This document provides guidance from NICE on the assessment and treatment of acute stroke. It outlines recommendations for promptly admitting patients to specialist stroke units, performing brain imaging, providing thrombolysis or mechanical clot retrieval if appropriate, administering antiplatelets or anticoagulants, managing blood pressure and blood sugar, assessing swallowing function and providing nutrition, and carrying out carotid imaging and endarterectomy if indicated. The pathway is designed to optimize stroke care from initial presentation through the acute and subacute phases of recovery.
1) The document provides guidelines for coronary artery revascularization from the 2021 ACC/AHA/SCAI, including definitions of lesion severity, recommendations for revascularization of infarct arteries in STEMI, and timing of invasive strategies for NSTE-ACS.
2) It recommends using tools like the SYNTAX score and coronary physiology to help define lesion severity and guide revascularization decisions for intermediate lesions.
3) For STEMI patients, the guidelines recommend PCI if within 12 hours of symptoms or CABG if mechanical complications occur, and provide recommendations for revascularizing non-infarct arteries.
The study investigated changes in symptoms and stress testing results over one year in patients with INOCA (ischemic heart disease with <50% stenosis but signs of ischemia). It found that about half of INOCA patients had normal stress echo results after one year, but 45% had the same or worse ischemia. There was no correlation between changes in angina and changes in ischemia. The study aims to better understand the natural history and whether ischemia solely causes angina in INOCA patients.
This document provides an overview of cardiac arrhythmias including their classification, mechanisms, clinical manifestations, diagnostic approaches and management strategies. It discusses various specific arrhythmias in detail such as atrial fibrillation, atrial flutter, supraventricular tachycardia, ventricular arrhythmias, sick sinus syndrome and heart block. Treatment options covered include pharmacological therapies using different classes of antiarrhythmic drugs, procedures like cardiac ablation and use of devices like pacemakers.
The document discusses electrocardiograms (ECGs) in the context of acute coronary syndrome. It begins by describing the normal conduction system and the 12 standard ECG leads. It then explains how ECGs are recorded and the positioning of limb and precordial leads. The document discusses ST segments, T waves, and how to evaluate for ST elevations. It defines acute coronary syndrome and describes the classifications of ST-elevation MI, non-ST-elevation MI, and unstable angina based on ECG and cardiac enzyme findings. Specific ECG patterns for lateral, inferior, septal, and posterior wall MIs are also shown.
Globally, about 17 million strokes occur every year. Stroke is the second leading cause of death and the third most common cause of disability worldwide. The presentation of stroke includes sudden onset of focal neurological deficits such as numbness, weakness, confusion, trouble speaking or understanding, or trouble with vision, walking, balance or coordination. Timely treatment is critical, as more time elapsed means greater brain damage. Prehospital evaluation involves using stroke scales to identify high-risk patients who require rapid transport to certified stroke centers for emergency evaluation and treatment within strict time windows in order to minimize disability or death from stroke.
Primary PCI is the preferred treatment for STEMI, achieving success rates of around 90% compared to 50% for thrombolysis. While thrombolysis has mortality rates of 7-10% in trials and 10-17% in registries, primary PCI has lower mortality rates of 5% in trials and 5-9% in registries. The PRAGUE studies showed lower combined endpoints of death, re-infarction and stroke for primary PCI compared to thrombolysis. Guidelines now recommend primary PCI as the default reperfusion strategy for STEMI when it can be performed in a timely manner.
This document discusses thoracic endografts and future goals for their design. It describes the challenges of treating the thoracic aorta including its pulsatile blood flow, curved anatomy, and diverse pathologies. Current endograft designs aim to provide easy deployment, exclude lesions with a good seal and fixation, be durable and conformable, and be biocompatible. Design considerations include sufficient landing zones, radial pressure of stent frames, proximal bare metal stents, and deployment methods. Future areas of research include hybrid procedures, tapered endografts, new materials, and computational modeling of blood flow to improve endograft performance.
1) The document provides guidelines for coronary artery revascularization from the 2021 ACC/AHA/SCAI, including definitions of lesion severity, recommendations for revascularization of infarct arteries in STEMI, and timing of invasive strategies for NSTE-ACS.
2) It recommends using tools like the SYNTAX score and coronary physiology to help define lesion severity and guide revascularization decisions for intermediate lesions.
3) For STEMI patients, the guidelines recommend PCI if within 12 hours of symptoms or CABG if mechanical complications occur, and provide recommendations for revascularizing non-infarct arteries.
The study investigated changes in symptoms and stress testing results over one year in patients with INOCA (ischemic heart disease with <50% stenosis but signs of ischemia). It found that about half of INOCA patients had normal stress echo results after one year, but 45% had the same or worse ischemia. There was no correlation between changes in angina and changes in ischemia. The study aims to better understand the natural history and whether ischemia solely causes angina in INOCA patients.
This document provides an overview of cardiac arrhythmias including their classification, mechanisms, clinical manifestations, diagnostic approaches and management strategies. It discusses various specific arrhythmias in detail such as atrial fibrillation, atrial flutter, supraventricular tachycardia, ventricular arrhythmias, sick sinus syndrome and heart block. Treatment options covered include pharmacological therapies using different classes of antiarrhythmic drugs, procedures like cardiac ablation and use of devices like pacemakers.
The document discusses electrocardiograms (ECGs) in the context of acute coronary syndrome. It begins by describing the normal conduction system and the 12 standard ECG leads. It then explains how ECGs are recorded and the positioning of limb and precordial leads. The document discusses ST segments, T waves, and how to evaluate for ST elevations. It defines acute coronary syndrome and describes the classifications of ST-elevation MI, non-ST-elevation MI, and unstable angina based on ECG and cardiac enzyme findings. Specific ECG patterns for lateral, inferior, septal, and posterior wall MIs are also shown.
