This document discusses various types of valvular heart disease, including stenosis (narrowing of the valves), regurgitation (backward flow of blood through valves), aortic stenosis, aortic insufficiency, mitral stenosis, and mitral insufficiency. It describes the causes, pathophysiology, clinical manifestations, diagnosis, and treatment of each condition. Valvular diseases are generally asymptomatic for years initially but can progress to cause heart failure if left untreated. Diagnosis is typically via echocardiogram and treatment involves lifestyle changes, medications, or valve repair/replacement surgery depending on severity.
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CARDIAC TAMPONADE ( Cardiac emergency) • Cardiac Tamponade is a life threatening complication caused by excessive accumulation of fluid in the pericardium. Or • Compression of all cardiac chambers due to excessive accumulation of pericardial fluid leading to compromised cardiac out put.
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Some of the slides, i hide it from my real presentations for my own reference. Download to see all of them.
CARDIAC TAMPONADE ( Cardiac emergency) • Cardiac Tamponade is a life threatening complication caused by excessive accumulation of fluid in the pericardium. Or • Compression of all cardiac chambers due to excessive accumulation of pericardial fluid leading to compromised cardiac out put.
Aortic stenosis is a valvular heart disease resulting in reduction of blood flow to the body and making the heart work harder. The heart may weaken causing chest pain, fatigue and shortness of breath.
ECG Rhythm Interpretation
ST Elevation and non-ST Elevation MIs
ECG Changes
ECG Changes & the Evolving MI
Left Ventricular Hypertrophy
Normal Impulse Conduction
Bundle Branch Blocks
Valvular heart disease is any cardiovascular disease process involving one or more of the four valves of the heart (the aortic and mitral valves on the left side of heart and the pulmonic and tricuspid valves on the right side of heart).
Aortic stenosis is a valvular heart disease resulting in reduction of blood flow to the body and making the heart work harder. The heart may weaken causing chest pain, fatigue and shortness of breath.
ECG Rhythm Interpretation
ST Elevation and non-ST Elevation MIs
ECG Changes
ECG Changes & the Evolving MI
Left Ventricular Hypertrophy
Normal Impulse Conduction
Bundle Branch Blocks
Valvular heart disease is any cardiovascular disease process involving one or more of the four valves of the heart (the aortic and mitral valves on the left side of heart and the pulmonic and tricuspid valves on the right side of heart).
Heart failure is a clinical syndrome that results when the heart is unable to provide sufficient blood flow to meet metabolic requirements or accommodate systemic venous return.
Definition
Causes
Pathophysiology
Types Of Heart Failure
Symptoms
Signs
Complications
Investigations
Treatment
Aortic insufficiency (AI), also known as aortic regurgitation (AR), is the leaking of the aortic valve of the heart that causes blood to flow in the reverse direction
Asthma is a chronic inflammatory condition associated with airway hyperresponsiveness (an exaggerated airway-narrowing response to specific triggers such as viruses, allergens and exercise).
Physiotherapy can provide relief from symptoms of uncontrolled asthma, including coughing, wheezing, tightness in the chest, shortness of breath and QOL.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
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NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
3. Introduction
• Malfunction of the heart valves, which can be caused by infection, congenital
abnormalities, aging, or disease, is much more common on the left side of the
heart than on the right and often involves more than one valve.
• Valvular abnormalities are often asymptomatic for years to decades, but
eventually cardiac function may become impaired, resulting in diastolic
dysfunction, systolic dysfunction, or both, with consequent pulmonary or
systemic vascular congestion, as well as decreased cardiac output.
4. • When valve disease is severe, heart failure and sudden death may occur.
• Abnormal valvular structures create turbulent blood flow,,which increases the
hemodynamic stress on these structures and leads to progressive damage and
dysfunction.
• Compensatory mechanisms, including ventricular hypertrophy, chamber dilatation,
and peripheral adaptations, can help to maintain the overall performance of the heart
for may years, often decades, even when there is malfunction of more than one valve.
