Antiarrhythmic drug therapy in Heart Failure and Atrial Fibrillation, what is reasonable?
Presented in the 8th International conference of the Egyptian Cardiac Arrhythmia Association (ECRA) on 23 October 2013
Role of Blood Pressure in Recurrent StrokeSudhir Kumar
Hypertension is a major risk factor for the first stroke as well as recurrent stroke. Therefore, adequate control of BP is necessary to reduce the risk of stroke recurrence. This presentation looks at the ABCD 2 score to predict the exact risk of stroke recurrence after TIA. Target BP that needs to be achieved has been discussed. Various antihypertensive agents based on the scientific evidence have been discussed.
drug therapy in ventricular tachyarrhithmias in emergenciesEmergency Live
Antiarrhythmic drug therapy in patients with supraventricular or ventricular tachyarrhythmias in emergencies
Dietrich Andresen, Hans-Joachim Trappe*
Klinik für Kardiologie, Allgemeine Innere Medizin und konservative Intensivmedizin, Vivantes Klinikum am Urban und im Friedrichshain, Berlin, Germany;
*Medizinische Klinik II (Kardiologie und Angiologie), Ruhr-Universität Bochum, Herne, Germany
Heart failure: From Evidence To Clinical CarePavanAchaya
It includes pathophysiology, classification and treatment of heart failure according to landmark clinical trials for established medications as well as for novel treatment molecules like ARNI
Role of Blood Pressure in Recurrent StrokeSudhir Kumar
Hypertension is a major risk factor for the first stroke as well as recurrent stroke. Therefore, adequate control of BP is necessary to reduce the risk of stroke recurrence. This presentation looks at the ABCD 2 score to predict the exact risk of stroke recurrence after TIA. Target BP that needs to be achieved has been discussed. Various antihypertensive agents based on the scientific evidence have been discussed.
drug therapy in ventricular tachyarrhithmias in emergenciesEmergency Live
Antiarrhythmic drug therapy in patients with supraventricular or ventricular tachyarrhythmias in emergencies
Dietrich Andresen, Hans-Joachim Trappe*
Klinik für Kardiologie, Allgemeine Innere Medizin und konservative Intensivmedizin, Vivantes Klinikum am Urban und im Friedrichshain, Berlin, Germany;
*Medizinische Klinik II (Kardiologie und Angiologie), Ruhr-Universität Bochum, Herne, Germany
Heart failure: From Evidence To Clinical CarePavanAchaya
It includes pathophysiology, classification and treatment of heart failure according to landmark clinical trials for established medications as well as for novel treatment molecules like ARNI
Medical Management of Heart Failure in the ClinicHenry Tran
This is a review focusing on medical therapies for Heart Failure. The intended audience is general internists and residents. There is a brief overview of Entresto and Corlanor as well.
Vymada Tablet (ARNI: Angiotensin Receptor Neprilysin Inhibitor) is an anti-hypertensive drug used in combination with Sacubitril & Valsartan to reduce the risk of cardiovascular events in patients with chronic heart failure (NYHA Class II-IV) and reduced ejection fraction.
Cresar-H (Generic Telmisartan and Hydrochlorothiazide Tablets) The Swiss Pharmacy
Cresar-H (Generic Telmisartan and Hydrochlorothiazide Tablets) is used for the treatment of hypertension, to lower blood pressure as second line therapy. This fixed dose combination is not indicated for initial therapy for the treatment of hypertension. Lowering blood pressure reduces the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions.
Cresar H / Cresar 80 H should be taken in patients whose blood pressure is not adequately controlled by Telmisartan alone.
Javed Butler, MD, MPH, MBA, discusses heart failure in this CME activity titled, "New Frontiers in Managing Heart Failure: Are SGLT2 Inhibitors the Next Leap Forward in Optimizing Patient Care?" For the full presentation, downloadable infographics, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2JG2v9l. CME credit will be available until May 29, 2020.
Medical Management of Heart Failure in the ClinicHenry Tran
This is a review focusing on medical therapies for Heart Failure. The intended audience is general internists and residents. There is a brief overview of Entresto and Corlanor as well.
Vymada Tablet (ARNI: Angiotensin Receptor Neprilysin Inhibitor) is an anti-hypertensive drug used in combination with Sacubitril & Valsartan to reduce the risk of cardiovascular events in patients with chronic heart failure (NYHA Class II-IV) and reduced ejection fraction.
Cresar-H (Generic Telmisartan and Hydrochlorothiazide Tablets) The Swiss Pharmacy
Cresar-H (Generic Telmisartan and Hydrochlorothiazide Tablets) is used for the treatment of hypertension, to lower blood pressure as second line therapy. This fixed dose combination is not indicated for initial therapy for the treatment of hypertension. Lowering blood pressure reduces the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions.
Cresar H / Cresar 80 H should be taken in patients whose blood pressure is not adequately controlled by Telmisartan alone.
Javed Butler, MD, MPH, MBA, discusses heart failure in this CME activity titled, "New Frontiers in Managing Heart Failure: Are SGLT2 Inhibitors the Next Leap Forward in Optimizing Patient Care?" For the full presentation, downloadable infographics, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2JG2v9l. CME credit will be available until May 29, 2020.
Summary of the European Society of Cardiology of two recent guidelines of management of atrial fibrillation (2020) and supraventricular tachycardia (2019)
To every girl and every woman, this word is provided: You are princess, You’re ambassador to the king , You’re a servant of the King, Jesus Christ is the king, Jesus is in your heart, You can befriend Jesus
A beautiful paper published by Eugene Braunwald
European Heart Journal, Volume 42, Issue 24, 21 June 2021, Pages 2327–2328, https://doi.org/10.1093/eurheartj/ehab264
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
4. Recommendations for Use of
Dronedarone (Multaq) in Atrial
Fibrillation
Class IIa
1.Dronedarone is reasonable to decrease
the need for hospitalization for
cardiovascular events in patients with
paroxysmal AF or after conversion of
persistent AF. Dronedarone can be
initiated during outpatient therapy.
