This document summarizes a seminar presentation on deep venous thrombosis (DVT). It defines DVT, discusses its incidence in India compared to Western populations, and outlines Virchow's triad of factors that can lead to DVT - venous stasis, endothelial damage, and hypercoagulability. Diagnostic tests like Doppler ultrasound, MRI, and D-dimer are covered. Treatment options include anticoagulation with heparin or warfarin, thrombolytic therapy, and surgery in some cases. Compression stockings and duration of treatment are also discussed.
1) Primary PCI is the recommended reperfusion method when it can be performed in a timely manner by experienced operators, while fibrinolytic therapy is recommended when the anticipated PCI time exceeds 120 minutes.
2) When fibrinolytic therapy is indicated, it should be administered within 30 minutes of hospital arrival.
3) In the absence of contraindications, fibrinolytic therapy should be given to patients with STEMI symptoms within the previous 12 hours when primary PCI cannot be performed within 120 minutes of first medical contact.
This document provides guidelines from the 2019 ACC/AHA on primary prevention of cardiovascular disease. It discusses assessing cardiovascular risk in adults aged 40-75 using pooled cohort equations to calculate 10-year risk. For those at borderline or intermediate risk, additional risk-enhancing factors can guide treatment decisions such as statin therapy. Lifestyle modifications like diet, exercise, weight management and treating conditions like diabetes and high blood pressure are emphasized. Nutrition recommendations include eating vegetables, fruits, whole grains and fish; limiting sodium, processed meats and sugar-sweetened drinks. Adults should aim for 150 minutes of moderate exercise weekly.
#flozins
🫀DAPA 🆚placebo in HFpEF
Now we have a positive trial!
⬇️18% in CV☠️ death or
worsening HF among LVEF>40%
⬇️ 21%heart failure
💥Results same for LVEF> 60% 🆚LVEF<60%
Renal Replacement Therapy: modes and evidenceMohd Saif Khan
This document discusses various modes of renal replacement therapy (RRT) for acute kidney injury (AKI) patients, including their principles, advantages, disadvantages, and evidence regarding optimal dosing. It summarizes that while early RRT initiation and higher RRT doses were associated with better outcomes in some studies, large randomized controlled trials found no significant differences in mortality between early versus late initiation or higher versus lower RRT doses. The optimal RRT modality and timing remains unclear based on current evidence.
Deep vein thrombosis (DVT) is a blood clot that forms in the deep veins, usually in the legs. Virchow's triad of venous stasis, hypercoagulability, and endothelial injury can lead to thrombus formation. Risk factors include age, immobilization, surgery, cancer, and genetic factors. Patients may experience pain, swelling, warmth, and tenderness. Diagnosis involves a Wells score, D-dimer test, ultrasound or venography. Treatment is anticoagulation with heparin, low molecular weight heparin, fondaparinux, or warfarin to prevent pulmonary embolism. Long-term anticoagulation and compression stockings can help prevent
Shock is characterized by reduced systemic tissue perfusion and oxygen delivery, creating an imbalance between oxygen delivery and consumption. Prolonged oxygen deprivation can lead to cellular hypoxia and biochemical derangements. There are several types of shock including hypovolemic, cardiogenic, septic, neurogenic, and hypoadrenal shock. Mean arterial pressure depends on cardiac output and systemic vascular resistance. Parameters like lactate, blood pressure, heart rate, respiratory rate, urine output are used to classify shock into compensated, decompensated, and irreversible stages. Treatment involves identifying and treating the underlying cause while aggressively resuscitating with fluids and vasopressors.
1) Primary PCI is the recommended reperfusion method when it can be performed in a timely manner by experienced operators, while fibrinolytic therapy is recommended when the anticipated PCI time exceeds 120 minutes.
2) When fibrinolytic therapy is indicated, it should be administered within 30 minutes of hospital arrival.
3) In the absence of contraindications, fibrinolytic therapy should be given to patients with STEMI symptoms within the previous 12 hours when primary PCI cannot be performed within 120 minutes of first medical contact.
This document provides guidelines from the 2019 ACC/AHA on primary prevention of cardiovascular disease. It discusses assessing cardiovascular risk in adults aged 40-75 using pooled cohort equations to calculate 10-year risk. For those at borderline or intermediate risk, additional risk-enhancing factors can guide treatment decisions such as statin therapy. Lifestyle modifications like diet, exercise, weight management and treating conditions like diabetes and high blood pressure are emphasized. Nutrition recommendations include eating vegetables, fruits, whole grains and fish; limiting sodium, processed meats and sugar-sweetened drinks. Adults should aim for 150 minutes of moderate exercise weekly.
#flozins
🫀DAPA 🆚placebo in HFpEF
Now we have a positive trial!
⬇️18% in CV☠️ death or
worsening HF among LVEF>40%
⬇️ 21%heart failure
💥Results same for LVEF> 60% 🆚LVEF<60%
Renal Replacement Therapy: modes and evidenceMohd Saif Khan
This document discusses various modes of renal replacement therapy (RRT) for acute kidney injury (AKI) patients, including their principles, advantages, disadvantages, and evidence regarding optimal dosing. It summarizes that while early RRT initiation and higher RRT doses were associated with better outcomes in some studies, large randomized controlled trials found no significant differences in mortality between early versus late initiation or higher versus lower RRT doses. The optimal RRT modality and timing remains unclear based on current evidence.
Deep vein thrombosis (DVT) is a blood clot that forms in the deep veins, usually in the legs. Virchow's triad of venous stasis, hypercoagulability, and endothelial injury can lead to thrombus formation. Risk factors include age, immobilization, surgery, cancer, and genetic factors. Patients may experience pain, swelling, warmth, and tenderness. Diagnosis involves a Wells score, D-dimer test, ultrasound or venography. Treatment is anticoagulation with heparin, low molecular weight heparin, fondaparinux, or warfarin to prevent pulmonary embolism. Long-term anticoagulation and compression stockings can help prevent
Shock is characterized by reduced systemic tissue perfusion and oxygen delivery, creating an imbalance between oxygen delivery and consumption. Prolonged oxygen deprivation can lead to cellular hypoxia and biochemical derangements. There are several types of shock including hypovolemic, cardiogenic, septic, neurogenic, and hypoadrenal shock. Mean arterial pressure depends on cardiac output and systemic vascular resistance. Parameters like lactate, blood pressure, heart rate, respiratory rate, urine output are used to classify shock into compensated, decompensated, and irreversible stages. Treatment involves identifying and treating the underlying cause while aggressively resuscitating with fluids and vasopressors.
