has no noticeable symptoms and is called the "silent killer".
- Uncontrolled hypertension can lead to
Blood pressure
Blood pressure is regulated through short term and long term mechanisms. Short term regulation involves the sympathetic nervous system (SNS) and vascular endothelium. The SNS activates baroreceptor and chemoreceptor reflexes to constrict blood vessels and increase heart rate. The vascular endothelium releases vasoconstrictors and vasodilators. Long term regulation is controlled by the renal system and endocrine system. The renal system regulates blood volume and pressure through mechanisms like the renin-angiotensin-aldosterone system (RAAS) and natriuretic peptides. The endocrine system releases hormones like epinephrine, aldosterone, and antidiuretic hormone (ADH) which increase blood volume and
Angina pectoris
Angina pectoris is a clinical syndrome characterized by episodes of chest pain or pressure due to coronary artery disease. It occurs when myocardial oxygen demand exceeds supply. The document discusses the pathophysiology, risk factors, types, diagnosis and management of angina pectoris. Nursing interventions focus on treating episodes, reducing anxiety, and educating patients on prevention through lifestyle modifications and medication adherence. The goals are prompt relief of pain, decreased anxiety, avoidance of complications, and adherence to a self-care program.
Hypertension
This document discusses the physiological regulation of blood pressure and drug treatment of hypertension. It begins by defining key terms like blood pressure, systolic and diastolic pressure, and mean arterial pressure. It then covers the cardiac and vascular mechanisms that regulate blood pressure, including factors like stroke volume, cardiac output, peripheral resistance, and vascular volume. Local and systemic regulators of blood pressure are also outlined, such as substances secreted by the endothelium, hormones, and the autonomic nervous system. The document concludes by defining hypertension and discussing drug classes used to treat it, including diuretics, beta blockers, ACE inhibitors, and others.
Hypertension Congestive Heart Failure Pharmacology Talk Part 1
This document discusses the pharmacologic management of hypertension and congestive heart failure. It begins by defining cardiac output and its relationship to heart rate and stroke volume. It then discusses factors that affect blood pressure such as total peripheral resistance, cardiac output, and blood volume. The document reviews treatment for both chronic hypertension through lifestyle modifications and medication, as well as treatment for hypertensive emergencies and urgencies through rapid-acting parenteral and oral antihypertensive agents. The goal of therapy is to reduce blood pressure by no more than 25% over 1-2 hours to prevent target organ damage.
Angina pectoris
Angina pectoris is a type of chest pain or discomfort that occurs when the heart muscle does not receive enough oxygen-rich blood. It is caused by an imbalance between the heart's oxygen supply and demand. There are several types of angina including stable angina, unstable angina, and variant angina. Risk factors that can trigger angina include atherosclerosis, coronary artery spasm, increased cardiac output from exercise or stress, and damaged heart muscle. Diagnosis involves taking a medical history, physical exam, ECG, blood tests, imaging tests like angiography, and exercise testing. Treatment focuses on lifestyle changes, medications like nitroglycerin, beta blockers, and calcium channel blockers, and procedures like
Renin angiotensin system
This document discusses drugs that inhibit the renin-angiotensin system for treating hypertension and other conditions. It describes how ACE inhibitors work by inhibiting the angiotensin converting enzyme and decreasing angiotensin II formation, while also increasing bradykinin levels. Angiotensin receptor blockers competitively block the angiotensin II receptor. Both classes lower blood pressure by vasodilation and reduced sodium retention. They are used to treat hypertension, heart failure, diabetic nephropathy, and myocardial infarction. Adverse effects include hypotension, hyperkalemia, and cough with ACE inhibitors.
CHF Hosp. San Lucas interno new
Congestive heart failure is the most common cause of hospital admission in the United States. It occurs when the heart is unable to pump sufficiently, leading to poor oxygen delivery and fluid accumulation in the lungs. There are two main types: systolic dysfunction with reduced ejection fraction and diastolic dysfunction with impaired relaxation. Common causes of systolic dysfunction include hypertension, myocardial infarction, and valvular heart disease. Treatment focuses on ACE inhibitors, beta blockers, diuretics, and devices like implantable defibrillators for severe cases. While treatments are available for systolic dysfunction, there are no proven therapies yet for diastolic dysfunction beyond diuretics and beta blockers.
