The document discusses the impact of sleep apnea on the cardiovascular system. Sleep apnea causes temporary pauses in breathing during sleep that reduce oxygen levels in the body. This leads to health issues like hypertension, arrhythmia, coronary artery disease, stroke, and heart failure. The document outlines the pathophysiological mechanisms by which sleep apnea affects the cardiovascular system, including hypoxia, increased sympathetic activity, and changes in intrathoracic pressure. Treatment with CPAP can help improve oxygenation, reduce blood pressure and sympathetic activity, and decrease cardiovascular risks.
Heart failure (HF) is a clinical syndrome characterized by symptoms such as breathlessness and fatigue caused by structural or functional abnormalities of the heart. Arrhythmias are common in HF and increase mortality and morbidity. Atrial fibrillation is the most prevalent arrhythmia in HF, affecting 10-50% of patients depending on HF severity. While rhythm control has been shown to improve symptoms, it does not reduce mortality compared to rate control. Anticoagulation is recommended for stroke prevention based on risk scores. Catheter ablation may be considered for symptomatic patients after failed medical treatment.
1) Pulmonary thromboembolism (PTE) is difficult to diagnose but can be life-threatening, with mortality rates around 30% in haemodynamically unstable patients.
2) PTE is a common cardiovascular emergency caused by emboli blocking pulmonary arteries, and has high morbidity and mortality rates.
3) Autopsy studies have found PTE to be the actual cause of death in up to 15% of hospitalized patients and the leading cause of unexpected in-hospital deaths.
Atrial fibrillation can be characterized on electrocardiogram by low-amplitude baseline oscillations and irregular ventricular rhythm. It is classified as paroxysmal if self-terminating within 7 days, persistent between 7 days to 1 year, or permanent if lasting over 1 year. Risk factors include heart disease, hypertension, age, and obesity. Prevention of thromboembolic complications involves risk stratification using CHADS2 or CHA2DS2-VASc scores to determine need for anticoagulation. Warfarin reduces risk of stroke but comes with risk of bleeding, while newer oral anticoagulants such as dabigatran and rivaroxaban are equally effective with less monitoring
1. Pregnancy places significant demands on the cardiovascular system due to increases in blood volume, cardiac output, and heart rate.
2. Common cardiac problems during pregnancy include congenital heart defects, heart failure, and pulmonary hypertension. These conditions can lead to complications for both mother and baby if not properly managed.
3. Testing such as echocardiography and stress testing are used to evaluate cardiac function during pregnancy. Treatment depends on the severity and type of condition, with termination of pregnancy recommended for very high risk cases.
This document provides an overview of atrial fibrillation (AF), including its causes, risk factors, types, pathophysiology, clinical features, diagnosis, and treatment approaches. AF is the most common cardiac arrhythmia whose occurrence increases with age. It can be categorized temporally as paroxysmal, persistent, or permanent, and etiologically as secondary to structural heart disease or idiopathic. Treatment involves rate or rhythm control as well as anticoagulation to prevent strokes, with the goals of reducing stroke risk, preventing tachycardia-induced heart failure, and relieving symptoms.
Atrial fibrillation is the most common arrhythmia and becomes more prevalent with age. It is associated with increased risks of mortality, stroke, and heart failure. The estimated global prevalence is over 30 million people and is expected to rise significantly by 2030. Treatment involves rate or rhythm control, with rhythm control indicated to improve symptoms in those remaining symptomatic on rate control. Anticoagulation therapy is crucial to prevent stroke in high risk patients based on risk scores like CHA2DS2-VASc. Non-vitamin K antagonist oral anticoagulants are suitable alternatives to warfarin for stroke prevention.
The document discusses the impact of sleep apnea on the cardiovascular system. Sleep apnea causes temporary pauses in breathing during sleep that reduce oxygen levels in the body. This leads to health issues like hypertension, arrhythmia, coronary artery disease, stroke, and heart failure. The document outlines the pathophysiological mechanisms by which sleep apnea affects the cardiovascular system, including hypoxia, increased sympathetic activity, and changes in intrathoracic pressure. Treatment with CPAP can help improve oxygenation, reduce blood pressure and sympathetic activity, and decrease cardiovascular risks.