Deep vein thrombosis (DVT) and Pulmonary embolism (PE)Aminul Haque
Deep vein thrombosis (DVT) and pulmonary embolism (PE), collectively referred to as venous thromboembolism (VTE), constitute a major global burden of disease.
These are the slides from a presentation I recently gave at work. It demonstrates two fascinating cases [one massive & one submassive PE] & lends itself to a review of the literature assessing the roles and evidence behind thrombolysis for pulmonary embolism.
Covered includes the MAPPET-3, MOPPET & PEITHO trials.
This document provides guidelines for the diagnosis and treatment of deep vein thrombosis (DVT). It recommends venous duplex scanning to diagnose DVT and further tests like venography if the scan is negative but clinical suspicion remains high. For treatment, it suggests anticoagulant drugs like low molecular weight heparin or warfarin depending on the patient's risk factors, pregnancy status, and whether they are hospitalized. It also provides recommendations for screening for thrombophilia and lengths of treatment with warfarin based on the type and risk factors associated with the DVT. Catheter-directed thrombolysis is considered for recent large DVT to help prevent post-thrombotic syndrome.
DVT refers to deep vein thrombosis, which is the formation of a blood clot in the deep veins, usually of the legs. Risk factors include age, immobilization, pregnancy, surgery, cancer and genetic factors. Symptoms include leg swelling, pain, redness and tenderness. Diagnosis involves a clinical probability assessment, D-dimer testing and duplex ultrasonography. Treatment includes anticoagulation medications and compression stockings to prevent complications like pulmonary embolism and post-thrombotic syndrome.
Management strategy in HF with ARNI - Recent updates Praveen Nagula
- The document discusses management strategies for heart failure with reduced ejection fraction (HFrEF), including recent updates.
- It summarizes key differences between Indian and Western HF patients, noting that Indians develop HF at a younger age and with lower ejection fractions. Prognosis is also worse for Indian patients compared to those in the West.
- Core therapies for HFrEF are discussed, including a paradigm shift with the approval of sacubitril-valsartan which has been shown to reduce cardiovascular death compared to ACE inhibitors or ARBs alone in clinical trials.
The document discusses the rationale and history of using combination therapy to treat hypertension. It notes that combination therapy has been used since the 1950s and studies in the 1960s showed improved blood pressure control and reduced morbidity. Guidelines now recommend initial combination therapy using single pill combinations over stepwise monotherapy due to greater effectiveness in reducing blood pressure and heart disease risk. For patients still uncontrolled on dual therapy, guidelines recommend adding a third drug, often in a single pill combination, to help achieve target blood pressure goals.
the 1-year cumulative incidence of a composite end point consisting of cardiovascular death, myocardial infarction, ischemic or hemorrhagic stroke, definite stent thrombosis, and major bleeding was 2.4% in the 1-month DAPT group and 3.7% in the 12-month DAPT group, a difference that met the noninferiority margin of a hazard ratio of 0.5, as well as superiority.
HFPEF is defined as clinical signs of congestive heart failure with a preserved left ventricular ejection fraction over 50%. It accounts for about half of all heart failure cases and is associated with significant mortality. The pathophysiology involves abnormal ventricular stiffness from an upward and leftward shift in the end diastolic pressure-volume relationship. This results in poor exercise tolerance and fatigue. While the exact causes are unclear, comorbidities like hypertension, diabetes and obesity likely play a key role. No treatments shown to improve outcomes for heart failure with reduced ejection fraction have been effective for HFPEF.
Polypill for primary and secondary preventions of cardiovascularBhaswat Chakraborty
This document discusses cardiovascular diseases (CVDs) and strategies for primary and secondary prevention. It summarizes that CVDs are caused by risk factors like hypertension, diabetes, smoking, obesity, and high cholesterol. Modifying these risk factors can prevent CVDs. The document outlines that a polypill containing multiple drugs can provide primary prevention by lowering risk factors. Studies on Cadila Pharmaceuticals' polypill product Polycap found it reduced blood pressure and LDL cholesterol similarly to the individual drugs. Polycap was also found to have no drug interactions and preserve the bioavailability of components, establishing its potential for CVD prevention.
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.
The document summarizes the EMPULSE clinical trial which evaluated the use of empagliflozin in patients hospitalized for acute heart failure. The trial randomized approximately 500 patients within 5 days of hospitalization to empagliflozin 10mg or placebo once daily. The primary endpoint was a composite of death, heart failure events and change in symptoms after 90 days. Key results showed the primary endpoint was met with empagliflozin reducing the risk of the composite endpoint compared to placebo. Empagliflozin also showed benefits on secondary endpoints including time to cardiovascular death or heart failure event and was found to have an excellent safety profile in acute heart failure patients.
A comprehensive approach to Atrial Fibrillation. Everything you need to know about Atrial fibrillation. Including recent 2014 AHA guidelines of management.
The document discusses chronic kidney disease in elderly patients. It notes that the elderly population is growing rapidly and will more than double between 2000 and 2030. Chronic kidney disease is also an epidemic among the elderly, as aging leads to a decline in kidney function even without other risk factors. Outcomes of chronic kidney disease and end-stage renal disease are generally worse in elderly patients compared to younger patients due to higher rates of comorbidities. Management of chronic kidney disease in the elderly requires an individualized approach balancing treatment goals with patient preferences and prognosis. Palliative care is also an important part of care for elderly patients with advanced chronic kidney disease or end-stage renal disease.
A 56-year-old woman presents with symptoms of hyperthyroidism including palpitations, weight loss, and anxiety. Her pulse is irregular at 140-150 bpm. Examination shows signs of Graves' disease including a goiter and exophthalmos. The diagnosis is hyperthyroidism causing atrial fibrillation. Investigations would include thyroid function tests.
Rhythm control for atrial fibrillation is pursued over rate control when a patient remains symptomatic despite adequate rate control or has a strong preference for restoring normal rhythm.
