The jugular venous pressure (JVP, sometimes referred to as jugular venous pulse) is the indirectly observed pressure over the venous system via visualization of the internal jugular vein. It can be useful in the differentiation of different forms of heart and lung disease.
The jugular venous pressure (JVP, sometimes referred to as jugular venous pulse) is the indirectly observed pressure over the venous system via visualization of the internal jugular vein. It can be useful in the differentiation of different forms of heart and lung disease.
A 45 years old lady presented with generalized weakness and palpitations. She is a diagnosed case of chronic renal failure with Diabetes mellitus and Hypertension. Her serum K+ level is 6.8 meq/L. She had the following ECG.
Case; A 54 years old gentleman complained of chest discomfort on exertion for the last 5 months. He is smoker for 10 years, diabetic for 5 years and hypertensive for 3 years. He had the following ECG.
Case: A 25 years old gentleman presented with chest pain and fever .He was normotensive, non-smoker and non-diabetic. His pulse 128b/min and BP-130/80 mm Hg. Troponin I was normal.
Case: A 58 years old gentleman complained of severe central chest pain with excessive sweating 5 days back. He is smoker for 7 years, diabetic for 5 years and hypertensive for 4 years. His BP-90/70 mm Hg. He had the following ECG.
Cardiac murmur is an abnormal heart sounds. can be heard with stethoscope or auscultation. the etiology of the cardiac murmur may be septal defect, valvular defects or vascular defects. the two main causes that lead to cardiac murmur, like stenosis and incompetence.
Brief Presentation on clinical examination of Cardio Vascular System with Report of Normal case
references:
macleod's clinical examination 13th edition
hutchinson clinical methods
Clinical examination in cardiolgy starts with the examination of arterial pulse.
In this PowerPoint presentation we have discussed all about this important topic
A 45 years old lady presented with generalized weakness and palpitations. She is a diagnosed case of chronic renal failure with Diabetes mellitus and Hypertension. Her serum K+ level is 6.8 meq/L. She had the following ECG.
Case; A 54 years old gentleman complained of chest discomfort on exertion for the last 5 months. He is smoker for 10 years, diabetic for 5 years and hypertensive for 3 years. He had the following ECG.
Case: A 25 years old gentleman presented with chest pain and fever .He was normotensive, non-smoker and non-diabetic. His pulse 128b/min and BP-130/80 mm Hg. Troponin I was normal.
Case: A 58 years old gentleman complained of severe central chest pain with excessive sweating 5 days back. He is smoker for 7 years, diabetic for 5 years and hypertensive for 4 years. His BP-90/70 mm Hg. He had the following ECG.
Cardiac murmur is an abnormal heart sounds. can be heard with stethoscope or auscultation. the etiology of the cardiac murmur may be septal defect, valvular defects or vascular defects. the two main causes that lead to cardiac murmur, like stenosis and incompetence.
Brief Presentation on clinical examination of Cardio Vascular System with Report of Normal case
references:
macleod's clinical examination 13th edition
hutchinson clinical methods
Clinical examination in cardiolgy starts with the examination of arterial pulse.
In this PowerPoint presentation we have discussed all about this important topic
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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2. DEFINITION
• Greek word meaning ‘move to and fro’.
• Rhythmic expansion of the arterial wall due to
transmission of pressure waves that travels along
the arteries due to forceful ejection of blood during
cardiac systole into the arterial system.
4. PULSE WAVE PATTERN IN CENTRAL AND PERIPHERAL ARTERIES
CENTRAL ARTERY (AORTA) PERIPHERAL ARTERY (BRACHIAL)
Upstroke rises to a rounded dome. Upstroke is steeper.
Ascending limb has an anacrotic notch. Anacrotic notch in the ascending limb
disappears.
Descending limb has dicrotic notch followed by
dicrotic wave.
Dicrotic notch in descending limb is lowered and
is followed by dicrotic wave.
5.
6. EXAMINATION OF ARTERIAL PULSE
• All major arterial pulses should be bilaterally examined for
• Rate of the pulse
• Rhythm
• Character
• Volume
• Condition of the arterial wall (thickness)
• Radio radial delay and radio femoral delay
15. RATE OF PULSE
• In adult person - between 60 and 100 beats per minute.
• In children average rate at
• 1 week of age 140/min
• 1 yr of age 120/min
• 6 yrs of age 100/min and
• Puberty 80/min
23. RHYTHM
The normal pulse is regular in rhythm. If the pulse is irregular, note whether it is
regularly irregular or irregularly irregular.
REGULARLY IRREGULAR IRREGULARLY IRREGULAR
Sinus arrhythmia Atrial fibrillation
Pulsus bigeminus ,pulsus trigeminy Multifocal atrial tachycardia
Atrial flutter with fixed block Frequent PVCs
Partial (1st and 2nd degrees) heart blocks Atrial flutter with variable block
24.
