Septal ablation involves injecting alcohol into the septal artery to induce a controlled infarction and is used to treat HOCM. The procedure uses TEE monitoring and a temporary pacemaker. Atrial ablation uses a catheter to deliver energy like cryothermy, radiofrequency, or lasers to scar tissue causing arrhythmias like Afib or flutter. Both procedures carry risks like infection or damage but have high success rates around 90% for treating conditions like HOCM, Afib, or SVT.
Our concepts of heart disease are based on the enormous reservoir of physiologic and anatomic knowledge derived from the past 70 years' of experience in the cardiac catheterization laboratory.
As Andre Cournand remarked in his Nobel lecture of December 11, 1956, the cardiac catheter was the key in the lock.
By turning this key, Cournand and his colleagues led us into a new era in the understanding of normal and disordered cardiac function in huma
Our concepts of heart disease are based on the enormous reservoir of physiologic and anatomic knowledge derived from the past 70 years' of experience in the cardiac catheterization laboratory.
As Andre Cournand remarked in his Nobel lecture of December 11, 1956, the cardiac catheter was the key in the lock.
By turning this key, Cournand and his colleagues led us into a new era in the understanding of normal and disordered cardiac function in huma
A lecture on the echocardiographic evaluation of hypertrophic cardiomyopathy. Starts with an overview of the topic then a systematic approach to diagnosis and then a differential diagnosis followed by take-home messages and conclusion.
Various coronary physiological measurements can be made in the cardiac catheterization laboratory using sensor-tipped guidewires; they include the measurement of poststenotic absolute coronary flow reserve, the relative coronary flow reserve, and the pressure-derived fractional flow reserve of the myocardium. Ambiguity regarding abnormal microcirculation has been reduced or eliminated with measurements of relative coronary flow reserve and fractional flow reserve. The role of microvascular flow impairment can be separately determined with coronary flow velocity reserve measurements. In addition to lesion assessment before and after intervention, emerging applications of coronary physiology include the determination of physiological responses to new pharmacological agents, such as glycoprotein IIb/IIIa blockers, in patients with acute myocardial infarction. Measurements of coronary physiology in the catheterization laboratory provide objective data that complement angiography for clinical decision-making
A transesophageal echocardiogram, or TEE, is an alternative way to perform an echocardiogram. A specialized probe containing an ultrasound transducer at its tip is passed into the patient's esophagus. This allows image and Doppler evaluation which can be recorded. It has several advantages and some disadvantages compared with a transthoracic echocardiogram.
Percutaneous Balloon Mitral Valvuloplasty (PBMV) is a procedure to dilated the mitral valve in the setting of rheumatic mitral valve stenosis. A catheter is inserted into the femoral vein, advanced to the right atrium and across the interatrial septum. Then the mitral valve is crossed with a balloon and it is inflated to relieve the fusion of the mitral valve commissures effectively acting to increase the mitral valve area and reduce the degree of mitral stenosis. Mitral regurgitation is a potential complication and thus PBMV is contraindicated if moderate or severe regurgitation is present. The Wilkins score examines mitral valve morphology and is determined via echocardiography to assess the likelihood of using PBMV based on certain echocardiographic criteria.
A lecture on the echocardiographic evaluation of hypertrophic cardiomyopathy. Starts with an overview of the topic then a systematic approach to diagnosis and then a differential diagnosis followed by take-home messages and conclusion.
Various coronary physiological measurements can be made in the cardiac catheterization laboratory using sensor-tipped guidewires; they include the measurement of poststenotic absolute coronary flow reserve, the relative coronary flow reserve, and the pressure-derived fractional flow reserve of the myocardium. Ambiguity regarding abnormal microcirculation has been reduced or eliminated with measurements of relative coronary flow reserve and fractional flow reserve. The role of microvascular flow impairment can be separately determined with coronary flow velocity reserve measurements. In addition to lesion assessment before and after intervention, emerging applications of coronary physiology include the determination of physiological responses to new pharmacological agents, such as glycoprotein IIb/IIIa blockers, in patients with acute myocardial infarction. Measurements of coronary physiology in the catheterization laboratory provide objective data that complement angiography for clinical decision-making
A transesophageal echocardiogram, or TEE, is an alternative way to perform an echocardiogram. A specialized probe containing an ultrasound transducer at its tip is passed into the patient's esophagus. This allows image and Doppler evaluation which can be recorded. It has several advantages and some disadvantages compared with a transthoracic echocardiogram.