This document discusses current management of atrial fibrillation including evaluating thromboembolic risk, rate or rhythm control strategies, anticoagulation guidelines, cardio
The document summarizes guidelines from the International Society of Hypertension (ISH), World Health Organization (WHO), American College of Cardiology/American Heart Association (ACC/AHA), and European Society of Cardiology/European Society of Hypertension (ESC/ESH) on the diagnosis and treatment of hypertension. It compares the guidelines on prevalence of hypertension, treatment thresholds and targets, drug choice and sequencing, and targets for specific patient groups. While the guidelines have some differences, they also have many similarities, including treatment targets of under 140/90 mmHg for most patients and under 130/80 mmHg for high-risk groups.
Pulmonary Hypertension, Current Guidelines and Future Directions of Therapy.Bassel Ericsoussi, MD
The document discusses the classification, pathophysiology, diagnosis, and treatment of pulmonary hypertension. It is classified by the WHO into 5 groups based on underlying mechanisms. The pathophysiology involves vasoconstriction, remodeling of the pulmonary arteries, and thrombosis. Diagnosis requires right heart catheterization showing elevated pulmonary artery pressure. Prognostic factors include functional status and hemodynamics. Treatment involves basic supportive care as well as vasodilator medications, including prostanoids, endothelin receptor antagonists, phosphodiesterase-5 inhibitors, and nitric oxide. Combination therapy may provide added benefits.
This document discusses diabetic foot ulcers. The main points are:
- Diabetic foot ulcers affect 15-25% of diabetes patients and precede 85% of lower limb amputations. They are costly and preventable.
- Neuropathy, vasculopathy, and susceptibility to infections contribute to ulcer development. Neuropathy causes insensitivity, deformity, and trauma while vasculopathy limits blood supply.
- Management involves assessing vascular supply, treating infections early, and redistributing plantar pressure through casts, walkers, or therapeutic shoes. Good glucose control also supports immune response and healing.
DVT is the formation of a blood clot in the deep veins, usually in the legs. Risk factors include age, immobilization, pregnancy, cancer, family history. Symptoms are leg swelling, pain, shortness of breath. Diagnosis involves a physical exam, Wells score, D-dimer test, ultrasound or CT scan. Treatment is blood thinners like heparin or warfarin to prevent clots from getting worse or causing pulmonary embolisms.
Deep vein thrombosis (DVT) and Pulmonary embolism (PE)Aminul Haque
Deep vein thrombosis (DVT) and pulmonary embolism (PE), collectively referred to as venous thromboembolism (VTE), constitute a major global burden of disease.
These are the slides from a presentation I recently gave at work. It demonstrates two fascinating cases [one massive & one submassive PE] & lends itself to a review of the literature assessing the roles and evidence behind thrombolysis for pulmonary embolism.
Covered includes the MAPPET-3, MOPPET & PEITHO trials.
This document provides guidelines for the diagnosis and treatment of deep vein thrombosis (DVT). It recommends venous duplex scanning to diagnose DVT and further tests like venography if the scan is negative but clinical suspicion remains high. For treatment, it suggests anticoagulant drugs like low molecular weight heparin or warfarin depending on the patient's risk factors, pregnancy status, and whether they are hospitalized. It also provides recommendations for screening for thrombophilia and lengths of treatment with warfarin based on the type and risk factors associated with the DVT. Catheter-directed thrombolysis is considered for recent large DVT to help prevent post-thrombotic syndrome.
DVT refers to deep vein thrombosis, which is the formation of a blood clot in the deep veins, usually of the legs. Risk factors include age, immobilization, pregnancy, surgery, cancer and genetic factors. Symptoms include leg swelling, pain, redness and tenderness. Diagnosis involves a clinical probability assessment, D-dimer testing and duplex ultrasonography. Treatment includes anticoagulation medications and compression stockings to prevent complications like pulmonary embolism and post-thrombotic syndrome.
Management strategy in HF with ARNI - Recent updates Praveen Nagula
- The document discusses management strategies for heart failure with reduced ejection fraction (HFrEF), including recent updates.
- It summarizes key differences between Indian and Western HF patients, noting that Indians develop HF at a younger age and with lower ejection fractions. Prognosis is also worse for Indian patients compared to those in the West.
- Core therapies for HFrEF are discussed, including a paradigm shift with the approval of sacubitril-valsartan which has been shown to reduce cardiovascular death compared to ACE inhibitors or ARBs alone in clinical trials.
The document discusses the rationale and history of using combination therapy to treat hypertension. It notes that combination therapy has been used since the 1950s and studies in the 1960s showed improved blood pressure control and reduced morbidity. Guidelines now recommend initial combination therapy using single pill combinations over stepwise monotherapy due to greater effectiveness in reducing blood pressure and heart disease risk. For patients still uncontrolled on dual therapy, guidelines recommend adding a third drug, often in a single pill combination, to help achieve target blood pressure goals.
the 1-year cumulative incidence of a composite end point consisting of cardiovascular death, myocardial infarction, ischemic or hemorrhagic stroke, definite stent thrombosis, and major bleeding was 2.4% in the 1-month DAPT group and 3.7% in the 12-month DAPT group, a difference that met the noninferiority margin of a hazard ratio of 0.5, as well as superiority.
HFPEF is defined as clinical signs of congestive heart failure with a preserved left ventricular ejection fraction over 50%. It accounts for about half of all heart failure cases and is associated with significant mortality. The pathophysiology involves abnormal ventricular stiffness from an upward and leftward shift in the end diastolic pressure-volume relationship. This results in poor exercise tolerance and fatigue. While the exact causes are unclear, comorbidities like hypertension, diabetes and obesity likely play a key role. No treatments shown to improve outcomes for heart failure with reduced ejection fraction have been effective for HFPEF.
Polypill for primary and secondary preventions of cardiovascularBhaswat Chakraborty
This document discusses cardiovascular diseases (CVDs) and strategies for primary and secondary prevention. It summarizes that CVDs are caused by risk factors like hypertension, diabetes, smoking, obesity, and high cholesterol. Modifying these risk factors can prevent CVDs. The document outlines that a polypill containing multiple drugs can provide primary prevention by lowering risk factors. Studies on Cadila Pharmaceuticals' polypill product Polycap found it reduced blood pressure and LDL cholesterol similarly to the individual drugs. Polycap was also found to have no drug interactions and preserve the bioavailability of components, establishing its potential for CVD prevention.
