The document discusses whether there is strong evidence to support deferring elective surgery in patients with poorly controlled hypertension. While guidelines recommend managing hypertension before surgery due to risks, the evidence is uncertain. Some studies found associations between hypertension and perioperative complications, but others found no relationship between elevated preoperative blood pressure measurements and complications. The importance of factors like multiple blood pressure readings and the type of hypertension (systolic vs. diastolic) in predicting risks also remains unclear. More research is needed to determine best practices.
This document reviews the management of hypertensive emergencies associated with aortic dissection and thoracic aortic aneurysms. It discusses that immediate control of blood pressure is critical for these conditions to prevent further damage. For aortic dissections, surgery is usually recommended for Type A dissections while medical therapy is preferred for Type B dissections. The goals of treatment are to relieve symptoms, reduce complications, and prevent rupture. Several antihypertensive drugs are discussed for rapidly lowering blood pressure in hypertensive emergencies associated with these aortic conditions. Outcomes have improved but morbidity and mortality remain high, posing a significant treatment challenge.
This document summarizes the key aspects of performing a physical examination of the cardiovascular system. It outlines the order and components of the exam, including inspection, palpation, auscultation, and associated cardiac findings. Specific physical findings are organized into tables with the associated cardiac conditions. The exam is presented as a systematic approach to help establish differential diagnoses and correlate physical and ECG findings to accurately diagnose underlying heart conditions.
Cardiology: Treatment of Heart FailureVedica Sethi
Abstract Heart Failure (HF) is the most widely recognized cardiovascular disorder behind medical clinic affirmation for individuals more established than 60 years old. Hardly any regions in medication have advanced as surprisingly as HF treatment in the course of recent decades. Be that as it may, progress has been reliable just for ceaseless HF with diminished discharge part. In intensely decompensated HF and HF with safeguarded discharge part, none of the medications tried to date have been conclusively demonstrated to improve endurance. Deferring or forestalling HF has gotten progressively significant in patients who are inclined to HF. The anticipation of declining interminable HF and hospitalisations for intense decompensation is likewise critical. The target of this paper is to give a compact and down to earth rundown of the accessible medication medicines for HF. The most ideal proof based medication treatment (counting inhibitors of the renin–angiotensin– aldosterone framework and β blockers) is helpful just when ideally actualized. Notwithstanding, usage may be testing. To accept that ailment the executives projects can be useful in giving a multidisciplinary, comprehensive way to deal with the conveyance of ideal clinical consideration. Keywords; heart failure, multidisciplinary approach, Beat-blocker, RAAS framework
Connections Between Hepatic and Cardiovascular Disease,Diagnostic criteria for cirrhotic cardiomyopathy 2005 and 2019.New CCM criteria based
on contemporary CV imaging parameters
LV Systolic Function.
LV Diastolic Dysfunction.cardiac evaluation algorithm for liver transplant candidates
The Progression of Hypertensive Heart Disease.From hypertension to heart failuremagdy elmasry
Staging of Hypertensive Heart Disease.Precipitants and clinical sequelae related to LVH and myocardial fibrosis.Imaging in hypertensive heart disease .Differential diagnosis of LVH.Concentric LVH .Eccentric LVH . Concentric remodeling .linking hypertension and atrial fibrillation
This document discusses the relationship between arterial stiffness, heart failure, and kidney dysfunction (known as the cardiorenal syndrome). It makes three key points:
1) Stiffening of the central arteries like the aorta is associated with aging and increases pulse pressure in these arteries. This higher pulsatile stress can damage kidneys over time.
2) Stiffer arteries increase the workload on the heart, potentially leading to impaired heart function. Weaker heart function then reduces kidney blood flow and function.
3) Stiff arteries may initially cause damage to both the heart and kidneys. Further heart dysfunction exacerbates the cardiorenal syndrome, so treating arterial stiffness could help both organs.
Austin Spine is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Spine.
The journal aims to promote latest information and provide a forum for doctors, researchers, physicians, and healthcare professionals to find most recent advances in the areas of Spine. Austin Spine accepts research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of Spine.
Austin Spine strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing.
Acute gastrointestinal bleeding is a common medical emergency that frequently results in hospitalization. Rapid initial assessment of clinical parameters such as estimated volume of blood lost, appearance of expelled blood, hypotension, mental status changes, and coagulopathy should all be evaluated as part of the outcomes prediction equation. For upper gastrointestinal bleeding, early endoscopy of the upper gastrointestinal tract will also provide important information to aid in efforts to predict risk. Endoscopic evidence of ongoing rapid bleeding or the presence of a “visible vessel” or adherent clot on the ulcer base are findings that are associated with a high likelihood of continued bleeding or recurrent bleeding. Endoscopic therapy can reduce the rates of recurrent bleeding, surgery, and length of hospital stay in patient with
This document reviews the management of hypertensive emergencies associated with aortic dissection and thoracic aortic aneurysms. It discusses that immediate control of blood pressure is critical for these conditions to prevent further damage. For aortic dissections, surgery is usually recommended for Type A dissections while medical therapy is preferred for Type B dissections. The goals of treatment are to relieve symptoms, reduce complications, and prevent rupture. Several antihypertensive drugs are discussed for rapidly lowering blood pressure in hypertensive emergencies associated with these aortic conditions. Outcomes have improved but morbidity and mortality remain high, posing a significant treatment challenge.
This document summarizes the key aspects of performing a physical examination of the cardiovascular system. It outlines the order and components of the exam, including inspection, palpation, auscultation, and associated cardiac findings. Specific physical findings are organized into tables with the associated cardiac conditions. The exam is presented as a systematic approach to help establish differential diagnoses and correlate physical and ECG findings to accurately diagnose underlying heart conditions.
