Shunt quantification
•Download as PPTX, PDF•
3 likes•712 views
A cardiac shunt is a pattern of blood flow in the heart that deviates from the normal circuit of the circulatory system. It may be described as right-left, left-right or bidirectional, or as systemic-to-pulmonary or pulmonary-to-systemic.
Report
Share
Report
Share
Recommended
Echo assesment of rv function
This document discusses the limitations and techniques for assessing right ventricular (RV) function using echocardiography. It is difficult to accurately evaluate RV volume, delineate borders, and image the entire RV using echocardiography due to its complex crescent shape. However, the document recommends using RV fractional area change, tricuspid annular plane systolic excursion, tissue Doppler S' velocity, and Tei index to quantitatively assess RV systolic function as they are reproducible methods. RV dimensions, wall thickness, and outflow tract size can also provide information on RV size and function. Assessment of RV diastolic function includes parameters like E/A ratio, E/E' ratio, and deceleration time.
Asd ppt
The document discusses atrial septal defects (ASDs), including indications for closure, procedural details, and echocardiographic assessment. Key points include:
- ASD closure is recommended in the presence of right-sided heart volume overload or symptoms. It prevents further deterioration and helps normalize heart size.
- Indications for closure include hemodynamically significant ASD, paradoxical embolism risk, and transient cyanosis. Contraindications include irreversible pulmonary hypertension.
- Echocardiography is used to assess defect size, rims, and shunt severity. Deficient rims, especially aortic and superior vena cava, increase erosion risk post-closure.
Echo assessment of RV function
The document provides an overview of right ventricular assessment using echocardiography. It discusses normal RV anatomy, segmental nomenclature, and coronary supply. Key metrics for evaluating RV size, wall thickness, function, and pressures are outlined. Normal values and technical aspects of measuring RV dimensions, area/fractional area change, tricuspid annular plane systolic excursion, myocardial velocity, and diastolic function are summarized. Hemodynamic assessment of pulmonary pressures is also reviewed.
Shunt quantification
This document discusses various methods for quantifying intracardiac shunts in patients with congenital heart lesions. It describes invasive oximetry and indicator dilution techniques as well as noninvasive Doppler echocardiography methods. For echocardiography, it outlines techniques for quantifying left-to-right shunts using pulmonary and aortic flow measurements, as well as a simplified method using diameter ratios. It also discusses limitations and sources of error for these quantification methods.
Id Pressure Waveforms
This document contains descriptions of 30 hemodynamic slides showing various cardiac pathologies. It provides the problems or pathologies seen in each slide and explanations. Some of the pathologies described include constrictive pericarditis, pulmonary valvular stenosis, ventricularization, hypertrophic obstructive cardiomyopathy, coarctation of the aorta, cardiac tamponade, and trigeminy. The document tests the reader's ability to interpret cardiac catheterization images and understand different cardiac pressures, waveforms and pathophysiology.
VSD devices
This document summarizes different devices used for closing ventricular septal defects (VSDs). It describes the common complications of VSD devices which are mostly minor, including embolization, arrhythmias, and conduction defects. Three types of Amplatzer devices are outlined - the muscular VSD device, asymmetric VSD occluder, and perimembranous VSD devices. Sizes and designs of each are provided. Results of post-myocardial infarction VSD closure show high residual leak rates. Finally, it briefly mentions some VSD devices manufactured in China including by Yatai and Lifetech, and introduces the novel NitOcclud VSD coil.
Coronary anomalies
The document discusses various coronary artery anomalies including anomalies of origination, course, and intrinsic anatomy. Some key points include:
- Coronary artery anomalies have a global incidence of 5.64% and incidence of sudden death is 0.6%
- Anomalous origination of the left main coronary artery from the pulmonary artery (ALCAPA) is a rare but serious anomaly if left untreated
- Certain anomalous coronary artery courses, such as between the aorta and pulmonary artery, are associated with higher risks of sudden cardiac death
- Other anomalies discussed include single coronary arteries, coronary hypoplasia, ectasia/aneurysms, and intramural coronary arteries
Asd device closure
Atrial septal defect (ASD) closure can be performed surgically or percutaneously. Percutaneous closure is preferred for secundum ASDs that meet criteria such as defect size less than 38mm and adequate rim tissue. Echocardiography guides device placement and confirms closure. Complications include device embolization, arrhythmias, and erosion. Most studies report high success rates with percutaneous closure and shorter hospital stays than surgery. Surgical closure is preferred for sinus venosus, primum, or coronary sinus defects.
Recommended
Echo assesment of rv function
This document discusses the limitations and techniques for assessing right ventricular (RV) function using echocardiography. It is difficult to accurately evaluate RV volume, delineate borders, and image the entire RV using echocardiography due to its complex crescent shape. However, the document recommends using RV fractional area change, tricuspid annular plane systolic excursion, tissue Doppler S' velocity, and Tei index to quantitatively assess RV systolic function as they are reproducible methods. RV dimensions, wall thickness, and outflow tract size can also provide information on RV size and function. Assessment of RV diastolic function includes parameters like E/A ratio, E/E' ratio, and deceleration time.
Asd ppt
The document discusses atrial septal defects (ASDs), including indications for closure, procedural details, and echocardiographic assessment. Key points include:
- ASD closure is recommended in the presence of right-sided heart volume overload or symptoms. It prevents further deterioration and helps normalize heart size.
- Indications for closure include hemodynamically significant ASD, paradoxical embolism risk, and transient cyanosis. Contraindications include irreversible pulmonary hypertension.
- Echocardiography is used to assess defect size, rims, and shunt severity. Deficient rims, especially aortic and superior vena cava, increase erosion risk post-closure.
Echo assessment of RV function
The document provides an overview of right ventricular assessment using echocardiography. It discusses normal RV anatomy, segmental nomenclature, and coronary supply. Key metrics for evaluating RV size, wall thickness, function, and pressures are outlined. Normal values and technical aspects of measuring RV dimensions, area/fractional area change, tricuspid annular plane systolic excursion, myocardial velocity, and diastolic function are summarized. Hemodynamic assessment of pulmonary pressures is also reviewed.
Shunt quantification
This document discusses various methods for quantifying intracardiac shunts in patients with congenital heart lesions. It describes invasive oximetry and indicator dilution techniques as well as noninvasive Doppler echocardiography methods. For echocardiography, it outlines techniques for quantifying left-to-right shunts using pulmonary and aortic flow measurements, as well as a simplified method using diameter ratios. It also discusses limitations and sources of error for these quantification methods.
Id Pressure Waveforms
This document contains descriptions of 30 hemodynamic slides showing various cardiac pathologies. It provides the problems or pathologies seen in each slide and explanations. Some of the pathologies described include constrictive pericarditis, pulmonary valvular stenosis, ventricularization, hypertrophic obstructive cardiomyopathy, coarctation of the aorta, cardiac tamponade, and trigeminy. The document tests the reader's ability to interpret cardiac catheterization images and understand different cardiac pressures, waveforms and pathophysiology.