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.
The document summarizes the EMPULSE clinical trial which evaluated the use of empagliflozin in patients hospitalized for acute heart failure. The trial randomized approximately 500 patients within 5 days of hospitalization to empagliflozin 10mg or placebo once daily. The primary endpoint was a composite of death, heart failure events and change in symptoms after 90 days. Key results showed the primary endpoint was met with empagliflozin reducing the risk of the composite endpoint compared to placebo. Empagliflozin also showed benefits on secondary endpoints including time to cardiovascular death or heart failure event and was found to have an excellent safety profile in acute heart failure patients.
A comprehensive approach to Atrial Fibrillation. Everything you need to know about Atrial fibrillation. Including recent 2014 AHA guidelines of management.
The document discusses chronic kidney disease in elderly patients. It notes that the elderly population is growing rapidly and will more than double between 2000 and 2030. Chronic kidney disease is also an epidemic among the elderly, as aging leads to a decline in kidney function even without other risk factors. Outcomes of chronic kidney disease and end-stage renal disease are generally worse in elderly patients compared to younger patients due to higher rates of comorbidities. Management of chronic kidney disease in the elderly requires an individualized approach balancing treatment goals with patient preferences and prognosis. Palliative care is also an important part of care for elderly patients with advanced chronic kidney disease or end-stage renal disease.
A 56-year-old woman presents with symptoms of hyperthyroidism including palpitations, weight loss, and anxiety. Her pulse is irregular at 140-150 bpm. Examination shows signs of Graves' disease including a goiter and exophthalmos. The diagnosis is hyperthyroidism causing atrial fibrillation. Investigations would include thyroid function tests.
Rhythm control for atrial fibrillation is pursued over rate control when a patient remains symptomatic despite adequate rate control or has a strong preference for restoring normal rhythm.
This document discusses current management of atrial fibrillation including evaluating thromboembolic risk, rate or rhythm control strategies, anticoagulation guidelines, cardio
The document summarizes guidelines from the International Society of Hypertension (ISH), World Health Organization (WHO), American College of Cardiology/American Heart Association (ACC/AHA), and European Society of Cardiology/European Society of Hypertension (ESC/ESH) on the diagnosis and treatment of hypertension. It compares the guidelines on prevalence of hypertension, treatment thresholds and targets, drug choice and sequencing, and targets for specific patient groups. While the guidelines have some differences, they also have many similarities, including treatment targets of under 140/90 mmHg for most patients and under 130/80 mmHg for high-risk groups.
Pulmonary Hypertension, Current Guidelines and Future Directions of Therapy.Bassel Ericsoussi, MD
The document discusses the classification, pathophysiology, diagnosis, and treatment of pulmonary hypertension. It is classified by the WHO into 5 groups based on underlying mechanisms. The pathophysiology involves vasoconstriction, remodeling of the pulmonary arteries, and thrombosis. Diagnosis requires right heart catheterization showing elevated pulmonary artery pressure. Prognostic factors include functional status and hemodynamics. Treatment involves basic supportive care as well as vasodilator medications, including prostanoids, endothelin receptor antagonists, phosphodiesterase-5 inhibitors, and nitric oxide. Combination therapy may provide added benefits.
This document discusses diabetic foot ulcers. The main points are:
- Diabetic foot ulcers affect 15-25% of diabetes patients and precede 85% of lower limb amputations. They are costly and preventable.
- Neuropathy, vasculopathy, and susceptibility to infections contribute to ulcer development. Neuropathy causes insensitivity, deformity, and trauma while vasculopathy limits blood supply.
- Management involves assessing vascular supply, treating infections early, and redistributing plantar pressure through casts, walkers, or therapeutic shoes. Good glucose control also supports immune response and healing.
DVT is the formation of a blood clot in the deep veins, usually in the legs. Risk factors include age, immobilization, pregnancy, cancer, family history. Symptoms are leg swelling, pain, shortness of breath. Diagnosis involves a physical exam, Wells score, D-dimer test, ultrasound or CT scan. Treatment is blood thinners like heparin or warfarin to prevent clots from getting worse or causing pulmonary embolisms.
Deep vein thrombosis (DVT) is a blood clot that forms in the deep veins, usually of the legs. It can be asymptomatic or cause leg pain, swelling, warmth, and redness. Risk factors include prolonged bed rest, surgery, cancer, and inherited or acquired hypercoagulable states. Diagnosis involves the Wells criteria for pre-test probability followed by D-dimer testing and duplex ultrasound imaging of the legs. Treatment aims to prevent pulmonary embolism and includes bed rest, leg elevation, compression stockings, and anticoagulation medications like heparin or warfarin. Differential diagnoses include cellulitis, arthritis, and peripheral edema from other causes.
Vte, identification and management of patients at riskWale Jesudemi
Venous thrombo-embolism (VTE) refers to deep vein thrombosis (DVT) and pulmonary embolism (PE) caused by blood clots. The document discusses risk factors for VTE, signs and symptoms, diagnostic tests including ultrasound and CT scans, and treatment including anticoagulation medications and thrombolytic therapy. It also provides guidelines for assessing VTE risk in patients and implementing preventative measures.
This document discusses the clinical applications of Doppler ultrasound. It begins by outlining the advantages and disadvantages of Doppler, then describes its use in evaluating the extremities, renal and hepatic vessels, carotid arteries, male and female genital systems, obstetrics, inflammation, and masses. Doppler is described as a safe, rapid and low-cost imaging method that has expanded diagnostic capabilities in radiology. It can be used to diagnose many medical and surgical conditions involving blood flow.
Deep vein thrombosis (DVT) is a blood clot that forms in the deep veins, usually of the legs. Virchow's triad describes the three main factors that contribute to DVT formation: venous stasis, hypercoagulability, and endothelial injury. Clinical signs of DVT include calf pain, swelling, and tenderness. Diagnosis involves a clinical prediction model like the Wells criteria along with D-dimer testing and ultrasound imaging. Treatment consists of anticoagulation with heparin or warfarin to prevent pulmonary embolism and further complications.
