How To Recognise and Manage a Pre Shock SettingHan Naung Tun
This document discusses the recognition and management of pre-shock in the context of anterior ST-elevation myocardial infarction (STEMI). Pre-shock, also known as SCAI shock stages A-B, involves persistent hemodynamic compromise without fully meeting shock criteria and these patients are prone to rapid deterioration. The case describes a 65-year-old man with anterior STEMI who did not improve after percutaneous coronary intervention on the culprit lesion, meeting some but not all criteria for cardiogenic shock. Invasive hemodynamic monitoring showed features of pre-shock and upfront use of an intra-aortic balloon pump provided immediate hemodynamic support, preventing further deterioration. Early recognition of pre-shock using both clinical and invasive parameters can guide
Hospital Readmission of Heart Failure Patients And Its Precipitated Factors a...Han Naung Tun
Hypertension is one of the most prevalent modifiable risk factor for the development of heart failure (HF). Chronic heart failure (CHF) is the most common cause of readmission for patients in worldwide
96091164 Slice Ct And Cerebral Atherosclerosis02calaf0618
1. Carotid endarterectomy reduces the risk of stroke compared to medical therapy alone in patients with symptomatic moderate (50-69%) carotid stenosis, with an absolute risk reduction of about 5-10% over 5 years.
2. For asymptomatic carotid stenosis ≥60%, carotid endarterectomy provides a relative risk reduction of 53% compared to aspirin alone, but medical therapy is still usually recommended due to the low baseline risk.
3. Carotid artery stenting is recommended for patients who are not suitable for surgery due to high surgical risk from conditions like severe cardiac or pulmonary disease.
This document summarizes the case of a woman who presented with nausea, respiratory failure, and hypotension. She was found to have signs of cardiogenic and septic shock. Imaging and testing revealed she had suffered an anterior myocardial infarction with rupture of the anterior papillary muscle, causing mitral regurgitation. She underwent surgery to repair the valve and bypass the coronary artery. Her postoperative recovery was complicated but she was eventually discharged and made a full recovery.
This document summarizes key information about device therapy in heart failure, including implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy (CRT). It discusses major clinical trials that have evaluated the benefits of these devices for primary and secondary prevention of sudden cardiac death. Factors influencing the benefits of ICD therapy are summarized, as well as predictors of mortality after ICD implantation. Complications related to ICDs and CRT devices are also briefly outlined.
Guidelines on anticoagulation in Atrial FibrillationDr Raja Mohammed
Atrial fibrillation is the commonest cardiovascular rhythm disorder with a worldwide prevalence. ESC and AHA releases guidelines on anti-coagulation and is followed world over. This lecture is intended to help junior medical colleagues, budding cardiologists, internal medicine and family medicine colleagues, those work in coronary care and intensive care units, emergency room physicians, those involved in cardiovascular medical and nursing care and support staff.
Acute coronary syndrome management by RxVichuZ! ;)RxVichuZ
This is my 99th powerpoint...
Deals with ACS(Acute coronary syndrome), its clinical features, and management strategies, based on standard guidelines and literatures.
This document summarizes a study reporting on patients experiencing cardiogenic shock following acute myocardial infarction. The study analyzed 1,190 patients registered in the SHOCK Trial Registry between 1993-1997. It found that predominant left ventricular failure was the most common cause of shock (78.5%), while mechanical complications like ventricular septal rupture or tamponade caused shock in about 12% of cases. In-hospital mortality was 60% overall but higher at 87.3% for patients with ventricular septal rupture. Outcomes were better for patients receiving treatments like thrombolysis, intra-aortic balloon counterpulsation, coronary angiography, angioplasty or bypass surgery. After adjusting for treatments, early revascularization was found to
How To Recognise and Manage a Pre Shock SettingHan Naung Tun
This document discusses the recognition and management of pre-shock in the context of anterior ST-elevation myocardial infarction (STEMI). Pre-shock, also known as SCAI shock stages A-B, involves persistent hemodynamic compromise without fully meeting shock criteria and these patients are prone to rapid deterioration. The case describes a 65-year-old man with anterior STEMI who did not improve after percutaneous coronary intervention on the culprit lesion, meeting some but not all criteria for cardiogenic shock. Invasive hemodynamic monitoring showed features of pre-shock and upfront use of an intra-aortic balloon pump provided immediate hemodynamic support, preventing further deterioration. Early recognition of pre-shock using both clinical and invasive parameters can guide
Hospital Readmission of Heart Failure Patients And Its Precipitated Factors a...Han Naung Tun
Hypertension is one of the most prevalent modifiable risk factor for the development of heart failure (HF). Chronic heart failure (CHF) is the most common cause of readmission for patients in worldwide
96091164 Slice Ct And Cerebral Atherosclerosis02calaf0618
1. Carotid endarterectomy reduces the risk of stroke compared to medical therapy alone in patients with symptomatic moderate (50-69%) carotid stenosis, with an absolute risk reduction of about 5-10% over 5 years.
2. For asymptomatic carotid stenosis ≥60%, carotid endarterectomy provides a relative risk reduction of 53% compared to aspirin alone, but medical therapy is still usually recommended due to the low baseline risk.
3. Carotid artery stenting is recommended for patients who are not suitable for surgery due to high surgical risk from conditions like severe cardiac or pulmonary disease.