Globally, about 17 million strokes occur every year. Stroke is the second leading cause of death and the third most common cause of disability worldwide. The presentation of stroke includes sudden onset of focal neurological deficits such as numbness, weakness, confusion, trouble speaking or understanding, or trouble with vision, walking, balance or coordination. Timely treatment is critical, as more time elapsed means greater brain damage. Prehospital evaluation involves using stroke scales to identify high-risk patients who require rapid transport to certified stroke centers for emergency evaluation and treatment within strict time windows in order to minimize disability or death from stroke.
Primary PCI is the preferred treatment for STEMI, achieving success rates of around 90% compared to 50% for thrombolysis. While thrombolysis has mortality rates of 7-10% in trials and 10-17% in registries, primary PCI has lower mortality rates of 5% in trials and 5-9% in registries. The PRAGUE studies showed lower combined endpoints of death, re-infarction and stroke for primary PCI compared to thrombolysis. Guidelines now recommend primary PCI as the default reperfusion strategy for STEMI when it can be performed in a timely manner.
This document discusses thoracic endografts and future goals for their design. It describes the challenges of treating the thoracic aorta including its pulsatile blood flow, curved anatomy, and diverse pathologies. Current endograft designs aim to provide easy deployment, exclude lesions with a good seal and fixation, be durable and conformable, and be biocompatible. Design considerations include sufficient landing zones, radial pressure of stent frames, proximal bare metal stents, and deployment methods. Future areas of research include hybrid procedures, tapered endografts, new materials, and computational modeling of blood flow to improve endograft performance.
Mr. Sajal, age 35, presented with chest pain for 5 hours. His ECG showed signs of myocardial infarction, but his coronary angiogram (CAG) revealed non-obstructive coronary arteries. This is known as myocardial infarction with non-obstructive coronary arteries (MINOCA). MINOCA can affect up to 14% of AMI patients, particularly younger patients and women. Cardiac magnetic resonance imaging (CMR) can identify the underlying cause in up to 87% of MINOCA cases. While initially thought to be benign, MINOCA carries similar mortality risks as MI with obstructive coronary artery disease. Identifying the specific cause through tests like CMR is important to determine the proper long-
Pci or throm or pi in stemi best strategy(apicon 09022019)-finalDr.Vinod Sharma
- Primary angioplasty, thrombolysis, and pharmaco-invasive therapy are strategies for reperfusion in STEMI patients.
- The optimal strategy depends on factors like time since symptom onset, mortality risk from STEMI, availability of a skilled PCI laboratory, and time required for transport.
- Minimizing total ischemic time is critical as myocardial necrosis increases significantly past 40 minutes from occlusion. Every 30 minute delay in reperfusion increases 1-year mortality by 8%.
Coronary heart disease is a major cause of mortality worldwide. Percutaneous coronary intervention (PCI), also known as coronary angioplasty, is a non-surgical procedure used to treat blockages within the coronary arteries of the heart. During PCI, a catheter is inserted into an artery and guided to the site of blockage where a balloon is inflated to open the artery. Often a stent is placed to keep the artery open. PCI has become a common revascularization treatment for acute coronary syndromes and stable angina. While generally safe, complications from PCI occur in less than 2% of patients and include adverse reactions, acute myocardial infarction, bleeding, and death in less than 0.08% of patients.
This document provides an overview of acute coronary syndrome (ACS). It begins with a review of coronary artery anatomy and variations. It then discusses the presentations of ACS, including ischemic chest pain and equivalents. The main types of ACS - unstable angina, NSTEMI, and STEMI - are defined based on symptoms, electrocardiogram findings, and cardiac biomarker levels. Diagnosis and management strategies are outlined, including reperfusion therapies and drug treatments. Follow-up care after ACS and indications for procedures like cardiac catheterization and ICD placement are also summarized.
Coronary artery spasm is a reversible constriction of the coronary arteries caused by contraction of the smooth muscle cells in the artery wall. It was initially described in 1959 and can be triggered by factors like smoking, cocaine, or caffeine. During a spasm, electrocardiogram changes like ST elevation may occur and resolve quickly with nitroglycerin. Coronary angiography is used to diagnose spasm by using medications like ergonovine or acetylcholine to provoke episodes during testing. Treatment focuses on calcium channel blockers and nitrates, while avoiding beta blockers which may worsen spasms. Refractory cases can be treated with coronary stenting.
This document discusses coronary artery disease (CAD) and ischemic heart disease (IHD). It defines IHD as a disease of the heart muscle resulting from a lack of oxygen due to an imbalance between myocardial oxygen requirements and supply. CAD is most commonly caused by atherosclerosis. The spectrum of IHD ranges from silent ischemia to myocardial infarction and heart failure. Acute coronary syndrome (ACS) refers to the unstable spectrum of IHD and includes unstable angina and myocardial infarction. Biomarkers, imaging, and risk scores are used to stratify patients according to their risk. Medical management involves anti-ischemic therapies, antiplatelet agents, and risk factor modification.
Carotid endarterectomy versus carotid stentingKrishna Prasad
Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are procedures used to treat carotid artery stenosis. While CEA has been shown to be beneficial in clinical trials, CAS was developed to provide a less invasive option. However, concerns with CAS include higher risks of periprocedural complications like stroke. Several studies have compared CEA and CAS, finding CAS to be noninferior with similar composite outcomes, but higher risks of periprocedural stroke with CAS. Long term results are inconclusive, and patient factors like age, plaque characteristics, and vessel anatomy influence outcomes for each procedure. Ongoing studies continue to evaluate optimal treatment of carotid artery stenosis.