Percutaneous Balloon Mitral Valvuloplasty (PBMV) is a procedure to dilated the mitral valve in the setting of rheumatic mitral valve stenosis. A catheter is inserted into the femoral vein, advanced to the right atrium and across the interatrial septum. Then the mitral valve is crossed with a balloon and it is inflated to relieve the fusion of the mitral valve commissures effectively acting to increase the mitral valve area and reduce the degree of mitral stenosis. Mitral regurgitation is a potential complication and thus PBMV is contraindicated if moderate or severe regurgitation is present. The Wilkins score examines mitral valve morphology and is determined via echocardiography to assess the likelihood of using PBMV based on certain echocardiographic criteria.
Definition of stroke and cerebrovascular disorders and pathophysiology of cerebral infarct and CT imaging overview of acute-subacute and chronic infarcts and penumbra.
causes of cerebral edema , Radiological signs of acute infarct and hemorrhagic infarct and comparison of MRI and CT in the diagnosis of acute infarct
Role of diffusion weighted imaging (DWI) and diffusion perfusion mismatch
This essay discusses accrediting organization in the ultrasound field. It can challenging and a bit overwhelming for ultrasound students to choose what accreditation they should get in order to obtain the best suited job after graduation.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
These lecture slides, by Dr Sidra Arshad, offer a quick overview of 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 leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
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. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- 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
2. OBJECTIVES
Describe the differences between septal ablation & atrial
ablation
Be able to explain the general procedure for each type of
ablation
Understand the specific uses for each type of ablation
By the end of this presentation you should be able to:
4. WHAT IS “ALCOHOL SEPTALABLATION”?
Procedure involving injection of pure alcohol into the target septal
branch of the LAD to induce a controlled infarction
HISTORY:
Minimally invasive procedure introduced in 1994
Targeted poor surgical candidates
Treatment for HOCM patients
5. HYPERTROPHIC CARDIOMYOPATHY
(HCM)
Non-obstructed vs. Obstructed
1/3 patients have non-obstructed HCM
Obstruction to LVOT is typically found
Symptoms: SOB, CP, Heart Murmur, Palpitations
Causes: Genetically inherited
Relative screening
6. HYPERTROPHIC OBSTRUCTIVE
CARDIOMYOPATHY (HOCM)
Septum becomes asymmetrically thickened & mitral valve moves in
an anterior motion, obstructing aortic outflow in systole
Obstructive vs. Provocable
Obstructive: ASH + SAM
Provocable: SAM of MV leaflets, mid-systolic closure of AoV,
& mitral regurgitation with exercise
7. PROCEDURE
1. Sedative administered
2. TEE monitors cardiac activity
3. Tubes are inserted into groin + temporary pacemaker passed to RV
4. Guide wire & balloon catheter
5. Position of sepal artery is identified (contrast + balloon catheter)
8. PROCEDURE CONTINUED…
6. Alcohol (2-5 cc) is injected
7. Balloon is deflated and removed
Refined over the years:
Utilization of myocardial contrast
Alcohol reduction
12. WHAT IS “CATHETER ABLATION”?
A procedure that uses an energy source to destroy a small
area of the heart tissue that is causing rapid & irregular heart
beats
History:
Originated in 1980s
1990s: Atrial fibrillation
13. WHY HAVE A CATHETER ABLATION?
Unsuccessful medications
Serious side effects
Arrhythmias that respond extremely well to procedure
(Wolff-Parkinson-White Syndrome)
High risk of complications
16. PROCEDURE
1. Catheter inserted & threaded to heart
2. Catheter’s tip threaded through incision in atrial septum
3. Positioned to ablate tissue related to source of erratic electrical signal
(typically PV)
4. Catheter uses an energy source to create a lesion of scar tissue)
Cryothermy (intense cold)
Radiofrequency energy (radio)
Laser energy (light waves)
18. RISKS
Catheter site infection
Damage to vessels
Puncture of heart
Damage to heart valves
Venous thromboembolism
Stroke or heart attack
Damage to heart’s electrical system
Very low risk (90% success)
19. - Use of pure alcohol
- Treat HOCM patients
- Use of TEE
-Catheter balloon
-Contrast used
-Temporary pacemaker
- Energy source based
(cold, radio, light)
- Treats Afib, Atrial
flutter, SVT
- 3D mapping
Septal Ablation Atrial Ablation
-Catheter
based
-SOB, CP,
arrhythmias
-low risk
20. QUIZ
1. Septal ablation is typically a treatment option for patients with
what type of cardiomyopathy?