Cardiology: Treatment of Heart FailureVedica Sethi
Abstract Heart Failure (HF) is the most widely recognized cardiovascular disorder behind medical clinic affirmation for individuals more established than 60 years old. Hardly any regions in medication have advanced as surprisingly as HF treatment in the course of recent decades. Be that as it may, progress has been reliable just for ceaseless HF with diminished discharge part. In intensely decompensated HF and HF with safeguarded discharge part, none of the medications tried to date have been conclusively demonstrated to improve endurance. Deferring or forestalling HF has gotten progressively significant in patients who are inclined to HF. The anticipation of declining interminable HF and hospitalisations for intense decompensation is likewise critical. The target of this paper is to give a compact and down to earth rundown of the accessible medication medicines for HF. The most ideal proof based medication treatment (counting inhibitors of the renin–angiotensin– aldosterone framework and β blockers) is helpful just when ideally actualized. Notwithstanding, usage may be testing. To accept that ailment the executives projects can be useful in giving a multidisciplinary, comprehensive way to deal with the conveyance of ideal clinical consideration. Keywords; heart failure, multidisciplinary approach, Beat-blocker, RAAS framework
Connections Between Hepatic and Cardiovascular Disease,Diagnostic criteria for cirrhotic cardiomyopathy 2005 and 2019.New CCM criteria based
on contemporary CV imaging parameters
LV Systolic Function.
LV Diastolic Dysfunction.cardiac evaluation algorithm for liver transplant candidates
The Progression of Hypertensive Heart Disease.From hypertension to heart failuremagdy elmasry
Staging of Hypertensive Heart Disease.Precipitants and clinical sequelae related to LVH and myocardial fibrosis.Imaging in hypertensive heart disease .Differential diagnosis of LVH.Concentric LVH .Eccentric LVH . Concentric remodeling .linking hypertension and atrial fibrillation
This document discusses the relationship between arterial stiffness, heart failure, and kidney dysfunction (known as the cardiorenal syndrome). It makes three key points:
1) Stiffening of the central arteries like the aorta is associated with aging and increases pulse pressure in these arteries. This higher pulsatile stress can damage kidneys over time.
2) Stiffer arteries increase the workload on the heart, potentially leading to impaired heart function. Weaker heart function then reduces kidney blood flow and function.
3) Stiff arteries may initially cause damage to both the heart and kidneys. Further heart dysfunction exacerbates the cardiorenal syndrome, so treating arterial stiffness could help both organs.
Austin Spine is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Spine.
The journal aims to promote latest information and provide a forum for doctors, researchers, physicians, and healthcare professionals to find most recent advances in the areas of Spine. Austin Spine accepts research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of Spine.
Austin Spine strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing.
Acute gastrointestinal bleeding is a common medical emergency that frequently results in hospitalization. Rapid initial assessment of clinical parameters such as estimated volume of blood lost, appearance of expelled blood, hypotension, mental status changes, and coagulopathy should all be evaluated as part of the outcomes prediction equation. For upper gastrointestinal bleeding, early endoscopy of the upper gastrointestinal tract will also provide important information to aid in efforts to predict risk. Endoscopic evidence of ongoing rapid bleeding or the presence of a “visible vessel” or adherent clot on the ulcer base are findings that are associated with a high likelihood of continued bleeding or recurrent bleeding. Endoscopic therapy can reduce the rates of recurrent bleeding, surgery, and length of hospital stay in patient with
This document discusses anesthetic considerations for patients with advanced valvular heart disease undergoing noncardiac surgery. It begins by noting the increasing prevalence of valvular heart disease in the aging population. It then focuses on aortic stenosis, describing its epidemiology, causes, symptoms, pathophysiology and how the disease progresses. The key anesthetic considerations for patients with aortic stenosis are maintaining sinus rhythm, a slow heart rate, adequate preload and afterload to minimize the risk of myocardial ischemia due to the pathophysiology of the disease. Careful preoperative evaluation and perioperative management are important to optimize outcomes.
The document provides guidelines for the diagnosis and management of systolic heart failure in low- and middle-income countries. It discusses the clinical assessment of patients with heart failure, including taking a thorough history focusing on symptoms, etiology, functional status, comorbidities, and medications. Physical examination and various diagnostic tests are also outlined, along with goals of therapy and pharmacological and surgical management approaches. Comorbid conditions that often accompany heart failure like kidney disease, angina, and sleep disorders are also addressed.
ST-segment Depression: All are Not Created Equal!asclepiuspdfs
ST depression on an electrocardiography can be from various causes including ischemia, acute coronary syndrome, electrolyte imbalance, posterior myocardial infarction, pulmonary embolism and others. Making the right diagnosis and therefore the right treatment is of paramount importance. This article goes into depth explaining why all ST-segment depressions are not created equal.
Cardio-Renal Protection Through Renin–Angiotensin–Aldosterone System Inhibitionmagdy elmasry
Physiological and detrimental roles of RAAS molecules in cardiac, vascular tissues and kidneys.‘cardiovascular continuum’ Barriers In Optimizing RAAS Inhibition.The effects of angiotensin II inhibition and improvement in bradykinin availability
Left Ventricular Apical Ballooning, Catecholamine Toxicity, and Cardiomyopathyasclepiuspdfs
Case reports and clinical experiences have implicated catecholamine. Excess likely contributes to the pathophysiologic process as a cause of cardiac dysfunction, impaired hemodynamic function, and poor outcomes. Cardiac dysfunction has also been described in many other diseases; there is likely a common underlying pathophysiology. In this review, we will examine the pathophysiology of cardiac dysfunction after catecholamine surge and discuss the evidence surrounding cardiac dysfunction.