Ace inhibitors from basic science to therapeutic agents
Pulmonary angiotensin converting enzyme (ACE), First ACE inhibitor (Capoten), therapeutic uses of ACE inhibitors since 1981
Pulmonary Hypertension
1) Pulmonary hypertension is defined as a mean pulmonary arterial pressure exceeding 25% of systemic levels.
2) It is classified as primary, which has no known cause but some cases are hereditary, or secondary due to structural abnormalities in the heart or lungs.
3) The pathology involves thickening of the walls of small pulmonary arteries and intimal fibrosis, most prominently in arteries 40-300 micrometers in diameter.
Congestive Heart Failure
This document discusses treatment options for congestive heart failure. It describes several classes of drugs used including inotropic drugs like digoxin to increase heart contraction; diuretics like furosemide and thiazide to reduce fluid overload; ACE inhibitors like captopril and enalapril to reduce afterload and preload; vasodilators to reduce preload and afterload; beta blockers like bisoprolol and carvedilol which are preferred to improve ventricular function; and aldosterone antagonists like spironolactone to prevent sodium reabsorption. The mechanisms of action and side effects of each drug class are explained in detail. Non-drug treatments like reducing salt intake and exercise
Fetal and perinatal circulation
Educative ppt for students and trainees in Paediatrics, Paediatric Critical care , Neonatology , DCH, DNB Paediatrics
Acute myocardial infarction
Myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops to a part of the heart, causing damage to the heart muscle. Find a good presentation on Acute myocardial infarction here.
Cardiac medications
ACE inhibitors (ACEi) and angiotensin II receptor blockers (ARB)
Drugs
ACEi include enalapril, ramipril, and lisinopril.
ARBs include losartan and candesartan.
Mechanism
Reduce levels (ACEi) or effects (ARB) of angiotensin II.
Angiotensin II increases BP via systemic vasoconstriction, sodium retention, and aldosterone and ADH release.
Lower efficacy in black patients, so not 1st line in this group.
The medicos PDF app was used to collect this information. I stumbled discovered this amazing app when searching for various slides and books and decided to share it with you all. The Google Play Store has a free version of the app.
Antianginal drug
Anti-anginal agents are used to treat angina pectoris, which is characterized by chest pain due to insufficient oxygen supply to the heart. There are several classes of anti-anginal agents that work by different mechanisms: nitrates increase oxygen supply by dilating coronary arteries and reducing blood pressure; beta blockers decrease oxygen demand by lowering heart rate and blood pressure; calcium channel blockers increase oxygen supply and decrease demand by dilating arteries and relaxing smooth muscle. Organic nitrates are commonly used anti-anginal agents that work by dilating coronary arteries and veins to increase blood flow and decrease workload, thereby relieving chest pain.
M of angina & ami
1. Stable angina is caused by fixed stenosis, while unstable angina involves dynamic obstruction from plaque rupture and thrombosis. Acute myocardial infarction results from acute coronary artery occlusion and necrosis.
2. Management involves controlling risk factors, treating symptoms, and improving prognosis. Symptomatic treatment includes nitrates, beta blockers, or calcium channel blockers. Prognostic treatment consists of aspirin, other antiplatelets, and statins. Invasive options are percutaneous coronary intervention or coronary artery bypass grafting.
3. For acute myocardial infarction, treatment focuses on reperfusion through thrombolysis or angioplasty, pain management, and prevention of complications. Long-term management emphasizes secondary prevention with
Mi and angina
Coronary artery disease and its resulting conditions of angina pectoris and myocardial infarction are discussed. Coronary artery disease occurs when plaque builds up in the coronary arteries, limiting blood flow to the heart. Angina pectoris, commonly known as chest pain, occurs when oxygen demand of the heart exceeds supply and has types including stable, unstable, and variant angina. Myocardial infarction, or heart attack, happens when an area of heart muscle dies due to lack of oxygen from a blockage of one of the coronary arteries. Nursing care focuses on pain management, preventing complications, health education, and cardiac rehabilitation.