This document summarizes the case of a woman who presented with nausea, respiratory failure, and hypotension. She was found to have signs of cardiogenic and septic shock. Imaging and testing revealed she had suffered an anterior myocardial infarction with rupture of the anterior papillary muscle, causing mitral regurgitation. She underwent surgery to repair the valve and bypass the coronary artery. Her postoperative recovery was complicated but she was eventually discharged and made a full recovery.
This document summarizes key information about device therapy in heart failure, including implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy (CRT). It discusses major clinical trials that have evaluated the benefits of these devices for primary and secondary prevention of sudden cardiac death. Factors influencing the benefits of ICD therapy are summarized, as well as predictors of mortality after ICD implantation. Complications related to ICDs and CRT devices are also briefly outlined.
Guidelines on anticoagulation in Atrial FibrillationDr Raja Mohammed
Atrial fibrillation is the commonest cardiovascular rhythm disorder with a worldwide prevalence. ESC and AHA releases guidelines on anti-coagulation and is followed world over. This lecture is intended to help junior medical colleagues, budding cardiologists, internal medicine and family medicine colleagues, those work in coronary care and intensive care units, emergency room physicians, those involved in cardiovascular medical and nursing care and support staff.
Acute coronary syndrome management by RxVichuZ! ;)RxVichuZ
This is my 99th powerpoint...
Deals with ACS(Acute coronary syndrome), its clinical features, and management strategies, based on standard guidelines and literatures.
This document summarizes a study reporting on patients experiencing cardiogenic shock following acute myocardial infarction. The study analyzed 1,190 patients registered in the SHOCK Trial Registry between 1993-1997. It found that predominant left ventricular failure was the most common cause of shock (78.5%), while mechanical complications like ventricular septal rupture or tamponade caused shock in about 12% of cases. In-hospital mortality was 60% overall but higher at 87.3% for patients with ventricular septal rupture. Outcomes were better for patients receiving treatments like thrombolysis, intra-aortic balloon counterpulsation, coronary angiography, angioplasty or bypass surgery. After adjusting for treatments, early revascularization was found to
1) Management of ST elevation myocardial infarction (STEMI) at the emergency department is critical as time lost is myocardial lost. The goal is to achieve door-to-needle time of 30 minutes to administer reperfusion therapy like streptokinase.
2) Reperfusion therapy within 30 minutes of arrival at the emergency department can reduce myocardial damage and mortality from STEMI. Hospitals should have a plan to minimize delays and ensure thrombolytic drugs are readily available.
3) Absolute contraindications for thrombolytic therapy include recent bleeding, stroke or surgery. Relative contraindications include uncontrolled high blood pressure and use of anticoagulants. Hospitals need ongoing evaluation to meet time targets for reperfusion therapy.
The document discusses guidelines for pre-operative cardiac evaluation to identify patients at risk of peri-operative complications and determine the need for interventions. It outlines goals of evaluating a patient's history, physical exam, and tests to determine cardiac risk. Non-invasive tests include ECG, stress testing, and echocardiogram. Surgical risk is stratified as high, moderate, low. Guidelines provide a framework to screen patients. The evaluation involves assessing risk factors, functional capacity, surgical risk to categorize patients and guide management through anesthesia, medical optimization, or possible revascularization.
The document defines acute myocardial infarction (AMI) and unstable angina, and outlines the management of non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in six steps: 1) initial evaluation and pathway, 2) diagnosis validation and risk assessment, 3) antithrombotic treatment, 4) invasive strategy, 5) revascularization modalities, and 6) discharge and post-discharge management. It provides details on risk stratification, antithrombotic and antiplatelet therapies such as aspirin, P2Y12 inhibitors, and anticoagulants. Clinical trials comparing drugs for NSTE-ACS are summarized, including findings on prasugrel, ticagrelor,
This document provides an overview of STEMI (ST-segment elevation myocardial infarction). It defines STEMI and lists its clinical features and complications. It discusses the important investigations for STEMI including electrocardiogram, cardiac markers, echocardiogram, and MRI. It also outlines the management of STEMI both in the emergency department and hospital, including reperfusion therapies, medications, monitoring for complications, and addressing issues like hypotension and hypovolemia.
Early and effective treatment of patients with acute coronary syndrome saves lives. Lot of progress has been made in last few years in understanding patho-physiology and management of these patients.
The document discusses devices used in advanced heart failure syndromes. It provides definitions of heart failure and advanced heart failure. It discusses recommendations for implanting devices like ICDs and CRT to treat heart failure. It describes various mechanical circulatory support devices that can be used as bridges to decision, candidacy, transplantation or as destination therapy. It discusses patient selection criteria for long-term left ventricular assist devices based on INTERMACS profiles and guidelines.
1. The document discusses preoperative cardiac evaluation and risk stratification of patients undergoing non-cardiac surgery based on ACC/AHA guidelines.
2. It outlines 5 factors to consider for risk stratification: recency of cardiac procedures or evaluation, clinical predictors of risk, functional status, and risk of the planned surgery.
3. Based on risk assessment, the document recommends different preoperative testing like ECG, stress testing, echocardiogram or angiogram and outlines perioperative therapies like beta blockers to optimize patient condition and reduce cardiac risk during surgery.