Diagnosis of Early Risks, Management of Risks, and Reduction of Vascular Dise...asclepiuspdfs
In a recent issue of the Journal of Circulation, American Heart Association has published a scientific statement, related to the excess heart disease and acute vascular events in South Asians living in the USA. The same group of experts, also have published a complementary article in Circulation titled, “call to action: Cardiovascular disease (CVD) in Asian Americans.”I being a South Asian immigrant living in the USA, have always wondered as to why we do not have the same benefits as the other resident Americans in terms of the advantages of living in a highly advanced country? According to a study done in 2013, cardiovascular mortality has declined and diabetes mortality has increased in high-income countries. The study done in 26 industrialized nations, estimated the potential role of trends in population, for body mass index, systolic blood pressure, serum total cholesterol, and smoking, the modifiable risk factors identified as the promoters of CVD, and acute vascular events, by the Framingham Heart Study (FHS) group.
CVD in cancer survivors.Screening of cancer survivors.Chest Radiotherapy .JACC Scientific Expert Panel
( J Am Coll Cardiol 2019;74:905–27 )manifestations of chest and mediastinal radiotherapy .
Low dose dopamine increases GFR and RBF. The DAD-HF trial investigated 60 patients randomized to low dose furosemide (continuous infusion 0.5 mg/kg/day) with or without low dose dopamine (2 μg/kg/min). Dopamine preserved renal function compared to furosemide alone in patients with acute decompensated heart failure. There were no significant differences found in a trial comparing high vs low dose furosemide or bolus vs continuous infusion on renal function or symptoms. Novel agents targeting fluid overload, renal function, contractility, and vasomotion may provide new therapeutic options for acute heart failure.
Chronic Obstructive Pulmonary Disease and Heart Failure The challenges facin...magdy elmasry
Chronic Obstructive Pulmonary Disease and Heart Failure
The challenges facing cardiologists and pulmonologists,
prevalence of heart failure in COPD patients .Association of Cardiovascular Disease With Respiratory Disease,An atypical presentation of myocardial infarction (MI) should be considered in every patient presenting with COPD exacerbation ,Cardiovascular and pulmonary disease in the context of inflammation
(“CardioPulmonary Continuum”),The cornerstones of therapy are beta-blockers and beta-agonists ,which as their modes of action suggest oppose each other’s action
Treatment of pulmonary arterial hypertensionbsphamphong
This document summarizes treatment options for pulmonary arterial hypertension. It discusses the pathophysiology of the condition and highlights three major treatment approaches - calcium channel blockers, intravenous prostacyclin, and endothelin receptor antagonists. For patients who respond well to acute vasodilator challenges, long-term calcium channel blocker therapy may be appropriate. Intravenous prostacyclin is reserved for patients with severe disease to improve symptoms and survival. Endothelin receptor antagonists target an important pathway in the condition and have shown benefits in clinical trials.
Cardiac resynchronization therapy (CRT) and implantable cardioverter defibrillators (ICDs) can help optimize heart failure management. CRT improves symptoms, reduces hospitalizations, and increases survival in patients with reduced ejection fraction, left bundle branch block, and wide QRS duration. ICDs prevent sudden cardiac death in high-risk patients with prior heart failure, low ejection fraction, or history of dangerous arrhythmias. New devices use adaptive and multi-point pacing to better resynchronize the left ventricle. Device therapy improves outcomes when guided by clinical evidence and used in appropriate heart failure patients.
Important Clinical Trials In Cardiology - An Overview 2016-17Amit Verma
A randomized clinical trial compared outcomes of 885 patients with STEMI and multivessel disease who underwent primary PCI of an infarct artery and were then randomly assigned to either complete revascularization of additional arteries guided by FFR (fractional flow reserve) or no further intervention. The primary composite outcome of death, MI, revascularization or stroke occurred in 8% of those who received complete revascularization versus 21% of those who received PCI only of the infarct artery. Complete revascularization significantly reduced risk of future cardiovascular events.
This clinical trial studied the effects of cinaciguat, a soluble guanylate cyclase activator, in patients with acute decompensated heart failure. The trial found that cinaciguat significantly reduced pulmonary capillary wedge pressure and right atrial pressure compared with placebo after 8 hours. However, cinaciguat also caused a significant decrease in blood pressure. The trial was terminated prematurely due to an increased risk of hypotension at cinaciguat doses of 200 mg/h or higher. While cinaciguat showed potential for unloading the heart, high doses were associated with hypotension, demonstrating a narrow therapeutic window.
This journal club discusses a study comparing outcomes for patients receiving drug-eluting stents (DES) versus bare-metal stents (BMS) for percutaneous coronary intervention (PCI) of saphenous vein grafts (SVGs). The study analyzed data from the British Cardiovascular Intervention Society on over 15,000 patients undergoing SVG PCI from 2006-2013. It found lower rates of in-hospital major adverse cardiac events, 30-day mortality, and 1-year mortality for patients receiving DES, particularly newer generation DES, compared to BMS. The results provide reassurance on the safety and effectiveness of newer DES for treating SVG disease based on a large real-world dataset.
The document discusses the clinical examination of congestion in heart failure patients. It provides details on examining symptoms, jugular vein pressure, auscultation of the heart and lungs, liver examination, and peripheral edema. Clinical signs like elevated jugular vein pressure and S3 heart sound are shown to have prognostic value. While not perfect, clinical examination is still reasonably accurate for assessing congestion and has independent prognostic information. Experience performing examinations is important.