This document provides information on paediatric oncology and various childhood cancers. It discusses that benign tumors are more common than malignant tumors in children, but cancer is a leading cause of death after accidents. The most common malignant tumors in children arise from hematopoietic, nervous and soft tissues. It then describes several specific childhood cancers like acute lymphoblastic leukemia, Wilms tumor, neuroblastoma, Hodgkin's lymphoma, and non-Hodgkin lymphoma. For each cancer, it discusses clinical features, diagnostic evaluation, classification, treatment and prognosis.
1) Deep vein thrombosis is a blood clot that forms in the deep veins, usually of the legs. It can break off and travel to the lungs, blocking blood flow (pulmonary embolism).
2) Risk factors include prolonged bed rest, surgery, cancer, and inherited or acquired hypercoagulable states. Symptoms include leg pain, swelling, warmth, and redness. Diagnosis involves a clinical evaluation along with D-dimer testing and ultrasound imaging of the legs.
3) Treatment focuses on blood thinners to prevent clot growth and reduce the risk of embolism. Left untreated, a DVT can lead to long-term leg damage or potentially fatal blockages in
- Screening with ABI should be conducted in all diabetic patients older than 50 years and those younger than 50 with risk factors like hypertension, smoking, and diabetes duration over 10 years.
- Primary prevention is important through addressing risk factors such as smoking, blood pressure and glucose control, antiplatelet therapy, and foot care.
- Cilostazol is preferred over pentoxifylline for treatment of symptomatic PAD to improve walking ability and quality of life.
Deep vein thrombosis is a blood clot that forms in the deep veins, usually of the legs. It can dislodge and travel to the lungs, causing a pulmonary embolism. Risk factors include surgery, trauma, cancer, and prolonged immobility. Symptoms may include leg pain, swelling, redness, and warmth. Diagnosis involves assessing risk factors and testing such as ultrasound, venography, MRI, or D-dimer blood test. Treatment focuses on blood thinners to prevent clot growth and embolism.
This document discusses the approach to evaluating a rheumatologic patient, including common complaints, history taking, physical examination, and laboratory studies. It emphasizes obtaining a thorough history focused on joint issues, physical characteristics, and other illnesses. The physical exam should inspect all joints and systems potentially involved. Rheumatologic conditions are often diagnosed clinically, but laboratory tests like CBC, ESR, CRP, RF, ANA, and synovial fluid analysis can help identify conditions like rheumatoid arthritis. Proper evaluation relies on a detailed history, comprehensive physical exam, and selective use of lab tests.
Deep Vein Thrombosis and Pulmonary Embolism, by Prof. Minnu M. PanditraoMinnu Panditrao
Dr. Mrs. Minnu Panditrao, goes in depth with the very important topic of Deep Vein Thrombosis, Pulmonary embolism, aetio patheogenesis, clinical features, management etc.
This document discusses deep vein thrombosis (DVT). It begins with an overview of risk factors for DVT, including oral contraceptive use and antiphospholipid antibodies. The clinical presentation of DVT is then described, including signs of swelling, pain, warmth, and redness in the affected leg. Complications of DVT include pulmonary embolism and post-thrombotic syndrome. The diagnosis of DVT involves clinical assessment using Well's criteria, D-dimer testing, and imaging with ultrasound or other modalities. Treatment consists of anticoagulation with low molecular weight heparin or warfarin. Prevention strategies incorporate early mobilization, mechanical methods, and pharmacological prophylaxis.
Deep vein thrombosis is the formation of a blood clot in the deep veins, usually in the leg. It is caused by Virchow's triad of venous stasis, endothelial damage, and hypercoagulability. Common risk factors include surgery, trauma, pregnancy, oral contraceptives, and inherited coagulation disorders. Patients may present with calf pain, swelling, warmth, or tenderness. Diagnosis involves Wells criteria, D-dimer testing, ultrasound, venography or MRI. Treatment focuses on anticoagulation to prevent pulmonary embolism.
The document discusses deep vein thrombosis (DVT) in pregnancy. It notes that DVT occurs in 0.13-0.61 per 1000 pregnancies. Risk factors include pregnancy itself, hypercoagulability, stasis, and endothelial injury. Diagnosis is challenging due to physiological changes and atypical presentations in pregnancy. Non-invasive tests like Doppler ultrasonography and impedance plethysmography are effective screening tools. Venography remains the diagnostic standard but poses risks to mother and fetus. Newer techniques like MRI show promise as accurate alternatives for diagnosis.
Deep vein thrombosis (DVT) is a common and potentially fatal condition. It can lead to pulmonary embolism (PE), which is a leading cause of preventable hospital death. While DVT often has no symptoms, it puts patients at risk for long-term complications. Standard diagnostic tests include ultrasound, CT scans, and D-dimer tests. Risk factors include surgery, trauma, immobility, and cancer. Prophylaxis with blood thinners, compression devices, and stockings can significantly reduce the risk of DVT, especially in high-risk hospitalized patients. Early diagnosis and treatment are important to prevent fatal PE and long-term issues.
This topic comes under the category - Venous Diseases. It is very important for a 3rd year MBBS Student to know about Varicose Veins, which is one of the commonest diseases encountered among out-patients.
This document provides information on deep vein thrombosis (DVT), including:
- DVT occurs when a blood clot forms in a deep vein, most often in the leg. Part of the clot can break off and cause a pulmonary embolism.
- Risk factors include pregnancy and immobilization. Ultrasound is the main imaging method used to diagnose DVT.
- Ultrasound findings of DVT include non-compressible veins, lack of flow, and visualization of thrombus within the vein. Differential diagnoses when DVT is ruled out include muscle injuries, hernias, cysts, and arterial diseases. Proper patient positioning and knowledge of anatomy are important for accurate ultrasound evaluation.
description of the most common and rare vascular malformation of the GIT and main presentation and approach to treatment and the most common complications
This presentation was provided by Rebecca Benner, Ph.D., of the American Society of Anesthesiologists, for the second session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session Two: 'Expanding Pathways to Publishing Careers,' was held June 13, 2024.
A Visual Guide to 1 Samuel | A Tale of Two HeartsSteve Thomason
These slides walk through the story of 1 Samuel. Samuel is the last judge of Israel. The people reject God and want a king. Saul is anointed as the first king, but he is not a good king. David, the shepherd boy is anointed and Saul is envious of him. David shows honor while Saul continues to self destruct.