Heart Disease & Chest Pain Treatment At NT Cardiovascular Center Georgiamelvillejackson
http://www.ntcardiovascularcenter.com NT Cardiovascular Center providing latest cutting edge and comprehensive technology for heart disease, chest pain treatments, congestive heart failure, coronary artery disease monitoring, or any critical heart condition.
This document provides a summary of guidelines for the management of patients with non-ST-elevation acute coronary syndromes (NSTE-ACS). It discusses definitions, pathophysiology, initial evaluation and management including risk stratification using ECG, biomarkers and risk scores. It provides recommendations on standard medical therapies in the early hospital care including oxygen, nitrates, analgesics, beta-blockers and calcium channel blockers. It emphasizes the importance of risk stratification, biomarker testing, and initiation of anti-ischemic therapies in the first 24 hours for management of NSTE-ACS.
Perioperative myocardial infarction is a common cause of morbidity and mortality in patients undergoing noncardiac surgery. It can occur through acute coronary syndrome or prolonged myocardial ischemia in patients with stable coronary artery disease. Diagnosis is difficult as symptoms often do not present in anesthetized patients. Risk is determined by patient clinical factors, exercise capacity, and surgery risk. Management may include beta blockers, statins, aspirin, and evaluating need for revascularization based on standard criteria.
Atrial fibrillation review of principlesJwan AlSofi
Atrial fibrillation is the most common cardiac arrhythmia, affecting around 1% of people aged 60-64 and 9% of those over 80. It occurs due to abnormal automatic firing in the atria and re-entry circuits. Episodes are initiated by ectopic beats from the pulmonary veins and become sustained via re-entry or continued ectopic firing. Management involves rate or rhythm control as well as anticoagulation to prevent strokes. Rate control uses medications like beta-blockers, digoxin, and calcium channel blockers while rhythm control attempts cardioversion or ablation. Anticoagulants include warfarin and newer direct oral anticoagulants that are as effective as warfarin
The document defines different types of acute coronary syndrome (ACS), including unstable angina, non-ST elevation myocardial infarction (NSTEMI), and ST elevation myocardial infarction (STEMI). It provides guidelines for the initial management and treatment of ACS, including medications, revascularization procedures, and timelines for invasive strategies depending on patient risk factors. The treatment guidelines are from organizations such as ACC/AHA, ESC, and Uptodate and aim to rapidly diagnose and treat ACS to reduce mortality.
Perioperative myocardial ischaemia in non cardiac surgery-pptMukeshWadhwa6
This document discusses myocardial ischemia and infarction in the surgical population. It defines myocardial ischemia as insufficient blood flow to the heart muscle and myocardial infarction as death of heart muscle cells due to prolonged ischemia. The document notes that myocardial ischemia can lead to infarction and is a major cause of short and long term morbidity and mortality in surgical patients. It provides details on the pathophysiology, diagnosis, incidence, risk factors, and strategies for prevention and management of perioperative myocardial ischemia.
This document discusses various surgical options for treating heart failure, including:
- Coronary artery revascularization to improve blood flow in ischemic cardiomyopathy.
- Valve surgery like mitral valve repair to address functional mitral regurgitation and reduce ventricular volume overload.
- Left ventricular reconstruction to remove scar tissue, restore a more elliptical chamber shape, and decrease wall stress.
- Passive cardiac support devices like the CorCap that provide external diastolic support to facilitate reverse remodeling.
- Mechanical circulatory support options for short-term support like IABP or long-term support like left ventricular assist devices as a bridge to transplant.
- Cardiac transplantation as the gold
What to choose in stable CAD- Medical therapy only or PCI or CABG?cardiositeindia
This document summarizes guidelines for determining the appropriateness of coronary revascularization via percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) for stable coronary artery disease (CAD) based on symptoms, risk level determined by noninvasive testing, medical therapy, and coronary anatomy. Key factors that determine appropriateness include angina class, extent of ischemia on stress testing, use of optimal medical management, and severity and location of coronary lesions. PCI or CABG is generally considered appropriate for high-risk patients or those with significant symptoms despite medical therapy.
The document discusses the diagnosis and management of non-ST elevation acute coronary syndromes (NSTE ACS), including defining NSTE ACS, assessing risk through patient history, physical exam, and investigations, and providing medical therapy including antiplatelet agents, anticoagulants, and risk factor modification. It also addresses evaluating specific patient cases presenting with chest pain and evaluating treatment options.
This document discusses the diagnosis of peri-operative myocardial infarction. It defines peri-operative myocardial ischemia and explains why the traditional MI definition does not apply under anesthesia. The ACC criteria for diagnosing a peri-operative MI is described. The pathophysiology involves acute coronary syndrome (Type I) or oxygen supply-demand imbalance (Type II). Diagnostic tools include electrocardiography, cardiac enzymes, echocardiography, nuclear imaging techniques and cardiac MRI/CT. Early recognition can help prevent morbidity and mortality through pharmacological interventions.
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.
The document discusses guidelines for the treatment of ST-elevation myocardial infarction (STEMI). It defines STEMI as a type of acute coronary syndrome where a completely occlusive thrombus results in total cessation of blood flow seen as ST elevation on an electrocardiogram. Immediate treatment goals for STEMI patients include pain control, rapid identification for reperfusion therapy, and avoiding inappropriate discharge. Initial emergency room management involves aspirin, clopidogrel, nitrates, morphine, and supplemental oxygen. Reperfusion options include fibrinolysis or primary percutaneous coronary intervention. Complications of STEMI can be early issues like cardiogenic shock or late problems like heart failure.