Heart failure (HF) is a clinical syndrome characterized by symptoms such as breathlessness and fatigue caused by structural or functional abnormalities of the heart. Arrhythmias are common in HF and increase mortality and morbidity. Atrial fibrillation is the most prevalent arrhythmia in HF, affecting 10-50% of patients depending on HF severity. While rhythm control has been shown to improve symptoms, it does not reduce mortality compared to rate control. Anticoagulation is recommended for stroke prevention based on risk scores. Catheter ablation may be considered for symptomatic patients after failed medical treatment.
1) Pulmonary thromboembolism (PTE) is difficult to diagnose but can be life-threatening, with mortality rates around 30% in haemodynamically unstable patients.
2) PTE is a common cardiovascular emergency caused by emboli blocking pulmonary arteries, and has high morbidity and mortality rates.
3) Autopsy studies have found PTE to be the actual cause of death in up to 15% of hospitalized patients and the leading cause of unexpected in-hospital deaths.
Atrial fibrillation can be characterized on electrocardiogram by low-amplitude baseline oscillations and irregular ventricular rhythm. It is classified as paroxysmal if self-terminating within 7 days, persistent between 7 days to 1 year, or permanent if lasting over 1 year. Risk factors include heart disease, hypertension, age, and obesity. Prevention of thromboembolic complications involves risk stratification using CHADS2 or CHA2DS2-VASc scores to determine need for anticoagulation. Warfarin reduces risk of stroke but comes with risk of bleeding, while newer oral anticoagulants such as dabigatran and rivaroxaban are equally effective with less monitoring
1. Pregnancy places significant demands on the cardiovascular system due to increases in blood volume, cardiac output, and heart rate.
2. Common cardiac problems during pregnancy include congenital heart defects, heart failure, and pulmonary hypertension. These conditions can lead to complications for both mother and baby if not properly managed.
3. Testing such as echocardiography and stress testing are used to evaluate cardiac function during pregnancy. Treatment depends on the severity and type of condition, with termination of pregnancy recommended for very high risk cases.
This document provides an overview of atrial fibrillation (AF), including its causes, risk factors, types, pathophysiology, clinical features, diagnosis, and treatment approaches. AF is the most common cardiac arrhythmia whose occurrence increases with age. It can be categorized temporally as paroxysmal, persistent, or permanent, and etiologically as secondary to structural heart disease or idiopathic. Treatment involves rate or rhythm control as well as anticoagulation to prevent strokes, with the goals of reducing stroke risk, preventing tachycardia-induced heart failure, and relieving symptoms.
Atrial fibrillation is the most common arrhythmia and becomes more prevalent with age. It is associated with increased risks of mortality, stroke, and heart failure. The estimated global prevalence is over 30 million people and is expected to rise significantly by 2030. Treatment involves rate or rhythm control, with rhythm control indicated to improve symptoms in those remaining symptomatic on rate control. Anticoagulation therapy is crucial to prevent stroke in high risk patients based on risk scores like CHA2DS2-VASc. Non-vitamin K antagonist oral anticoagulants are suitable alternatives to warfarin for stroke prevention.
This document discusses venous thromboembolic disease (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE). Some key points:
- PE is a common cause of death and VTE can result in long-term disability. Risk factors include hospitalization, surgery, trauma, and reduced mobility.
- VTE has variable and non-specific symptoms, making it difficult to diagnose. Imaging tests like ultrasound, CT, and pulmonary angiography are used to confirm diagnosis.
- Treatment involves anticoagulation to prevent clot extension and recurrence. Therapy is typically divided into acute, maintenance, and long-term phases. Anticoagulation is effective but carries
Cardiovascular Manifestations, Systemic Sclerosis by Dr. Jonathan R. Lindner MDmaushard
Presentation by Dr. Jonathan R. Lindner MD at the 13th Annual Cheri Woo Scleroderma Education Seminar on March 8, 2014 in Portland, Oregon. The seminar is a free public service hosted by the Oregon Chapter of the Scleroderma Foundation.