VSD devices
This document summarizes different devices used for closing ventricular septal defects (VSDs). It describes the common complications of VSD devices which are mostly minor, including embolization, arrhythmias, and conduction defects. Three types of Amplatzer devices are outlined - the muscular VSD device, asymmetric VSD occluder, and perimembranous VSD devices. Sizes and designs of each are provided. Results of post-myocardial infarction VSD closure show high residual leak rates. Finally, it briefly mentions some VSD devices manufactured in China including by Yatai and Lifetech, and introduces the novel NitOcclud VSD coil.
Coronary anomalies
The document discusses various coronary artery anomalies including anomalies of origination, course, and intrinsic anatomy. Some key points include:
- Coronary artery anomalies have a global incidence of 5.64% and incidence of sudden death is 0.6%
- Anomalous origination of the left main coronary artery from the pulmonary artery (ALCAPA) is a rare but serious anomaly if left untreated
- Certain anomalous coronary artery courses, such as between the aorta and pulmonary artery, are associated with higher risks of sudden cardiac death
- Other anomalies discussed include single coronary arteries, coronary hypoplasia, ectasia/aneurysms, and intramural coronary arteries
Asd device closure
Atrial septal defect (ASD) closure can be performed surgically or percutaneously. Percutaneous closure is preferred for secundum ASDs that meet criteria such as defect size less than 38mm and adequate rim tissue. Echocardiography guides device placement and confirms closure. Complications include device embolization, arrhythmias, and erosion. Most studies report high success rates with percutaneous closure and shorter hospital stays than surgery. Surgical closure is preferred for sinus venosus, primum, or coronary sinus defects.
PBMV:Tips and Tricks
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.
Right heart catheters
This document provides information about right heart catheters and angiographic catheters. It discusses the history of right heart catheters from 1929 to 1970. It then describes the diagnostic and therapeutic indications for right heart catheterization. The document outlines the parts of a catheter including the hub, body, and tip. It summarizes several general purpose catheters used for right heart catheterization including the Cournand, Goodale-Lubin, multipurpose, and Swan-Ganz balloon flotation catheters. Finally, it discusses several angiographic catheters used including the pigtail, NIH, Berman, Gensini, and Lehman catheters.
EISENMENGER SYNDROME- PAUL WOOD
This document discusses Eisenmenger syndrome, a condition where pulmonary hypertension develops due to increased blood flow through defects between the systemic and pulmonary circulations. It provides details on causes, clinical features, pathology findings, and treatments. Key points include:
- Eisenmenger syndrome is caused by defects like VSDs, ASDs, and PDA that allow high blood flow to the lungs and cause pulmonary hypertension over time.
- Common causes of death include hemoptysis from pulmonary artery ruptures, heart failure, and complications from attempted defect repair surgery.
- Pathological findings show thickened pulmonary arteries that resemble the fetal pattern and contribute to high pulmonary vascular resistance.
- Medical treatments are generally ineffective once int
Atrial septostomy
This document discusses the history and technique of atrial septostomy. It describes how William Rashkind first developed the procedure in 1966 as a way to create an atrial septal defect without surgery. The document outlines the common indications for atrial septostomy in various congenital heart conditions. It provides details on the technical aspects of the procedure, including types of catheters, approaches, positioning, and success criteria. Complications are also mentioned, such as cardiac perforation which occurred in one case and was managed with surgery.
Percutaneous Pulmonary Valve Interventions
This document discusses percutaneous pulmonary valve interventions. It begins by providing background on the history of pulmonary valve interventions, starting with open surgical techniques and moving to percutaneous approaches developed in the 1950s. It then discusses the first successful percutaneous pulmonary valve implantation in 2000. The document provides details on the anatomy of the pulmonary valve, causes of pulmonary valve disease, techniques for percutaneous balloon pulmonary valvuloplasty, indications and contraindications for percutaneous pulmonary valve interventions, and the evolution and indications for transcatheter pulmonary valve implantation.
Strain and strain rate
This document discusses strain and strain rate imaging techniques used to quantify regional myocardial function. It describes various methods to measure strain, including tissue Doppler, 2D speckle tracking, and cardiac MRI. It outlines normal values and patterns of strain in healthy individuals and how strain is altered in various cardiac diseases, such as coronary artery disease, heart failure, cardiomyopathies, and congenital heart disease. Strain imaging can identify myocardial scar, viability, dysfunction, and response to treatments.
Echocardiography of CHD in Adults
This document discusses the use of echocardiography in evaluating congenital heart diseases in adults. It outlines the indications for echocardiography and describes how to perform the examination and interpret findings. Key abnormalities that can be identified include atrial septal defects, ventricular septal defects, atrioventricular septal defects, anomalies of venous inflow, and abnormalities of ventricular morphology. Echocardiography is well-suited for diagnosing and monitoring these congenital heart conditions in adulthood.
ASD devices
This document summarizes various devices used to close atrial septal defects (ASDs), including their designs, sizes, advantages, and disadvantages. The most commonly used device is the Amplatzer Septal Occluder, which has a double disc design and is self-expanding. Other devices discussed include the Gore HELEX, Lifetech/Cera, Figulla, Cardioseal/Starflex, and newer bioabsorbable options like the Biotrek. Complication rates of ASD device closure are generally low, below 10%, with embolization and arrhythmias being the most common issues. Larger trials have shown the Amplatzer to be very effective and easy
Diastolic Dysfunction 2016
The document discusses guidelines for assessing diastolic dysfunction according to the ASE/EACVI 2016 guidelines. It defines diastolic dysfunction and describes the stages from grade I to grade IV. For each grade, it discusses the pathophysiology and key echocardiographic findings including mitral inflow patterns, tissue Doppler measurements, pulmonary vein flow, and left atrial size. The guidelines simplify the assessment of diastolic function into four grades based on parameters of left ventricular relaxation, left atrial pressure, mitral E/A ratio, E/e' ratio, pulmonary vein flow, and left atrial size.
TAVR/TAVI/TRANCATHETER SAORTIC VALVE REPLECEMENT
,virbhan ,dr virbhan balai ,virbhan ppt ,tavr ,tavi ,transcatheter aortic valve replacement ,trans catheter aortic valve implantation ,aortic valve replacement ,severe as ,aortic stenosis ,bicuspid aortic valve
PRESSURE MEASUREMENT by Cardiac catheterisation_Dr Amol Patil.pptx
1) Cardiac catheterization allows measurement of pressures within the heart by inserting catheters connected to transducers.
2) Proper equipment selection and setup is important to minimize artifacts and obtain accurate pressure tracings.
3) Different catheter types are used depending on the specific chamber being measured.
NO REFLOW
The document defines no-reflow as inadequate myocardial perfusion through a coronary circulation segment without mechanical vessel obstruction. No-reflow occurs in 30% of patients after reperfusion for myocardial infarction and is associated with worse outcomes. It results from microvascular obstruction from distal embolization, ischemic injury, and reperfusion injury. Diagnosis involves assessing TIMI flow, myocardial blush grade, and imaging techniques. Prevention focuses on reducing embolization using thrombectomy or filters while treatment involves vasodilators like adenosine, verapamil, and glycoprotein IIb/IIIa inhibitors.