Chronic chf
This document provides information on chronic congestive heart failure (CHF), including its definition, stages of evolution, pathophysiology, treatment objectives and options. It discusses the effects and uses of various drug classes for CHF treatment, including diuretics, digoxin, inotropic agents, vasodilators and neurohormonal antagonists. It describes the mechanisms of action, effects, benefits, risks and guidelines for use of these drug classes in managing CHF.
Myocardial infarction
This document defines acute myocardial infarction (AMI or heart attack) and discusses its causes, risk factors, signs and symptoms, diagnostic testing, treatment options, and long-term management. An AMI occurs when blood flow to the heart is reduced, damaging heart muscle. The main causes are blockages in the coronary arteries, often due to blood clots forming on top of plaques. Risk factors include age, family history, smoking, diabetes, high blood pressure, high cholesterol, obesity, and physical inactivity. Treatment focuses on restoring blood flow through medications, angioplasty, or bypass surgery, along with long-term lifestyle changes and medications to prevent future issues.
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This document discusses pulmonary hypertension (PH), including its definition, classification, pathophysiology, diagnosis, and management in intensive care patients. It defines PH as a mean pulmonary artery pressure >25 mmHg and outlines the various causes classified under five groups. The pathophysiology of PH involves vasoconstriction, vascular remodeling, thrombosis and endothelial dysfunction. Diagnosis involves history, physical exam, imaging like chest X-ray and ECG, as well as right heart catheterization. Management focuses on treating the underlying cause, using vasodilators, inotropes to support the right ventricle, diuretics, oxygen therapy and potentially surgery in refractory cases. PH increases mortality and deteriorations can be rapid
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Pulmonary hypertension is defined as a mean pulmonary arterial pressure of at least 25 mm Hg. It can be caused by various conditions and is classified accordingly. Idiopathic pulmonary hypertension has no known cause. It presents with dyspnea and right heart failure. Diagnosis involves right heart catheterization showing elevated pulmonary pressures. Treatment includes diuretics, vasodilators like calcium channel blockers, endothelin receptor antagonists, phosphodiesterase inhibitors, prostanoids, and sometimes atrial septostomy or lung transplantation for severe cases refractory to medical therapy. Prognosis depends on factors like functional status, hemodynamics, and response to treatment.
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1. The document discusses drug trials for acute decompensated heart failure and their results. Many trials tested drugs like nesiritide, milrinone, tezosentan, levosimendan, tolvaptan, and rolofylline but did not show clinical benefit.
2. It proposes classifying patients based on their clinical profile into those with volume overload, reduced cardiac output, or a combination, to help determine optimal treatment which may include diuretics, vasodilators, inotropes, or renal preservation agents.
3. The management of acute heart failure is divided into initial, in-hospital, and discharge phases, with goals like establishing diagnoses, treating precip
Cardiogenic shock
The document discusses cardiogenic shock, which occurs in 5-8% of patients hospitalized with ST elevation myocardial infarction (STEMI). It describes the pathophysiology, criteria for diagnosis, causes, clinical presentation, investigations including echocardiography and pulmonary artery catheterization, management with inotropes, vasopressors, IABP, and early revascularization, as well as prognosis. Early revascularization via PCI or CABG within 18 hours of shock improves survival substantially. Newer mechanical support devices such as percutaneous LVADs are promising but limited by complications. Most hospital survivors have excellent long term survival and quality of life.
Management of Hypertension in Critical Illness
This document provides an overview of the management of hypertension, including hypertensive emergencies. It discusses the prevalence and pathophysiology of hypertension, outlines treatment goals, and reviews pharmacologic treatment options. Key points include:
1) Hypertensive emergencies require rapid blood pressure control to prevent end-organ damage, while avoiding precipitous drops in pressure.
