Role of Blood Pressure in Recurrent StrokeSudhir Kumar
Hypertension is a major risk factor for the first stroke as well as recurrent stroke. Therefore, adequate control of BP is necessary to reduce the risk of stroke recurrence. This presentation looks at the ABCD 2 score to predict the exact risk of stroke recurrence after TIA. Target BP that needs to be achieved has been discussed. Various antihypertensive agents based on the scientific evidence have been discussed.
Role of Blood Pressure in Recurrent StrokeSudhir Kumar
Hypertension is a major risk factor for the first stroke as well as recurrent stroke. Therefore, adequate control of BP is necessary to reduce the risk of stroke recurrence. This presentation looks at the ABCD 2 score to predict the exact risk of stroke recurrence after TIA. Target BP that needs to be achieved has been discussed. Various antihypertensive agents based on the scientific evidence have been discussed.
Current management of Spontaneous intracerebral haemorrhage 2016Woralux Phusoongern
Reference : Dastur CK, Yu W. Current management of spontaneous intracerebral haemorrhage. Stroke and Vascular Neurology 2017;00: e000047. doi:10.1136/svn- 2016-000047
Described the BP targets in Ischemic stroke with and without IV thrombolysis, with and without mechanic thrombectomy, Intra cerebral Heamorrhage, SAH and other Neurological emergencies with revised AHA/ ASA upated guidelines
ALSO showed different journal evidence of work on blood pressure management in acute ischemic and heamorrhagic stroke, BP tergets in SAH, PRES
newer drug combinations in management of hypertension,esp in presence of CAD, making them more potent anti-hypertensives, with lesser side effects especially pedal edema
Updated Hypertension Management – ESH 2023.pdfDr. Nayan Ray
Hypertension is the most prevalent CV disorder in the world and according to the WHO, it affects 1.28 billion adults aged 30–79 years worldwide, two-thirds living in low-income and middle-income countries.
In 2019, the global age-standardized average prevalence of hypertension in adults aged 30–79 years was reported to be 34% in men and 32% in women.
At younger ages (<50 years), hypertension is more prevalent in men, whereas a steeper increase of SBP in women from their third decade (and more so following menopause) makes the prevalence of hypertension greater in women in older age categories (>65 years).
Rule of Halves
Half the people with high blood pressure are not known (“rule 1”),
Half of those known are not treated (“rule 2”) and
Half of those treated are not controlled (“rule 3”)'
Definition:
Hypertension is defined based on repeated office SBP values ≥ 140 mmHg and/or DBP ≥ 90 mmHg.
Renal function is greatly important in risk stratification, pharmacologic therapy, and the prognosis of patients with heart failure (HF).
The deterioration of heart function can result in the worsening renal function (WRF) and vice versa.
Besides the heart function itself, the Pharmacologic Treatment of HF is closely related to renal function as regards initiation, titration, and discontinuation, making the situation more complex.
Current management of Spontaneous intracerebral haemorrhage 2016Woralux Phusoongern
Reference : Dastur CK, Yu W. Current management of spontaneous intracerebral haemorrhage. Stroke and Vascular Neurology 2017;00: e000047. doi:10.1136/svn- 2016-000047
Described the BP targets in Ischemic stroke with and without IV thrombolysis, with and without mechanic thrombectomy, Intra cerebral Heamorrhage, SAH and other Neurological emergencies with revised AHA/ ASA upated guidelines
ALSO showed different journal evidence of work on blood pressure management in acute ischemic and heamorrhagic stroke, BP tergets in SAH, PRES
newer drug combinations in management of hypertension,esp in presence of CAD, making them more potent anti-hypertensives, with lesser side effects especially pedal edema
Updated Hypertension Management – ESH 2023.pdfDr. Nayan Ray
Hypertension is the most prevalent CV disorder in the world and according to the WHO, it affects 1.28 billion adults aged 30–79 years worldwide, two-thirds living in low-income and middle-income countries.