Aortic stenosis is the abnormal narrowing of the aortic valve opening. It can be caused by congenital heart defects, calcification of the valve, or rheumatic fever. Symptoms include chest pain, fainting, fatigue, and heart failure. Diagnosis involves echocardiogram, ECG, chest x-ray and cardiac catheterization. Treatment depends on severity and includes medications, balloon valvuloplasty, transcatheter aortic valve replacement, surgical aortic valve replacement, and lifestyle changes like quitting smoking.
This document discusses fractional flow reserve (FFR), a technique used during coronary catheterization to measure pressure differences across a coronary stenosis and determine if it is causing myocardial ischemia. An FFR value below 0.75 is considered functionally significant while a value above 0.80 rules out ischemia. FFR is useful for evaluating single-vessel disease, left main stenosis, tandem lesions, diffuse disease, grafts, and ostial lesions. Limitations include inability to assess plaque morphology.
Este documento presenta el índice de autores del libro "Fundamentos de Obstetricia" publicado por la Sociedad Española de Ginecología y Obstetricia (SEGO). El libro fue editado por los doctores Bajo Arenas, Melchor Marcos y Mercé y coordinado por los presidentes de las diferentes secciones de SEGO. El índice incluye los nombres y afiliaciones de más de 100 autores que contribuyeron al libro.
Ruby and Twitter at the Ruby drink-up of Sophia, January 2013rivierarb
The document summarizes Twitter's history with Ruby on Rails. It began using Rails to quickly prototype and launch the initial site. However, scaling issues emerged as Twitter grew rapidly. By 2009, performance problems led Twitter to abandon Rails for the backend and instead use technologies like Scala, Java, and Lucene. While Ruby was kept for the frontend, Twitter replaced even the Rails frontend in 2011. Scaling demands required moving away from Rails as the site expanded to hundreds of millions of users.
This document discusses anesthetic considerations for patients with advanced valvular heart disease undergoing noncardiac surgery. It begins by noting the increasing prevalence of valvular heart disease in the aging population. It then focuses on aortic stenosis, describing its epidemiology, causes, symptoms, pathophysiology and how the disease progresses. The key anesthetic considerations for patients with aortic stenosis are maintaining sinus rhythm, a slow heart rate, adequate preload and afterload to minimize the risk of myocardial ischemia due to the pathophysiology of the disease. Careful preoperative evaluation and perioperative management are important to optimize outcomes.
The document provides guidelines for the diagnosis and management of systolic heart failure in low- and middle-income countries. It discusses the clinical assessment of patients with heart failure, including taking a thorough history focusing on symptoms, etiology, functional status, comorbidities, and medications. Physical examination and various diagnostic tests are also outlined, along with goals of therapy and pharmacological and surgical management approaches. Comorbid conditions that often accompany heart failure like kidney disease, angina, and sleep disorders are also addressed.
ST-segment Depression: All are Not Created Equal!asclepiuspdfs
ST depression on an electrocardiography can be from various causes including ischemia, acute coronary syndrome, electrolyte imbalance, posterior myocardial infarction, pulmonary embolism and others. Making the right diagnosis and therefore the right treatment is of paramount importance. This article goes into depth explaining why all ST-segment depressions are not created equal.
Cardio-Renal Protection Through Renin–Angiotensin–Aldosterone System Inhibitionmagdy elmasry
Physiological and detrimental roles of RAAS molecules in cardiac, vascular tissues and kidneys.‘cardiovascular continuum’ Barriers In Optimizing RAAS Inhibition.The effects of angiotensin II inhibition and improvement in bradykinin availability
Left Ventricular Apical Ballooning, Catecholamine Toxicity, and Cardiomyopathyasclepiuspdfs
Case reports and clinical experiences have implicated catecholamine. Excess likely contributes to the pathophysiologic process as a cause of cardiac dysfunction, impaired hemodynamic function, and poor outcomes. Cardiac dysfunction has also been described in many other diseases; there is likely a common underlying pathophysiology. In this review, we will examine the pathophysiology of cardiac dysfunction after catecholamine surge and discuss the evidence surrounding cardiac dysfunction.
Diagnosis of Early Risks, Management of Risks, and Reduction of Vascular Dise...asclepiuspdfs
In a recent issue of the Journal of Circulation, American Heart Association has published a scientific statement, related to the excess heart disease and acute vascular events in South Asians living in the USA. The same group of experts, also have published a complementary article in Circulation titled, “call to action: Cardiovascular disease (CVD) in Asian Americans.”I being a South Asian immigrant living in the USA, have always wondered as to why we do not have the same benefits as the other resident Americans in terms of the advantages of living in a highly advanced country? According to a study done in 2013, cardiovascular mortality has declined and diabetes mortality has increased in high-income countries. The study done in 26 industrialized nations, estimated the potential role of trends in population, for body mass index, systolic blood pressure, serum total cholesterol, and smoking, the modifiable risk factors identified as the promoters of CVD, and acute vascular events, by the Framingham Heart Study (FHS) group.
CVD in cancer survivors.Screening of cancer survivors.Chest Radiotherapy .JACC Scientific Expert Panel
( J Am Coll Cardiol 2019;74:905–27 )manifestations of chest and mediastinal radiotherapy .
Low dose dopamine increases GFR and RBF. The DAD-HF trial investigated 60 patients randomized to low dose furosemide (continuous infusion 0.5 mg/kg/day) with or without low dose dopamine (2 μg/kg/min). Dopamine preserved renal function compared to furosemide alone in patients with acute decompensated heart failure. There were no significant differences found in a trial comparing high vs low dose furosemide or bolus vs continuous infusion on renal function or symptoms. Novel agents targeting fluid overload, renal function, contractility, and vasomotion may provide new therapeutic options for acute heart failure.
