This document discusses the surgical treatment of diastolic heart disease. It covers the mythology and history of surgical treatments for conditions that affect diastole such as constrictive pericarditis, hypertrophic obstructive cardiomyopathy, aortic stenosis, and aortic regurgitation. It notes that while surgery addresses the primary disease, underlying diastolic dysfunction can remain and impact prognosis. A better understanding of diastolic disease in surgical patients may help optimize timing of intervention and improve outcomes.
Surgical Management of Lower Limb Occlusive Arterial Diseaserajendra meena
This slide explains briefly touches upon Occlusive Arterial Disease (Peripheral Arterial Disease (PAD)) in the lower limbs along with the types, classification, diagnostic evaluation and various management protocols.
Correlation Between ECG Changes and 2D Speckle Tracking Echocardiography with...Premier Publishers
The clinical presentation of acute coronary syndrome is variable Patients with suspected NSTE-ACS are a heterogeneous group. Coronary occlusion may or may not be present. To correlate 2D speckle tracking echocardiography with coronary angiography results in non-ST segment elevation myocardial infarction patients and test its ability to predict culprit lesion. It is a prospective study where 100 patients with non-ST elevation myocardial infarction were enrolled in the study where regional wall motion score index was obtained by echocardiography then 2D speckle tracking echocardiography was done and territorial longitudinal strain for each vessel was obtained and finally coronary angiography was done. By using the bull’s eye view of the territorial LS values obtained from the 17 myocardial segments to predict the culprit artery for each patient the sensitivity for prediction of culprit LAD was 93.3 %, specificity was 92.7 %, For LCX; sensitivity was 82.7 %, specificity was 92.9 % and for RCA; sensitivity was 84 %, specificity was 93.3 %. Longitudinal strain imaging by 2D speckle-tracking might help in the work-up of non-ST elevation myocardial infarction patients. In addition, it may be helpful to localize coronary artery stenosis in a given perfusion territory.
La rivascolarizzazione degli arti inferiori nel paziente anziano: rischi e va...ASMaD
Presentazione a cura del Professor Angelo Cioppa - XII° Congresso Nazionale FIMeG 2018 - The Silver Tsunami: l'anziano fra appropriatezza e farmaeconomia
Surgical Management of Lower Limb Occlusive Arterial Diseaserajendra meena
This slide explains briefly touches upon Occlusive Arterial Disease (Peripheral Arterial Disease (PAD)) in the lower limbs along with the types, classification, diagnostic evaluation and various management protocols.
Correlation Between ECG Changes and 2D Speckle Tracking Echocardiography with...Premier Publishers
The clinical presentation of acute coronary syndrome is variable Patients with suspected NSTE-ACS are a heterogeneous group. Coronary occlusion may or may not be present. To correlate 2D speckle tracking echocardiography with coronary angiography results in non-ST segment elevation myocardial infarction patients and test its ability to predict culprit lesion. It is a prospective study where 100 patients with non-ST elevation myocardial infarction were enrolled in the study where regional wall motion score index was obtained by echocardiography then 2D speckle tracking echocardiography was done and territorial longitudinal strain for each vessel was obtained and finally coronary angiography was done. By using the bull’s eye view of the territorial LS values obtained from the 17 myocardial segments to predict the culprit artery for each patient the sensitivity for prediction of culprit LAD was 93.3 %, specificity was 92.7 %, For LCX; sensitivity was 82.7 %, specificity was 92.9 % and for RCA; sensitivity was 84 %, specificity was 93.3 %. Longitudinal strain imaging by 2D speckle-tracking might help in the work-up of non-ST elevation myocardial infarction patients. In addition, it may be helpful to localize coronary artery stenosis in a given perfusion territory.
La rivascolarizzazione degli arti inferiori nel paziente anziano: rischi e va...ASMaD
Presentazione a cura del Professor Angelo Cioppa - XII° Congresso Nazionale FIMeG 2018 - The Silver Tsunami: l'anziano fra appropriatezza e farmaeconomia
Abdominal Aortic and Thoracic AneurysmsOmar Haqqani
Authored by Dr. Andris Kazmers, MD. Presented at the First Annual Omar P. Haqqani MD Vascular Symposium, November 10, 2016, Midland Country Club, Midland, MI.
Radiological evaluation of takayasu arteritis Dr. muhammad Bin Zulfiqar Servi...Dr. Muhammad Bin Zulfiqar
Radiological evaluation of takayasu arteritis Dr. muhammad Bin Zulfiqar Services Institute of Medical Sciences Services Hospital Lahore
In this presentation we will discuss the role of imaging in TA.