Atrial fibrillation is the most common arrhythmia and increases mortality risk. It is classified as paroxysmal, persistent, or permanent based on duration. The CHA2DS2-VASc score is used to assess stroke risk and determine need for anticoagulation. Treatment focuses on rate control with medications like calcium channel blockers or cardioversion for hemodynamic instability. Anticoagulation is recommended for CHA2DS2-VASc score over 2 to prevent stroke.
This document summarizes information on device therapy for congestive heart failure, including cardiac resynchronization therapy (CRT). It discusses:
1) The prevalence and mortality rates of heart failure in the US. Up to 30% of CHF patients have intraventricular conduction delays which increase mortality.
2) NYHA heart failure classifications and guidelines for CRT approval for classes III and IV.
3) Clinical trials that demonstrated the benefits of CRT including increased exercise capacity, quality of life, and decreased hospitalizations and mortality.
4) Anatomical challenges of CRT implantation via the coronary sinus and risks of the procedure. Proper lead placement is important to reduce asynchrony.
1) Management of ST elevation myocardial infarction (STEMI) at the emergency department is critical as time lost is myocardial lost. The goal is to achieve door-to-needle time of 30 minutes to administer reperfusion therapy like streptokinase.
2) Reperfusion therapy within 30 minutes of arrival at the emergency department can reduce myocardial damage and mortality from STEMI. Hospitals should have a plan to minimize delays and ensure thrombolytic drugs are readily available.
3) Absolute contraindications for thrombolytic therapy include recent bleeding, stroke or surgery. Relative contraindications include uncontrolled high blood pressure and use of anticoagulants. Hospitals need ongoing evaluation to meet time targets for reperfusion therapy.
The document discusses guidelines for pre-operative cardiac evaluation to identify patients at risk of peri-operative complications and determine the need for interventions. It outlines goals of evaluating a patient's history, physical exam, and tests to determine cardiac risk. Non-invasive tests include ECG, stress testing, and echocardiogram. Surgical risk is stratified as high, moderate, low. Guidelines provide a framework to screen patients. The evaluation involves assessing risk factors, functional capacity, surgical risk to categorize patients and guide management through anesthesia, medical optimization, or possible revascularization.
The document defines acute myocardial infarction (AMI) and unstable angina, and outlines the management of non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in six steps: 1) initial evaluation and pathway, 2) diagnosis validation and risk assessment, 3) antithrombotic treatment, 4) invasive strategy, 5) revascularization modalities, and 6) discharge and post-discharge management. It provides details on risk stratification, antithrombotic and antiplatelet therapies such as aspirin, P2Y12 inhibitors, and anticoagulants. Clinical trials comparing drugs for NSTE-ACS are summarized, including findings on prasugrel, ticagrelor,
This document provides an overview of STEMI (ST-segment elevation myocardial infarction). It defines STEMI and lists its clinical features and complications. It discusses the important investigations for STEMI including electrocardiogram, cardiac markers, echocardiogram, and MRI. It also outlines the management of STEMI both in the emergency department and hospital, including reperfusion therapies, medications, monitoring for complications, and addressing issues like hypotension and hypovolemia.
Early and effective treatment of patients with acute coronary syndrome saves lives. Lot of progress has been made in last few years in understanding patho-physiology and management of these patients.
The document discusses devices used in advanced heart failure syndromes. It provides definitions of heart failure and advanced heart failure. It discusses recommendations for implanting devices like ICDs and CRT to treat heart failure. It describes various mechanical circulatory support devices that can be used as bridges to decision, candidacy, transplantation or as destination therapy. It discusses patient selection criteria for long-term left ventricular assist devices based on INTERMACS profiles and guidelines.
1. The document discusses preoperative cardiac evaluation and risk stratification of patients undergoing non-cardiac surgery based on ACC/AHA guidelines.
2. It outlines 5 factors to consider for risk stratification: recency of cardiac procedures or evaluation, clinical predictors of risk, functional status, and risk of the planned surgery.
3. Based on risk assessment, the document recommends different preoperative testing like ECG, stress testing, echocardiogram or angiogram and outlines perioperative therapies like beta blockers to optimize patient condition and reduce cardiac risk during surgery.
Heart Disease & Chest Pain Treatment At NT Cardiovascular Center Georgiamelvillejackson
http://www.ntcardiovascularcenter.com NT Cardiovascular Center providing latest cutting edge and comprehensive technology for heart disease, chest pain treatments, congestive heart failure, coronary artery disease monitoring, or any critical heart condition.
This document provides a summary of guidelines for the management of patients with non-ST-elevation acute coronary syndromes (NSTE-ACS). It discusses definitions, pathophysiology, initial evaluation and management including risk stratification using ECG, biomarkers and risk scores. It provides recommendations on standard medical therapies in the early hospital care including oxygen, nitrates, analgesics, beta-blockers and calcium channel blockers. It emphasizes the importance of risk stratification, biomarker testing, and initiation of anti-ischemic therapies in the first 24 hours for management of NSTE-ACS.