• Eventually, however, these compensatory mechanisms may become exhausted so that
heart failure develops.
5. Valvular Stenosis
• Restriction of blood flow due to narrowing of valvular opening, creates an
obstruction to forward flow through the valve and thus a pressure and volume
load on the chamber preceding it and generates a pressure gradient across the
valve that is proportional to the severity of stenosis.
• Concentric hypertrophy develops in response to the pressure load and attempts
to normalize the SV that is pumped through the narrow valve.
6.
7. Valvular Regurgitation/ Insufficiency
• Incompetent valve closure results in backward flow (regurgitation) of blood from
the receiving chamber or vessel to the antecedent chamber or vessel.
• This creates a volume load (normal filling volume plus regurgitant volume) on the
chambers or vessels on both sides of the affected valve, leading to dilatation and
often hypertrophy.
10. Pathophysiology
• Restricted opening of the AoV
• Increase pressure load on LV
• Increase LV systolic pressure, prolongation of ejection
• Left ventricular hypertrophy
• Decrease Compliance
• Increase LV filling pressures dependence of adequate LV filling on atrial contraction
• Increase Risk of subendocardial ischemia
• Increase pressures in pulmonary vessels and RV
11. • Most commonly, the left ventricular wall thickening occurs in response to
pressure overload, and chamber dilatation occurs in response to the volume
overload.
12. Clinical Manifestations
• May be asymptomatic, even with significant AS, for many years. Once symptoms develop, prognosis is
poor.
• Dyspnea, especially on exertion
• Angina pectoris
• Lightheadedness,
• Syncope on exertion: Syncope is caused by the decrease in cerebral perfusion occurring during
exertion when the arterial pressure declines due to systemic vasodilation and an inadequate increase
in cardiac output related to stenosis.
• Sudden death
• Possible systemic emboli
• Harsh systolic ejection murmur at second ICS radiating to the neck
13. Evaluation
• Echocardiography remains the standard approach method to evaluate and follow-up
patients with aortic stenosis and stratify them for the surgery. It allows imaging of the
valve anatomy and the severity of valve calcification and can also allow direct imaging
of the orifice area.
• Exercise testing helps in unmasking symptoms in asymptomatic patients, but it should
be avoided in symptomatic patients.
• Cardiac computed tomography (CT) use is expanding in patients with calcific aortic
valve disease. It is used when all the non-invasive tests are inconclusive.
• Cardiac magnetic resonance imaging (MRI) can assess LV mass, function, and volume
when it cannot be obtained readily in echocardiography.
15. Incomplete closure of the AoV
Backflow of blood to left ventricle
Left ventricular hypertrophy &
dialation
Increase left atrial pressure
Left sided heart failure (late
stage)
Left atrium hypertrophy
Increase pulmonary pressure
Right sided HF
Increase right ventricular
Pressure
16. Clinical Manifestations
• If chronic AI, gradual LV dilatation allows asymptomatic status for decades, then
similar to AS, except for less angina and syncope.
17. Mitral Stenosis
• Mitral stenosis is almost always rheumatic in origin.
• In older people it can be caused by heavy calcification of the mitral valve
apparatus.
• There is also a rare form of congenital mitral stenosis.
18. • In rheumatic mitral stenosis, the mitral valve orifice is slowly diminished by
progressive fibrosis, calcification of the valve leaflets, and fusion of the cusps and
subvalvular apparatus.
• The flow of blood from LA to LV is restricted and left atrial pressure rises, leading
to pulmonary venous congestion and breathlessness.
• There is dilatation and hypertrophy of the LA and left ventricular filling becomes
more dependent on left atrial contraction.
19. • The mitral valve orifice is normally about 5 cm2 in diastole and may be reduced
to 1 cm2 in severe mitral stenosis.
• Patients usually remain asymptomatic until the stenosis is less than 2 cm2.