Chronic Obstructive Pulmonary Disease and Heart Failure The challenges facin...magdy elmasry
Chronic Obstructive Pulmonary Disease and Heart Failure
The challenges facing cardiologists and pulmonologists,
prevalence of heart failure in COPD patients .Association of Cardiovascular Disease With Respiratory Disease,An atypical presentation of myocardial infarction (MI) should be considered in every patient presenting with COPD exacerbation ,Cardiovascular and pulmonary disease in the context of inflammation
(“CardioPulmonary Continuum”),The cornerstones of therapy are beta-blockers and beta-agonists ,which as their modes of action suggest oppose each other’s action
Treatment of pulmonary arterial hypertensionbsphamphong
This document summarizes treatment options for pulmonary arterial hypertension. It discusses the pathophysiology of the condition and highlights three major treatment approaches - calcium channel blockers, intravenous prostacyclin, and endothelin receptor antagonists. For patients who respond well to acute vasodilator challenges, long-term calcium channel blocker therapy may be appropriate. Intravenous prostacyclin is reserved for patients with severe disease to improve symptoms and survival. Endothelin receptor antagonists target an important pathway in the condition and have shown benefits in clinical trials.
Cardiac resynchronization therapy (CRT) and implantable cardioverter defibrillators (ICDs) can help optimize heart failure management. CRT improves symptoms, reduces hospitalizations, and increases survival in patients with reduced ejection fraction, left bundle branch block, and wide QRS duration. ICDs prevent sudden cardiac death in high-risk patients with prior heart failure, low ejection fraction, or history of dangerous arrhythmias. New devices use adaptive and multi-point pacing to better resynchronize the left ventricle. Device therapy improves outcomes when guided by clinical evidence and used in appropriate heart failure patients.
Important Clinical Trials In Cardiology - An Overview 2016-17Amit Verma
A randomized clinical trial compared outcomes of 885 patients with STEMI and multivessel disease who underwent primary PCI of an infarct artery and were then randomly assigned to either complete revascularization of additional arteries guided by FFR (fractional flow reserve) or no further intervention. The primary composite outcome of death, MI, revascularization or stroke occurred in 8% of those who received complete revascularization versus 21% of those who received PCI only of the infarct artery. Complete revascularization significantly reduced risk of future cardiovascular events.
This clinical trial studied the effects of cinaciguat, a soluble guanylate cyclase activator, in patients with acute decompensated heart failure. The trial found that cinaciguat significantly reduced pulmonary capillary wedge pressure and right atrial pressure compared with placebo after 8 hours. However, cinaciguat also caused a significant decrease in blood pressure. The trial was terminated prematurely due to an increased risk of hypotension at cinaciguat doses of 200 mg/h or higher. While cinaciguat showed potential for unloading the heart, high doses were associated with hypotension, demonstrating a narrow therapeutic window.
This journal club discusses a study comparing outcomes for patients receiving drug-eluting stents (DES) versus bare-metal stents (BMS) for percutaneous coronary intervention (PCI) of saphenous vein grafts (SVGs). The study analyzed data from the British Cardiovascular Intervention Society on over 15,000 patients undergoing SVG PCI from 2006-2013. It found lower rates of in-hospital major adverse cardiac events, 30-day mortality, and 1-year mortality for patients receiving DES, particularly newer generation DES, compared to BMS. The results provide reassurance on the safety and effectiveness of newer DES for treating SVG disease based on a large real-world dataset.
The document discusses the clinical examination of congestion in heart failure patients. It provides details on examining symptoms, jugular vein pressure, auscultation of the heart and lungs, liver examination, and peripheral edema. Clinical signs like elevated jugular vein pressure and S3 heart sound are shown to have prognostic value. While not perfect, clinical examination is still reasonably accurate for assessing congestion and has independent prognostic information. Experience performing examinations is important.
Aortic stenosis is the abnormal narrowing of the aortic valve opening. It can be caused by congenital heart defects, calcification of the valve, or rheumatic fever. Symptoms include chest pain, fainting, fatigue, and heart failure. Diagnosis involves echocardiogram, ECG, chest x-ray and cardiac catheterization. Treatment depends on severity and includes medications, balloon valvuloplasty, transcatheter aortic valve replacement, surgical aortic valve replacement, and lifestyle changes like quitting smoking.
This document discusses fractional flow reserve (FFR), a technique used during coronary catheterization to measure pressure differences across a coronary stenosis and determine if it is causing myocardial ischemia. An FFR value below 0.75 is considered functionally significant while a value above 0.80 rules out ischemia. FFR is useful for evaluating single-vessel disease, left main stenosis, tandem lesions, diffuse disease, grafts, and ostial lesions. Limitations include inability to assess plaque morphology.
Este documento presenta el índice de autores del libro "Fundamentos de Obstetricia" publicado por la Sociedad Española de Ginecología y Obstetricia (SEGO). El libro fue editado por los doctores Bajo Arenas, Melchor Marcos y Mercé y coordinado por los presidentes de las diferentes secciones de SEGO. El índice incluye los nombres y afiliaciones de más de 100 autores que contribuyeron al libro.
Ruby and Twitter at the Ruby drink-up of Sophia, January 2013rivierarb
The document summarizes Twitter's history with Ruby on Rails. It began using Rails to quickly prototype and launch the initial site. However, scaling issues emerged as Twitter grew rapidly. By 2009, performance problems led Twitter to abandon Rails for the backend and instead use technologies like Scala, Java, and Lucene. While Ruby was kept for the frontend, Twitter replaced even the Rails frontend in 2011. Scaling demands required moving away from Rails as the site expanded to hundreds of millions of users.
