Syncope
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Dr. Jignesh Vora discusses syncope, or temporary loss of consciousness followed by full wakefulness, which can be caused by reduced blood flow to the brain, cardiac issues like arrhythmias and structural problems, or abnormalities in the vertebrobasilar system. Evaluation includes taking a history, ECG, blood tests to check cell counts, blood sugar, electrolytes, and lipids, and an echocardiogram can help rule out valvular diseases as potential causes.
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Sudden cardiac death is defined as a natural death from cardiac causes within one hour of the onset of symptoms. It can occur unexpectedly in people with known or unknown pre-existing heart disease. The main causes of sudden cardiac death are heart attacks in those over 35 and hypertrophic cardiomyopathy, commotio cordis, and coronary anomalies in those under 35. Pacemakers and implantable cardioverter-defibrillators have been developed to treat arrhythmias and help prevent sudden cardiac death.
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The document describes a 62-year-old man named Robert who fell from a ladder while picking mangoes and was found unconscious. He was brought to the emergency department conscious but confused, complaining of left arm pain. His medical history includes hypertension. A physical exam found signs of head injury including a hematoma and neurological deficits on the right side of his body. The summary provides key details about the patient's condition and situation.
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2. Diagnosis involves electrocardiograms, cardiac enzyme levels, imaging modalities and angiography. Signs and symptoms can range from chest pain to dyspnea, sweating or nausea.
3. Treatment goals are to restore blood flow and salvage heart muscle. This involves medications, fibrinolytics, percutaneous coronary intervention or bypass surgery depending on the individual case.
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Schematic diagram of stroke
Neurons in the brain can die from a lack of oxygen and nutrients if blood flow is impaired due to thrombosis, embolism, or hemorrhaging in cerebral vessels. This tissue injury triggers an inflammatory response and swelling, increasing intracranial pressure and further damaging brain cells. Regulatory mechanisms attempt to maintain equilibrium by increasing blood pressure and intracranial pressure, but ruptured cerebral vessels constricting to limit blood loss can also cause additional ischemia and tissue death.
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This document summarizes information about several cardiac conditions:
- Hypertrophic obstructive cardiomyopathy (HOCM) is characterized by a thickened, non-dilated left ventricle with a familial incidence in 55% of cases. Symptoms include syncope, chest pain, and palpitations.
- Brugada syndrome is associated with sudden cardiac death and characterized by ECG abnormalities in leads V1-V3 and a 10% mortality per year without treatment.
- Wolff-Parkinson-White syndrome involves a short PR interval, wide QRS, and delta wave on ECG due to pre-excitation.
- Long QT syndrome increases the risk of torsades de
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1. Stroke is defined as a clinical syndrome of rapid onset of focal deficits of brain function lasting more than 24 hours or leading to death. There are two main types - ischemic and hemorrhagic.
2. Ischemic strokes account for 80% of cases and result from arterial occlusion blocking blood flow. Hemorrhagic strokes can be either intracerebral hemorrhage from ruptured small arteries damaged by hypertension, or subarachnoid hemorrhage from ruptured aneurysms.
3. The pathophysiology of ischemic stroke involves development of an ischemic core with immediate cell death surrounded by an ischemic penumbra of reversibly dysfunctional tissue that can potentially be salvaged by reperfusion
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Sudden cardiac arrest/death is the sudden cessation of cardiac activity that can lead to death if not treated rapidly. It is usually due to sustained ventricular tachycardia or fibrillation. Ischemic heart disease is the leading cause, accounting for around 70% of cases. Risk increases with age and underlying cardiac conditions. While screening the general population has not been shown to effectively identify high risk individuals, risk factor reduction through treatments like controlling hypertension, cholesterol, and diabetes as well as lifestyle changes can help with primary prevention. For secondary prevention, an implantable cardioverter-defibrillator is the preferred treatment for survivors of sudden cardiac arrest to terminate recurrent ventricular arrhythmias.
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Cardiomyopathy refers to diseases of the heart muscle that weaken the heart's ability to pump blood effectively. The three main types are dilated, hypertrophic, and restrictive cardiomyopathy. Dilated cardiomyopathy causes the left ventricle to enlarge and weaken, impairing its ability to pump blood. Causes include viral infections, toxins, genetic factors, and hypertension. Symptoms include fatigue, shortness of breath, and fluid retention. Diagnosis involves echocardiograms, electrocardiograms, and cardiac catheterization. Treatment focuses on managing symptoms through medications, lifestyle changes, and potentially surgery or transplantation.