This document discusses hypertensive heart disease and its effects on the heart. It notes that hypertensive heart disease can cause left ventricular hypertrophy, left ventricular dysfunction (both diastolic and systolic), heart failure, arrhythmias, conduction abnormalities, coronary heart disease, and aortic regurgitation. It provides details on left ventricular hypertrophy including its classification, regression, diagnosis, and risks. It also discusses how hypertension can lead to left ventricular diastolic and systolic dysfunction as well as heart failure. The document outlines treatment options for regressing left ventricular hypertrophy, treating diastolic dysfunction and heart failure, and treating left ventricular systolic dysfunction.
This document discusses the pathogenesis and diagnosis of acute decompensated heart failure (ADHF). It defines ADHF and describes its epidemiology, including the high rates of hospitalization. Common comorbidities are hypertension, coronary artery disease, diabetes, and COPD. ADHF can be classified based on history, blood pressure, signs/symptoms, and ejection fraction. Causes include nonadherence, infection, ischemia, and arrhythmias. Pathophysiology involves impaired function, renal dysfunction, neurohormonal activation, and fluid overload leading to congestion. Evaluation includes symptoms, vital signs, jugular vein pressure, lung sounds, and edema. Labs include BNP/NT-proBNP, troponin,
Obstructive sleep apnea (OSA) is a common sleep disorder where the airway becomes blocked during sleep, disrupting breathing. It is associated with loud snoring, daytime sleepiness, and increased risk of health conditions like diabetes, heart disease, and stroke. Left untreated, OSA can increase the risk of health complications and even sudden cardiac death. Diagnosis involves an overnight sleep study and treatment typically involves wearing a CPAP machine during sleep to keep the airway open. Adhering to CPAP therapy can significantly improve symptoms and quality of life by reducing daytime sleepiness and improving cardiovascular health.
This document provides an outline and overview of congenital heart disease. It defines CHD and discusses incidence rates. It covers the development of the heart, fetal circulation, classification of CHD types, etiology, associated syndromes, signs to suspect CHD, diagnostic steps, management approaches, and details several specific types of CHDs like PDA, VSD, ASD, pulmonary stenosis, bicuspid aortic valve, and coarctation of the aorta.
1) The document discusses different types and causes of heart failure, including high-output heart failure caused by conditions that increase cardiac output demand, and acute decompensated heart failure caused by elevated left ventricular pressures.
2) Symptoms of heart failure are described, such as dyspnea, fatigue, orthopnea, paroxysmal nocturnal dyspnea, and Cheyne-Stokes respiration.
3) Prognosis is generally poor, with 30-40% of patients dying within one year of diagnosis. Functional status and symptoms predict mortality, with class IV symptoms carrying the highest risk.
Heart failure is a clinical syndrome where the heart is unable to pump enough blood to meet the body's needs. It can be caused by conditions that reduce the heart's ability to contract or fill properly and common symptoms include dyspnea, fatigue, and edema. Upon presentation, patients exhibiting signs of congestion such as elevated jugular pressure, rales, and edema are treated with diuretics, while those with low blood pressure or organ dysfunction may require inotropic support or mechanical circulatory support.
This document provides an overview of atrial fibrillation (AF). It begins with the basic electrophysiology of the heart and defines AF. It describes the classification, causes, pathophysiology and epidemiology of AF. It discusses the risks of stroke and methods for assessing stroke risk, including various risk scores. The document outlines the guidelines for managing AF, including treatment options and newer oral anticoagulants. It provides details on evaluating a patient with AF through history, physical exam, ECG and echocardiogram.
1. Cardiac disease complicates around 2% of pregnancies worldwide and is a leading cause of maternal mortality, especially in developing countries where rheumatic heart disease is most common.
2. Pregnancy places additional strain on the heart and can cause cardiac failure, especially for those with preexisting heart conditions or risk factors like hypertension, infection, anemia.
3. Management involves careful prenatal monitoring and treatment to prevent cardiac failure, with multidisciplinary care and delivery in a hospital for high-risk patients. Conditions requiring termination or corrective surgery prior to pregnancy include pulmonary hypertension and severe aortic stenosis.