2) Intravenous antihypertensive agents discussed include labetalol, esmolol, nicardipine, sodium nitroprusside, and fenoldopam.
3) Nicardipine is highlighted as an effective option for hypertensive emergencies due to its rapid onset, titratability, and limited
Peripartum cardiomyopathy
This document discusses peripartum cardiomyopathy (PPCM), a type of dilated cardiomyopathy that presents with left ventricular systolic dysfunction and heart failure near the end of pregnancy or in the months following delivery. The case is of a 29-year old woman who presented with dyspnea and fatigue two days after an uneventful delivery of her first child. PPCM has an incidence of 1 in 4,000 live births in the United States. While the exact cause is unknown, proposed mechanisms include viral myocarditis, an abnormal immune response, and prolonged use of tocolytics. Diagnosis involves excluding other potential causes and is confirmed by echocardiogram showing reduced left ventricular function. Treatment involves standard heart failure medications,
Cardiomyopathy by dr sajid.pptx
This document provides information on peripartum cardiomyopathy (PPCM), including its definition, incidence, risk factors, etiology, presentation, diagnosis, management, outcomes, and prognosis. PPCM is defined as an idiopathic cardiomyopathy presenting with heart failure in the last month of pregnancy or months following delivery. It has an incidence ranging from 1 in 1000 to 1 in 4000 live births in the US. While the cause is unknown, proposed mechanisms include viral myocarditis, immune responses, and oxidative stress. Diagnosis involves ruling out other causes and showing left ventricular dysfunction. Treatment follows heart failure guidelines, while avoiding certain medications during pregnancy. Prognosis is generally better than other cardiomyopathies, with 50% of patients
Pulmonary Arterial Hypertension
MCTD is an autoimmune disease characterized by features of SLE, scleroderma, and polymyositis, along with the presence of anti-U1 RNP antibodies. PAH commonly occurs in 20-30% of MCTD cases and is a leading cause of death. Diagnosis involves assessing clinical features, serology, echocardiogram and right heart catheterization. Treatment focuses on managing symptoms and slowing disease progression. Prognosis is poor if PAH develops, with median survival of 12 months without treatment.
Heart disease pregnancy new dr rabi
This document discusses cardiac diseases in pregnancy. It begins with the epidemiology and classification of heart diseases. It then covers the normal cardiovascular alterations in pregnancy, the effects of pregnancy on heart diseases and vice versa. It provides details on diagnosing and managing heart diseases in pregnancy, including specific cardiac conditions and complications like arrhythmias and heart failure. Close monitoring is needed during pregnancy for women with cardiac issues due to risks of maternal mortality, preterm delivery, fetal growth problems, and congenital heart defects in the baby.
Pulmonary Arterial Hypertension (PAH) presentation
Pulmonary arterial hypertension (PAH) is high blood pressure in the arteries connecting the heart and lungs. The document defines PAH and related types, and discusses risk factors, symptoms, diagnosis, classification, complications and treatments. PAH has no known cause in many cases, but can result from other conditions. Common symptoms include shortness of breath, chest pain and fatigue. Diagnosis involves medical tests and right heart catheterization. Treatment aims to improve symptoms and outcomes through medications, supplemental oxygen, diet changes and exercise.
Ph in lhd cteph and copd
This document provides an overview of targeting pulmonary hypertension in different disease states. It discusses classification of pulmonary arterial hypertension and focuses on pulmonary hypertension associated with left heart disease, venous thromboembolism, and common lung diseases like COPD. Key points include that pulmonary hypertension in left heart disease is usually treated by optimizing heart failure therapies as PAH medications are not approved and may be harmful. For CTEPH, pulmonary thromboendarterectomy is the treatment of choice for operable patients, while medical therapy trials are ongoing for inoperable cases. Pulmonary hypertension is very common in severe COPD but usually mild to moderate.