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1. Myocardial infarction occurs when blood flow to the heart is blocked, causing death of heart muscle cells.
2. The degree of heart damage depends on the size of the blocked artery and amount of heart tissue affected.
3. There are two main types - ST-elevation MI where the full thickness of heart muscle is damaged, and non-ST-elevation MI where the inner layer is most affected.
ECG A: first part.
This document provides an overview of several cardiac arrhythmias and conditions including:
1. Accelerated idioventricular rhythm (AIVR), which results when an ectopic ventricular pacemaker exceeds the sinus node rate. AIVR is seen post-myocardial infarction and features a regular rhythm between 50-110 bpm with three or more QRS complexes.
2. Atrial flutter, a supraventricular tachycardia caused by a reentry circuit in the right atrium with a rate of around 300 bpm. The ventricular rate is determined by AV conduction.
3. Atrial fibrillation, the most common sustained arrhythmia characterized by irregularly irregular rhythm without
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Strong muscles
The strongest muscles in the body are arranged in a zigzag pattern from the lower to upper body, including the calves, quadriceps, back, chest, and neck muscles. The strongest individual muscle is the masseter muscle, which is responsible for mastication or chewing. The masseter muscle is stronger than other muscles like the calves, quadriceps, back, and chest muscles.
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This document summarizes the pathophysiology of stroke. It discusses the two main types of stroke - ischemia (lack of blood flow) and hemorrhage (bleeding). Ischemic injury depends on factors like the rate and duration of reduced blood flow as well as collateral circulation. There are different zones of brain tissue impacted by ischemia. Neuronal death occurs through mechanisms like excitotoxicity, coagulation necrosis, and apoptosis over varying timeframes. Strokes can be caused by thrombosis, embolism, or hypotension. Restoring blood flow after ischemia can cause hemorrhage or edema in the brain.
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This document defines and discusses sudden cardiac death and its various causes. It provides epidemiological data showing 300,000 cases per year in the US, with a bimodal distribution. The main causes discussed are long QT syndrome, Brugada syndrome, hypertrophic cardiomyopathy, arrhythmogenic right ventricular dysplasia, commotio cordis, and congenital coronary artery anomalies. For each cause, the document outlines presentation, diagnosis, and treatment options.
Schematic diagram of stroke
Neurons in the brain can die from a lack of oxygen and nutrients if blood flow is impaired due to thrombosis, embolism, or hemorrhaging in cerebral vessels. This tissue injury triggers an inflammatory response and swelling, increasing intracranial pressure and further damaging brain cells. Regulatory mechanisms attempt to maintain equilibrium by increasing blood pressure and intracranial pressure, but ruptured cerebral vessels constricting to limit blood loss can also cause additional ischemia and tissue death.
Syncope, sudden death and ekg
This document summarizes information about several cardiac conditions:
- Hypertrophic obstructive cardiomyopathy (HOCM) is characterized by a thickened, non-dilated left ventricle with a familial incidence in 55% of cases. Symptoms include syncope, chest pain, and palpitations.
- Brugada syndrome is associated with sudden cardiac death and characterized by ECG abnormalities in leads V1-V3 and a 10% mortality per year without treatment.
- Wolff-Parkinson-White syndrome involves a short PR interval, wide QRS, and delta wave on ECG due to pre-excitation.
- Long QT syndrome increases the risk of torsades de
Approach to a patient with stroke - Pathophysiology of stroke
1. Stroke is defined as a clinical syndrome of rapid onset of focal deficits of brain function lasting more than 24 hours or leading to death. There are two main types - ischemic and hemorrhagic.
2. Ischemic strokes account for 80% of cases and result from arterial occlusion blocking blood flow. Hemorrhagic strokes can be either intracerebral hemorrhage from ruptured small arteries damaged by hypertension, or subarachnoid hemorrhage from ruptured aneurysms.
3. The pathophysiology of ischemic stroke involves development of an ischemic core with immediate cell death surrounded by an ischemic penumbra of reversibly dysfunctional tissue that can potentially be salvaged by reperfusion
Top ten (or 11) ekg killers
This document provides an overview of important EKG findings that can indicate potentially life-threatening cardiac conditions. It discusses various cardiomyopathies, channelopathies, structural abnormalities and other conditions that can cause syncope, palpitations or sudden cardiac death. Specific EKG patterns are presented that can help identify conditions like hypertrophic cardiomyopathy, arrhythmogenic right ventricular dysplasia, long QT syndrome, Brugada syndrome, pulmonary embolism and more. Causes of nonspecific EKG changes are explored. The importance of interpreting the EKG in the full clinical context is emphasized.