Abdominal Aortic and Thoracic AneurysmsOmar Haqqani
Authored by Dr. Andris Kazmers, MD. Presented at the First Annual Omar P. Haqqani MD Vascular Symposium, November 10, 2016, Midland Country Club, Midland, MI.
Radiological evaluation of takayasu arteritis Dr. muhammad Bin Zulfiqar Servi...Dr. Muhammad Bin Zulfiqar
Radiological evaluation of takayasu arteritis Dr. muhammad Bin Zulfiqar Services Institute of Medical Sciences Services Hospital Lahore
In this presentation we will discuss the role of imaging in TA.
Heberden meticulously described a symptom, but he did not understand the disease. Edward Jenner noticed thickened coronary arteries at autopsy of his colleague John Hunter who had died suddenly after an angina attack in 1793,2 but it took decades for a first remedy for angina pectoris and even longer for a true understanding of the underlying disease
Wellens’ Syndrome: Exception to the Rule: One Referral at a Time!asclepiuspdfs
We describe two patients with Wellens’ syndrome. In these patients, the electrocardiogram changes must be recognized promptly and accurately. These cases are managed aggressively and early invasive treatment approach is recommended to avoid myocardial infarction and death.
Takotsubo syndrome diagnostic criteria.
position papers :Mayo clnic ,HFA and InterTAK Diagnostic Criteria.Takotsubo Syndrome and COVID-19.Noninvasive Multimodality Imaging
in the Diagnosis and Management
of Patients with Takotsubo Syndrome
Similar to Surgery of dd bianchi presentation (20)
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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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.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
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
DISSERTATION on NEW DRUG DISCOVERY AND DEVELOPMENT STAGES OF DRUG DISCOVERYNEHA GUPTA
The process of drug discovery and development is a complex and multi-step endeavor aimed at bringing new pharmaceutical drugs to market. It begins with identifying and validating a biological target, such as a protein, gene, or RNA, that is associated with a disease. This step involves understanding the target's role in the disease and confirming that modulating it can have therapeutic effects. The next stage, hit identification, employs high-throughput screening (HTS) and other methods to find compounds that interact with the target. Computational techniques may also be used to identify potential hits from large compound libraries.
Following hit identification, the hits are optimized to improve their efficacy, selectivity, and pharmacokinetic properties, resulting in lead compounds. These leads undergo further refinement to enhance their potency, reduce toxicity, and improve drug-like characteristics, creating drug candidates suitable for preclinical testing. In the preclinical development phase, drug candidates are tested in vitro (in cell cultures) and in vivo (in animal models) to evaluate their safety, efficacy, pharmacokinetics, and pharmacodynamics. Toxicology studies are conducted to assess potential risks.
Before clinical trials can begin, an Investigational New Drug (IND) application must be submitted to regulatory authorities. This application includes data from preclinical studies and plans for clinical trials. Clinical development involves human trials in three phases: Phase I tests the drug's safety and dosage in a small group of healthy volunteers, Phase II assesses the drug's efficacy and side effects in a larger group of patients with the target disease, and Phase III confirms the drug's efficacy and monitors adverse reactions in a large population, often compared to existing treatments.
After successful clinical trials, a New Drug Application (NDA) is submitted to regulatory authorities for approval, including all data from preclinical and clinical studies, as well as proposed labeling and manufacturing information. Regulatory authorities then review the NDA to ensure the drug is safe, effective, and of high quality, potentially requiring additional studies. Finally, after a drug is approved and marketed, it undergoes post-marketing surveillance, which includes continuous monitoring for long-term safety and effectiveness, pharmacovigilance, and reporting of any adverse effects.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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
13. • Comparable post-op LAP !
• Abnormal Diastole: longer duration of symptoms
before surgery
Senni et al JACC 1999
Kim JS et al Int J Cardiol 2009
DE: doppler echocardiography
15. Motoki H et al. JASE 2013
Contractile Reservoir Conduit
16. Surgery - DD - Constrictive Pericarditis
❖ Pericardiectomy is effective in relieving constriction of the
heart!
❖ Symptoms improvement occur in a significant proportion
of patients!
❖ Prognosis is still linked to preoperative functional status
and duration of the disease!
❖ Diastolic function analysis after treatment may unmask
patients with underlying disease, extensive myocardial
damage, untreated comorbilities.
18. Hallopeau!1869!
Liouiville!1869!
Schminke!1907
Pathology Description!
(reports of findings compatible with HOCM)
Davies 1952
Description of familiar HOCM and report of 3 cases of
sudden death
Brock 1957 diffuse subaortic stenosis!
“Functional obstruction of the left ventricle”
Brock 1957-1959
“Surgical report” !