This document discusses guidelines for managing acute coronary syndrome (ACS) in patients without persistent ST-segment elevation. It defines ACS and its classifications. It emphasizes the importance of analyzing chest pain characteristics, ECG, and biomarkers to determine if a patient has unstable angina or non-ST-segment elevation myocardial infarction (NSTEMI). Risk stratification is crucial for deciding admission and treatment strategy. Treatment may involve antiplatelet and anticoagulant medications, as well as invasive procedures depending on risk level. Timely reperfusion is emphasized as the primary therapy for ST-segment elevation myocardial infarction (STEMI) patients. Dosing guidelines are provided for various antiplatelet and anticoagulant drugs used in ACS management
This document summarizes Dicky Aligheri's experience with hybrid procedures for aortic arch involvement between 2013-2014 at the National Cardiac & Vascular Centre Harapan Kita in Jakarta. It describes several case studies of patients who received treatments like total arch replacement, hemi arch replacement, and the frozen elephant trunk procedure. It also reviews literature on debates around the best surgical strategies for aortic arch pathology and the safety and efficacy of hybrid techniques compared to open surgery.
Guidelines in the management of carotid stenosisuvcd
This document provides an overview of guidelines for the management of carotid stenosis. It discusses:
1) Stroke is a major cause of death, with many caused by carotid artery disease. The risk of stroke is directly related to the degree of stenosis.
2) Natural history studies show that the risk of stroke is highest in the first year after symptoms and then declines over time. The risk is higher for more severe stenosis.
3) Early trials demonstrated the benefits of carotid endarterectomy (CEA) in reducing stroke risks compared to medical management alone for symptomatic and some asymptomatic patients.
4) Later trials evaluated carotid angioplasty and stenting (CAS) as an alternative to CEA but
This document discusses anticoagulant options for atrial fibrillation patients in Asia, specifically whether to switch patients stable on warfarin to novel oral anticoagulants (NOACs). It notes that maintaining the international normalized ratio for warfarin is challenging in Asian patients who are also at higher risk of intracranial hemorrhage. Clinical trials found NOACs reduced strokes, systemic embolisms, myocardial infarctions and all-cause death similarly in Asian and non-Asian patients, while significantly reducing hemorrhagic strokes in Asians. The document concludes NOACs are preferred over warfarin for Asian atrial fibrillation patients due to better efficacy and safety outcomes as well as
This document discusses left atrial appendage occlusion for stroke prevention in patients with atrial fibrillation. It provides background on atrial fibrillation and the increased risk of stroke. Left atrial appendage occlusion is recommended for patients with a high stroke risk who have contraindications to oral anticoagulation. The document reviews patient selection criteria and contraindications for left atrial appendage occlusion. It also examines left atrial appendage anatomy, imaging techniques for evaluation, and various closure devices including the Watchman, Amplatzer, and Lariat systems.
The document provides guidelines for the management of infective endocarditis from the European Society of Cardiology. It discusses definitions of infective endocarditis, recommendations for antibiotic prophylaxis, the role of echocardiography in diagnosis, etiologic agents, predictors of poor outcome, surgical indications, and treatment of various microorganisms including streptococci, staphylococci, enterococci, and culture-negative cases. It also addresses management considerations for infective endocarditis in specific patient populations such as those with prosthetic valves, congenital heart disease, or pregnancy.
This document summarizes recent evidence on medical treatments, percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG) for stable coronary artery disease. Key findings include:
1) Large clinical trials found no significant difference in outcomes between PCI and optimal medical therapy for stable CAD patients.
2) CABG was shown to reduce mortality, myocardial infarction, and repeat revascularization compared to medical therapy or PCI for multi-vessel disease.
3) For left main coronary artery disease, CABG may be preferable to PCI for patients with high anatomical complexity scores.
4) Ongoing trials like ISCHEMIA are further evaluating optimal revascularization strategies for stable CAD patients with ischemia.
2018 AHA ASA guideline - guidelines for the early management of patients with...Vinh Pham Nguyen
The document provides guidelines for the early management of acute ischemic stroke, covering prehospital stroke management and systems of care, emergency evaluation and treatment, and in-hospital supportive care. It recommends public education on stroke signs and calling 911, designating stroke centers and teams, and using telemedicine to expand access to stroke expertise. The goal is to optimize early management through improved systems and rapid treatment to increase utilization of therapies like IV alteplase and endovascular procedures.
Cryptogenic stroke and PFO have always been a controversial topic with no closure trial in the past showing significant benefit from closing the PFO in preventing the recurrent stroke. Also thought to be due to imperfect definition of cryptogenic stroke which is evolving with drop in the fraction of patients from 20-40% in the past to very fewer numbers due to increased understanding of the mechanisms involved in acute stroke. Recent trials REDUCE and CLOSE targeted the niche population of PFO with moderate to large shunt and atrial septal aneurysm and showed benefit of closing PFO compared to the antiplatelet therapy alone but with the risk of A.fib, device and procedure related complications. This presentation is made in the Cerebrovascular center weekly conference at the Cleveland Clinic with my perspective after these current trials.
Trans-Cranial Doppler (TCD) is a non-invasive ultrasound technique used to evaluate cerebral blood flow velocities. There are two main types of TCD devices - non-duplex devices which identify arteries "blindly" based on Doppler shift and duplex devices which combine Doppler with B-mode imaging to directly visualize arteries. TCD allows evaluation of intracranial steno-occlusive disease, vasospasm, aneurysms, and other conditions. It can detect elevated velocities indicative of stenosis but has limitations including operator dependence and inability to image distal arteries. TCD is useful for monitoring conditions like sickle cell disease where elevated velocities increase stroke risk.