In 2019, the global age-standardized average prevalence of hypertension in adults aged 30–79 years was reported to be 34% in men and 32% in women.
At younger ages (<50 years), hypertension is more prevalent in men, whereas a steeper increase of SBP in women from their third decade (and more so following menopause) makes the prevalence of hypertension greater in women in older age categories (>65 years).
Rule of Halves
Half the people with high blood pressure are not known (“rule 1”),
Half of those known are not treated (“rule 2”) and
Half of those treated are not controlled (“rule 3”)'
Definition:
Hypertension is defined based on repeated office SBP values ≥ 140 mmHg and/or DBP ≥ 90 mmHg.
Renal function is greatly important in risk stratification, pharmacologic therapy, and the prognosis of patients with heart failure (HF).
The deterioration of heart function can result in the worsening renal function (WRF) and vice versa.
Besides the heart function itself, the Pharmacologic Treatment of HF is closely related to renal function as regards initiation, titration, and discontinuation, making the situation more complex.
Cardiac arrest is the cessation of functional cardiac contraction and is the final common pathway in death from any pathology.
In the clinical context, cardiac arrest refers to the sudden loss of cardiac output that prompts an emergency response.
Pathogenesis, prognosis and management of in-hospital and out-of-hospital cardiac arrest are subtly different; however, the basic principles of cardiopulmonary resuscitation (CPR) are to maintain forward flow of oxygenated blood, correct the causative factor and restore spontaneous circulation.
CVD Risk Managemnt- Focus on HTN & Dys.pdfDr. Nayan Ray
Cardiovascular disease is a major cause of disability and premature death throughout the world and contributes substantially to the escalating costs of health care.
The underlying pathology is atherosclerosis, which develops over many years and is usually advanced by the time symptoms occur, generally in middle age.
Acute coronary and cerebrovascular events frequently occur suddenly and are often fatal before medical care can be given.
Modification of risk factors has been shown to reduce mortality and morbidity in people with diagnosed or undiagnosed cardiovascular disease.
In patients with coronary artery disease (CAD), percutaneous coronary interventions (PCI) are the cornerstone of treatment for those presenting with an acute coronary syndrome (ACS); PCI has also been largely adopted in patients with chronic coronary syndromes (CCS).
Adjunctive pharmacotherapy, in particular antithrombotic therapy, has a pivotal role in optimising outcomes in patients undergoing PCI23. In fact, patients undergoing PCI may develop both acute and long-term ischaemic events.
Therefore, antithrombotic drugs, in particular antiplatelet agents, are key to the treatment and prevention of both local and systemic thrombotic complications.
Coronary Revascularization in Chronic Kidney Disease Patient.pptxDr. Nayan Ray
Chronic kidney disease (CKD) is an independent risk factor for the development of coronary artery disease, and for more severe coronary heart disease (CHD).
CKD is also associated with adverse outcomes in those with existing cardiovascular disease.
This includes increased mortality after an acute coronary syndrome, after percutaneous coronary intervention (PCI) with or without stenting, and after coronary artery bypass. In addition, patients with CKD are more likely to present with atypical symptoms, which may delay diagnosis and adversely affect outcomes.
Having more than two year experiences, presently anticoagulant is an essential component of management of COVID 19
Its role is recommended in moderate to severe to critically ill patients with different opinion in the dosage
Giving anticoagulants in asymptomatic or mild cases is still need to be validated though there are suggestions in favor.
There is recommendation for post discharge patients who had clinically suspected/established thromboembolism events
Dyslipidemia in Chronic Kidney Diseases.pdfDr. Nayan Ray
Dyslipidaemia in Chronic Kidney Disease: An Approach to Pathogenesis and Treatment
Slides Include:
1. Stages of CKD
2. Developments of atherogenesis
3. Lipoprotein in CKD
4. Drug Therapies
5.Summary KDIGO Guideline
Management of HTN according to gender. This slides will answer some questions such as
1. Why there is BP variability difference between male and female?
2. What's the regulatory mechanism of HTN in gender?
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
2. Introduction
Stroke has a global incidence of 15 million people per year, is the
third leading cause of death and is the most common cause of
disability in the western world.