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This document summarizes the pathophysiology of ischemic stroke and reperfusion injury. It describes how a reduction in blood flow during stroke can lead to tissue damage through various mechanisms like depletion of ATP, ionic imbalances, and free radical accumulation. It also discusses cerebral autoregulation and how its impairment during stroke contributes to low oxygen delivery. The consequences of reduced blood flow like focal ischemia, cell injury pathways like excitotoxicity and inflammation are summarized. Risk factors for reperfusion syndrome following revascularization like hypertension, dysautoregulation and ischemia-reperfusion are highlighted. Methods to assess risk and prevent reperfusion injury through blood pressure control are also summarized.
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Sudden cardiac arrest/death is the sudden cessation of cardiac activity that can lead to death if not treated rapidly. It is usually due to sustained ventricular tachycardia or fibrillation. Ischemic heart disease is the leading cause, accounting for around 70% of cases. Risk increases with age and underlying cardiac conditions. While screening the general population has not been shown to effectively identify high risk individuals, risk factor reduction through treatments like controlling hypertension, cholesterol, and diabetes as well as lifestyle changes can help with primary prevention. For secondary prevention, an implantable cardioverter-defibrillator is the preferred treatment for survivors of sudden cardiac arrest to terminate recurrent ventricular arrhythmias.
Valvular heart disease
Rheumatic fever is the most common cause of valvular heart disease, often resulting in mitral stenosis. Mitral stenosis causes elevated left atrial pressure, pulmonary hypertension, and right heart failure if severe. It is diagnosed based on symptoms, murmurs, echocardiogram findings and history of rheumatic fever. Treatment involves medications, balloon valvuloplasty, or valve replacement depending on severity.
Trimetazidine
Trikat MR is used to treat angina pectoris by protecting heart cells from reduced oxygen supply. It works by inhibiting fatty acid oxidation and increasing glucose oxidation, allowing the heart to function more efficiently during ischemia. The recommended dosage is one 35 mg tablet twice daily with meals. Common side effects include dizziness, headache, and abdominal pain. Trikat MR is contraindicated in patients with movement disorders or severe renal impairment.
Paroxysmal cold hemoglobinuria -PCH
Paroxysmal cold hemoglobinuria (PCH) is a type of autoimmune hemolytic anemia caused by an IgG biphasic Donath-Landsteiner antibody. The antibody binds to red blood cells at low temperatures, causing intravascular hemolysis when the body warms up. This results in hemoglobinuria and hemosiderinuria. A peripheral blood film may show auto-agglutination of red blood cells, spherocytes, and reticulocytes. PCH is associated with viral illnesses in children or acquired syphilis.
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Cardiomyopathy
Cardiomyopathy refers to diseases of the heart muscle that weaken the heart's ability to pump blood effectively. The three main types are dilated, hypertrophic, and restrictive cardiomyopathy. Dilated cardiomyopathy causes the left ventricle to enlarge and weaken, impairing its ability to pump blood. Causes include viral infections, toxins, genetic factors, and hypertension. Symptoms include fatigue, shortness of breath, and fluid retention. Diagnosis involves echocardiograms, electrocardiograms, and cardiac catheterization. Treatment focuses on managing symptoms through medications, lifestyle changes, and potentially surgery or transplantation.
Myocardial infarction - Medicalbooksvn.wordpress.com
1. Myocardial infarction occurs when blood flow to the heart is blocked, causing death of heart muscle cells.
2. The degree of heart damage depends on the size of the blocked artery and amount of heart tissue affected.
3. There are two main types - ST-elevation MI where the full thickness of heart muscle is damaged, and non-ST-elevation MI where the inner layer is most affected.
ECG A: first part.
This document provides an overview of several cardiac arrhythmias and conditions including:
1. Accelerated idioventricular rhythm (AIVR), which results when an ectopic ventricular pacemaker exceeds the sinus node rate. AIVR is seen post-myocardial infarction and features a regular rhythm between 50-110 bpm with three or more QRS complexes.
2. Atrial flutter, a supraventricular tachycardia caused by a reentry circuit in the right atrium with a rate of around 300 bpm. The ventricular rate is determined by AV conduction.