This document discusses cardioembolic stroke, which occurs when heart issues cause materials to enter the brain's blood vessels. Common causes include atrial fibrillation, heart failure, and mechanical heart valves. Diagnosis involves echocardiography and monitoring for embolic signals. Treatment depends on the specific heart condition but often includes anticoagulants to prevent clots. Anticoagulation reduces stroke risk from atrial fibrillation by 60-90% compared to placebo. Managing cardioembolic stroke risk requires identifying the underlying heart condition and addressing it with medications, surgery, or lifestyle changes.
This document provides an overview of stroke neuroimaging essentials. It begins with an introduction to stroke basics, including definitions of ischemic and hemorrhagic strokes. It then covers typical stroke presentations based on the affected territory. The document outlines the imaging approach to acute stroke, including the role of non-contrast CT, CTA, and MRA. It reviews common early signs on non-contrast CT such as the hyperdense vessel sign. Later signs like hypoattenuation and mass effect are also discussed. The document concludes with an example case walking through the imaging and management of an acute stroke patient.
4. stroke- investigations and managementmariam hamzah
The document summarizes the investigations and management of stroke. Key points include:
1. Imaging such as CT or MRI is used to distinguish between hemorrhagic and ischemic stroke and identify underlying causes. CT is more widely available while MRI is more sensitive.
2. Risk factors, cardiac investigations, and vascular imaging are also conducted to determine the cause of ischemic stroke.
3. Management of ischemic stroke involves supportive care, thrombolysis within 3 hours, aspirin to prevent recurrence, and carotid surgery for severe stenosis to reduce risk of further stroke.
4. For hemorrhagic stroke, reversal of coagulopathy and surgical evacuation may be considered to control bleeding and intracranial pressure
Mr. Sajal, age 35, presented with chest pain for 5 hours. His ECG showed signs of myocardial infarction, but his coronary angiogram (CAG) revealed non-obstructive coronary arteries. This is known as myocardial infarction with non-obstructive coronary arteries (MINOCA). MINOCA can affect up to 14% of AMI patients, particularly younger patients and women. Cardiac magnetic resonance imaging (CMR) can identify the underlying cause in up to 87% of MINOCA cases. While initially thought to be benign, MINOCA carries similar mortality risks as MI with obstructive coronary artery disease. Identifying the specific cause through tests like CMR is important to determine the proper long-
Pci or throm or pi in stemi best strategy(apicon 09022019)-finalDr.Vinod Sharma
- Primary angioplasty, thrombolysis, and pharmaco-invasive therapy are strategies for reperfusion in STEMI patients.
- The optimal strategy depends on factors like time since symptom onset, mortality risk from STEMI, availability of a skilled PCI laboratory, and time required for transport.
- Minimizing total ischemic time is critical as myocardial necrosis increases significantly past 40 minutes from occlusion. Every 30 minute delay in reperfusion increases 1-year mortality by 8%.
Coronary heart disease is a major cause of mortality worldwide. Percutaneous coronary intervention (PCI), also known as coronary angioplasty, is a non-surgical procedure used to treat blockages within the coronary arteries of the heart. During PCI, a catheter is inserted into an artery and guided to the site of blockage where a balloon is inflated to open the artery. Often a stent is placed to keep the artery open. PCI has become a common revascularization treatment for acute coronary syndromes and stable angina. While generally safe, complications from PCI occur in less than 2% of patients and include adverse reactions, acute myocardial infarction, bleeding, and death in less than 0.08% of patients.
This document provides an overview of acute coronary syndrome (ACS). It begins with a review of coronary artery anatomy and variations. It then discusses the presentations of ACS, including ischemic chest pain and equivalents. The main types of ACS - unstable angina, NSTEMI, and STEMI - are defined based on symptoms, electrocardiogram findings, and cardiac biomarker levels. Diagnosis and management strategies are outlined, including reperfusion therapies and drug treatments. Follow-up care after ACS and indications for procedures like cardiac catheterization and ICD placement are also summarized.
Coronary artery spasm is a reversible constriction of the coronary arteries caused by contraction of the smooth muscle cells in the artery wall. It was initially described in 1959 and can be triggered by factors like smoking, cocaine, or caffeine. During a spasm, electrocardiogram changes like ST elevation may occur and resolve quickly with nitroglycerin. Coronary angiography is used to diagnose spasm by using medications like ergonovine or acetylcholine to provoke episodes during testing. Treatment focuses on calcium channel blockers and nitrates, while avoiding beta blockers which may worsen spasms. Refractory cases can be treated with coronary stenting.
This document discusses coronary artery disease (CAD) and ischemic heart disease (IHD). It defines IHD as a disease of the heart muscle resulting from a lack of oxygen due to an imbalance between myocardial oxygen requirements and supply. CAD is most commonly caused by atherosclerosis. The spectrum of IHD ranges from silent ischemia to myocardial infarction and heart failure. Acute coronary syndrome (ACS) refers to the unstable spectrum of IHD and includes unstable angina and myocardial infarction. Biomarkers, imaging, and risk scores are used to stratify patients according to their risk. Medical management involves anti-ischemic therapies, antiplatelet agents, and risk factor modification.
Carotid endarterectomy versus carotid stentingKrishna Prasad
Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are procedures used to treat carotid artery stenosis. While CEA has been shown to be beneficial in clinical trials, CAS was developed to provide a less invasive option. However, concerns with CAS include higher risks of periprocedural complications like stroke. Several studies have compared CEA and CAS, finding CAS to be noninferior with similar composite outcomes, but higher risks of periprocedural stroke with CAS. Long term results are inconclusive, and patient factors like age, plaque characteristics, and vessel anatomy influence outcomes for each procedure. Ongoing studies continue to evaluate optimal treatment of carotid artery stenosis.