This document discusses congenital heart disease in adults. It notes that 1 million adults in the US have congenital heart disease, with 20,000 more reaching adulthood each year due to increased survival of children with CHD. Common adult presentations of CHD include effort dyspnea, atrial fibrillation, and right heart failure. The document reviews the pathophysiology, clinical features, diagnostic evaluation, and management of various CHD lesions that may present in adulthood, such as atrial septal defects, ventricular septal defects, patent ductus arteriosus, tetralogy of Fallot, Ebstein's anomaly, and coarctation of the aorta. Surgical and percutaneous interventions are discussed
This document discusses heart disease in pregnancy. It outlines some common symptoms seen in pregnant women with heart disease like dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. Examination may reveal murmurs, accentuated heart sounds, cyanosis, displaced apex beat, and signs of heart failure. Echocardiography, ECG, chest x-rays are used for diagnosis. Prognosis depends on functional status - classes I and II usually do well while classes III and IV have higher mortality risks. Maternal and fetal outcomes vary depending on the type and severity of heart condition.
Ventricular preexcitation syndrome refers to abnormal accessory pathways in the heart's electrical system that bypass the normal conduction pathway. This leads to early activation of the ventricles seen on ECG as a short PR interval and delta wave. The most common forms are Wolff-Parkinson-White, Lown-Ganong-Levine, and Mahaim syndromes. While often congenital, it can also be associated with genetic mutations, structural heart defects, age and gender. Management involves monitoring, medications, catheter ablation to destroy accessory pathways, and educating patients on symptoms and emergency preparedness.
Pulmonary Arterial Hypertension in Rural Communities: Early Diagnosis and Int...HorizonCME
Pulmonary Arterial Hypertension in Rural Communities: Early Diagnosis and Intervention to Improve Outcomes
Learning Objectives
-Identify the signs, symptoms, and risk factors associated with PAH to facilitate timely referral of patients to specialized pulmonary hypertension centers for early diagnosis and treatment
-Explain the WHO PH Groups and functional status classifications for PAH and their impact on treatment selection
-Outline the diagnostic tests that may be used to identify patients with PAH
-Identify the indications and contraindications for currently available therapies used in the treatment of patients with PAH
-Describe the role of PCPs in managing PAH patients
This document summarizes a presentation on cardiology topics including acute and advanced heart failure. It discusses trends in heart failure hospitalizations and mortality. It describes different hemodynamic profiles in acute heart failure patients and their corresponding treatments. It also discusses topics like iron deficiency in heart failure, sleep disordered breathing, and a study showing sleep disordered breathing is common in acute heart failure and predicts mortality.
A vivid description of the anaesthetic management in a case of congenital heart disease posted for non cardiac surgery.Briefing of the various CHD'S from basics.Clear description of the pathophysiology,Illustrated with flowcharts and understanding of the complex modified circulatory states.Completely discussed with Head Of the Department and Cardiac Anaesthetic.
A 17-year-old male basketball player collapsed during practice and suffered cardiac arrest. An autopsy later revealed he had hypertrophic cardiomyopathy (HCM), a genetic heart condition where the heart muscle becomes abnormally thick. HCM is a leading cause of sudden cardiac death in young athletes. The patient had previously noticed some shortness of breath with exertion but it did not limit his activity. He was found to have a heart murmur as a child but it was never investigated. HCM causes the left ventricle to become thickened and stiff, which can obstruct blood flow out of the heart and cause heart failure, chest pain, arrhythmias, and sudden cardiac death.
The Art and Science of Management of Hypertension SYEDRAZA56411
Blood pressure measurement is a simple routine in daily medical practice. However, less emphasis is laid on if the blood pressure has been recorded using correct technique. The errors in blood pressure readings may be misleading in clinical decision making as well use or misuse of resources including patient harm or quality of care. This presentation probes one of similar issues . At the same time this would provide a practical guide to clinicians to optimally manage their hypertensive patients.
Underuse and Misuse of Newer Anti diabetic Medications in Patients at Risk an...SYEDRAZA56411
Are the newer anti-diabetic medications being prescribed after assessment of cardiovascular risk ?
Current practice in light of evidence and guidelines . What do the trial data tell us ?
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This document discusses venous thromboembolic disease (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE). Some key points:
- PE is a common cause of death and VTE can result in long-term disability. Risk factors include hospitalization, surgery, trauma, and reduced mobility.
- VTE has variable and non-specific symptoms, making it difficult to diagnose. Imaging tests like ultrasound, CT, and pulmonary angiography are used to confirm diagnosis.