(no surgical treatment provided)
Teare 1958
first accurate categorisation of HOCM!
(muscle fibers thickening and disarray)
Fix 1964 Recognise the contribution of the AL of mitral valve: SAM
Godwin!
Oakley
1960-1972 Reduced LV compliance; “inflow” obstruction
HOCM - Mythology and Epos
MYTHOLOGY
19. Cleland 1960 First performed surgical incision - myotomy
Kelly!
Morrow!
Wigle
1966!
1961-1964!
1962
Routinely performed !
“Myotomy”
Kirklin 1961 Surgical excision of hypertrophied muscle - “Myectomy”
Troubl 1962 Aortic approach
Lillehei!
Levy
1963 Treatment of anterior leaflet of mitral valve
Dobella!
Scott
1964 Left atrial approach
Swan 1964 Ventriculotomy approach
Julian 1965 “Fishmouth” ventriculotomy
Morrow 1975-1978 Trans-aortic myectomy
Cooley 1973-1976 Mitral valve replacement
HOCM - Mythology and Epos
EPOS
22. 1983-2001
Ommen SR et el. JACC 2005 Sedehi D et el. J Cardiol 2015
1972-2006
1994-2005
Smedira NG et el. Ann Thorac Surg 2008
23. Effect of Septal Myectomy on Diastolic Function
Small proportion of SM patients had
decrease in DT, but not in E and E/A ratio
Masuyama et al. JASE 1990
Non-surgical septal reduction therapy:
decrease in pre-A pressure and tau
velocity with increase of Ea and LVEDV
Nagueh SF et al. Circulation 1999
Both myectomy and PTSMA reduce
LVOT obstruction and significantly!
improve NYHA functional class in
patients with HOCM
Qin JX et al. JACC 2001
[…]diastolic function indexes obtained
by echocardiography changed after
septal reduction interventions in
patients with obstructive HC.
Sitges M et al. Am J Cardiol 2003
Valeti U et al. JACC 2007
24. Effect of Septal Myectomy on Diastolic Function
Monteiro PF et al. Am J Cardiol 2007
Pre-Myectomy Post-myectomy p-value
LVOT 106±44 17±13 <0.001
MR grade 3±1 2±1! <0.001
RSVP 40±8 31±6 <0.01
E/E’ 20.7±6.0 10.8±4.0 <0.01
LAVI 52.1±21.2 33.2±11.9 <0.001
LAVI!
pre-myectomy: ! MR grade (r2=0.76); p=0.003!
! ! ! ! E/E’; p=0.03!
!
post-myectomy:! LVOTG (r2=0.33); p=0.006!!
!
Menon SC et al. JASE 2008
Yang H et al. JASE 2005
25. Effect of Septal Myectomy of Diastolic Function
Tower-Rader A et al. Am J Cardiol 2014 Moravsky G et al. JASE 2013
*
26. Surgery of DD - Hypertrophic Obstructive Cardiomyopathy
❖ Surgical treatment in obstructive forms guarantees a “normal”
lifespan!
❖ Septal myectomy is still the most reliable, reproducible and effective
procedure for HOCM!
❖ Prognosis is still dictated by the form and thus the age of presentation!
❖ Septal myectomy advantage goes beyond the wall thickness and
LVOTG reduction, involving also improvement of diastolic function!
❖ E/E’, LAVI and speckle tracking parameters are potential markers of
myectomy effectiveness and also has the potential of prognostic
values.
44. Surgery of DD - Aortic Stenosis and Regurgitation
❖ Aortic valve disease is a disease of the valve and the myocardium!
❖ Myocardial remodeling, although with a different “primum movens”, eventually affects
the diastole!
❖ Hypertension, vascular disease, diabetes mellitus, COPD, renal disease could coexist,
over impose their features in terms of diastole remodelling, exacerbate ultimately
leading to a vicious cycle!
❖ Relieve of the increased afterload is effective in modifying the natural history of the
disease per se and also promoting a reverse remodelling!
❖ Adjunctive pharmacological strategies are necessary to obtain the maximum from the
therapeutic intervention!
❖ In patients that fail to improve after surgery, underlying advanced diastolic disease
could provide an explanation and also a further preoperative tool to stratify
intervention timing.
45. Conclusions
❖ Diastolic disease is an underlying and often overlooked
feature of many cardiac pathologies.!
❖ Surgical treatment often address the main feature of the
disease!
❖ Diastolic disfunction could impact heavily on patients’
prognosis!
❖ A better understanding of the diseased diastole in surgical
patients and its impact on early and late outcome could lead
to a better timing of the intervention and improved prognosis