This document discusses guidelines for managing acute coronary syndrome (ACS) in patients without persistent ST-segment elevation. It defines ACS and its classifications. It emphasizes the importance of analyzing chest pain characteristics, ECG, and biomarkers to determine if a patient has unstable angina or non-ST-segment elevation myocardial infarction (NSTEMI). Risk stratification is crucial for deciding admission and treatment strategy. Treatment may involve antiplatelet and anticoagulant medications, as well as invasive procedures depending on risk level. Timely reperfusion is emphasized as the primary therapy for ST-segment elevation myocardial infarction (STEMI) patients. Dosing guidelines are provided for various antiplatelet and anticoagulant drugs used in ACS management
This document summarizes Dicky Aligheri's experience with hybrid procedures for aortic arch involvement between 2013-2014 at the National Cardiac & Vascular Centre Harapan Kita in Jakarta. It describes several case studies of patients who received treatments like total arch replacement, hemi arch replacement, and the frozen elephant trunk procedure. It also reviews literature on debates around the best surgical strategies for aortic arch pathology and the safety and efficacy of hybrid techniques compared to open surgery.
Guidelines in the management of carotid stenosisuvcd
This document provides an overview of guidelines for the management of carotid stenosis. It discusses:
1) Stroke is a major cause of death, with many caused by carotid artery disease. The risk of stroke is directly related to the degree of stenosis.
2) Natural history studies show that the risk of stroke is highest in the first year after symptoms and then declines over time. The risk is higher for more severe stenosis.
3) Early trials demonstrated the benefits of carotid endarterectomy (CEA) in reducing stroke risks compared to medical management alone for symptomatic and some asymptomatic patients.
4) Later trials evaluated carotid angioplasty and stenting (CAS) as an alternative to CEA but
This document discusses anticoagulant options for atrial fibrillation patients in Asia, specifically whether to switch patients stable on warfarin to novel oral anticoagulants (NOACs). It notes that maintaining the international normalized ratio for warfarin is challenging in Asian patients who are also at higher risk of intracranial hemorrhage. Clinical trials found NOACs reduced strokes, systemic embolisms, myocardial infarctions and all-cause death similarly in Asian and non-Asian patients, while significantly reducing hemorrhagic strokes in Asians. The document concludes NOACs are preferred over warfarin for Asian atrial fibrillation patients due to better efficacy and safety outcomes as well as
This document discusses left atrial appendage occlusion for stroke prevention in patients with atrial fibrillation. It provides background on atrial fibrillation and the increased risk of stroke. Left atrial appendage occlusion is recommended for patients with a high stroke risk who have contraindications to oral anticoagulation. The document reviews patient selection criteria and contraindications for left atrial appendage occlusion. It also examines left atrial appendage anatomy, imaging techniques for evaluation, and various closure devices including the Watchman, Amplatzer, and Lariat systems.
The document provides guidelines for the management of infective endocarditis from the European Society of Cardiology. It discusses definitions of infective endocarditis, recommendations for antibiotic prophylaxis, the role of echocardiography in diagnosis, etiologic agents, predictors of poor outcome, surgical indications, and treatment of various microorganisms including streptococci, staphylococci, enterococci, and culture-negative cases. It also addresses management considerations for infective endocarditis in specific patient populations such as those with prosthetic valves, congenital heart disease, or pregnancy.
This document summarizes recent evidence on medical treatments, percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG) for stable coronary artery disease. Key findings include:
1) Large clinical trials found no significant difference in outcomes between PCI and optimal medical therapy for stable CAD patients.
2) CABG was shown to reduce mortality, myocardial infarction, and repeat revascularization compared to medical therapy or PCI for multi-vessel disease.
3) For left main coronary artery disease, CABG may be preferable to PCI for patients with high anatomical complexity scores.
4) Ongoing trials like ISCHEMIA are further evaluating optimal revascularization strategies for stable CAD patients with ischemia.
2018 AHA ASA guideline - guidelines for the early management of patients with...Vinh Pham Nguyen
The document provides guidelines for the early management of acute ischemic stroke, covering prehospital stroke management and systems of care, emergency evaluation and treatment, and in-hospital supportive care. It recommends public education on stroke signs and calling 911, designating stroke centers and teams, and using telemedicine to expand access to stroke expertise. The goal is to optimize early management through improved systems and rapid treatment to increase utilization of therapies like IV alteplase and endovascular procedures.
Cryptogenic stroke and PFO have always been a controversial topic with no closure trial in the past showing significant benefit from closing the PFO in preventing the recurrent stroke. Also thought to be due to imperfect definition of cryptogenic stroke which is evolving with drop in the fraction of patients from 20-40% in the past to very fewer numbers due to increased understanding of the mechanisms involved in acute stroke. Recent trials REDUCE and CLOSE targeted the niche population of PFO with moderate to large shunt and atrial septal aneurysm and showed benefit of closing PFO compared to the antiplatelet therapy alone but with the risk of A.fib, device and procedure related complications. This presentation is made in the Cerebrovascular center weekly conference at the Cleveland Clinic with my perspective after these current trials.
Trans-Cranial Doppler (TCD) is a non-invasive ultrasound technique used to evaluate cerebral blood flow velocities. There are two main types of TCD devices - non-duplex devices which identify arteries "blindly" based on Doppler shift and duplex devices which combine Doppler with B-mode imaging to directly visualize arteries. TCD allows evaluation of intracranial steno-occlusive disease, vasospasm, aneurysms, and other conditions. It can detect elevated velocities indicative of stenosis but has limitations including operator dependence and inability to image distal arteries. TCD is useful for monitoring conditions like sickle cell disease where elevated velocities increase stroke risk.