No reflow and slow flow phenomenon during pci
This document discusses strategies and prevention of slow flow and no-reflow phenomenon during percutaneous coronary intervention (PCI). It defines no-reflow as inadequate myocardial perfusion through a coronary artery without mechanical obstruction. No-reflow occurs in 8-11% of primary PCIs and is associated with worse clinical outcomes. The pathophysiology involves distal embolization, ischemic injury, reperfusion injury, and individual patient susceptibility. Preventing no-reflow requires reducing thrombus burden, ischemia time, reperfusion injury through anti-inflammatory drugs, and addressing risk factors like diabetes.
cath Lab Hemoduhynamic
This document discusses hemodynamic principles and various cardiac pressures measured in the circulatory system. It begins by explaining how electrical activity leads to mechanical functions that generate pressure waves. It then discusses how to measure and interpret pressures in different parts of the heart including the aorta, pulmonary artery, right and left ventricles, and right atrium. Factors that influence pressures and common abnormalities are provided. Diagrams of normal pressure waveforms are displayed. The document concludes by defining pulmonary and systemic vascular resistances.
hemodynamic in cath lab: aortic stenosis and hocm
1) Cardiac catheterization can provide key information about aortic stenosis including transvalvular pressure gradients, the level of stenosis, and estimation of valve area.
2) Low-flow, low-gradient aortic stenosis can be further classified as either having a decreased ejection fraction or a paradoxically normal ejection fraction.
3) In hypertrophic cardiomyopathy, cardiac catheterization can identify dynamic intraventricular pressure gradients that may only be provoked with maneuvers like the Valsalva maneuver.
TAVI - Transcatheter Aortic Valve Implantation
An extensive presentation on the upcoming catheter based aortic valve implantation including a future perspective of TAVI
Cath hemodynamics vir
The document summarizes key aspects of cardiac catheterization and hemodynamic data collection. It describes the normal cardiac cycle, pressure measurement systems, normal pressure waveforms, methods to measure cardiac output like thermodilution and Fick, how to evaluate valvular stenosis and regurgitation, determine vascular resistance and shunts. Specific details are provided on assessing aortic stenosis, mitral stenosis, right-sided valves and quantifying regurgitant fractions. Oxygen saturation analysis and Fick principles are outlined for shunt determinations.
Norwood Procedure.pptx
The Norwood procedure is the first of three surgeries required to treat single-ventricle conditions such as hypoplastic left heart syndrome (HLHS). Because the left side of the heart can’t be fixed, the series of surgeries rebuilds other parts of the heart.
The Norwood procedure is performed in the baby’s first or second week of life.to redirect the blood flow.
Three goals for the Norwood procedure:
1, Build a new aorta.
2, Direct blood from the right ventricle through the new aorta and on to the rest of the body.
3, Direct the right ventricle to pump blood to the lungs until the next surgery.
FRACTIONAL FLOW RESERVE
This document discusses fractional flow reserve (FFR), which is a technique used to functionally assess the significance of coronary artery stenosis. FFR is defined as the ratio of maximum blood flow in a stenotic artery to maximum blood flow if there was no stenosis. It is calculated as the ratio of mean distal coronary pressure (Pd) to mean aortic pressure (Pa) during maximal hyperemia induced by pharmacological agents. An FFR value below 0.75 is associated with inducible ischemia, while a value above 0.80 indicates an insignificant stenosis in most cases. FFR has advantages over angiography alone in evaluating stenosis as it accounts for vessel characteristics like length and takes collateral flow into consideration.
Tte and tee assessment for asd closure 2
1) Transthoracic and transesophageal echocardiography are important modalities for assessing atrial septal defects (ASDs). TTE can identify RV volume overload and septal flattening, while TEE precisely measures defect size and evaluates rim morphology.
2) The four main types of ASDs - ostium secundum, ostium primum, sinus venosus, and coronary sinus defects - have distinguishing echo features. Doppler can demonstrate shunt direction and magnitude.
3) Echocardiography guides percutaneous ASD closure by assessing defect and rim anatomy, device sizing, and post-procedure result. Understanding echo features is key to ensuring procedure success.
oxymetery.pptx
This document discusses oximetry, a technique used to detect left-to-right and right-to-left cardiac shunts by measuring oxygen saturation levels in different chambers of the heart. It explains how to perform an oximetry run to collect blood samples and calculate pulmonary and systemic blood flows. A significant step up in oxygen saturation between chambers indicates the presence and location of a shunt. The document also discusses limitations of oximetry and alternative methods for detecting shunts like angiography and echocardiography.
Chap 40
1. The document discusses the transport of oxygen and carbon dioxide in the blood and tissues. It describes how oxygen is carried by hemoglobin in red blood cells and is transported to tissues where it is released, while carbon dioxide is transported primarily as bicarbonate in the blood and transported to the lungs to be released.
2. The oxygen dissociation curve is explained, showing hemoglobin's affinity for oxygen at different partial pressures. Factors like pH, temperature, and 2,3-DPG can shift the curve right or left.
3. Carbon dioxide is transported in three forms - dissolved, as bicarbonate, and bound to hemoglobin. The chloride shift and Bohr and Haldane effects
More Related Content
What's hot
PBMV:Tips and Tricks
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.
Right heart catheters
This document provides information about right heart catheters and angiographic catheters. It discusses the history of right heart catheters from 1929 to 1970. It then describes the diagnostic and therapeutic indications for right heart catheterization. The document outlines the parts of a catheter including the hub, body, and tip. It summarizes several general purpose catheters used for right heart catheterization including the Cournand, Goodale-Lubin, multipurpose, and Swan-Ganz balloon flotation catheters. Finally, it discusses several angiographic catheters used including the pigtail, NIH, Berman, Gensini, and Lehman catheters.
EISENMENGER SYNDROME- PAUL WOOD
This document discusses Eisenmenger syndrome, a condition where pulmonary hypertension develops due to increased blood flow through defects between the systemic and pulmonary circulations. It provides details on causes, clinical features, pathology findings, and treatments. Key points include:
- Eisenmenger syndrome is caused by defects like VSDs, ASDs, and PDA that allow high blood flow to the lungs and cause pulmonary hypertension over time.
- Common causes of death include hemoptysis from pulmonary artery ruptures, heart failure, and complications from attempted defect repair surgery.
- Pathological findings show thickened pulmonary arteries that resemble the fetal pattern and contribute to high pulmonary vascular resistance.
- Medical treatments are generally ineffective once int
Atrial septostomy
This document discusses the history and technique of atrial septostomy. It describes how William Rashkind first developed the procedure in 1966 as a way to create an atrial septal defect without surgery. The document outlines the common indications for atrial septostomy in various congenital heart conditions. It provides details on the technical aspects of the procedure, including types of catheters, approaches, positioning, and success criteria. Complications are also mentioned, such as cardiac perforation which occurred in one case and was managed with surgery.