- Treatment involves anticoagulation to prevent clot extension and recurrence. Therapy is typically divided into acute, maintenance, and long-term phases. Anticoagulation is effective but carries
Cardiovascular Manifestations, Systemic Sclerosis by Dr. Jonathan R. Lindner MDmaushard
Presentation by Dr. Jonathan R. Lindner MD at the 13th Annual Cheri Woo Scleroderma Education Seminar on March 8, 2014 in Portland, Oregon. The seminar is a free public service hosted by the Oregon Chapter of the Scleroderma Foundation.
This document discusses hypertensive heart disease and its effects on the heart. It notes that hypertensive heart disease can cause left ventricular hypertrophy, left ventricular dysfunction (both diastolic and systolic), heart failure, arrhythmias, conduction abnormalities, coronary heart disease, and aortic regurgitation. It provides details on left ventricular hypertrophy including its classification, regression, diagnosis, and risks. It also discusses how hypertension can lead to left ventricular diastolic and systolic dysfunction as well as heart failure. The document outlines treatment options for regressing left ventricular hypertrophy, treating diastolic dysfunction and heart failure, and treating left ventricular systolic dysfunction.
This document discusses the pathogenesis and diagnosis of acute decompensated heart failure (ADHF). It defines ADHF and describes its epidemiology, including the high rates of hospitalization. Common comorbidities are hypertension, coronary artery disease, diabetes, and COPD. ADHF can be classified based on history, blood pressure, signs/symptoms, and ejection fraction. Causes include nonadherence, infection, ischemia, and arrhythmias. Pathophysiology involves impaired function, renal dysfunction, neurohormonal activation, and fluid overload leading to congestion. Evaluation includes symptoms, vital signs, jugular vein pressure, lung sounds, and edema. Labs include BNP/NT-proBNP, troponin,
Obstructive sleep apnea (OSA) is a common sleep disorder where the airway becomes blocked during sleep, disrupting breathing. It is associated with loud snoring, daytime sleepiness, and increased risk of health conditions like diabetes, heart disease, and stroke. Left untreated, OSA can increase the risk of health complications and even sudden cardiac death. Diagnosis involves an overnight sleep study and treatment typically involves wearing a CPAP machine during sleep to keep the airway open. Adhering to CPAP therapy can significantly improve symptoms and quality of life by reducing daytime sleepiness and improving cardiovascular health.
This document provides an outline and overview of congenital heart disease. It defines CHD and discusses incidence rates. It covers the development of the heart, fetal circulation, classification of CHD types, etiology, associated syndromes, signs to suspect CHD, diagnostic steps, management approaches, and details several specific types of CHDs like PDA, VSD, ASD, pulmonary stenosis, bicuspid aortic valve, and coarctation of the aorta.
1) The document discusses different types and causes of heart failure, including high-output heart failure caused by conditions that increase cardiac output demand, and acute decompensated heart failure caused by elevated left ventricular pressures.
2) Symptoms of heart failure are described, such as dyspnea, fatigue, orthopnea, paroxysmal nocturnal dyspnea, and Cheyne-Stokes respiration.
3) Prognosis is generally poor, with 30-40% of patients dying within one year of diagnosis. Functional status and symptoms predict mortality, with class IV symptoms carrying the highest risk.
Heart failure is a clinical syndrome where the heart is unable to pump enough blood to meet the body's needs. It can be caused by conditions that reduce the heart's ability to contract or fill properly and common symptoms include dyspnea, fatigue, and edema. Upon presentation, patients exhibiting signs of congestion such as elevated jugular pressure, rales, and edema are treated with diuretics, while those with low blood pressure or organ dysfunction may require inotropic support or mechanical circulatory support.
This document provides an overview of atrial fibrillation (AF). It begins with the basic electrophysiology of the heart and defines AF. It describes the classification, causes, pathophysiology and epidemiology of AF. It discusses the risks of stroke and methods for assessing stroke risk, including various risk scores. The document outlines the guidelines for managing AF, including treatment options and newer oral anticoagulants. It provides details on evaluating a patient with AF through history, physical exam, ECG and echocardiogram.
1. Cardiac disease complicates around 2% of pregnancies worldwide and is a leading cause of maternal mortality, especially in developing countries where rheumatic heart disease is most common.