Perioperative myocardial infarction is a common cause of morbidity and mortality in patients undergoing noncardiac surgery. It can occur through acute coronary syndrome or prolonged myocardial ischemia in patients with stable coronary artery disease. Diagnosis is difficult as symptoms often do not present in anesthetized patients. Risk is determined by patient clinical factors, exercise capacity, and surgery risk. Management may include beta blockers, statins, aspirin, and evaluating need for revascularization based on standard criteria.
Atrial fibrillation review of principlesJwan AlSofi
Atrial fibrillation is the most common cardiac arrhythmia, affecting around 1% of people aged 60-64 and 9% of those over 80. It occurs due to abnormal automatic firing in the atria and re-entry circuits. Episodes are initiated by ectopic beats from the pulmonary veins and become sustained via re-entry or continued ectopic firing. Management involves rate or rhythm control as well as anticoagulation to prevent strokes. Rate control uses medications like beta-blockers, digoxin, and calcium channel blockers while rhythm control attempts cardioversion or ablation. Anticoagulants include warfarin and newer direct oral anticoagulants that are as effective as warfarin
The document defines different types of acute coronary syndrome (ACS), including unstable angina, non-ST elevation myocardial infarction (NSTEMI), and ST elevation myocardial infarction (STEMI). It provides guidelines for the initial management and treatment of ACS, including medications, revascularization procedures, and timelines for invasive strategies depending on patient risk factors. The treatment guidelines are from organizations such as ACC/AHA, ESC, and Uptodate and aim to rapidly diagnose and treat ACS to reduce mortality.
Perioperative myocardial ischaemia in non cardiac surgery-pptMukeshWadhwa6
This document discusses myocardial ischemia and infarction in the surgical population. It defines myocardial ischemia as insufficient blood flow to the heart muscle and myocardial infarction as death of heart muscle cells due to prolonged ischemia. The document notes that myocardial ischemia can lead to infarction and is a major cause of short and long term morbidity and mortality in surgical patients. It provides details on the pathophysiology, diagnosis, incidence, risk factors, and strategies for prevention and management of perioperative myocardial ischemia.
This document discusses various surgical options for treating heart failure, including:
- Coronary artery revascularization to improve blood flow in ischemic cardiomyopathy.
- Valve surgery like mitral valve repair to address functional mitral regurgitation and reduce ventricular volume overload.
- Left ventricular reconstruction to remove scar tissue, restore a more elliptical chamber shape, and decrease wall stress.
- Passive cardiac support devices like the CorCap that provide external diastolic support to facilitate reverse remodeling.
- Mechanical circulatory support options for short-term support like IABP or long-term support like left ventricular assist devices as a bridge to transplant.
- Cardiac transplantation as the gold
What to choose in stable CAD- Medical therapy only or PCI or CABG?cardiositeindia
This document summarizes guidelines for determining the appropriateness of coronary revascularization via percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) for stable coronary artery disease (CAD) based on symptoms, risk level determined by noninvasive testing, medical therapy, and coronary anatomy. Key factors that determine appropriateness include angina class, extent of ischemia on stress testing, use of optimal medical management, and severity and location of coronary lesions. PCI or CABG is generally considered appropriate for high-risk patients or those with significant symptoms despite medical therapy.
The document discusses the diagnosis and management of non-ST elevation acute coronary syndromes (NSTE ACS), including defining NSTE ACS, assessing risk through patient history, physical exam, and investigations, and providing medical therapy including antiplatelet agents, anticoagulants, and risk factor modification. It also addresses evaluating specific patient cases presenting with chest pain and evaluating treatment options.
This document discusses the diagnosis of peri-operative myocardial infarction. It defines peri-operative myocardial ischemia and explains why the traditional MI definition does not apply under anesthesia. The ACC criteria for diagnosing a peri-operative MI is described. The pathophysiology involves acute coronary syndrome (Type I) or oxygen supply-demand imbalance (Type II). Diagnostic tools include electrocardiography, cardiac enzymes, echocardiography, nuclear imaging techniques and cardiac MRI/CT. Early recognition can help prevent morbidity and mortality through pharmacological interventions.
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.
The document discusses guidelines for the treatment of ST-elevation myocardial infarction (STEMI). It defines STEMI as a type of acute coronary syndrome where a completely occlusive thrombus results in total cessation of blood flow seen as ST elevation on an electrocardiogram. Immediate treatment goals for STEMI patients include pain control, rapid identification for reperfusion therapy, and avoiding inappropriate discharge. Initial emergency room management involves aspirin, clopidogrel, nitrates, morphine, and supplemental oxygen. Reperfusion options include fibrinolysis or primary percutaneous coronary intervention. Complications of STEMI can be early issues like cardiogenic shock or late problems like heart failure.
Atrial fibrillation is the most common arrhythmia and increases mortality risk. It is classified as paroxysmal, persistent, or permanent based on duration. The CHA2DS2-VASc score is used to assess stroke risk and determine need for anticoagulation. Treatment focuses on rate control with medications like calcium channel blockers or cardioversion for hemodynamic instability. Anticoagulation is recommended for CHA2DS2-VASc score over 2 to prevent stroke.
This document summarizes information on device therapy for congestive heart failure, including cardiac resynchronization therapy (CRT). It discusses:
1) The prevalence and mortality rates of heart failure in the US. Up to 30% of CHF patients have intraventricular conduction delays which increase mortality.
2) NYHA heart failure classifications and guidelines for CRT approval for classes III and IV.