2. (True/False) Septal & Atrial ablations are considered low risk
procedures.
3. What are the three types of catheter energy sources associated with
atrial ablations?
Cryothermy (cold), Radiofrequency (radio), laser energy (light)
HOCM
True
Induce a controlled infarction of the hypertrophied septum & get rid of the dynamic outflow obstruction
1994: less invasive treatment instead of surgical myomectomy for HOCM patients
Disease in which the myocardium becomes abnormally thick
Sudden death in young athletes
Causes: 50% chance of passing mutation to child
Obstructive: Asymmetric Septal Hypertrophy + Septal Anterior Motion
--- Resting gradient > or equal to 30 mmHg
Provocable: “Dynamic Obstruction”
----Resting gradient is < 30 mmHg but obstruction occurs with exercise
For pain & relaxation
Before & after procedure
Tubes inserted into groin via artery & vein /// Pacemaker passed through venous system to RV of heart
Moved towards heart
via contrast injection, & a balloon catheter is inflated to temporarily block the septal artery
“Septal Artery” = Coronary Art
6. causing the muscles cells in that area to shrink or die
7. From septal artery
Refined:
--for localization area at risk of infarction
--
--10% of patients eventually need a permanent pacemaker
Top Left: To show where ablation should be performed.
Bottom Right: septal ablation procedure for symptomatic HOCM patient
A) Angio sequence: first major septal perforator (connector of deep + superficial vessel) artery with 2 sub-branches (black arrows) as the target vessels for procedure. The long white arrow indicated the temporary pacemaker, while the shorter white arrow indicated the pigtail catheter in LV, with the balloon at the proximal part of the septal perforator
B) distal vessel of the 2 sub-branches with angioplasty
C) Balloon is advanced super-selective into left/basal sub branch
Corresponding Echo sequence:
D) dotted area circling target region of septum with SAM & subaortic obstruction
E) Test injection of echo contrast agent in balloon position of angio B picture (White arrows: highlighting the basal half of septum plus a RV papillary muscle)
F) After the super-selective balloon position of angio C picture, correct opacification of target region achieved
Super-selective angiography: smaller catheter passed through a larger one into a branch artery supplying a small area of tissue
--1980s: treating cardiac arrhythmias
--Variations of procedure have evolved over time
--No success with medications used to treat arrhythmias
--Had a serious side effect from arrhythmia medications
--- WCW: extra electrical pathway between Atria and Ventricles which causes a rapid heart beat (tachycardia)
--Affects people of all ages (11-50 years), including infants
--typically not life threatening but serious heart problems can occur
--from arrhythmias (cardiac arrest)
SVT:
---Due to an abnormal section of heart muscle that allows electricity to “loop”
---1 in 1,000 people
Small punctures are made in the groin, arm, or neck and a thin
4. such as radiofrequency energy (radio waves), cryothermy (intense cold), or laser energy (light waves) to create a lesion of scar tissue (conduction block), that stops the electrical signals from traveling through the heart
Catheter ablation procedure may be necessary to stop heart tissue from causing the arrhythmia.
Numbing small area of groin with a needle
Short, hollow tube in inserted in femoral vein called a catheter sheath
Long, flexible tube is inserted through the sheath
Catheter is guided to the heart through the IVC
5-6.Once catheter reaches heart, it is guided via 3D mapping to correction location of the arrhythmia area
7. Tip of the catheter will admit either hot or cold energy to ablate the tissue
8-9. If affected area is small: focal ablation used
Area is large + complex: ablation remodeling used
--Damage to vessels due to catheter scrapping it as it traveled to heart
--Damage to electrical system…worsening patient’s and require a pacemaker to correct