Percutaneous Pulmonary Valve Interventions
This document discusses percutaneous pulmonary valve interventions. It begins by providing background on the history of pulmonary valve interventions, starting with open surgical techniques and moving to percutaneous approaches developed in the 1950s. It then discusses the first successful percutaneous pulmonary valve implantation in 2000. The document provides details on the anatomy of the pulmonary valve, causes of pulmonary valve disease, techniques for percutaneous balloon pulmonary valvuloplasty, indications and contraindications for percutaneous pulmonary valve interventions, and the evolution and indications for transcatheter pulmonary valve implantation.
Strain and strain rate
This document discusses strain and strain rate imaging techniques used to quantify regional myocardial function. It describes various methods to measure strain, including tissue Doppler, 2D speckle tracking, and cardiac MRI. It outlines normal values and patterns of strain in healthy individuals and how strain is altered in various cardiac diseases, such as coronary artery disease, heart failure, cardiomyopathies, and congenital heart disease. Strain imaging can identify myocardial scar, viability, dysfunction, and response to treatments.
Echocardiography of CHD in Adults
This document discusses the use of echocardiography in evaluating congenital heart diseases in adults. It outlines the indications for echocardiography and describes how to perform the examination and interpret findings. Key abnormalities that can be identified include atrial septal defects, ventricular septal defects, atrioventricular septal defects, anomalies of venous inflow, and abnormalities of ventricular morphology. Echocardiography is well-suited for diagnosing and monitoring these congenital heart conditions in adulthood.
ASD devices
This document summarizes various devices used to close atrial septal defects (ASDs), including their designs, sizes, advantages, and disadvantages. The most commonly used device is the Amplatzer Septal Occluder, which has a double disc design and is self-expanding. Other devices discussed include the Gore HELEX, Lifetech/Cera, Figulla, Cardioseal/Starflex, and newer bioabsorbable options like the Biotrek. Complication rates of ASD device closure are generally low, below 10%, with embolization and arrhythmias being the most common issues. Larger trials have shown the Amplatzer to be very effective and easy
Diastolic Dysfunction 2016
The document discusses guidelines for assessing diastolic dysfunction according to the ASE/EACVI 2016 guidelines. It defines diastolic dysfunction and describes the stages from grade I to grade IV. For each grade, it discusses the pathophysiology and key echocardiographic findings including mitral inflow patterns, tissue Doppler measurements, pulmonary vein flow, and left atrial size. The guidelines simplify the assessment of diastolic function into four grades based on parameters of left ventricular relaxation, left atrial pressure, mitral E/A ratio, E/e' ratio, pulmonary vein flow, and left atrial size.
TAVR/TAVI/TRANCATHETER SAORTIC VALVE REPLECEMENT
,virbhan ,dr virbhan balai ,virbhan ppt ,tavr ,tavi ,transcatheter aortic valve replacement ,trans catheter aortic valve implantation ,aortic valve replacement ,severe as ,aortic stenosis ,bicuspid aortic valve
PRESSURE MEASUREMENT by Cardiac catheterisation_Dr Amol Patil.pptx
1) Cardiac catheterization allows measurement of pressures within the heart by inserting catheters connected to transducers.
2) Proper equipment selection and setup is important to minimize artifacts and obtain accurate pressure tracings.
3) Different catheter types are used depending on the specific chamber being measured.
NO REFLOW
The document defines no-reflow as inadequate myocardial perfusion through a coronary circulation segment without mechanical vessel obstruction. No-reflow occurs in 30% of patients after reperfusion for myocardial infarction and is associated with worse outcomes. It results from microvascular obstruction from distal embolization, ischemic injury, and reperfusion injury. Diagnosis involves assessing TIMI flow, myocardial blush grade, and imaging techniques. Prevention focuses on reducing embolization using thrombectomy or filters while treatment involves vasodilators like adenosine, verapamil, and glycoprotein IIb/IIIa inhibitors.
No reflow and slow flow phenomenon during pci
This document discusses strategies and prevention of slow flow and no-reflow phenomenon during percutaneous coronary intervention (PCI). It defines no-reflow as inadequate myocardial perfusion through a coronary artery without mechanical obstruction. No-reflow occurs in 8-11% of primary PCIs and is associated with worse clinical outcomes. The pathophysiology involves distal embolization, ischemic injury, reperfusion injury, and individual patient susceptibility. Preventing no-reflow requires reducing thrombus burden, ischemia time, reperfusion injury through anti-inflammatory drugs, and addressing risk factors like diabetes.
cath Lab Hemoduhynamic
This document discusses hemodynamic principles and various cardiac pressures measured in the circulatory system. It begins by explaining how electrical activity leads to mechanical functions that generate pressure waves. It then discusses how to measure and interpret pressures in different parts of the heart including the aorta, pulmonary artery, right and left ventricles, and right atrium. Factors that influence pressures and common abnormalities are provided. Diagrams of normal pressure waveforms are displayed. The document concludes by defining pulmonary and systemic vascular resistances.
hemodynamic in cath lab: aortic stenosis and hocm
1) Cardiac catheterization can provide key information about aortic stenosis including transvalvular pressure gradients, the level of stenosis, and estimation of valve area.
2) Low-flow, low-gradient aortic stenosis can be further classified as either having a decreased ejection fraction or a paradoxically normal ejection fraction.
3) In hypertrophic cardiomyopathy, cardiac catheterization can identify dynamic intraventricular pressure gradients that may only be provoked with maneuvers like the Valsalva maneuver.
TAVI - Transcatheter Aortic Valve Implantation
An extensive presentation on the upcoming catheter based aortic valve implantation including a future perspective of TAVI
Cath hemodynamics vir
The document summarizes key aspects of cardiac catheterization and hemodynamic data collection. It describes the normal cardiac cycle, pressure measurement systems, normal pressure waveforms, methods to measure cardiac output like thermodilution and Fick, how to evaluate valvular stenosis and regurgitation, determine vascular resistance and shunts. Specific details are provided on assessing aortic stenosis, mitral stenosis, right-sided valves and quantifying regurgitant fractions. Oxygen saturation analysis and Fick principles are outlined for shunt determinations.
Norwood Procedure.pptx
The Norwood procedure is the first of three surgeries required to treat single-ventricle conditions such as hypoplastic left heart syndrome (HLHS). Because the left side of the heart can’t be fixed, the series of surgeries rebuilds other parts of the heart.
The Norwood procedure is performed in the baby’s first or second week of life.to redirect the blood flow.
Three goals for the Norwood procedure:
1, Build a new aorta.
2, Direct blood from the right ventricle through the new aorta and on to the rest of the body.
3, Direct the right ventricle to pump blood to the lungs until the next surgery.
FRACTIONAL FLOW RESERVE
This document discusses fractional flow reserve (FFR), which is a technique used to functionally assess the significance of coronary artery stenosis. FFR is defined as the ratio of maximum blood flow in a stenotic artery to maximum blood flow if there was no stenosis. It is calculated as the ratio of mean distal coronary pressure (Pd) to mean aortic pressure (Pa) during maximal hyperemia induced by pharmacological agents. An FFR value below 0.75 is associated with inducible ischemia, while a value above 0.80 indicates an insignificant stenosis in most cases. FFR has advantages over angiography alone in evaluating stenosis as it accounts for vessel characteristics like length and takes collateral flow into consideration.