3) Clinical trials that demonstrated the benefits of CRT including increased exercise capacity, quality of life, and decreased hospitalizations and mortality.
4) Anatomical challenges of CRT implantation via the coronary sinus and risks of the procedure. Proper lead placement is important to reduce asynchrony.
The document discusses the approach to anesthesia for patients with cardiac disease undergoing non-cardiac surgery. It emphasizes the importance of preoperative evaluation and risk stratification to determine the safest anesthetic plan. During surgery, careful monitoring is recommended to detect any deterioration in cardiac function. The appropriate selection of anesthetic drugs and techniques can help minimize stress on the heart. Overall, the key is choosing an anesthetic that provides stability for the patient's cardiac condition.
This document discusses the nursing management of a patient experiencing a myocardial infarction in the emergency room. It provides information on the clinical manifestations of a heart attack, including chest pain and other symptoms. It outlines the nursing assessment process in the ER, including taking a history, examination, vital signs monitoring, and ECG. The nursing goals are to detect changes early and reduce chest discomfort. Interventions include medication administration, monitoring, communication with physicians, and providing a calm environment to promote patient comfort and recovery.
This clinical case presentation discusses a 70-year-old male who suffered cardiac arrest at home and was found to have an anterior ST-elevation myocardial infarction. He underwent percutaneous coronary intervention to open the blocked left anterior descending artery with a drug-eluting stent. Imaging also revealed chronic total occlusion of the right coronary artery and total occlusion of the abdominal aorta. The patient was treated with hypothermia and an intra-aortic balloon pump. He stabilized in the cardiac care unit. Key issues for management include treating his peripheral vascular disease both acutely and chronically, as well as determining the optimal method and timing for sudden cardiac death prevention given his reduced ejection fraction post-MI.
This document discusses interventional heart failure therapies including heart transplantation, ventricular assist devices, closure devices for defects, valve repair/replacement procedures, defibrillators, and cardiac resynchronization therapy. It provides details on outcomes of these therapies and notes limitations such as limited organ availability for transplantation. Guidelines for use of defibrillators and cardiac resynchronization therapy are summarized. Ongoing research into treating patients with narrow QRS complexes and those in NYHA class IV is also reviewed.
Tentiran GP Provita Acute Heart Failure (2).pptxWayan Gunawan
Acute heart failure requires urgent evaluation and management according to three steps:
1. Initial management focuses on treating life-threatening conditions like acute coronary syndrome, arrhythmias, or pulmonary embolism.
2. Diagnosis involves ruling in or ruling out acute heart failure based on symptoms of congestion and hypoperfusion.
3. Management is then based on symptoms, providing diuretics and vasodilators for congestion or inotropes for hypoperfusion, with a goal of achieving a "warm dry" state for discharge. Early initiation of evidence-based oral therapies and close follow-up after discharge are also emphasized.
Cardiology morning presentation to internal medicine2232018 finalhospital
1) The document describes a presentation on cardiology cases including a 38-year-old lady with palpitations and shortness of breath found to have atrial fibrillation, a 93-year-old ECG showing sinus rhythm with first degree AV block and left ventricular hypertrophy, and a 20-year-old with history of open heart surgery and stroke.
2) Definitions of different types of atrial fibrillation are provided including paroxysmal, persistent, long-standing persistent, and permanent AF.
3) Tachycardia-induced cardiomyopathy is discussed as a reversible cause of left ventricular dysfunction caused by chronic tachycardia. Treatment involves controlling the heart rate
The document discusses common arrhythmias seen in emergency settings, including bradycardia and tachycardia. It covers the classification, mechanisms, diagnosis and treatment of various arrhythmias like sinus bradycardia, heart blocks, supraventricular tachycardia, ventricular tachycardia and fibrillation. Diagnostic tests mentioned include 12-lead ECG, exercise stress testing, Holter monitoring and implanted cardiac monitors. Treatment depends on the type of arrhythmia and includes atropine, pacing, cardioversion, defibrillation and drugs.
1) Acute coronary syndrome includes unstable angina and myocardial infarction, characterized by chest pain and elevated cardiac biomarkers.
2) Clinical features include severe, prolonged chest pain that may radiate to other areas, as well as syncope, vomiting, and arrhythmias.
3) Complications include heart failure, arrhythmias like ventricular fibrillation, cardiac rupture, and remodelling. Diagnosis involves ECG, cardiac enzymes, and angiography. Management focuses on reperfusion therapy, anticoagulation, and risk factor reduction.
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.
This document discusses acute coronary syndrome (ACS) and non-ST-segment elevation acute coronary syndrome (NSTE-ACS). It defines unstable angina (UA) and non-ST elevation myocardial infarction (NSTEMI) and covers their clinical presentation, diagnostic criteria, laboratory investigation, and management. The key goals of diagnosis and treatment for NSTE-ACS patients are to recognize or exclude myocardial infarction, detect resting ischemia, and identify coronary artery obstruction. Treatment involves anti-ischemic, antithrombotic medications and consideration of coronary revascularization.
The document discusses congestive cardiac failure (heart failure) and its management. It provides details on:
- The high prevalence and mortality of heart failure.
- Current medical therapies including ACE inhibitors, beta-blockers, and aldosterone antagonists that have been shown to improve survival.