• Reduced lung compliance, due to chronic pulmonary venous congestion,
contributes to breathlessness, and a low cardiac output may cause fatigue.
23. • The forces that open and close the mitral valve increase as left atrial pressure
rises. The first heart sound (S1) is therefore loud and can be palpable (tapping
apex beat).
• An opening snap may be audible and moves closer to the second sound (S2) as
the stenosis becomes more severe and left atrial pressure rises.
• However, the first heart sound and opening snap may be inaudible if the valve is
heavily calcified.
28. MITRAL VALVE PROLAPSE
• Mitral valve prolapse is a type of myxomatous valve disease. The tissue of the
mitral valve leaflets and chordae are abnormally stretchy, so that as the heart
beats, the mitral valve bows or flops back into the left atrium.
29.
30. ETIOLOGY
• MVP usually occurs as an isolated condition in connective tissue disorders such as
Marfan syndrome, osteogenesis imperfecta, pseudoxanthoma elasticum
syndrome.
31. PATHOPHYSIOLOGY
• MVP is the primary myxomatous degeneration of one or both leaflets of the
mitral valve.
• Myxomatous degeneration may involve valve leaflet abnormalities, chordae
tendinaeae weakening, and elongation, mitral annular dilatation or thickened
leaflet tissue, elongated chordae, mitral annular enlargement leading to
segmental mitral leaflet prolapse.
• Other pathophysiological changes include fibroelastic deficiency characterized by
thin, translucent and smooth leaflets or deficiency in elastin, proteoglycan, and
collagen with connective tissue deficiency.
32. • Endothelium disruption leads to complications such as infectious endocarditis
and thromboembolism. Most MVP individuals have minimal mitral valve structure
derangement which is not clinically significant.
• There is usually a gross redundancy of the mitral valve leaflets which fails
coaptation of the leaflets during systole, leading to mitral insufficiency.
33. PHYSICAL SYMPTOMS
• Frequently asymptomatic.
• MVP can be asymptomatic and can also present with symptoms of atypical chest
pain, palpitations, dyspnea on exertion, and exercise intolerance.
34. Over the years, it has been noted that patients with MVP do develop a range of autonomic symptoms that include:
• Panic attacks
• Anxiety
• Exercise intolerance
• Palpitations
• Fatigue
• Atypical chest discomfort
• Orthostasis
• Mood changes
• Syncope
35. DIAGNOSIS
• The most useful method of making a
diagnosis of MVP is by
echocardiogram.
• Mitral Valve Prolapse is defined as
mitral valve displacement more than
2 mm above mitral annulus in long-
axis view
36. MEDICAL AND SURGICAL TREATMENT
• MVP patients with no symptoms often require no treatment.
• MVP patients with symptoms of dysautonomia (chest pain, palpitations), should be treated with
beta-blockers such as propranolol.
• MVP with severe mitral regurgitation may benefit from mitral valve repair or mitral valve
replacement.
• Asymptomatic patients with mitral valve prolapse are managed conservatively with observation
and monitoring.
• If the patient is symptomatic with palpitations, anxiety, chest pain, other etiologies should be
ruled out.
• Symptomatic patients with severe mitral regurgitation, systolic heart failure, and symptom
progression require surgical intervention.
38. OTHER
• Regular monitoring of cardiac function to determine necessity of surgical
interventions before irreversible deterioration develops or risk of sudden death
becomes significant
• Lifestyle modifications (e.g., salt restriction; avoidance of caffeine, alcohol, and
nicotine)
• Prophylactic antibiotics to prevent endocarditis
39. • Treatment for CHF
• Treatment for pulmonary edema and shock if acute
• Antiarrhythmic agents, as indicated
40. • Surgical interventions once symptomatic:
• Balloon valvuloplasty or valvulotomy/commissurotomy for valvular stenosis
• Valvuloplasty or annuloplasty for valvular incompetence
• Valve replacement
• Heart transplantation for extremely high-risk individuals