Tte and tee assessment for asd closure 2
1) Transthoracic and transesophageal echocardiography are important modalities for assessing atrial septal defects (ASDs). TTE can identify RV volume overload and septal flattening, while TEE precisely measures defect size and evaluates rim morphology.
2) The four main types of ASDs - ostium secundum, ostium primum, sinus venosus, and coronary sinus defects - have distinguishing echo features. Doppler can demonstrate shunt direction and magnitude.
3) Echocardiography guides percutaneous ASD closure by assessing defect and rim anatomy, device sizing, and post-procedure result. Understanding echo features is key to ensuring procedure success.
What's hot (20)
PRESSURE MEASUREMENT by Cardiac catheterisation_Dr Amol Patil.pptx
PRESSURE MEASUREMENT by Cardiac catheterisation_Dr Amol Patil.pptx
Similar to Shunt quantification
oxymetery.pptx
This document discusses oximetry, a technique used to detect left-to-right and right-to-left cardiac shunts by measuring oxygen saturation levels in different chambers of the heart. It explains how to perform an oximetry run to collect blood samples and calculate pulmonary and systemic blood flows. A significant step up in oxygen saturation between chambers indicates the presence and location of a shunt. The document also discusses limitations of oximetry and alternative methods for detecting shunts like angiography and echocardiography.
Chap 40
1. The document discusses the transport of oxygen and carbon dioxide in the blood and tissues. It describes how oxygen is carried by hemoglobin in red blood cells and is transported to tissues where it is released, while carbon dioxide is transported primarily as bicarbonate in the blood and transported to the lungs to be released.
2. The oxygen dissociation curve is explained, showing hemoglobin's affinity for oxygen at different partial pressures. Factors like pH, temperature, and 2,3-DPG can shift the curve right or left.
3. Carbon dioxide is transported in three forms - dissolved, as bicarbonate, and bound to hemoglobin. The chloride shift and Bohr and Haldane effects
Acid base homeosatsis
This document provides an overview of acid-base homeostasis and acid-base disorders. It discusses the key roles of the lungs, kidneys, and buffers in maintaining acid-base balance. The lungs regulate carbon dioxide levels through respiration. The kidneys regulate bicarbonate levels through reabsorption and new generation. Buffers function instantly to regulate pH. Acid-base disorders are classified as respiratory or metabolic based on underlying causes. Compensation mechanisms aim to restore pH. Clinical assessment involves analyzing blood gases, electrolytes, and calculating the anion gap. Case examples demonstrate applying this analysis to diagnose the acid-base disorder.
Transport of oxygen and carbon dioxide
1. Oxygen is transported from the lungs to tissues through a multi-step process involving diffusion, binding to hemoglobin, and active transport via blood circulation. (2) Oxygen diffuses from alveoli into pulmonary capillary blood where it binds to hemoglobin, becoming saturated at 98% in the lungs. (3) Oxygen is then transported to tissues where it dissociates from hemoglobin due to lower oxygen partial pressures, supplying oxygen for cellular respiration through diffusion into tissue fluid and cells.
ABG by DJ
This document provides an overview of arterial blood gas (ABG) analysis, including:
1. ABG analysis measures oxygen, carbon dioxide, pH, and bicarbonate levels in arterial blood to evaluate respiratory and metabolic function.
2. It is ordered to assess patients with breathing issues, lung disease, or those on oxygen therapy to monitor treatment effectiveness.
3. Normal ABG results include a pH of 7.35-7.45, PaO2 of 80-100 mmHg, PaCO2 of 35-45 mmHg, and bicarbonate of 22-26 mmol/L.
Abnormal results can indicate respiratory or metabolic acidosis/alkalosis helping clinicians
Cardiac catheteriztion, Oximetery study in a patient with VSD
In this ppt i am going to discuss how to do cardiac catheterisation study, oximetry study and how to analyse its data in a patient with VSD who came to our hospital
5.sakina respiratory regulation of ph
This document provides an overview of acid-base balance and pH regulation in the human body. It discusses the importance of maintaining pH levels, the various buffer systems that help regulate pH (including the bicarbonate buffer system and phosphate buffer system), and the roles of respiration and the kidneys in pH regulation. Blood gas analysis is described as a way to determine acid-base balance and oxygenation by measuring values like pH, pCO2, pO2, HCO3-, and oxygen saturation. Conditions like respiratory acidosis and alkalosis that disrupt acid-base balance are also summarized.
ABG for ICU Clinical PhARMACIST
This document provides an overview of a presentation on arterial blood gases (ABG) and acid-base balance. It includes the following:
1. Three main targets of the presentation: understanding acid-base disorders, making ABG interpretation easy, and treatment of acid-base disorders.
2. The presentation is divided into three parts: concepts, practice with case scenarios, and treatment of acid-base disorders.
3. Part 1 on concepts covers pulmonary gas exchange, acid-base balance disorders, ABG sampling and interpretation. It aims to explain the basics of gas exchange, acid-base balance, and ABG values.
4. Part 2 involves practicing ABG analysis through a series of case
Hypoxia today
1) Hypoxia can lead to decreased ATP synthesis, lactic acidosis, impaired protein synthesis, and irreversible cell changes due to increased cytosolic calcium.
2) Pao2, Sao2, and oxygen content are important measures of oxygen levels in the blood. Pulse oximetry can monitor Sao2 non-invasively but has limitations.
3) Arterial blood gas analysis precisely measures oxygen, carbon dioxide, pH, bicarbonate, and base excess levels to evaluate oxygenation and ventilation.
Monitoring Hypoxia and oxygen supplementation
1) Hypoxia can lead to decreased ATP synthesis, lactic acidosis, impaired protein synthesis, and irreversible cell changes due to increased cytosolic calcium.
2) Pao2, Sao2, and oxygen content are important measures of oxygen levels in the blood. Pulse oximetry can monitor Sao2 non-invasively but has limitations.
3) Arterial blood gas analysis precisely measures oxygen, carbon dioxide, pH, and bicarbonate levels to assess oxygenation and ventilation.
Respiratory physiology in awake and anaesthetized patients
This document summarizes key concepts in respiratory physiology during anesthesia. It discusses how anesthesia decreases functional residual capacity which can lead to atelectasis. It also reviews factors influencing ventilation and perfusion matching, gas transport, and the effects of anesthesia on lung volumes. Hypoxic pulmonary vasoconstriction and other mechanisms regulating blood flow distribution are also summarized.
Arterial Blood Gases
This document provides information about arterial blood gases (ABG), including how ABG samples are collected, normal ABG values, interpreting ABG results, and the principles of oxygen saturation and pulse oximetry. It discusses analyzing primary versus compensatory acid-base imbalances based on pH, pCO2, and HCO3 levels. Ventilation-perfusion imbalance is a major cause of low pO2. Pulse oximetry indirectly measures oxygen saturation but cannot detect carboxyhemoglobin or methemoglobin.