- Device therapies like cardiac resynchronization therapy and implantable cardioverter defibrillators that treat symptoms and reduce mortality.
- The benefits of multidisciplinary and integrated care approaches including telehealth monitoring in improving outcomes for heart failure patients.
This document discusses advanced treatments for refractory heart failure, including devices and surgery. Cardiac resynchronization therapy (CRT), implantable cardioverter defibrillators (ICD), and combination devices are recommended implantable options. Percutaneous and surgical interventions include coronary revascularization, stem cell therapy, mitral valve procedures, LV assist devices, cardiac reshaping surgeries, and heart transplantation. Other treatments mentioned are ultrafiltration to remove fluid overload and CPAP for patients with heart failure and sleep apnea.
This document discusses hemodynamic monitoring in critically ill patients. It notes that while hemodynamic monitoring is a cornerstone of management, the utility of most methods is unproven. Physicians have become psychologically dependent on feedback from monitors independent of their effectiveness. The effectiveness of monitoring is limited to specific patient groups and diseases where proven effective treatments exist. The document discusses various hemodynamic monitoring methods including invasive and non-invasive options like arterial catheters, central venous pressure, and echocardiography. It notes that no individual parameter necessarily defines hemodynamic stability and thresholds vary between patients and clinical contexts.
This document summarizes management of congestive cardiac failure. It discusses current medical therapies including ACE inhibitors, beta blockers, and aldosterone antagonists which have been shown to improve survival. Device therapies like biventricular pacing and implantable cardioverter defibrillators are also used to treat heart failure and reduce mortality and sudden death. Lifestyle modifications and multidisciplinary management in the community can further benefit patients.
This document discusses the management and treatment of patients with advanced heart failure who require admission to the intensive care unit (ICU). It defines advanced heart failure and provides criteria for determining which heart failure patients should be admitted to the ICU. It covers monitoring in the ICU, classification of heart failure, medical treatment including diuretics and inotropic drugs, and mechanical circulatory support options. The future of treatments like ventricular assist devices is also mentioned.
1) Cardiac arrhythmias are common in the ICU and represent a major source of morbidity and potential increased mortality. Arrhythmias may be the primary reason for admission or develop during critical illness.
2) Factors that increase the risk of life-threatening arrhythmias in ICU patients include their underlying critical illnesses, drugs, electrolyte imbalances, hypoxia, sepsis and other metabolic disturbances, and fluctuations in intravascular volume.
3) Arrhythmias can be life-threatening if the heart rate is too fast or slow resulting in hemodynamic instability, if it degenerates to ventricular fibrillation, or if associated with severe hypokalemia/hypomagnesemia or underlying
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Sudden cardiac death and cardiogenic shock a team approach to save heart and brain
1. Sudden Cardiac Death And Cardiogenic
Shock : A Team Approach To Save Heart
and Brain
Dr Han Naung Tun, MBBS, MD, FACTM
National Representative Heart Failure Specialist of Tomorrow for Myanmar in HFA and
Ambassador of Echocardiography in EACVI, ESC
Council of Clinical Practice and Working Groups of European Society of Cardiology ,
France
Twitter : @HanCardiomd
2. Preamble
Main Topic: Ventricular Arrhythmias and SCD
– Clinical
ESC Guidelines: Ventricular Arrhythmias and
the Prevention of Sudden Cardiac Death
3. Patient Presentation
A 35-year-old male patient presented with out-of-hospital cardiac arrest.
He received immediate bystander phone-guided CPR.
After 5 minutes the medical intervention team arrived.
The initial rhythm was ventricular fibrillation.
There was ROSC after five cycles of CPR.
General malaise and dyspnoea since a few days, no chest pain (heteroanamnesis)
and he was intubated on site
4. Past Medical History
1 year before admission: ‘palpitations’, ECG: first degree AV block normal
24h rhythm monitoring, exercise test and echocardiography
3 months before admission: ‘longstanding cough’, CT thorax: nodular
opacities
2 months before admission: total AV-block during bronchoscopy,
R/implantation DDD-pacemaker, Echo: moderately ↓ LVEF and↓ RVEF
5. Table from JACC V O L. 6 8 , NO . 4 , 2 0 1 6
Cardiac Sarcoidosis
David H. Birnie, MD, MBCHB,a Pablo B. Nery, MD,a
Andrew C. Ha, MD,b Rob S.B. Beanlands, MDa
7. No known allergies
Familial medical history - Grandfather died of unidentified pulmonary
disease
Medication at admission - Methylprednisolone 24 mg OD, Omeprazole
20 mg OD
Social history - Theatre director
8. BP 90/50 mm Hg; HR 95 bpm; T 35,9°C; SpO2 95%
Full sedation (GCS 3/15), intubated and mechanically ventilated with low
ventilatory settings
Cold and clammy extremities, no signs of congestion
Tachycardia, no murmurs
Soft abdomen, normal peristalsis
Physical examination
9.
10.
11.
12.