Mirror Designs frames existing mirrors with over 40 frame styles to choose from, offering consultation and installation services. Calling their number provides access to monthly specials. Framing mirrors is more affordable and easier than replacing them, with prices averaging $325-$450. They can frame triple mirrors and provide discounts for multiple frame orders.
AstraZeneca's approach to corporate responsibility focuses on diversity and inclusion in the workplace, employee health and safety, and engaging with local communities. They strive to increase representation of women and minorities in leadership and promote work-life balance. Their health initiatives include wellness programs, driving safety, and providing health services to employees and communities in developing countries. AstraZeneca also works to reduce their environmental impact and ensure high ethical standards with suppliers.
This document provides an overview of climate zones and climate classification systems. It begins with an introduction to climate and what determines different climate zones. It then discusses several prominent climate classification schemes, including Köppen climate zones and ecoregions. Several key factors that influence climate zones are outlined, such as latitude, proximity to large bodies of water, air currents, land formations, and altitude. Examples are given of how these factors shape regional climates. The document concludes with a brief discussion of Earth's energy balance.
GLOBE Advisors - British Columbia’s Clean Transportation Sector Market ReportGLOBE Series
Powering the Business of the Environment
GLOBE Advisors is a boutique sustainability consulting firm headquartered in Vancouver, Canada, that specializes in providing project management, partnership development, market research, and strategic consulting services. We invite you to explore our website to find out how GLOBE Advisors can assist your organization with its strategic goals and objectives
www.globeadvisors.ca
Advancing Opportunities for Business and the Environment
GLOBE Advisors, a subsidiary of the Vancouver-based not-for-profit GLOBE Foundation, was established in response to an increasing demand for project-based sustainability consulting services in the environmental business sector.
The "GLOBE" name was established in 1990 and has become a recognized brand, both in Canada and internationally, with respect to the "business of the environment" - due in large part to the GLOBE Series of Conferences and Trade Fair Exhibitions held in Vancouver every two years and organized by the not-for-profit GLOBE Foundation.
In 2012, the company's President and CEO, Dr. John Wiebe, was recognized as one of Canada's "Clean 16" for his outstanding contributions to clean capitalism.
Our philosophy? Environmental challenges bring enormous opportunity for the business sector. Moreover, companies can do well by doing good for the environment, without sacrificing their bottom lines.
Our three guiding principles:
-Environmental problems are business opportunities.
-Companies that can provide clean technologies and solutions will prosper.
-Proactive organizations that embrace environmental sustainability will be more competitive.
Proser utilizes certified chauffeurs and vehicles in Istanbul for VIP transfers and chauffeured services. Only certified drivers and vehicles are allowed to transport passengers within Istanbul. Proser offers luxury transportation services 24/7 with options like licensed tourist guides, hostesses, translators, and armed or unarmed guards. The fleet includes vehicles like the Platinum Line that has a kitchen sink and WC, and multiple Gold and Silver Line vehicles that can accommodate different passenger capacities.
- Globe Travel Network is a company located in St. Louis, MO that offers travel club memberships providing access to over 4,200 resorts and 200,000 units for less than typical timeshare maintenance fees.
- Members can book 7-night stays for as little as $299 and also receive cruise discounts as low as $299 along with amenities like champagne or onboard credit.
- For a $280 fee, members can become sales associates and earn bonuses up to $800 per sales period from commissions and bonuses for their own sales and those under them.
Experimenting With Titels and Critical Analysiselisedaniels94
The document discusses the author's experiments with creating suitable titles for a magazine and poster using Adobe Photoshop. It provides examples of different title designs the author tested out using variations of fonts, sizes, colors, shadows and other effects. The author analyzes the strengths and weaknesses of each design in conveying the intended horror genre. To determine the best design, the author created a questionnaire to get feedback from the target 15-40 age group audience on which title design they find most appealing and suited for the horror/thriller trailer.
This document is a 2014/2015 product catalog from Skyway Pet Products, a premier exporter of quality pet supplies. It provides an overview of the company, which has grown as an international manufacturer and exporter focused on service and innovation. The catalog then showcases the company's wide range of pet products, including cat trees, collars, leashes, beds, grooming tools, toys, clothes, and more. The products demonstrate natural, healthy designs and are made from materials like plush, sisal, bamboo, and loofah.
This document provides guidance on using Twitter for non-profits. It notes that Twitter has over 23 million accounts that tweet over 3 million times per day. It recommends participating, engaging, and listening on Twitter to build connections. Specific steps include creating custom profiles, finding influencers, engaging in conversations, sharing successes and stories, and measuring progress using tools like Bitly and Twitalyzer. Harnessing the "wisdom of crowds" allows non-profits to leverage resources and crowdsource ideas to make better decisions and create more impact.
Invasive hemodynamic monitoring using a pulmonary artery catheter can help guide treatment for complex patients by providing detailed cardiac information. While use of these catheters is declining somewhat, the data they provide on issues like cardiogenic shock and pulmonary pressures can still be useful for diagnosis and management. For a complex patient, this information could be used to individualize a treatment plan involving medications, devices, or other therapies. However, there are also risks to consider from potential complications of catheter insertion or use.
This document discusses acute decompensated heart failure (ADHF), which refers to new or worsening signs and symptoms of heart failure requiring medical care or hospitalization. ADHF accounts for over 50% of heart failure costs in the US. It has a high mortality and readmission rate. The document outlines common causes and presentations of ADHF and emphasizes the importance of a thorough clinical evaluation to diagnose ADHF and distinguish it from other potential causes of symptoms like shortness of breath. It describes assessing signs of congestion and hypoperfusion to classify patients and guide initial treatment.