3. Atrial fibrillation, the most common sustained arrhythmia characterized by irregularly irregular rhythm without
Brain strokes
A brain stroke occurs when blood supply to the brain is reduced or interrupted, depriving brain cells of oxygen and nutrients and potentially causing cell death. Strokes are medical emergencies that require immediate treatment to minimize brain damage and maximize chances of survival. The two main types of strokes are ischemic, caused by a blocked artery, and hemorrhagic, caused by a burst blood vessel. Risk factors include conditions like obesity, hypertension, smoking, and atrial fibrillation. Diagnosis involves tests like CT/MRI scans and treatment depends on the stroke type but generally focuses on restoring blood flow and preventing further damage. Ongoing rehabilitation is also important for recovery.
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This document provides an overview of cerebrovascular accidents (CVAs), also known as strokes. It defines CVAs, describes the blood supply to the brain, and classifies the major types of strokes as ischemic (caused by reduced blood flow) or hemorrhagic (caused by bleeding). It discusses the causes, risk factors, clinical presentation, progression, and management of different stroke subtypes, including transient ischemic attacks, infarction, and intracerebral hemorrhage.
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This document discusses heart failure and its treatment. Heart failure results from reduced cardiac output and activation of the sympathetic nervous system and renin-angiotensin-aldosterone system, leading to sodium and water retention. Beta-blockers are beneficial for treating heart failure despite initially reducing cardiac function, as they prevent ischemia, induce remodeling, reduce toxicity, and apoptosis. Inotropic drugs like cardiac glycosides and beta-adrenergic agonists increase contractility but their long term use increases mortality.
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More from Jignesh Vora
Strong muscles
The strongest muscles in the body are arranged in a zigzag pattern from the lower to upper body, including the calves, quadriceps, back, chest, and neck muscles. The strongest individual muscle is the masseter muscle, which is responsible for mastication or chewing. The masseter muscle is stronger than other muscles like the calves, quadriceps, back, and chest muscles.
Step ups
To perform step ups, stand on the floor and step up with the left foot onto an elevated surface, followed by stepping up with the right foot. Then step down with the right foot first and follow with the left foot, completing one repetition. Repeat this process 10 times.
Slr
This exercise involves lying on the floor and propping yourself up on your elbows. You bend one knee and keep the other leg straight with the toe pointed up, then use your thigh muscles to raise the straight leg upwards for 5 seconds and repeat 10 times before switching legs. An easier option is to do quad sets if fully raising the leg is too difficult.
Sit to stand
Sit to stand makes standing easier by teaching you to sit and stand from a chair by bending your knees outside your toes. This allows you to use your leg muscles rather than your back to lift yourself from a seated to standing position.
Side leg rise
This exercise involves holding onto a chair for support, placing your weight on your left leg while lifting your right leg tensed and straight, holding it for 5 seconds before lowering and repeating the motion 10 times.
Seated hip march
This exercise strengthens hip and thigh muscles by having the person sit straight in a chair and kick one foot back while lifting the other foot off the floor and holding it for 5 seconds, then lowering it and repeating 10 times before switching legs.
Quad set
Tighten the thigh muscles of one leg for 5 seconds and repeat 10 times, then switch legs and do the same tightening exercise to work the thigh muscles of the other leg.
Pillow squeeze
This exercise involves lying on your back with bent knees and a pillow placed between them, then squeezing the knees together around the pillow 10 times. The same motion can also be done while sitting up.
One leg balance
Balance on one leg for 20 seconds by shifting weight without locking the knee, then raise the other leg off the floor. Repeat twice on each leg to strengthen balance and core muscles. Switch legs and perform the same exercise to train both sides of the body.
Heel raise
This exercise involves standing straight and lifting the heels off the floor to rise up on the toes, holding for 5 seconds, then slowly lowering the heels back to the ground. The exercise should be repeated 10 times and can be done while holding onto a chair for support.
Hamstring stretch
Stretch the hamstring muscles by warming up with a 5 minute walk, then lying down and using a bedsheet to pull one leg up and hold the stretch for 20 seconds, repeating twice on each leg. Stretching helps increase muscle strength.
Anatomical motions
This document defines and describes various anatomical terms related to motion, including: flexion and extension, abduction and adduction, elevation and depression, rotation, flexion and extension of the foot and hand, pronation and supination, inversion and eversion, motions of the eyes, motions of teeth and jaw, and motions of fingers and thumb. Key terms are defined, such as flexion referring to a bending movement that decreases the angle between body parts, abduction pulling away from the body's midline, and pronation turning the forearm or foot outward.
Calf stretch
This document provides instructions for performing a calf stretch exercise. The instructions are to use a chair for balance, bend one leg while stepping the other leg back to feel a stretch, and lean forward while bending the front leg deeper to increase the stretch, holding for 20 seconds and repeating twice before switching legs.