13. Quick look TTE: severely impaired LV and moderately impaired RV
function
Coronary angiogram: normal
Pacemaker: 90% ventricular pacing, normal sensing and capture
threshold
Arterial blood gas: mild metabolic acidosis
Labs: raised cardiac and liver enzymes, acute kidney injury KDIGO 1,
raised inflammatory markers
14. Haemodynamically unstable
Recurrent VT, high dose of vasopressors (norepinephrine
0,800 µg/kg/min)
Amiodarone continuous infusion
Insertion of IABP
→ transfer to our hospital
Further course
15. Initial management in tertiary hospital
• Admission to ICCU
• Correction of electrolytes
• DDD-pacing at 100 bpm
• Association of Milrinone 0,400 µg/kg/min
• Targeted temperature management
• Persistent ventricular arrhythmia
• R/ Methylprednisolone 40 mg IV
• Lidocaine
• → stabilisation of arrhythmia, noradrenalin
16.
17. Further course on ICCU
Day 3
Persistent severely depressed left ventricular function
Inotrope dependent (milrinone)
Progressive organ failure (AKI stage 2, raised liver enzymes)
19. Still in the ICCU ...
Heart team: pLVAD 5,0L/min via right subclavian artery
Removal of IABP
Complicated by retroperitoneal haemorrhage
R/vascular surgery, transfusion with stabilisation
20.
21.
22.
23. Day 5 and after
D5
Haematoma insertion site; DVT right subclavian vein due to
compression
Sedation hold – neurologically intact
Start mobilisation (cycling)
Start beta blocker
D8
Extubation
25. What is the most appropriate next step to consider in this
patient?
(A) Weaning of mechanical circulatory support without other
measures
(B) Upgrade from DDD-pacemaker to CRT-D
(C) Insertion of long term left ventricular assist device
26.
27. Since the cardiac disease was
potentially reversible, LVAD as
bridge to heart transplant was
not yet considered. If no recovery
occurred, LVAD could be
considered since the patient
recovered from multiple organ
dysfunction but was still
dependent on temporary
mechanical support.
28. Since the cardiac disease was potentially reversible, LVAD as bridge to heart
transplant was not yet considered.
If no recovery occurred, LVAD could be considered since the patient recovered
from multiple organ dysfunction but was still dependent on temporary
mechanical support.
29. Because of the persistent very poor left ventricular systolic function, weaning
without other measures was not feasible.
Since there was persistent RV pacing with severely impaired left ventricular
ejection fraction and the need for a defibrillator in secondary prevention, the
pacemaker was upgraded to a CRT-D device with immediate positive
hemodynamic effect.
Milliez et al. Cardiac resynchronisation as a rescue therapy in patients with
catecholamine-dependent overt heart failure: Results from a short and mid-
term study European Journal of Heart Failure 2014
30. Because of the persistent very poor left
ventricular systolic function, weaning
without other measures was not feasible.
Since there was persistent RV pacing with
severely impaired left ventricular ejection
fraction and the need for a defibrillator in
secondary prevention, the pacemaker was
upgraded to a CRT-D device with
immediate positive hemodynamic effect
31.
32.
33.
34. D12
• Upgrade to CRT-D device because of persistent RV-pacing and septal dyskinesia
• Levosimendan
D14-16
• Gradual reduction of pLVAD flow – stable hemodynamics and biochemistry
• Sitting in a chair – cycling
D17
• Removal of pLVAD device
• Ischemic stroke (right ACM) – urgent thrombectomy
• Recuperation of left hemiparalysis
Day 12 and after ...
36. A multidisciplinary team approach is recommended in a patient with
cardiogenic shock and neurological complications to improve neurological
and cardiac outcome.
When a patient is 'sliding' on inotropes, temporary mechanical circulatory
support should be considered.
Bleeding and thrombotic complications of temporary mechanical
circulatory support (MCS) are frequent and should be monitored closely.
The risks of MCS should be balanced against benefits.
37. A percutaneous left ventricular assist device through the subclavian
artery permits early mobilisation and could buy time allowing cardiac
recovery.
Early sedation hold in patients with temporary MCS is useful to reveal
neurological complications and to facilitate appropriate management
and rehabilitation.
Early CRT-D implantation might have a beneficial hemodynamic effect
in acute heart failure, especially in the presence of high ventricular
pacing demands and dyssynchrony.
38. ESC guidelines:
Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death 2015
Acute and chronic heart failure 2016
Cardiac pacing and cardiac resynchronization therapy 2013
Alviar et al. Positive pressure ventilation in the cardiac intensive care unit JACC 2018.
Thiele et al. Management of cardiogenic shock complicating myocardial infarction
European Heart Journal 2019
Crespo-Leiro et al. Advanced heart failure: a position statement of the Heart Failure
Association of the European Society of Cardiology. European Journal of Heart Failure
2018
Milliez et al. Cardiac resynchronisation as a rescue therapy in patients with
catecholamine-dependent overt heart failure: Results from a short and mid-term study
European Journal of Heart Failure 2014
Birnie et al. Cardiac manifestations of sarcoidosis: diagnosis and management. EHJ 2016
Okada et al. Ventricular Arrhythmias in Cardiac Sarcoidosis. Circulation 2018
References
39. The best care of patients with
acute cardiovascular
syndromes relies on
immediate diagnosis and
decisions on treatment, some
of them life-saving.
The Clinical-Decision Making
Toolkit is THE tool to help all
practitioners make the best
bedside clinical decisions,
when managing patients with
acute cardiovascular diseases.
40. Acknowledgment
A clinical case form Dr. Schaubroeck Hannah
Subspecialty communities - Association for Acute
CardioVascular Care Education
Association for Acute CardioVascular Care
European Society of Cardiology