Blood Pressure Management in Cardiovascular Protection by DR Nasir Uddin.pptxNasir Sagar
High Blood pressure has multiple adverse reaction on different body system and its proper management causes beneficial effect in multiple co morbid condition.
Cardiogenic shock is caused by severe impairment of myocardial function leading to low cardiac output and organ hypoperfusion. It commonly results from acute myocardial infarction and presents as hypotension refractory to fluids with signs of poor organ perfusion. Definitions of cardiogenic shock require hypotension, evidence of end-organ damage, and suspected cardiac dysfunction. Treatment involves revascularization, inotropes, vasopressors, and mechanical circulatory support.
Prognosis and treatment of cardiogenic shock complicating acute myocardial in...drucsamal
This document discusses the prognosis and treatment of cardiogenic shock complicating acute myocardial infarction. It notes that while the mortality rate for cardiogenic shock used to be 80-90%, studies now report in-hospital mortality rates between 42-74%. Several factors predict higher mortality, such as increasing age, prior heart attack, and low blood pressure/cardiac output. The document recommends general measures like aspirin, heparin, and vasopressors to treat cardiogenic shock. It advises against beta blockers and favors early revascularization when possible to improve outcomes for patients experiencing this complication of a heart attack.
Cardiogenic shock is caused by severe impairment of myocardial function leading to low cardiac output and organ hypoperfusion. It commonly results from acute myocardial infarction and presents as hypotension refractory to fluids with signs of poor organ perfusion. While in-hospital mortality has improved slightly, medium-term mortality remains high at around 50%. Management involves identifying the cause, typically through cardiac catheterization, and revascularization when possible along with organ support.
This document reviews methods for evaluating congestion in patients with acute heart failure. It proposes combining available measurements including bedside assessment, laboratory tests, and dynamic maneuvers into a scoring system to quantify the degree of congestion. Key elements are clinical signs and symptoms, along with biomarkers and hemodynamic measurements. This congestion score could help guide therapy to optimize volume status during and after hospitalization.
lung ultrasound , ambulatory blood pressure monitoring Amr Albitar
This document is the thesis submitted by Amr Refay Albitar to the Faculty of Medicine at Cairo University in partial fulfillment of an MSc degree in Internal Medicine. The thesis aims to study ambulatory blood pressure monitoring and lung ultrasound as new predictors of cardiovascular morbidity in end stage renal disease patients. It includes an introduction, aim of work, materials and methods, results, discussion, conclusion, and recommendations sections. The materials and methods section describes how the study included 50 end stage renal disease patients on hemodialysis divided into two groups based on interdialytic weight gain and were subjected to medical history, exams, tests including ambulatory blood pressure monitoring and lung ultrasound.
Fluid Management in Patients with Chronic Heart Failure (2).pdfJohn Nguyen
This document discusses fluid management in patients with chronic heart failure. It notes that congestion, or fluid overload, is a classic clinical feature of heart failure and is associated with worse outcomes. However, congestion is not always clinically evident, so more objective measures may be helpful. Diuretics are the main treatment for congestion, though trials have not shown their effect on mortality. More research is needed to determine if detecting and treating subclinical congestion improves outcomes. The document discusses various clinical signs and tests to identify congestion and reviews current treatments focused on inducing diuresis.
Fluid Management in Patients with Chronic Heart Failure.pdfJohn Nguyen
This document discusses fluid management in patients with chronic heart failure. It notes that congestion, or fluid overload, is a classic clinical feature of heart failure and is associated with worse outcomes. However, congestion is not always clinically evident, so more objective measures may be helpful. Diuretics are the main treatment for congestion, though trials have not shown their effect on mortality. More research is needed to determine if detecting and treating subclinical congestion improves outcomes. The document discusses various clinical signs and tests to identify congestion and reviews current treatments focused on inducing diuresis.
Pro / Con Debate on Central Blood Pressuremagdy elmasry
The Basis : Forward & Reflected Pulse Waves
Central BP - Pro Side of the Argument
Central BP - Con Side of the Argument
Central BP - Consensus on Clinical Application
FDA-cleared devices for central BP and arterial stiffness assessment
Value of measuring central BP in clinComparative effect of
anti-hypertensive drugs and nitrates
on central systolic BP
ical practice
isolated systolic hypertension in the young
This document discusses a study that found patients presenting with acute myocardial infarction (AMI) and cardiogenic shock who also had peripheral artery disease (PAD) experienced higher mortality rates and worse outcomes compared to similar patients without PAD. PAD patients were less likely to receive revascularization procedures and experienced more complications like amputations. However, the study could not determine if PAD directly caused the poorer outcomes or if other factors like more advanced disease among PAD patients were responsible. The document argues for earlier identification and treatment of PAD to help reduce complications in high-risk cardiovascular patients undergoing complex procedures.
This study compared measurements of cardiac index and stroke volume obtained from impedance cardiography (ICG) to those obtained from thermodilution pulmonary artery catheterization (TD PAC) in 20 post-operative cardiac surgery patients over 8 hours. The correlation between ICG and TD PAC was significant for cardiac index but not stroke volume. When adjusted for fluid balance, the correlation was only significant for patients receiving small volumes of fluid. The study concludes ICG is unlikely to be valuable for hemodynamic monitoring in this patient population.
Bleeding complications in secondary stroke prevention by antiplatelet therapy...Duwan Arismendy
Abstract
Abstract. Boysen G (University of Copenhagen, Copenhagen, Denmark). Bleeding complications in secondary stroke prevention by antiplatelet therapy: a benefit–risk analysis (Review). J Intern Med 1999; 246: 239–245.