High-blood pressure (BP) is the leading modifiable risk factor for
both ischaemic and haemorrhagic stroke affecting 1 billion people
worldwide.
In acute stroke, 75% of patients have high BP and 50% of those
have a prior history of hypertension.
Although BP spontaneously falls in two-thirds of patients in the
first week following stroke, one-third remain hypertensive and
have an increased risk of a poor outcome.
Appleton JP, Sprigg N, Bath PM. Blood pressure management in acute stroke. Stroke and Vascular Neuro
2016;1:e000020. doi:10.1136/svn-2016-000020
NYN/DMA/BPL
3. HYPERTENSIVE INTRACEREBRAL
HEMORRHAGE
Patho-physiologically, long-standing poorly controlled HTN leads
to formation of microaneurysms of perforating arteries (Charcot-
Bouchard aneurysms)
These small penetrating arteries can leak or rupture leading to
hemorrhagic strokes
The most common locations for hypertensive hemorrhages
include the basal ganglia (particularly the putamen), thalamus,
pons, and cerebellum
(DiMuzio, Radiopedia, 2017)
NYN/DMA/BPL
5. In the long term, HTN causes atherosclerosis
(hardening of the arteries), which can cause
blockage of the small blood vessels in the brain
NYN/DMA/BPL
6. Acute Stroke Management
1. Hypotension and hypovolemia should be avoided to facilitate
systemic perfusion
2. Before intravenous fibrinolytic therapy is administered, BP should
be <185/110 mm Hg and <180/105 mm Hg in the first 24 hours after
such treatment
3. If mechanical thrombectomy is planned and intravenous
thrombolytic therapy has not been given, BP should be ≤185/110 mm
Hg before the procedure and ≤180/105 mm Hg in the first 24 hours
after the procedure
(Hypertension. 2020;76:1688-1695. DOI:
10.1161/HYPERTENSIONAHA.120.14653.)
NYN/DMA/BPL
7. 4. In patients who undergo successful reperfusion with mechanical
thrombectomy, it may be reasonable to maintain BP <180/105 mm Hg
5. Early treatment of hypertension may be indicated in the presence of
certain comorbid conditions (eg, heart failure, aortic dissection, acute
myocardial infarction
6. The usefulness of BP augmentation in acute ischemic stroke remains
uncertain
(Hypertension. 2020;76:1688-1695. DOI:
10.1161/HYPERTENSIONAHA.120.14653.)
Acute Stroke Management…
NYN/DMA/BPL
8. 7. For patients who are not treated with intravenous fibrinolytic
therapy or mechanical thrombectomy:
– If BP is ≥220/120 mm Hg and there are no comorbid conditions
requiring acute BP-lowering treatment, it is reasonable to initially
lower BP by 15% although the benefit of lowering or reinstituting BP
therapy in the first 48 to 72 hours is uncertain and
– Lowering BP when it is <220/120 mm Hg in the first 48 to 72 hours
seems to be a safe strategy but does not lower mortality or improve
functional outcome
(Hypertension. 2020;76:1688-1695. DOI:
10.1161/HYPERTENSIONAHA.120.14653.)
Acute Stroke Management…
NYN/DMA/BPL
9. Finally, it is reasonable to restart BP-lowering
medication in patients who have a BP >140/90
mm Hg once the patient is neurologically stable.
(Hypertension. 2020;76:1688-1695. DOI:
10.1161/HYPERTENSIONAHA.120.14653.)
Acute Stroke Management…
NYN/DMA/BPL
12. Recurrent Stroke Prevention
1. For those with SBP ≥140 mm Hg or DBP ≥90 mm Hg, BP-
lowering therapy is reasonable, and a target for BP lowering of
<140/90 mm Hg is reasonable and
2. For those with small vessel (ie, lacunar) cerebral ischemia, a
SBP-lowering target of <130 mm Hg is reasonable
3. For those with a stroke or TIA, a BP-lowering goal of <130/80
mm Hg may be reasonable
(Hypertension. 2020;76:1688-1695.