Alveolar gases and diffusion
The document discusses alveolar and arterial gases and diffusion across the respiratory membrane. It introduces key terms like PACO2, PAO2, PaCO2 and PaO2. It explains that alveolar levels determine arterial levels through diffusion. Factors like ventilation rate, oxygen concentration, and metabolism can affect both alveolar and arterial gas levels. Optimal ventilation-perfusion matching is needed for efficient gas exchange and delivery of oxygen to tissues while removing carbon dioxide.
Pulse oximetry journal
Pulse oximetry uses light absorption properties of oxyhemoglobin and deoxyhemoglobin to measure arterial oxygen saturation (SpO2). It works by emitting red and infrared light through tissue and detecting pulsatile changes caused by arterial blood flow. However, several medical conditions can cause inaccurate readings by interfering with this optical detection process. Understanding the limitations is important to avoid clinical errors.
Arterial Blood Gas Analysis Toufiqur Rahman
This document provides a summary of arterial blood gas analysis. It discusses the history of arterial blood sampling dating back to 1912. Key developments include the invention of electrodes that could rapidly measure parameters like PaO2, PaCO2 and pH in the 1950s. By the mid-1960s, several university centers could provide these measurements. The first automated blood gas machine was introduced in 1973. The document reviews normal blood gas values and equations for interpreting PaCO2, PaO2, and oxygen content. It also discusses indications, contraindications, specimen collection and storage, and the physiology required to properly interpret arterial blood gas results.
Abg interpretation
1) ABG analysis provides important information about ventilation, gas exchange and acid-base status by measuring values like pH, PaCO2, PaO2 and HCO3 in arterial blood.
2) ABG values can indicate if a patient has respiratory failure type 1 (hypoxemia) or type 2 (hypercapnia) and help identify acid-base disorders and gas exchange problems.
3) Interpreting ABG values involves looking at pH to determine acidosis or alkalosis, PaCO2 to determine respiratory causes, and HCO3 to determine metabolic causes, and seeing if the values are compensated.
ABG , ARTERIAL BLOOD GAS
1. The document provides normal values for arterial blood gases and discusses the interpretation and significance of various blood gas measurements. It covers topics like respiratory and metabolic acidosis/alkalosis, oxygen content, carbon monoxide poisoning, and ventilation/perfusion imbalance.
2. Causes, treatments, and compensatory mechanisms for different acid-base imbalances are explained. Various equations used in blood gas analysis are also presented, such as the Henderson-Hasselbalch and alveolar gas equations.
3. The role of the kidneys, lungs, and hemoglobin in maintaining acid-base balance is described. Factors that can cause hypoxemia and how to determine oxygen adequacy from blood gases are discussed.
Capnography
This document discusses advanced capnography techniques. It begins by listing the objectives which include describing the physiology of carbon dioxide monitoring, differentiating between mainstream and sidestream capnography, interpreting normal and abnormal time-based and volume-based capnograms, and discussing several clinical applications of capnography. It then covers the physiology of carbon dioxide, monitoring technologies, key technological issues, differences between mainstream and sidestream sampling, phases of normal time-based and volume-based capnograms, abnormalities, artifacts, and clinical uses including ventilation monitoring, cardiac output measurement, pulmonary embolism detection, and more.
PULMONARY FUNCTION TEST
This document discusses pulmonary function tests (PFTs), which assess lung function by measuring various parameters including tidal volume, vital capacity, and gas exchange. PFTs can detect and quantify respiratory disease, evaluate disease progression and response to therapy. The document describes several PFT techniques including spirometry, which measures volumes of air inhaled and exhaled; static lung volumes; diffusing capacity tests; and exercise testing. It provides indications for each test and discusses abnormal findings in obstructive and restrictive lung diseases.
Abg By Faruk Cfh
This document discusses taking and interpreting arterial blood gases (ABGs). It covers topics like:
- Anatomy of arteries used for ABG sampling
- Components of an ABG report and their definitions
- Key equations for understanding ABG results, relating to alveolar ventilation, oxygenation, and acid-base balance
- Causes and implications of abnormal ABG values like hypercapnia, hypoxemia, and changes in pH
- Factors that can affect ABG values like temperature, carbon monoxide levels, and hemoglobin concentration
Similar to Shunt quantification (20)
Cardiac catheteriztion, Oximetery study in a patient with VSD
Cardiac catheteriztion, Oximetery study in a patient with VSD
Respiratory physiology in awake and anaesthetized patients
Respiratory physiology in awake and anaesthetized patients
More from Ramachandra Barik
Willens's syndrome.pptx
A 57-year-old woman was admitted to the hospital with chest pain. Electrocardiograms and troponin levels were normal. Intravascular ultrasound was performed before placing a stent in the left main coronary artery and left anterior descending artery to treat a blockage. The minimum lumen area increased to 4.24mm x 4.13mm after stenting.
Intensive care of congenital heart disease.pptx
Congenital defects can put a strain on the heart, causing it to work harder. To stop your heart from getting weaker with this extra work, your doctor may try to treat you with medications. They are aimed at easing the burden on the heart muscle. You need to control your blood pressure if you have any type of heart problem.
Management of Hypetension.pptx
Changing your lifestyle can help control and manage high blood pressure. Your health care provider may recommend that you make lifestyle changes including:
Eating a heart-healthy diet with less salt
Getting regular physical activity
Maintaining a healthy weight or losing weight
Limiting alcohol
Not smoking
Getting 7 to 9 hours of sleep daily
CRISPR and cardiovascular diseases.pdf
CRISPR technologies have progressed by leaps and bounds over the past decade, not only having a transformative effect on
biomedical research but also yielding new therapies that are poised to enter the clinic. In this review, I give an overview of (i)
the various CRISPR DNA-editing technologies, including standard nuclease gene editing, base editing, prime editing, and epigenome editing, (ii) their impact on cardiovascular basic science research, including animal models, human pluripotent stem
cell models, and functional screens, and (iii) emerging therapeutic applications for patients with cardiovascular diseases, focusing on the examples of Hypercholesterolemia, transthyretin amyloidosis, and Duchenne muscular dystrophy.
Pacemaker Pocket Infection After Splenectomy
This case report describes a patient who underwent seven operations over one year to treat recurrent pacemaker pocket infections. The patient had undergone a splenectomy seven years prior due to a splenic rupture from a traffic accident. This left the patient immunocompromised and at higher risk for infection. The patient later required a pacemaker implantation for complete heart block. The pacemaker pocket developed repeated infections, likely due to the patient's asplenic state impairing immunity. The infections were difficult to treat due to multiple complicating factors, including an abandoned pacemaker lead and reuse of a sterilized pacemaker. This highlights the influence of patient factors like asplenia on procedural outcomes like pacemaker implantation.
Piccolo Duct Occluder.pdf
Transcatheter closure of patent ductus arteriosus (PDA) is feasible in low-birth-weight infants. A female baby was born prematurely with a birth weight of 924 g. She had a PDA measuring 3.7 mm. She was dependent on positive pressure ventilation for congestive heart failure in addition to the heart failure medications. She could not be discharged from the hospital even after 79 days of birth, and even though her weight reached 1.9 kg in the neonatal intensive care unit. We attempted to plug the PDA using an Amplatzer Piccolo Occluder, but the device failed to anchor. Then, the PDA was plugged using a 4-6 Amplatzer Duct Occluder using a 6-Fr sheath which was challenging.