Vertigo
Vertigo is an abnormal sensation that feels like spinning or that the world is spinning. It is usually caused by problems in the inner ear. Our balance is controlled by three sensory systems - vision, the inner ear vestibular system, and proprioception sensors. Common causes of vertigo include benign paroxysmal positional vertigo (BPPV), labyrinthitis, Meniere's disease, acoustic neuroma, and inner ear trauma. Symptoms include spinning sensations, hearing loss, tinnitus, and nausea. The Epley maneuver is an effective treatment for BPPV.
Vaso vagal syncope
Vasovagal syncope is a common cause of fainting caused by overstimulation of the vagus nerve which dilates blood vessels and lowers heart rate, preventing the heart from supplying enough blood to the brain. Fainting involves a brief loss of consciousness due to low cardiac output, heart rate, and blood pressure resulting in reduced blood flow to the brain. Common causes include the sight of blood, prolonged standing, heat exposure, straining during bowel movements, vigorous exercise, and certain medications. Tests can include ECG, stress test, and checking for low blood pressure when standing. Treatment focuses on avoiding triggers, keeping the head low, staying hydrated, and using medications if needed.
Tia
A transient ischemic attack (TIA) occurs when blood flow to the brain is temporarily blocked, usually by a blood clot or fatty deposits in blood vessels. This causes symptoms similar to a stroke but the blockage is temporary. Risk factors include family history, smoking, high blood pressure, high cholesterol, and diabetes. Symptoms depend on the location of the blockage but may include confusion, weakness, and numbness on one side of the body. Diagnosis involves assessing mental status, eye and facial movements, and listening to the neck. Treatment focuses on preventing another TIA through antiplatelet therapy like aspirin and addressing risk factors.
Tetanus
Tetanus is a potentially fatal disease caused by a toxin produced by the Clostridium tetani bacterium found in soil and intestines. The bacterium enters the body through contaminated wounds and causes painful muscle spasms by interfering with signals from nerves to muscles. Symptoms include muscle spasms, lockjaw, breathing difficulties, and can be fatal if the breathing muscles are affected. Treatment focuses on antibiotics to stop toxin production, antitoxins to neutralize existing toxin, and sedation for muscle spasms. Active immunization through tetanus shots and passive immunization with tetanus immunoglobulin for at-risk individuals are effective prevention methods.
Stroke
Dr. Jignesh Vora's document discusses cerebral vascular accidents (CVAs), also known as strokes. CVAs occur when there is reduced oxygen and glucose to brain cells, usually due to atherosclerosis, infarction, embolism from the heart, or hemorrhaging caused by high blood pressure, injury, or anticoagulants. Risk factors for CVAs include hypertension, diabetes, high lipids, age, smoking, alcohol, and cardiac diseases. Transient ischemic attacks (TIAs), or mini strokes, are short-lived and resolved attacks with similar symptoms to CVAs. Symptoms of a CVA can include weakness, tingling, confusion, reduced movement, slurred speech, headache, dizziness
Pituitary gland
The pituitary gland is a pea-sized gland located at the base of the brain that is protected by the sella turcica bone. It has three lobes and produces several important hormones, including growth hormone, thyroid-stimulating hormone, and others. These hormones regulate functions such as growth, blood pressure, pregnancy, breast milk production, sex organ functions, and thyroid gland function.
Persistent vegetative state
A persistent vegetative state is a disorder of consciousness where a patient is awake but not aware due to an absence of cognitive functions despite intact brain stem activity allowing for vegetative functions like breathing and digestion. Key signs include unresponsiveness to external stimuli while displaying sleep-wake cycles through actions like opening eyes during feeding or shedding tears. Common causes are hypoxic-ischemic brain injuries, trauma, degenerative changes, or metabolic disorders.
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There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
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Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
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The Electrocardiogram - Physiologic Principles
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
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Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
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4. Describe the influences of the Pneumotaxic and Apneustic centers
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7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
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3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
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Syncope
- 2. intro temporary loss of consciousness followed by return of full wakefulness Brain has two spheres - cerebellum & stem
- 3. Causes < bl to brain < cardiac o/p, atherosclerosis, dehydration cardiac arrhythmias due to beta blockers and CCBs MI, cardiomyopathy heart valve diseases: MR, MS, TR ,TS sudden cardiac death due to exercise postural hypotention vasovagal syncope anemia orthostatic hypotention
- 4. causes vertebro basilar sys smoking, HT, DM dyslipidmia electrolyte imbalance pregnancy hypoglycemia
- 5. Rx history ECG CBC RBS Lipid profile electrolytes R/o Rx Echo to r/o valvular diseases