🔥🔥🔥🔥🔥🔥🔥🔥🔥
إضغ بين إيديكم من أقوى الملازم التي صممتها
ملزمة تشريح الجهاز الهيكلي (نظري 3)
💀💀💀💀💀💀💀💀💀💀
تتميز هذهِ الملزمة بعِدة مُميزات :
1- مُترجمة ترجمة تُناسب جميع المستويات
2- تحتوي على 78 رسم توضيحي لكل كلمة موجودة بالملزمة (لكل كلمة !!!!)
#فهم_ماكو_درخ
3- دقة الكتابة والصور عالية جداً جداً جداً
4- هُنالك بعض المعلومات تم توضيحها بشكل تفصيلي جداً (تُعتبر لدى الطالب أو الطالبة بإنها معلومات مُبهمة ومع ذلك تم توضيح هذهِ المعلومات المُبهمة بشكل تفصيلي جداً
5- الملزمة تشرح نفسها ب نفسها بس تكلك تعال اقراني
6- تحتوي الملزمة في اول سلايد على خارطة تتضمن جميع تفرُعات معلومات الجهاز الهيكلي المذكورة في هذهِ الملزمة
واخيراً هذهِ الملزمة حلالٌ عليكم وإتمنى منكم إن تدعولي بالخير والصحة والعافية فقط
كل التوفيق زملائي وزميلاتي ، زميلكم محمد الذهبي 💊💊
🔥🔥🔥🔥🔥🔥🔥🔥🔥
This document provides an overview of wound healing, its functions, stages, mechanisms, factors affecting it, and complications.
A wound is a break in the integrity of the skin or tissues, which may be associated with disruption of the structure and function.
Healing is the body’s response to injury in an attempt to restore normal structure and functions.
Healing can occur in two ways: Regeneration and Repair
There are 4 phases of wound healing: hemostasis, inflammation, proliferation, and remodeling. This document also describes the mechanism of wound healing. Factors that affect healing include infection, uncontrolled diabetes, poor nutrition, age, anemia, the presence of foreign bodies, etc.
Complications of wound healing like infection, hyperpigmentation of scar, contractures, and keloid formation.
1. G.R. MEDICAL COLLEGEG.R. MEDICAL COLLEGE
DEPARTMENT OF SURGERYDEPARTMENT OF SURGERY
SEMINAR PRESENTATIONSEMINAR PRESENTATION
DEEP VENOUS THROMBOSISDEEP VENOUS THROMBOSIS
Guide:Guide: By:By:
Prof. Dr. Achal GuptaProf. Dr. Achal Gupta (M.S., DNB)(M.S., DNB) Dr Nikhil ChopraDr Nikhil Chopra
HODHOD 22ndnd
yryr PG StudentPG Student
2. DefinitionDefinition
• Deep vein thrombosis is the formation of a bloodDeep vein thrombosis is the formation of a blood
clot in one of the deep veins of the body, usually in theclot in one of the deep veins of the body, usually in the
legleg
• IncidenceIncidence: Indian population< Western population: Indian population< Western population
• Around 2.7 per 1000 person-days of hospital stay with 50%Around 2.7 per 1000 person-days of hospital stay with 50%
hospitalised population at risk.hospitalised population at risk.
• Ref: Sharma et al, Indian J med Dec 2009Ref: Sharma et al, Indian J med Dec 2009
3. ETIOLOGYETIOLOGY
DVT usually originates in the lower extremity venous levelDVT usually originates in the lower extremity venous level
,starting at the calf vein level and progressing proximally to,starting at the calf vein level and progressing proximally to
involve popliteal ,femoral ,or iliac system.involve popliteal ,femoral ,or iliac system.
80 -90 % pulmonary emboli originates here .80 -90 % pulmonary emboli originates here .
4. Virchow triadVirchow triad
Virchow described a triad of factors ofVirchow described a triad of factors of
a.a. Venous stasis,Venous stasis,
b.b. Endothelial damage, andEndothelial damage, and
c.c. Hypercoagulable stateHypercoagulable state
5. Venous stasisVenous stasis
Prolonged bed rest (4 days or more)Prolonged bed rest (4 days or more)
A cast on the legA cast on the leg
Limb paralysis from stroke or spinal cord injuryLimb paralysis from stroke or spinal cord injury
extended travel in a vehicleextended travel in a vehicle
HypercoagulabilityHypercoagulability
Surgery and traumaSurgery and trauma
MalignancyMalignancy
Increased estrogenIncreased estrogen
6. Disorders of coagulationDisorders of coagulation
InheritedInherited
Deficiencies ofDeficiencies of
1.1. Protein ‘S,Protein ‘S,
2.2. Protein ‘C,’ andProtein ‘C,’ and
3.3. Antithrombin IIIAntithrombin III
AcquiredAcquired
a.a. Nephrotic syndromeNephrotic syndrome
b.b. Antiphospholipid antibodiesAntiphospholipid antibodies
c.c. Inflammatory processes such as SLE, Sickle cell disease andInflammatory processes such as SLE, Sickle cell disease and
IBDIBD
8. Wells Clinical Prediction GuideWells Clinical Prediction Guide
Active cancer (treatment ongoing, or within 6 monthsActive cancer (treatment ongoing, or within 6 months
or palliative) = +1or palliative) = +1
Paralysis or recent immobilization = +1Paralysis or recent immobilization = +1
Recently bedridden for >3 days or major surgery <4Recently bedridden for >3 days or major surgery <4
weeks = +1weeks = +1
9. Localized tenderness along the distribution of the deepLocalized tenderness along the distribution of the deep
venous system = +1venous system = +1
Entire leg swelling = +1Entire leg swelling = +1
Calf swelling >3 cm compared to the asymptomatic legCalf swelling >3 cm compared to the asymptomatic leg
= +1= +1
Pitting edema (greater in the symptomatic leg) = +1Pitting edema (greater in the symptomatic leg) = +1
Collateral superficial veins (nonvaricose) = +1Collateral superficial veins (nonvaricose) = +1
Alternative diagnosis (as likely or > that of DVT)= -2Alternative diagnosis (as likely or > that of DVT)= -2
10. Total of Above ScoreTotal of Above Score
High probability: Score 3High probability: Score 3
Moderate probability: Score = 1 or 2Moderate probability: Score = 1 or 2
Low probability: Score 0Low probability: Score 0
11. Diagnostic StudiesDiagnostic Studies
Clinical examination alone is able to confirm only 20-Clinical examination alone is able to confirm only 20-
30% of cases of DVT30% of cases of DVT
Blood TestsBlood Tests
the D-dimerthe D-dimer
INR.INR.