DOI:
10.1161/HYPERTENSIONAHA.120.1465
NYN/DMA/BPL
13. BP-lowering therapy
1. Restart BP-lowering medications within several days after the
index stroke or TIA to reduce the risk of subsequent major
vascular events
2. Any of a number of medication classes may be used to lower
BP; however, a thiazide diuretic, ACE inhibitor, or angiotensin
receptor blocker or a combination of the first 2 medication
choices may be administered
3. Individualize the choice of BP-lowering medication based on
patient comorbidities and
4. The usefulness of BP-lowering in people with stroke or TIA
and SBP <140 mm Hg or DBP <90 mm Hg is not well established
(Hypertension. 2020;76:1688-1695. DOI:
10.1161/HYPERTENSIONAHA.120.14653.)
NYN/DMA/BPL
14. First Stroke Prevention
1. Regular screening of BP and treatment of elevated BP by
lifestyle and pharmacological measures
2. Lower BP to a target of <130/80 mm Hg
3. Based on patient comorbidities choose appropriate BP
lowering medications, however, successful lowering of BP is
emphasized over specific classes of BP-lowering medications
save for those with specific comorbidities requiring a specific
BP-lowering medication class and
4. Self-measurement of BP is recommended
(Hypertension. 2020;76:1688-1695. DOI:
10.1161/HYPERTENSIONAHA.120.14653.)
NYN/DMA/BPL
15. Intracerebral Hemorrhage
1. When SBP is between 150 and 220 mm Hg, acute BP lowering
may be effective in relation to improvement of functional
outcome and is safe and
2. When SBP is >220 mm Hg, it may be reasonable to lower BP
by administration of a continuous intravenous infusion
medication with initiation of frequent BP monitoring
Aim for a target SBP of 140 to 160 mm Hg early after the
onset of ICH.
(Hypertension. 2020;76:1688-1695. DOI:
10.1161/HYPERTENSIONAHA.120.14653.)
NYN/DMA/BPL
17. Most adults with hypertension, especially Black
patients and those with a high starting level of BP,
should be treated with ≥2 antihypertensive drugs, in
combination with lifestyle modification, to control
their BP.
Drugs with complementary mechanisms of action,
such as a diuretic and renin-angiotensin system
blockers, are preferred for combinations and should
be administered as a single-pill combination when
possible.
(Hypertension. 2020;76:1688-1695. DOI:
10.1161/HYPERTENSIONAHA.120.14653.)
NYN/DMA/BPL
19. In summary
BP lowering is a reasonable overall strategy as at the very
least it will reduce risk of stroke and other cardiovascular
diseases.
There is no definitive evidence that one class of
antihypertensive drugs is superior to another for
achievement of cognitive maintenance. It is reasonable to
consider the SPRINT BP lowering therapeutic regimen and BP
lowering target (<120 mm Hg systolic).
It is reasonable to control BP in middle-aged and young
elderly to lower risk of cognitive impairment and dementia.
P.B. Gorelick et al. International Journal of Cardiology Hypertension 3 (2019) 100021
NYN/DMA/BPL
20. In those with stroke, lowering of blood pressure may
reduce the risk of post-stroke dementia.
In those at risk for vascular cognitive impairment (e.g.,
multiple cardiovascular risks), lowering of BP may reduce
the risk of cognitive impairment.
For persons 80 years of age and older, the usefulness of BP
lowering for prevention of dementia in not established. In
fact, there is concern that with BP lowering in for
example certain older patients, there may be an increase
of small subcortical infarcts based on brain blood pressure
gradients
P.B. Gorelick et al. International Journal of Cardiology Hypertension 3 (2019) 100021
In summary……
NYN/DMA/BPL