MISPLACED ECG LEADS.pptx
Accidental misplacement of the limb lead electrodes is a common cause of ECG abnormality and may simulate pathology such as ectopic atrial rhythm, chamber enlargement or myocardial ischaemia and infarction
A Case of Device Closure of an Eccentric Atrial Septal Defect Using a Large D...
Device closure of an eccentric atrial septal defect can be challenging and needs technical modifications to avoid unnecessary complications. Here, we present a case of a 45-year-old woman who underwent device closure of an eccentric defect with a large device. The patient developed pericardial effusion and left-sided pleural effusion due to injury to the junction of right atrium and superior vena cava because of the malalignment of the delivery sheath and left atrial disc before the device was pulled across the eccentric defect despite releasing the left atrial disc in the left atrium in place of the left pulmonary vein. These two serious complications were managed conservatively with close monitoring of the case during and after the procedure.
Arrythmia-IV.pptx
1) Bradycardia can be caused by abnormalities in the conduction system or autonomic nervous system. The conduction system includes the sinus node, AV node, His-Purkinje system and different types of heart block can occur when impulses are blocked at different locations.
2) There are three main types of AV block - first degree, second degree (Mobitz types I and II), and third degree. High grade AV block involves blockage of two or more consecutive impulses.
3) Third degree or complete heart block results in complete dissociation between the atria and ventricles with independent pacemakers. It can occur at the AV node or below in the His-Purkin
Arrythmia-III.pptx
1. Bradycardia is defined as a resting heart rate below 50 beats per minute. It can be physiological or pathological.
2. Sinus bradycardia originates from the sinus node and has a normal P wave morphology with a prolonged PR interval. It can be caused by increased vagal tone, medications, or hypothyroidism.
3. Sick sinus syndrome is characterized by sinus bradycardia, sinus arrest, or combinations of sinus node and AV node dysfunction. It may involve intermittent bradycardia and tachycardia. Pacemaker implantation is usually treatment.
Arrythmia-II.pptx
This document discusses ventricular arrhythmias including their origins, characteristics, classifications, and causes. It provides details on:
- The sites of origin for supraventricular tachycardia (SVT) and ventricular arrhythmias.
- Characteristics that distinguish SVT from ventricular arrhythmias such as QRS width.
- Classifications of ventricular arrhythmias including premature ventricular complexes, ventricular tachycardia, fibrillation, and electrical storm.
- Causes and characteristics of different types of ventricular tachycardia such as monomorphic VT, polymorphic VT, and torsades de pointes.
- Investigations and treatments for ventricular arrhythmias including cardiac imaging
Arrythmia-I.pptx
This document provides information on supraventricular tachycardia (SVT), including:
- The anatomy and conduction system of the heart that is relevant to SVT.
- The mechanisms that can cause cardiac arrhythmias, including disorders of impulse formation, conduction, and combinations of the two.
- Characteristics used to classify different types of arrhythmias based on rate, rhythm, site of origin, and QRS morphology.
- Specific types of SVT like atrial fibrillation, AV nodal reentry tachycardia, and accessory pathway mediated tachycardias.
- Methods for diagnosing and treating SVT such as electrophysiology studies, catheter ablation
Trio of Rheumatic Mitral Stenosis, Right Posterior Septal Accessory Pathway a...
A 57-year-old male presented with recurrent palpitations. He was diagnosed with rheumatic mitral stenosis, right posterior septal accessory pathway and atrial flutter. An electrophysiological study after percutaneous balloon mitral valvotomy showed that the palpitations were due to atrial flutter with right bundle branch aberrancy. The right posterior septal pathway was a bystander because it had a higher refractory period than the atrioventricular node.
Anticoagulation therapy during pregnancy
This document discusses anticoagulation therapy options during pregnancy for different cardiac conditions. It notes that vitamin K antagonists (VKAs) should be avoided in the first trimester due to risk of embryopathy but can be used in the second and third trimester with risks of 0.7-2% of foetopathy. Unfractionated heparin does not cross the placenta but its use throughout pregnancy is not recommended due to risk of foetopathy. Low molecular weight heparin is considered the safest option for anticoagulation in weeks 6-12 when risk of embryopathy is a concern and has not been associated with risk of foetopathy. Fondaparinux use should be limited
Coronary guidewire
Percutaneous balloon dilatation, first described by
Andreas Gruentzig in 1979, was initially performed
without the use of guidewires.1 The prototype
balloon catheter was developed as a double lumen
catheter (one lumen for pressure monitoring or
distal perfusion, the other lumen for balloon inflation/deflation) with a short fixed and atraumatic
guidewire at the tip. Indeed, initially the technique
involved advancing a rather rigid balloon catheter
freely without much torque control into a coronary
artery. Bends, tortuosities, angulations, bifurcations,
and eccentric lesions could hardly, if at all, be negotiated, resulting in a rather frustrating low procedural success rate whenever the initial limited
indications (proximal, short, concentric, noncalcified) were negated.2 Luck was almost as
important as expertise, not only for the operator,
but also for the patient. It is to the merit of
Simpson who, in 1982, introduced the novelty of
advancing the balloon catheter over a removable
guidewire, which had first been advanced in the
target vessel.3 This major technical improvement
resulted overnight in a notable increase in the procedural success rate. Guidewires have since evolved
into very sophisticated devices.
Intracoronary optical coherence tomography
Optical coherence tomography-guided algorithm for percutaneous coronary intervention. Vessel diameter should be assessed using the external elastic lamina (EEL)-EEL diameter at the reference segments, and rounded down to select interventional devices (balloons, stents). If the EEL cannot be identified, luminal measures are used and rounded up to 0.5 mm larger for selection of the devices. Optical coherence tomography (OCT)-guided optimisation strategies post stent implantation per EEL-based diameter measurement and per lumen-based diameter measurement are shown. For instance, if the distal EEL-EEL diameter measures 3.2 mm×3.1 mm (i.e., the mean EEL-based diameter is 3.15 mm), this number is rounded down to the next available stent size and post-dilation balloon to be used at the distal segment. Thus, a 3.0 mm stent and non-compliant balloon diameter is selected. If the proximal EEL cannot be visualised, the mean lumen diameter should be used for device sizing. For instance, if the mean proximal lumen diameter measures 3.4 mm, this number is rounded up to the next available balloon diameter (within up to 0.5 mm larger) for post-dilation. MLA: minimal lumen area; MSA: minimal stent area;NC: non-compliant
Brugada syndrome
Brugada syndrome (BrS) is an inherited cardiac disorder,
characterised by a typical ECG pattern and an increased
risk of arrhythmias and sudden cardiac death (SCD).
BrS is a challenging entity, in regard to diagnosis as
well as arrhythmia risk prediction and management.
Nowadays, asymptomatic patients represent the majority
of newly diagnosed patients with BrS, and its incidence
is expected to rise due to (genetic) family screening.