25. CHARACTER OF PULSE
• Best evaluated by palpation
of the carotid pulse.
• PULSUS PARVUS ET TARDUS
• Slow rising pulse with
delayed systolic peak
(nearer to S2) and
upstroke, associated with
a thrill in the carotids
(carotid shudder) is
characteristic of AS.
26. • WATER-HAMMER (COLLAPSING) PULSE :
• Rapid upstroke (percussion wave) followed by rapid descent
(collapse) of the pulse wave without dicrotic notch.
27. • Rapid upstroke is due to the rapid ejection of greatly increased
stroke volume.
• Rapid descent is due to
• Diastolic ‘run-off’ (back flow) into the left ventricle .
• Reflex vasodilatation mediated by carotid baroreceptors
secondary to large stroke volume.
• The rapid run-off to the periphery due to decreased systemic
vascular resistance.
28.
29. • CAUSES OF COLLAPSING PULSE
• Hyperkinetic circulatory states .
• AR,AS WITH AR, PDA, aortopulmonary window, AV fistula.
31. • ANACROTIC PULSE
• Low rising pulse (pulsus tardus), a distinct notch (anacrotic) on the
upstroke of the carotid pulse with two separate waves (anacrotic
and percussion) can be palpated
Normal pulse Anacrotic pulse
32. • Seen in AS
• The presence of anacrotic pulse indicates
70mmHg pressure gradient.
33. • BISFERIENS PULSE
• Characterized by two systolic peaks (percussion and tidal waves)
separated by a distinct midsystolic dip.
NORMAL PULSE SEVERE AR HOCM
34. • CAUSES OF BISFERIENS PULSE
• Hyperkinetic circulatory states .
• AR.
• AR+AS.
• Hypertrophic obstructive cardiomyopathy.
35. • The two waves are equal or tidal wave is prominent in AR, AR+AS.
• In HOCM, percussion is more prominent than tidal wave.
• Bisferiens pulse disappears when the heart failure supervenes
36.
37. • DICROTIC PULSE
• Two peaks, one in systole (percussion wave) and the other in
diastole (dicrotic wave) immediately after S2.
38. • Commonly seen in low output states such as:
1. Enteric fever
2. Cardiomyopathy
3. Cardiac tamponade
4. Myocarditis
5. Hypovolemic shock
39. • PULSUS ALTERNANS
Alternating small and large volume pulse in regular rhythm.
precipitated by PVCs and is a sign of severe LV dysfunction
40. •PULSUS PARADOXUS :
Exaggerated decrease in the strength (amplitude) of the
arterial pulse during normal quiet inspiration due to the
exaggeration of normal inspiratory decline in the systolic
arterial pressure of 10 mmHg.
44. VOLUME OF PULSE
• Idea of the pulse pressure
• Depends on the stroke volume and the compliance of the
arteries.
• Types
1. Pulsus parvus.
2. Pulsus magnus.
3. Hyperkinetic pulse .
45. • PULSUS MAGNUS :
• High volume large amplitude pulse because of an
increased stroke volume
• Seen in AR
• HYPERKINETIC OR BOUNDING PULSE
• Increased stroke volume and rapid ejection from the left
ventricle.
• Seen in hyperkinetic circulatory states.
46. CONDITION OF VESSEL WALL
• Flattening the artery by digital pressure and sliding it
sideways.
• Monckeberg’s medial sclerosis
47. RADIAL PULSE SYNCHRONICITY
• Radial pulse on one side may be diminished or absent in
patients with
• Pre subclavian COA
• Takayasu arteritis .
• Thoracic outlet syndrome.
• Subclavian steal syndrome.
• Aneurysm of arch of aorta
• Dissection of aorta.
48. ABSENT OR DELAYED FEMORAL PULSATIONS
• Noticeable delay in the arrival of femoral pulse is suggestive
of:
• Coarctation of aorta
• Occlusive disease of the bifurcation of the aorta, common
iliac or external iliac arteries.
49. ARTERIAL PULSE IN SPECIFIC CARDIAC DISORDERS
• AORTIC STENOSIS :
• Pulsus parvus et tardus
• Anacrotic pulse
• SUPRAVALVULAR AORTIC STENOSIS
• Differential streaming of central aortic blood flow
• Right carotid pulse is relatively normal
• Left carotid pulse has the characteristic features of aortic valve
obstruction
51. • COARCTATION OF AORTA
• carotid pulses are increased in amplitude but have normal contour
• femoral pulses are small in volume and markedly delayed.
• AORTIC REGURGITATION
• Collapsing or bounding pulse
• Pure AR or AR + AS – Bisferiens pulse
• With CCF, Bisferiens pulse disappears