This document discusses cardioembolic stroke, which occurs when heart issues cause materials to enter the brain's blood vessels. Common causes include atrial fibrillation, heart failure, and mechanical heart valves. Diagnosis involves echocardiography and monitoring for embolic signals. Treatment depends on the specific heart condition but often includes anticoagulants to prevent clots. Anticoagulation reduces stroke risk from atrial fibrillation by 60-90% compared to placebo. Managing cardioembolic stroke risk requires identifying the underlying heart condition and addressing it with medications, surgery, or lifestyle changes.
This document provides an overview of stroke neuroimaging essentials. It begins with an introduction to stroke basics, including definitions of ischemic and hemorrhagic strokes. It then covers typical stroke presentations based on the affected territory. The document outlines the imaging approach to acute stroke, including the role of non-contrast CT, CTA, and MRA. It reviews common early signs on non-contrast CT such as the hyperdense vessel sign. Later signs like hypoattenuation and mass effect are also discussed. The document concludes with an example case walking through the imaging and management of an acute stroke patient.
4. stroke- investigations and managementmariam hamzah
The document summarizes the investigations and management of stroke. Key points include:
1. Imaging such as CT or MRI is used to distinguish between hemorrhagic and ischemic stroke and identify underlying causes. CT is more widely available while MRI is more sensitive.
2. Risk factors, cardiac investigations, and vascular imaging are also conducted to determine the cause of ischemic stroke.
3. Management of ischemic stroke involves supportive care, thrombolysis within 3 hours, aspirin to prevent recurrence, and carotid surgery for severe stenosis to reduce risk of further stroke.
4. For hemorrhagic stroke, reversal of coagulopathy and surgical evacuation may be considered to control bleeding and intracranial pressure
This document discusses the classification, presentation, diagnosis, and treatment of acute coronary syndrome (ACS). ACS results from an imbalance between myocardial oxygen supply and demand due to a thrombotic coronary artery. It is classified as ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), or unstable angina (UA) based on electrocardiogram findings and cardiac biomarker levels. Initial treatment involves oxygen, nitroglycerin, aspirin, a P2Y12 inhibitor, and anticoagulation. STEMI patients should receive reperfusion via primary percutaneous coronary intervention or fibrinolysis if primary PCI cannot be performed in a timely manner.
current stroke management guideline.pptxrigomontejo
This document provides guidelines for the current management of stroke. It recommends against urgent anticoagulation to prevent early recurrent stroke or improve outcomes. It also recommends against pharmacological or nonpharmacological emergency treatments lacking proven neuroprotective effects. Additionally, it advises dysphagia screening before oral intake and intermittent pneumatic compression for immobile patients to prevent DVT. Lastly, it recommends statin therapy during acute periods to reduce atherosclerotic risk and measuring lipid profiles to document baseline LDL levels.
Onset to Needle delay in Stroke Chain of SurvivalWafik Bahnasy
This document discusses acute ischemic stroke (AIS) management. It notes that AIS is caused by focal cerebral, spinal or retinal infarction. It highlights the importance of rapid identification, stabilization, and transport to a certified stroke center to reduce treatment delays. For thrombolysis to be effective, it must be administered within 4.5 hours of symptom onset. The document outlines evaluation and treatment protocols for AIS patients in the pre-hospital and emergency department settings. Overall, it emphasizes minimizing time delays to improve outcomes through coordinated systems of stroke care.
Recent Advances In Thrombolysis In Stroke PatientAdamya Gupta
1) Recent advances in thrombolysis for stroke patients include extending the treatment window for intravenous rt-PA from 3 hours to 4.5 hours post-stroke onset based on the ECASS III trial results.
2) Intravenous rt-PA is still the standard of care for eligible patients within 4.5 hours, but endovascular thrombectomy is now recommended for eligible patients with a large vessel occlusion up to 24 hours from last known normal.
3) Treatment protocols now focus on a rapid door-to-needle time of 60 minutes or less for intravenous rt-PA and include advances in imaging such as CTA and perfusion imaging to identify patients that may benefit from endovascular thrombectomy.
"Decoding Antithrombotics in Acute Ischemic Events with Dr. Ganesh"
🌟 Greetings, everyone! I'm Dr. Ganesh, and today we're diving into a critical topic: Antithrombotics in Acute Ischemic Events. Whether you're a healthcare professional, a patient, or just someone keen on understanding the complexities of cardiovascular health, this discussion is for you.
From vertigo to coma basilar artery occlusion بالاتر از سیاهی رنگی نیستramtinyoung
This document discusses standards of care for acute management of posterior circulation stroke patients. It summarizes that the patient presented with vertigo, blurred vision and other symptoms from an occlusion of the basilar artery, and received IV thrombolysis followed by a drug to promote recanalization, with improvement in symptoms. It also reviews general treatment approaches for posterior circulation strokes, including antiplatelet therapy, anticoagulation, management of blood pressure, and cautions around hemorrhagic transformation.
Stroke a rare complication in Post PCI patientPRAVEEN GUPTA
In this ppt i am going to describe about one patient who develop acute stroke after PCI in our hospital. Also i am going to discuss how to diagnose, manage and treat such patient, risk factor associated with stroke after PCI.
Transient ischemic attacks (TIAs) require urgent evaluation due to the high risk of stroke. A TIA is diagnosed using scales like the ABCD2 score and differentiated from conditions like seizures or migraines. The National Stroke Association recommends factors like symptom duration over 1 hour or carotid stenosis over 50% warrant hospitalization. For diagnosed strokes, treatments include IV alteplase within 4.5 hours, mechanical thrombectomy if eligible, and supportive care involving blood pressure and glucose control. Secondary prevention incorporates antithrombotics, treating underlying conditions, and lifestyle changes.