12. D-dimerD-dimer
D-dimer is a specific degradation product of cross-linked fibrin.D-dimer is a specific degradation product of cross-linked fibrin.
Because concurrent production and breakdown of clotBecause concurrent production and breakdown of clot
characterize thrombosis, patients with thromboembolic diseasecharacterize thrombosis, patients with thromboembolic disease
have elevated levels of D-dimerhave elevated levels of D-dimer
Three major approaches for measuring D-dimerThree major approaches for measuring D-dimer
ELISAELISA
Latex agglutinationLatex agglutination
Blood agglutination testBlood agglutination test
13. False-positive D-dimers occur in patients withFalse-positive D-dimers occur in patients with
recent (within 10 days) surgery or trauma,recent (within 10 days) surgery or trauma,
recent myocardial infarction or stroke,recent myocardial infarction or stroke,
acute infection,acute infection,
disseminated intravascular coagulation,disseminated intravascular coagulation,
pregnancy or recent delivery,pregnancy or recent delivery,
active collagen vascular disease, or metastatic canceractive collagen vascular disease, or metastatic cancer
15. VenographyVenography
Gold standard” modality for the diagnosis of DVTGold standard” modality for the diagnosis of DVT
Nuclear Medicine StudiesNuclear Medicine Studies
Can distinguish new clot fromCan distinguish new clot from an old clotan old clot
16. UltrasonographyUltrasonography
Color-flow Duplex scanning is the imaging test of choice forColor-flow Duplex scanning is the imaging test of choice for
patients with suspected DVTpatients with suspected DVT
inexpensive,inexpensive,
noninvasive,noninvasive,
widely availablewidely available
Ultrasound can also distinguish other causes of leg swelling, suchUltrasound can also distinguish other causes of leg swelling, such
as tumor, popliteal cyst, abscess, aneurysm, or hematoma. as tumor, popliteal cyst, abscess, aneurysm, or hematoma.
17. Clinical limitationsClinical limitations
expensiveexpensive
reader dependentreader dependent
Duplex scans are less likely to detect non-occluding thrombi.Duplex scans are less likely to detect non-occluding thrombi.
During the second half of pregnancy, ultrasound becomes lessDuring the second half of pregnancy, ultrasound becomes less
specific, because the gravid uterus compresses the inferior venaspecific, because the gravid uterus compresses the inferior vena
cava, thereby changing Doppler flow in the lower extremitiescava, thereby changing Doppler flow in the lower extremities
18. Magnetic Resonance ImagingMagnetic Resonance Imaging
It detects leg, pelvis, and pulmonary thrombi and is 97%It detects leg, pelvis, and pulmonary thrombi and is 97%
sensitive and 95% specific for DVT.sensitive and 95% specific for DVT.
It distinguishes a mature from an immature clot.It distinguishes a mature from an immature clot.
MRI is safe in all stages of pregnancy.MRI is safe in all stages of pregnancy.
19. DIFFERENTIAL DIAGNOSISDIFFERENTIAL DIAGNOSIS
CellulitisCellulitis
ThrombophlebitisThrombophlebitis
ArthritisArthritis
Peripheral edemaPeripheral edema
LymphangitisLymphangitis
Extrinsic compression of iliacExtrinsic compression of iliac
veinvein
LymphedemaLymphedema
Muscle or soft tissue injuryMuscle or soft tissue injury
Neurogenic painNeurogenic pain
Postphlebitic syndromePostphlebitic syndrome
Prolonged immobilization orProlonged immobilization or
limb paralysislimb paralysis
Ruptured Baker cystRuptured Baker cyst
Stress fractures or other bonyStress fractures or other bony
lesionslesions
Superficial thrombophlebitisSuperficial thrombophlebitis
Varicose veinsVaricose veins
23. Advantages of Low-Molecular-Weight
Heparin Over
Standard Unfractionated Heparin
Superior bioavailability
Superior or equivalent safety and efficacy
Subcutaneous once- or twice-daily dosing
No laboratory monitoring*
Less phlebotomy (no monitoring/no intravenous line)
Less thrombocytopenia
At the present time, 3 LMWH preparations,At the present time, 3 LMWH preparations,
Enoxaparin,Enoxaparin,
Dalteparin, andDalteparin, and
ArdeparinArdeparin
24. WarfarinWarfarin
Interferes with hepatic synthesis of vitamin K-dependentInterferes with hepatic synthesis of vitamin K-dependent
coagulation factorscoagulation factors
Monitoring: INRMonitoring: INR
caution in active tuberculosis or diabetes; patients with protein Ccaution in active tuberculosis or diabetes; patients with protein C
or S deficiencyor S deficiency
25. Thrombolytic therapy for DVTThrombolytic therapy for DVT
Advantages:Advantages:
prompt resolution of symptoms,prompt resolution of symptoms,
prevention of pulmonary embolism,prevention of pulmonary embolism,
restoration of normal venous circulation,restoration of normal venous circulation,
preservation of venous valvular function,preservation of venous valvular function,
prevention of postphlebitic syndromeprevention of postphlebitic syndrome
Thrombolytic therapy does not preventThrombolytic therapy does not prevent
clot propagation,clot propagation,
rethrombosis, orrethrombosis, or
subsequent embolization.subsequent embolization.
26. Surgery for DVTSurgery for DVT
IndicationsIndications
a.a. when anticoagulant therapy is ineffectivewhen anticoagulant therapy is ineffective
b.b. unsafe,unsafe,
c.c. contraindicated.contraindicated.
27. These pulmonary emboli removed at autopsy look likeThese pulmonary emboli removed at autopsy look like
casts of the deep veins of the leg where they originated.casts of the deep veins of the leg where they originated.