(Level of Evidence: B
4
5. Recommendations for Use of
Dronedarone in Atrial Fibrillation
Class III–Harm
1. Dronedarone should not be
administered to patients with class IV
heart failure or patients who have had an
episode of decompensated heart failure
in the past 4 weeks, especially if they
have depressed LV function (EF<35%).
(Level of Evidence: B)
5
6. - The major adverse cardiac effects of
dronedarone are bradycardia and QT
prolongation. Torsades de pointes has
been reported.
- Like amiodarone, dronedarone inhibits
renal tubular secretion of creatinine,
which can increase plasma creatinine
levels. However, there is no reduction in
GFR.
- Dronedarone increases digoxin levels
1.7- to 2.5-fold.
6
7. - Dronedarone is predominantly
metabolized by the liver (CYP3A4). It can
be administered with verapamil or
diltiazem, but low doses of these agents
should be used initially .
- Dronedarone does not alter the INR
when used with warfarin.
- The recommended oral dose of
dronedarone is 400 mg twice a day with
meals.
7
9. Dronedarone - ATHENA: Summary
Dronedarone significantly prolongs time to first CV
hospitalization or death in moderate- to high-risk AF
patients
All-cause mortality was not increased in patients
receiving dronedarone
CV mortality was lower in the dronedarone compared
to the placebo group
The reduction in CV hospitalization was mainly due to
fewer admissions for AF and acute coronary
syndromes
The application of Dronedarone may be useful in low
risk patients (only in NYHA Class I and II)
Hohnloser SH. Heart Rhythm Society 2008 Scientific Sessions;
May 15, 2008; San Francisco, CA.
10. Atrial Fibrillation and Acute Decompensated
Heart Failure
Although the optimal resting HR during AF is
between 60 and 100 bpm, rates below 100 bpm
may not be achievable during AHDF until volume
overload and hypoxia have been corrected. A
more realistic target is to achieve a HR < 120
bpm during the first hours of treatment. Digoxin
should be the first rate-control agent considered.
If the patient has already been taking digoxin, add
doses only if serum digoxin concentration is <0.5
ng/mL.
10
11. Atrial Fibrillation and Acute Decompensated
Heart Failure
Cautious addition of small doses of an IV B blocker,
usually metoprolol in 2.5- to 5-mg increments or, if
systolic function is preserved, diltiazem will often be
required.
If rate control along with relief of volume overload
and dyspnea can be achieved, patients will
frequently revert back to SR if the AF episode is of
recent onset. If the patient does not improve with
these measures, meets anticoagulation criteria for
conversion, and if not already on an antiarrhythmic
drug, a trial of IV amiodarone may be helpful.
11
12. Amiodarone can be reloaded in patients already
on chronic, moderate doses (<200 mg daily) but
should not be added if the patient has been
taking another antiarrhythmic drug that prolongs
the QT interval, such as sotalol or dofetilide.
If this approach fails and heart rates during AF
remain elevated, cardioversion after a period of
loading with an antiarrhythmic drug, usually
amiodarone, is the next step.
12
23. Flecainide (Tambocor) & propafenone
(Rythmol®) Toxicity and Cautions for Class
IC Drugs:
- They are proarrhythmic drugs causing
worsening of a preexisting arrhythmia or de
novo occurrence of life-threatening ventricular
tachycardia
- Notice: Class 1C drugs are particularly of
low safety and have shown even to increase
mortality when used chronically after MI.
24. With Sotalol (Betapace) and Dofetilide
(Tikosyn), the QT interval should be monitored
carefully during drug loading. Serum potassium
levels should also be watched carefully; in fact,
one should use torsades de pointes producing
agents with caution in patients requiring
potassium-wasting diuretics.
26
25. Dofetilide (Tikosyn) had no effect on cardiac
output, cardiac index, or systemic vascular
resistance in patients with ventricular
tachycardia, mild to moderate congestive heart
failure .
Because increase in QT interval and the risk of
ventricular arrhythmias are directly related to
plasma concentrations of dofetilide, dosage
adjustment based on calculated creatinine
clearance is critically important
27
27. Atrial Specific AADs
Vernakalant is a sodium channel blocker (I
Na) and a potassium channel blocker.
In ACT study, adverse events were reported in
32% of placebo recipients and 38% of
Vernakalant recipients. No deaths or torsade
de points were reported.
29
28. Vernakalant BRINAVESS is contraindicated
in patients with severe aortic stenosis, systolic
BP<100 mm Hg, and heart failure class III and
IV.
Vernakalant is contraindicated in patients with
prolonged QT at baseline (uncorrected >440
msec), severe bradycardia, sinus node
dysfunction, or second-degree or third-degree
heart block in the absence of a pacemaker.
30
29. Vernakalant is also contraindictated in patients
who use IV rhythm control antiarrhythmics
(class I and class III) within 4 hours prior to
administration of Vernakalant and patients with
acute coronary syndrome (including myocardial
infarction) within the last 30 days.
Adverse reactions (>5%) seen in the first 24
hours after receiving Vernakalant were taste
disturbance (20.1%), sneezing (14.6%), and
paraesthesia (9.7%).
31
30.
31.
32.
33.
34. Ain Sokhna – Stella di Mare Hotel and Beach - Egypt
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