This document provides an overview of cerebrovascular diseases for medical students. It covers anatomy of the intracranial cerebrovascular system, common acute stroke presentations based on arterial distribution, features suggestive of brainstem stroke, watershed areas vulnerable to hypoperfusion, stroke risk factors, types of strokes, stroke epidemiology, case examples, acute stroke treatment options including thrombolytics, management of blood pressure, stroke workup, secondary stroke prevention, post-stroke care, and intracranial hemorrhage. Key points include differences between transient ischemic attack and stroke, use of the NIH stroke scale to determine severity, eligibility criteria for thrombolysis with tPA, and management of cerebral venous sinus thrombosis.
This document discusses carotid artery stenosis, which can cause transient ischemic attacks (TIAs) or stroke. It presents 5 case studies of patients who presented with symptoms related to carotid stenosis. The key points are that carotid stenting can effectively treat symptomatic stenosis and reduce the risk of future strokes. However, stenting is not recommended for complete carotid occlusions seen on angiography. Medical management of associated conditions like diabetes and hypertension is also important. The timing of stenting depends on whether the patient presents with TIA versus an acute stroke.
AF.pdf in special conditions 2020 guidelinesMinaElbramosy
This document discusses several topics related to atrial fibrillation (AF):
1) Acute hemodynamic instability in AF patients requires prompt intervention such as electrical cardioversion or anticoagulation.
2) The risk of AF is increased in acute coronary syndrome patients, who may receive less appropriate treatment and have worse outcomes.
3) Managing antithrombotic therapy risks in AF patients having acute coronary syndromes or undergoing PCI requires balancing stroke, bleeding, and ischemic risks.
2017 ESC guidelines for the management of acuteIqbal Dar
The document summarizes key messages from the 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. It discusses 14 main points, including the epidemiology of STEMI, the importance of equal treatment for women and men, ECG diagnosis criteria, reperfusion strategy selection, the role of cardiac networks and protocols, antithrombotic therapy, imaging, special patient subsets, and quality indicators for auditing and improving STEMI care. The guidelines emphasize timely reperfusion therapy, coordination across emergency services and hospitals, and evidence-based treatments tailored to individual patient characteristics and circumstances.
- STEMI is a major cause of morbidity and mortality globally and in Saudi Arabia due to increasing risk factors. Only 42% of STEMI patients undergo primary PCI (PPCI) in Saudi Arabia, with only 62% achieving door-to-balloon times under 90 minutes. Mortality is influenced by factors like age, time to treatment, and presence of STEMI networks. PPCI is the preferred reperfusion strategy over fibrinolytics when possible. Guidelines recommend antiplatelet and anticoagulation medications during PPCI and secondary prevention medications like statins long-term.
The document summarizes guidelines for managing acute myocardial infarction with ST-segment elevation from the 2017 European Society of Cardiology. It outlines recommendations for initial ECG, diagnosis of STEMI, reperfusion therapy including primary PCI or fibrinolysis, medical therapies, management of complications, and long-term care. Key points include performing early ECG to diagnose STEMI, using primary PCI over fibrinolysis when possible, administering dual antiplatelet and anticoagulation therapies during PCI, and prescribing medications like beta-blockers and ACE inhibitors to reduce mortality and hospitalizations.
This document provides information on acute stroke, including its epidemiology, definition, risk factors, clinical presentation, investigations, imaging, and management. Some key points:
- Stroke is a leading cause of death worldwide and in South Africa. Incidence rates in SA are estimated to be 244 per 100,000 people.
- Risk factors for ischemic stroke include hypertension, tobacco use, diabetes, high cholesterol, physical inactivity, and others.
- Clinical presentation depends on location of stroke in the brain. Imaging such as CT scan is important to distinguish ischemic from hemorrhagic stroke.
- Management involves supportive care as well as specific treatments depending on stroke type, such as intravenous thrombolysis for ischemic strokes within
This document provides guidelines for managing diabetes during Ramadan fasting. It was created by the International Diabetes Federation and Diabetes and Ramadan International Alliance. The guidelines cover epidemiology of diabetes and Ramadan fasting, physiology changes during fasting, risk stratification for fasting, diabetes education, and medication adjustments. The goal is to enhance healthcare provider knowledge to safely support patients with diabetes who choose to fast during Ramadan.
This review article summarizes the 2011 evidence-based practice guideline published by the American Society of Hematology for the diagnosis and treatment of immune thrombocytopenia (ITP). The guideline was created using a rigorous evidence-based approach and provides treatment recommendations using the GRADE system where evidence exists. It identifies a lack of evidence in several key areas of ITP therapy, such as comparative studies of front-line therapies and management of bleeding. The guideline covers diagnosis and treatment of ITP in both children and adults, including recommendations for initial treatment, management of non-responders, treatment of specific secondary forms of ITP, and treatment during pregnancy.
Two types of acute diarrhoeal emergencies are cholera, which causes acute watery diarrhoea, and Shigella dysentery, which causes acute bloody diarrhoea. Both are transmitted through contaminated water, food, hands, and vomit or stool of sick individuals. The first steps in managing a diarrhoeal outbreak are determining if there are an unusual number of similar cases, identifying whether patients have cholera or Shigella by their symptoms, and being prepared for a potential increase in cases.