28. This patient underwent a thrombectomy. The thrombus has beenThis patient underwent a thrombectomy. The thrombus has been
laid over the approximate location in the leg veins where itlaid over the approximate location in the leg veins where it
developed.developed.
29. Filters for DVTFilters for DVT
Indications:Indications:
a.a. Pulmonary embolismPulmonary embolism
b.b. Recurrent pulmonary embolism despite adequate anticoagulationRecurrent pulmonary embolism despite adequate anticoagulation
Controversial indications:Controversial indications:
a.a. DVTDVT
b.b. In patients with pre-existing pulmonary hypertensionIn patients with pre-existing pulmonary hypertension
c.c. Free floating thrombusFree floating thrombus
d.d. Failure of existing filter deviceFailure of existing filter device
e.e. Post pulmonary embolectomyPost pulmonary embolectomy
32. Further Inpatient CareFurther Inpatient Care
Most patients with confirmed proximal vein DVT may be treatedMost patients with confirmed proximal vein DVT may be treated
safely on an outpatient basis. Exclusion criteria for outpatientsafely on an outpatient basis. Exclusion criteria for outpatient
management are as follows:management are as follows:
a.a. Suspected or proven concomitant pulmonary embolismSuspected or proven concomitant pulmonary embolism
b.b. Significant cardiovascular or pulmonary comorbiditySignificant cardiovascular or pulmonary comorbidity
c.c. Morbid obesityMorbid obesity
d.d. Renal failureRenal failure
e.e. Unavailable or unable to arrange close follow-up careUnavailable or unable to arrange close follow-up care
33. Duration of anticoagulation in patients with deepDuration of anticoagulation in patients with deep
vein thrombosisvein thrombosis
a.a. Transient cause and no other risk factors: 3 monthsTransient cause and no other risk factors: 3 months
b.b. Idiopathic: 3-6 monthsIdiopathic: 3-6 months
c.c. Ongoing risk: 6 -12 monthsOngoing risk: 6 -12 months
d.d. Recurrent pulmonary embolism/DVT: 6-12 monthsRecurrent pulmonary embolism/DVT: 6-12 months
e.e. Patients with high risk of recurrent thrombosis exceeding riskPatients with high risk of recurrent thrombosis exceeding risk
of anticoagulation: indefinite duration (subject to review)of anticoagulation: indefinite duration (subject to review)
35. Prognosis:Prognosis:
All patients with proximal vein DVT are at long-term risk of developingAll patients with proximal vein DVT are at long-term risk of developing
chronic venous insufficiency.chronic venous insufficiency.
Proximal DVT---- 20% PE --10% mortalityProximal DVT---- 20% PE --10% mortality
DVT confined to the calf: no PEDVT confined to the calf: no PE
36. Patient Education:Patient Education:
Advise women taking estrogen of the risks andAdvise women taking estrogen of the risks and
common symptoms of thromboembolic disease.common symptoms of thromboembolic disease.
Discourage prolonged immobility, particularly on planeDiscourage prolonged immobility, particularly on plane
rides and long car tripsrides and long car trips
37. DVT PROPHYLAXIS IN SURGICALDVT PROPHYLAXIS IN SURGICAL
PATIENTSPATIENTS
A VTE risk assessment should follow the following steps:A VTE risk assessment should follow the following steps:
Step 1Step 1 Assess the patient’s baseline risk of VTE, taking intoAssess the patient’s baseline risk of VTE, taking into
account inherited and acquired pt factorsaccount inherited and acquired pt factors
Step 2Step 2 Assess the patient’s additional risk of VTE, takingAssess the patient’s additional risk of VTE, taking
account of the reasons for hospitalisation.account of the reasons for hospitalisation.
Step 3Step 3 Assess the patient’s risk of bleeding.Assess the patient’s risk of bleeding.
Step 4Step 4 Formulate an overall risk assessment (with considerationFormulate an overall risk assessment (with consideration
of VTE risk and bleeding risk).of VTE risk and bleeding risk).
Step 5Step 5 Select appropriate methods of thromboprophylaxisSelect appropriate methods of thromboprophylaxis
based on the risk assessment.based on the risk assessment.
38. Thromboprophylaxis is initiated depending on combination ofThromboprophylaxis is initiated depending on combination of
multiple risk factors:multiple risk factors:
Individual pt risk factorsIndividual pt risk factors
Risk factors related to acute medical illnessRisk factors related to acute medical illness
Risk related to surgical procedureRisk related to surgical procedure
39. Individual patient risk factorsIndividual patient risk factors::
ageage
pregnancy and the puerperiumpregnancy and the puerperium
active or occult malignancyactive or occult malignancy
previous VTEprevious VTE
varicose veinsvaricose veins
marked obesitymarked obesity
prolonged severe immobilityprolonged severe immobility
use of oestrogen-containing hormone replacement therapy oruse of oestrogen-containing hormone replacement therapy or
oral contraceptivesoral contraceptives
•• inherited or acquired thrombophiliainherited or acquired thrombophilia
40. Risks related to an acute medical
illness:
a. acute or acute on chronic chest infection
b. heart failure
c. myocardial infarction
d. stroke with immobility
e. some forms of cancer chemotherapy
f. acute inflammatory bowel disease
Risks related to an injury or surgical
procedure:
All surgical procedures but especially abdominal,
pelvic, thoracic or orthopaedic surgical
procedures
41. BLEEDING RISKBLEEDING RISK
recent central nervous system bleedingrecent central nervous system bleeding
intracranial or spinal lesion at high risk for bleedingintracranial or spinal lesion at high risk for bleeding
current active major bleeding, defined as requiring at least twocurrent active major bleeding, defined as requiring at least two
units of blood or blood products to be transfused in 24 hoursunits of blood or blood products to be transfused in 24 hours
current chronic, clinically significant and measurable bleedingcurrent chronic, clinically significant and measurable bleeding
over 48 hoursover 48 hours
42. GuidelinesGuidelines
Identification of risk:Identification of risk:
RISK SURGERY AGE (yrs) RISK
FACTORS
Low <30min <40 Nil
Moderate <30 min
<30 min
>30 min
--
40-60
<40
+nt
Nil
Nil
High <30 min
>30 min
>60
> 40
+nt
+nt
Highest >30 min 60 +nt plus
history of
VTE