This review analyses the benefit–risk ratio of antiplatelet drugs in secondary stroke prevention and is based on the published data from eight large stroke prevention trials. In patients with prior transient ischaemic attack (TIA) or stroke, aspirin prevented one to two vascular events (stroke, AMI, or vascular death) per 100 treatment-years with an excess risk of fatal and severe bleeds of 0.4–0.6 per 100 treatment-years. The gastrointestinal bleeding risk was significantly lower with ticlopidine and clopidogrel, which were both somewhat more effective than aspirin in the prevention of vascular events. The combination of dipyridamole and aspirin prevented 2.82 strokes at the expense of an excess risk of 0.61 (95% CI = 0.27–0.95) fatal or severe bleeds per 100 treatment-years.
In the acute phase of stroke, the aspirin-associated risk of haemorrhagic complications was much increased compared with that in the stable phase after stroke, with 0.48 (95% CI = 0.13–0.83) fatal or severe bleeds per 100 treated patients for the first 4 weeks after stroke in the Chinese Acute Stroke Trial and 0.41 (95% CI = 0.05–0.77) in the International Stroke Trial. Still, there was a net benefit with the prevention of about one death or non-fatal ischaemic stroke per 100 treated patients.
This study aimed to evaluate myocardial injury in children with unoperated congenital heart diseases using cardiac troponin I levels. The study found an 80% incidence of elevated cTnI levels in children with CHDs, indicating a high prevalence of myocardial injury. Univariate analysis revealed significant correlations between higher cTnI levels and hemodynamic factors like higher pulmonary to systemic blood flow and pressure ratios. The study concludes that cTnI is a useful marker for detecting myocardial injury in children with unoperated CHDs.
The document summarizes research on stress-induced hypertensive responses during exercise and pharmacological stress tests. It finds that while some studies show exercise hypertension predicts worse outcomes, others show it predicts better outcomes or is a neutral factor. The document also discusses how stress-induced hypertensive responses are associated with subtle systolic dysfunction, diastolic dysfunction, hyperdynamic myocardial function, increased regional contractility, and potential nonischemic cardiomyopathy. It concludes that stress-induced hypertensive responses may have more clinical importance than previously recognized and warrant further evaluation.
This document discusses hemodynamic monitoring in critically ill patients. It notes that while hemodynamic monitoring is a cornerstone of management, the utility of most methods is unproven. Physicians have become psychologically dependent on feedback from monitors independent of their effectiveness. The effectiveness of monitoring is limited to specific patient groups and diseases where proven effective treatments exist. The document discusses various hemodynamic monitoring methods including invasive and non-invasive options like arterial catheters, central venous pressure, and echocardiography. It notes that no individual parameter necessarily defines hemodynamic stability and thresholds vary between patients and clinical contexts.
This study examined the association between blood cell count parameters and the development of new onset atrial fibrillation (AF) after acute myocardial infarction (AMI). The study found that patients who developed AF after AMI had significantly higher hemoglobin, hematocrit, and erythrocyte count levels compared to controls without AF. Logistic regression analysis revealed an independent association between higher hemoglobin, hematocrit, and erythrocyte count and increased odds of developing AF after AMI. However, the pathophysiological mechanisms for these associations require further investigation.
The SPRINT trial studied over 9,000 patients at high risk for cardiovascular events to compare intensive blood pressure control (target <120 mm Hg systolic) to standard control (target <140 mm Hg). It found that intensive control significantly reduced rates of fatal and nonfatal heart attacks, heart failure, and death from any cause. However, intensive control also increased some adverse effects like acute kidney injury and hypotension. Overall, the trial demonstrated benefits of very tight blood pressure control for high-risk patients without diabetes.
2. 20 Journal of Hypertension 2005, Vol 23 No 1
deferring surgery in order to lower BP, even in the
short term, may lead to a reduction in perioperative
cardiovascular complications. More recently, investiga-tions
have indicated that a history of hypertension is a
predictor of perioperative cardiac death in elective
cardiac and non-cardiac surgery [18,19]. Interestingly,
however, these studies have not been able to demon-strate
a direct relationship between high BP measure-ments
taken at the time of hospital admission and
perioperative cardiac complications [20,21] (Fig. 1),
suggesting that target organ damage associated with
long-standing hypertension may have a stronger prog-nostic
predictive value than the BP level per se [22]. A
similar conclusion can be derived from an earlier study
by Goldman and Caldera [23], who showed that most
of the perioperative complication in patients with a
previous diagnosis of hypertension occurred in the
treated/controlled group, casting some doubt on the
prognostic significance of admission BP measurements,
as these are unlikely to reflect the patient’s ‘usual’ BP.
As there is now compelling evidence indicating that
multiple BP readings by means of ambulatory or home
BP monitoring are better predictors of cardiovascular
events than isolated ‘office’ BP measurements [24–30]
(Fig. 2), it would be important to evaluate whether the
BP burden assessed using these techniques will prove
to be a more accurate predictor of cardiovascular
complications in surgical patients.
Although the potential predictive value of ‘white-coat’
hypertension in surgical patients has never been investi-gated,
%!!
4. Incidence of cardiovascular events according to office and 24-h
systolic blood pressure (BP). In each range of office systolic BP, a 24-h
ambulatory systolic BP 135 mmHg predicted a higher incidence of
cardiovascular events than a 24-h ambulatory systolic blood pressure
, 135 mmHg (from ref. 29, with permission).
the aforementioned absence of a relationship
Fig. 2