The document provides guidelines for diabetic eye care developed by the International Council of Ophthalmology (ICO). It aims to improve eye care quality worldwide by addressing screening and management of diabetic retinopathy for different resource settings. The guidelines describe classifying and screening for diabetic retinopathy, detailed eye exams, treating retinopathy and macular edema, and managing special circumstances. It includes tables outlining follow-up schedules and treatment recommendations based on retinopathy severity and resource level.
This document discusses special considerations for managing chronic myeloid leukemia (CML) during pregnancy and in the pediatric population. For pregnancy:
- Tyrosine kinase inhibitors (TKIs) used to treat CML are teratogenic and known to cause fetal toxicities. TKI therapy during pregnancy has been associated with higher rates of miscarriage and fetal abnormalities.
- If a patient wants to conceive, discontinuing TKI therapy may be considered if a deep molecular response has been maintained for at least 2 years. Close monitoring would be needed if CML recurs during pregnancy.
- For pediatric CML management, no evidence-based recommendations exist since CML is relatively rare in children. Specialized care at a cancer center is
This document discusses several minor blood group systems beyond ABO and Rh, including I/i, Lewis, P, MN, and SsU. It provides details on the antigens and antibodies in each system, including frequencies, clinical significance, and serological characteristics. The key points are:
- Over 500 antigens beyond ABO have been identified on red blood cells.
- The I/i, Lewis, P, MN, and SsU systems involve antigens that are inherited based on allelic genes and their interactions.
- Antibodies in these systems are usually naturally occurring and clinically insignificant, though some like anti-S, anti-s, and anti-U can cause hemolytic disease of the new
This document provides a focused update to the 2013 ACCF/AHA guidelines for the management of heart failure. It was developed by a writing group comprised of experts from the ACC, AHA, HFSA, and other organizations. The update provides new recommendations on the use of biomarkers for diagnosis and prognosis of heart failure as well as for treatment of stages A through D. It also includes new recommendations on treating anemia, hypertension, and sleep disordered breathing in heart failure patients. The update was reviewed and approved by several committees and is intended to provide guidance for clinicians on best practices in heart failure management.
These guidelines provide recommendations for managing dyslipidemia and preventing cardiovascular disease. They were developed by a writing committee and task force of experts based on reviews of current literature. The guidelines note that medical decisions should be made using clinical judgment and local resources, as rapid changes in the field may lead to periodic revisions. The document aims to assist healthcare professionals while not replacing their independent judgment.
This document provides an overview of the process and methods used to develop recommendations for the testing, management, and treatment of hepatitis C virus (HCV) infection. A panel of HCV experts from various medical fields develops the guidance using an evidence-based approach. Recommendations are rated based on the strength of evidence. The guidance is intended to be a living document that is regularly updated as new treatments and information become available. Strict processes are in place to manage conflicts of interest among panel members.
This document provides information on drugs that are contraindicated (Pregnancy Category X) for use during pregnancy. It lists the generic and brand names of drugs across several therapeutic categories including cardiovascular, dermatological, gastrointestinal, infections/infestations, musculoskeletal, neoplasms, nutrition, OB/GYN, pain/pyrexia, respiratory, and urogenital systems. For some drugs, it specifies the trimester or stage of pregnancy during which they should be avoided. The document also explains the pregnancy categories (A, B, C, D, X) used to qualify contraindications and precautions for drug use during pregnancy.
Muslims believe that death comes by divine decree and marks the beginning of an eternal journey in the afterlife. Some terminally ill Muslim patients receive care in intensive care units that prolong their lives through significant medical intervention when they may instead suffer without meaningful benefit. There is limited information available about Islamic beliefs regarding end of life issues for Muslims living in non-Muslim countries. Withdrawal of futile treatment is permitted in Islamic law for terminally ill patients to allow death to take its natural course. "Do not resuscitate" orders are also permitted in certain situations according to Islamic rulings if three physicians agree treatment would be non-beneficial. However, hydration and pain management should continue until death.
This document reviews recent guidelines for treating painful diabetic neuropathy (DPN) and compares their recommendations. It finds that the main drug classes recommended as first-line treatment are anticonvulsants like pregabalin and gabapentin, antidepressants like tricyclic antidepressants and duloxetine, and opioids. Pregabalin and duloxetine are the only drugs approved to treat neuropathic pain in diabetes. The guidelines differ in their methodologies, with some based more quantitatively on clinical trial evidence while others incorporate additional factors. Patient characteristics may also influence which treatment is most appropriate.
1) A randomized clinical trial of 576 adults with acute sore throat found that a single dose of oral dexamethasone did not increase the proportion of patients with complete resolution of symptoms at 24 hours compared to placebo.
2) However, at 48 hours significantly more patients in the dexamethasone group experienced complete resolution of symptoms than those in the placebo group.
3) The study found no other significant differences between the dexamethasone and placebo groups in secondary outcomes such as duration of symptoms, health care use, time off work, or medication use.
This document provides guidelines for managing diabetes during Ramadan fasting. It was created by the International Diabetes Federation and Diabetes and Ramadan International Alliance. The guidelines cover epidemiology of diabetes during Ramadan, physiology of fasting and how it impacts diabetes, risk stratification of patients, education recommendations, and medication adjustments for various diabetes medications and high-risk patient groups, such as those with type 1 diabetes. The goal is to enhance healthcare professionals' knowledge to best support patients during Ramadan fasting.
May-Hegglin anomaly is part of a spectrum of disorders called MYH9-related disease. Mutations in the MYH9 gene cause macrothrombocytopenia (low platelet count with large platelets) and basophilic inclusions in white blood cells. A diagnosis can be facilitated by platelet electron microscopy and MYH9 gene sequencing. While each disorder in the spectrum has some unique characteristics, they are all characterized by macrothrombocytopenia and are now considered manifestations of MYH9-related disease.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
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!
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.