Progress in our understanding of the genetic and
molecular pathophysiology is limited by the absence
of a true gold standard, with consensus on its clinical
definition changing over time. Nevertheless, novel
insights continue to arise from detailed and in-depth
studies, including the complex genetic and molecular
basis. This includes the increasingly recognised
relevance of an underlying structural substrate. Risk
stratification in patients with BrS remains challenging,
particularly in those who are asymptomatic, but recent
studies have demonstrated the potential usefulness
of risk scores to identify patients at high risk of
arrhythmia and SCD. Development and validation of
a model that incorporates clinical and genetic factors,
comorbidities, age and gender, and environmental
aspects may facilitate improved prediction of disease
expressivity and arrhythmia/SCD risk, and potentially
guide patient management and therapy. This review
provides an update of the diagnosis, pathophysiology
and management of BrS, and discusses its future
perspectives.
A roadmap for the human development
The Human Developmental Cell Atlas (HDCA) initiative, which is part of the Human Cell Atlas, aims to create a comprehensive reference map of cells during development. This will be critical to understanding normal organogenesis, the effect of mutations, environmental factors and infectious agents on human development, congenital and childhood disorders, and the cellular basis of ageing, cancer and regenerative medicine. Here we outline the HDCA initiative and the challenges of mapping and modelling human development using state-of-the-art technologies to create a reference atlas across gestation. Similar to the Human Genome Project, the HDCA will integrate the output from a growing community of scientists who are mapping human development into a unified atlas. We describe the early milestones that have been achieved and the use of human stem-cell-derived cultures, organoids and animal models to inform the HDCA, especially for prenatal tissues that are hard to acquire. Finally, we provide a roadmap towards a complete atlas of human development.
Intra aortic balloon pump
The treatment of patients with advanced acute heart failure is still challenging.
Intra-aortic balloon pump (IABP) has widely been used in the management of
patients with cardiogenic shock. However, according to international guidelines, its
routinary use in patients with cardiogenic shock is not recommended. This recommendation is derived from the results of the IABP-SHOCK II trial, which demonstrated
that IABP does not reduce all-cause mortality in patients with acute myocardial infarction and cardiogenic shock. The present position paper, released by the Italian
Association of Hospital Cardiologists, reviews the available data derived from clinical
studies. It also provides practical recommendations for the optimal use of IABP in
the treatment of cardiogenic shock and advanced acute heart failure.
Left ventricular false tendons
Left ventricular false tendons (LVFTs) are fibromuscular
structures, connecting the left ventricular
free wall or papillary muscle and the ventricular
septum.
There is some discussion about safety issues during
intense exercise in athletes with LVFTs, as these
bands have been associated with ventricular arrhythmias
and abnormal cardiac remodelling. However,
presence of LVFTs appears to be much more common
than previously noted as imaging techniques
have improved and the association between LVFTs
and abnormal remodelling could very well be explained
by better visibility in a dilated left ventricular
lumen.
Although LVFTsmay result in electrocardiographic abnormalities
and could form a substrate for ventricular
arrhythmias, it should be considered as a normal
anatomic variant. Persons with LVFTs do not appear
to have increased risk for ventricular arrhythmias or
sudden cardiac death.
More from Ramachandra Barik (20)
A Case of Device Closure of an Eccentric Atrial Septal Defect Using a Large D...
A Case of Device Closure of an Eccentric Atrial Septal Defect Using a Large D...
Trio of Rheumatic Mitral Stenosis, Right Posterior Septal Accessory Pathway a...
Trio of Rheumatic Mitral Stenosis, Right Posterior Septal Accessory Pathway a...
Recently uploaded
Top Travel Vaccinations in Manchester
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Post-Menstrual Smell- When to Suspect Vaginitis.pptx
Do you have abnormal smell after periods? It may be vaginitis. Do not worry, herbal medicine Fuyan Pill can help you get a cure.
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central
Hiranandani Hospital Powai News [Read Now].pdf
Hiranandani Hospital in Powai, Mumbai, is a premier healthcare institution that has been serving the community with exceptional medical care since its establishment. As a part of the renowned Hiranandani Group, the hospital is committed to delivering world-class healthcare services across a wide range of specialties, including kidney transplantation. With its state-of-the-art facilities, advanced medical technology, and a team of highly skilled healthcare professionals, Hiranandani Hospital has earned a reputation as a trusted name in the healthcare industry. The hospital's patient-centric approach, coupled with its focus on innovation and excellence, ensures that patients receive the highest standard of care in a compassionate and supportive environment.
Histololgy of Female Reproductive System.pptx
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Ketone bodies and metabolism-biochemistry
This slide consists of all the topics of ketone . This can be used for exam purpose for writing about Diabetic keto acidosis etc . Thank you
Integrating Ayurveda into Parkinson’s Management: A Holistic Approach
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptx
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Recently uploaded (20)
CHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdf
CHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdf
Post-Menstrual Smell- When to Suspect Vaginitis.pptx
Post-Menstrual Smell- When to Suspect Vaginitis.pptx
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
Outbreak management including quarantine, isolation, contact.pptx
Outbreak management including quarantine, isolation, contact.pptx
Tests for analysis of different pharmaceutical.pptx
Tests for analysis of different pharmaceutical.pptx
Integrating Ayurveda into Parkinson’s Management: A Holistic Approach
Integrating Ayurveda into Parkinson’s Management: A Holistic Approach
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Does Over-Masturbation Contribute to Chronic Prostatitis.pptx
Does Over-Masturbation Contribute to Chronic Prostatitis.pptx
Shunt quantification
- 1. Shunt Quantification IN CONGENITAL AND AQUAIRED HEART DISEASES
- 3. KEYWORDS • Pvo2 • Pao2 • Sao2 • Mvo2
- 4. EBF • The effective blood flow (EBF) is the fraction of mixed venous return received by the lungs without contamination by LEFT TO RIGHT shunt flow
- 5. Normal conditions • , PBF, SBF, and EBF are equal
- 7. Basic rule
- 8. O2 sampling sites • Pv o 2 , Pa o 2 , Sa o 2 , and Mv o 2 are oxygen saturation of pulmonary venous, pulmonary arterial, systemic arterial, and mixed venous blood, respectively
- 9. PBF
- 10. SBF
- 12. Mvo2 is calculated by the Flamm formula
- 13. • Systemic arterial oxygen saturation may be substituted for pulmonary venous sampling, if at least 95%. Otherwise, in the absence of a right- to-left shunt, systemic arterial oxygen content is used. If a right-to-left shunt is present, pulmonary venous oxygen content is calculated as 98% of the oxygen capacity.
- 15. • Clinically, the ratio of PBF to SBF (or Qp/Qs) is often used to express shunt significance. A ratio less than 1.5 indicates a small left-to-right shunt, a ratio of 1.5 to 2.0 a moderate-sized shunt, and a ratio greater than 2.0 a large left-to-right shunt. A flow ratio less than 1.0 indicates a net right-to-left shunt. •
- 16. If oxygen consumption is NOT KNOWN