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Respiratory distress syndrome (RDS), also known as hyaline membrane disease (HMD), is an acute lung disease in newborns caused by pulmonary surfactant deficiency, which tends to occur in preterm infants younger than 32 weeks gestational age. The incidence increases with lower gestational age and higher rates are seen in infants of diabetic mothers. Treatment involves oxygen therapy, ventilation support, and replacement of pulmonary surfactant to reduce mortality and complications like pneumothorax. Prevention strategies include antenatal corticosteroid therapy and prophylactic surfactant treatment.
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Pulmonary hypertension
- 2. Elevated mean pulmonary arterial pressure to ≥ 25mmHg at rest ≥ 30mmHg on exertion PCWP ≤ 15mmHg
- 3. The prevalence of PH was 14% (n=664)
- 4. 1-year mortality Low Risk - 2.8% (n=196) Intermediate risk- 9.9% (n=1116) High Risk - 21.2% (n=276).
- 5. Maternal mortality in pregnancy ranges 30-56%
- 6. Group 1: Pulmonary arterial hypertension Group 2: PH due to Left heart disease Group 3: PH due to lung disease or various causes of Hypoxemia Group 4: PH due to chronic thrombo-embolic disease Group 5: PH of unclear multifactorial mechanisms
- 7. ↑Pulmonary Blood Flow ↑Pulmonary Vascular resistance ↑Pulmonary Venous Pressure
- 9. Exertional dyspnea Chest pain Palpitations JVD Hepatomegaly with hepatojugular reflux Ascites LL edema
- 10. Bedside Cardiac USS Signs of RV strain Estimating pulmonary artery pressure Distinguishing grp 2 Pulmonary HTN R/o other causes of RV failure (tamponade, MI, Valvular abnormalities ECG Lab (BNP, HIV, ANA, RF, TSH,T3/T4) CXR, CT Chest V/Q scan r/o chronic thromboembolic disease
- 11. Bedside USS: Evidence of right heart strain - RV close to LV size with septal bowing /flattening (D-Sign) - McConnel sign - RV wall thickness - Tricuspid valve regurgitation - Plethoric IVC
- 12. ECG: Right axis deviation, S1Q3T3, T-wave inversions in inferior and anteroseptal leads Right ventricular hypertrophy, large R waves in precordial leads Tachyarrhythmias (A. Flatter, A. Fib)
- 14. Optimize oxygenation In sepsis or Hypovolemia, give IVF bolus and start norepinephrine drip target MAP >65 Optimize Oxygenation Optimize Circulation Early Consultation
- 15. Increase RV function and cardiac output Low dose of Dobutamine 2-10mcg/kg/min Milrinone 0.375-0.75mcg/kg/min Optimize RCA perfusion Norepinephrine 0.05mcg/min
- 16. Reduce RV afterload Avoid hypoxia, SP02>90% Avoid hypercapnea Avoid acidosis by pulmonary vasodilators Prostanoids (Epoprostenol 2ng/kg/min infusion) Endothelin antagonist (Busentan 62.5mg PO BD) PDE-5 inhibitors (Sildenafil 2.5-10mg PO/IV tds)
- 17. Treat arrhythmias(A.Fib, A.Flutter, Avoid CCB, BB) Anticoagulation Early consultation
- 18. In pregnancy- termination is advocated. [However, Prostacyclin and PDE-5 inhibitors reduce Mortality by 17-33%]
- 19. 1. Right heart failures with circulatory collapse and respiratory failure 2. Sudden death –During sedation, induction and Mechanical ventilation (PPV)
- 20. Should we give IVF or Not? Should we rely on IVC or not? Should we avoid intubation or not? If we must intubate, any precautions? Any role in reducing RV preload? What will be the role of diuretics, e.g. Furosemide? Is there a role of CPAP ?
- 21. www.uptodate.com Tintinalli 8th Ed. (Pg 409-12) https://emcrit.org/racc/pulmonary- hypertension-right-ventricular-failure/
Editor's Notes
- Measured by Right heart catheterization and ECHO- systolic
- e supplemental oxygen, optimizing intravascular volume, augmenting right ventricular function, maintaining coronary artery perfusion, and decreasing right ventricular afterload