2. Pregnancy places additional strain on the heart and can cause cardiac failure, especially for those with preexisting heart conditions or risk factors like hypertension, infection, anemia.
3. Management involves careful prenatal monitoring and treatment to prevent cardiac failure, with multidisciplinary care and delivery in a hospital for high-risk patients. Conditions requiring termination or corrective surgery prior to pregnancy include pulmonary hypertension and severe aortic stenosis.
This document discusses congenital heart disease in adults. It notes that 1 million adults in the US have congenital heart disease, with 20,000 more reaching adulthood each year due to increased survival of children with CHD. Common adult presentations of CHD include effort dyspnea, atrial fibrillation, and right heart failure. The document reviews the pathophysiology, clinical features, diagnostic evaluation, and management of various CHD lesions that may present in adulthood, such as atrial septal defects, ventricular septal defects, patent ductus arteriosus, tetralogy of Fallot, Ebstein's anomaly, and coarctation of the aorta. Surgical and percutaneous interventions are discussed
This document discusses heart disease in pregnancy. It outlines some common symptoms seen in pregnant women with heart disease like dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. Examination may reveal murmurs, accentuated heart sounds, cyanosis, displaced apex beat, and signs of heart failure. Echocardiography, ECG, chest x-rays are used for diagnosis. Prognosis depends on functional status - classes I and II usually do well while classes III and IV have higher mortality risks. Maternal and fetal outcomes vary depending on the type and severity of heart condition.
Ventricular preexcitation syndrome refers to abnormal accessory pathways in the heart's electrical system that bypass the normal conduction pathway. This leads to early activation of the ventricles seen on ECG as a short PR interval and delta wave. The most common forms are Wolff-Parkinson-White, Lown-Ganong-Levine, and Mahaim syndromes. While often congenital, it can also be associated with genetic mutations, structural heart defects, age and gender. Management involves monitoring, medications, catheter ablation to destroy accessory pathways, and educating patients on symptoms and emergency preparedness.
Pulmonary Arterial Hypertension in Rural Communities: Early Diagnosis and Int...HorizonCME
Pulmonary Arterial Hypertension in Rural Communities: Early Diagnosis and Intervention to Improve Outcomes
Learning Objectives
-Identify the signs, symptoms, and risk factors associated with PAH to facilitate timely referral of patients to specialized pulmonary hypertension centers for early diagnosis and treatment
-Explain the WHO PH Groups and functional status classifications for PAH and their impact on treatment selection
-Outline the diagnostic tests that may be used to identify patients with PAH
-Identify the indications and contraindications for currently available therapies used in the treatment of patients with PAH
-Describe the role of PCPs in managing PAH patients
This document summarizes a presentation on cardiology topics including acute and advanced heart failure. It discusses trends in heart failure hospitalizations and mortality. It describes different hemodynamic profiles in acute heart failure patients and their corresponding treatments. It also discusses topics like iron deficiency in heart failure, sleep disordered breathing, and a study showing sleep disordered breathing is common in acute heart failure and predicts mortality.
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A 17-year-old male basketball player collapsed during practice and suffered cardiac arrest. An autopsy later revealed he had hypertrophic cardiomyopathy (HCM), a genetic heart condition where the heart muscle becomes abnormally thick. HCM is a leading cause of sudden cardiac death in young athletes. The patient had previously noticed some shortness of breath with exertion but it did not limit his activity. He was found to have a heart murmur as a child but it was never investigated. HCM causes the left ventricle to become thickened and stiff, which can obstruct blood flow out of the heart and cause heart failure, chest pain, arrhythmias, and sudden cardiac death.
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The Art and Science of Management of Hypertension SYEDRAZA56411
Blood pressure measurement is a simple routine in daily medical practice. However, less emphasis is laid on if the blood pressure has been recorded using correct technique. The errors in blood pressure readings may be misleading in clinical decision making as well use or misuse of resources including patient harm or quality of care. This presentation probes one of similar issues . At the same time this would provide a practical guide to clinicians to optimally manage their hypertensive patients.
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Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
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Sleep Apnea and its impact on cardiovascular system
1. Sleep Apnea and its impact
on Cardiovascular System
Dr Syed Raza
MD, MRCP, FRCP, CCT , FESC, FACC, FECVI
Consultant Cardiologist
Awali Hospital
Bahrain
7. Hypertension
Nearly half of patients with Sleep Apnea have underlying high blood pressure
Blood pressure is generally resistant to medications
Nocturnal hypertension
Presence of hypertension in addition to co-existing co-morbidities increase
the risk of CV events as well as mortality.
8. Sleep Apnea and Arrhythmia
Exact prevalence and pathophysiology is not well
known
Brady-arrhythmia : Severe bradycardia ,sinus pause, 1st
degree AV block, Mobitz Type 1- 2nd degree AV block
Tachy-arrhythmia – PVCs , SVT, AF x 5 fold , VT (non
sustained and sustained)
9. Management of arrhythmia in Sleep Apnea
CPAP
Anti-arrhythmic generally not indicated
Specific targeted therapy if electrical conduction abnormality
detected
Atrial overdrive pacing does not help and not recommended
10. CAD and Stroke
Risk of CAD increases by 30%
Risk of stroke increases by 60%
They occur prematurely
SA apnea increases the CV mortality risk
11.
12. OSA - CAD and Stroke
1. Co-existing co-morbidities / consequence of OSA > Obesity , DM , HPN
2. AF predisposes to ischemic stroke
3. Incidence of subarachnoid hemorrhage is higher
4. Pre-dispose to fatal and non-fatal MI
5. Studies show higher incidence of revascularization in patients with OSA
6. CV mortality is higher
13. OSA - CAD and Stroke
7. Severity of OSA directly co-relate with CV
complications and mortality
8. Presence of OSA increase peri-operative (non
cardiac surgery) CV complications and CV mortality
8. OSA and its severity should be included as a risk
marker for future CV events
14. Sleep Apnea
and Heart Failure
• Sleep Apnea and Heart Failure
are inter-related
• At least 50% of patients with HF
have OSA or CSA
• Sleep apnea increases the risk of
heart failure by 140%
• The exact prevalence and
pathophysiology of HF in Sleep
Apnea is not known
15. Sleep Apnea in
HF patients:
common
preponderance
Age above 60
Male
NYHA Class III and IV
For unknown reason sleep apnea is not
commonly seen in female HF patients
16. Factors
influencing
HF in Sleep
Apnea
Associated HPN , AF
Sympathetic overdrive
Increase pre-load due to decreased intra-thoracic
pressure
Increase afterload leading to increase left ventricular
end diastolic pressure (LVeDP) and impaired LV systolic
function
Increased pulmonary artery pressure pre-dispose to right
heart failure
17. HF & SA
Heart failure and Sleep Apnea
co-exist
Central sleep apnea in HF
patients is independent risk
marker of mortality
Presence of HF and sleep apnea
together worsens mortality
18.
19. Sudden Cardiac
Death in Sleep
Apnea
• Obstructive sleep apnea (OSA) raises the risk
of sudden cardiac death (SCD) by 300–
400% depending on the severity of OSA.
• Published reports raised the association
between OSA and SCD but not the
mechanism of SCD..
31. Summary
Sleep Apnea is common but often go
undiagnosed.
Sleep Apnea leads to cardiovascular
complications and adverse CV events
Once suspected, diagnosis is not difficult
Applying right management strategies can
lead to life changing as well as life saving
experience.
Editor's Notes
1. Hypoxia combined with hypocapnia/ hypercapnia will lead to hypoxic tissue injury / oxidative stress / inflammation / endothelial dysfunction / vasoconstriction 2. Decrease intra thoracic pressure will increase the pre load and after load to the heart 3. Arousals will lead to sympathetic activation and parasympathetic withdrawal ( Cortisol , epinephrine / nor epinephrine )
One can cause or worsen the other
Old study - 2007 . Higher the AHI – more severe the sleep apnea - worse the survival
SERVE-HF is a negative trial as ASV increased mortality in patients with HFrEF , Hence contraindicated .
Reverses the adverse pathophysiology or mechanisms
P value not statistically significant - 1. Sleepy patients Epworth score > 15 and severe hypoxia < 80% (high risk patients ) excluded. 2. Poor compliance with CPAP. CPAP alone have been observed to weight gain. Combination of CPAP and weight loss is beneficial