This document describes the case of a 55-year-old hypertensive woman who presented to the emergency department with chest pain. She was diagnosed with an acute anterior wall myocardial infarction complicated by ventricular septal rupture based on her symptoms, ECG findings, cardiac enzymes, and echocardiogram. Her condition deteriorated with the development of a systolic murmur and cardiogenic shock. She was treated with inotropic support and taken for urgent surgery to repair the ventricular septal defect. The key points are: 1) Ventricular septal rupture occurs in 1-2% of myocardial infarctions and is associated with high mortality without surgery; 2) Echocardiogram and cardiac catheterization are important for diagnosis
This document discusses various patterns seen on cardiotocography (CTG) monitoring of fetal heart rate. It describes normal baseline heart rate ranges and variability. It also defines different periodic changes seen such as accelerations and decelerations including early decelerations, late decelerations, variable decelerations and prolonged decelerations. Various abnormal patterns are also described such as tachycardia, bradycardia, reduced variability and sinusoidal patterns. Causes and clinical significance of these findings are discussed.
The document discusses various aspects of fetal heart rate monitoring including:
1. Types of fetal heart rate tests including NST, CST, and acoustic stimulation test.
2. Components of fetal heart rate tracings including baseline rate, variability, accelerations, and decelerations.
3. Interpretation of normal, suspicious, and abnormal fetal heart rate tracing patterns.
4. Management recommendations based on the interpretation including continued monitoring, amniotomy, or discontinuing labor stimulating agents.
This document discusses various abnormal fetal heart rate patterns seen on a cardiotocography (CTG) tracing during labor and delivery. It describes fetal tachycardia as a heart rate over 160 bpm and potential causes like infection or drugs. Fetal bradycardia below 120 bpm is ominous and can be caused by hypoxia. Early decelerations occur with contractions and recover after, while late decelerations begin with contractions but recover slowly, indicating hypoxia. Variable decelerations can be caused by cord compression. Reduced variability may indicate fetal sleep, acidosis, or drugs. Management depends on whether the CTG is reassuring or pathological, with pathological cases requiring specialist evaluation and potential urgent delivery.
Intra Partum Cardiotocography - dr vivek patkardrvivekpatkar
Cardiotocography ( CTG )
is a procedure of graphically ( graph) recording fetal heart activity and uterine contractions ( Toco ) – both recorded in the same time scale simultaneously and continuously through uterine quiscience and contractions
CTG involves monitoring the fetal heart rate and uterine contractions during pregnancy using ultrasound and sensors placed on the maternal abdomen. It allows indirect assessment of fetal well-being but cannot directly measure oxygen levels or pH. The trace is analyzed based on baseline heart rate, variability, presence of accelerations or decelerations, and characteristics of uterine contractions. CTG interpretation involves categorizing the trace as normal, non-reassuring, or abnormal based on these features and guiding appropriate clinical management.
This document provides guidance on interpreting cardiotocography (CTG) readings during labor and delivery. It discusses how to prepare for and perform CTG monitoring, including setting up the machine, positioning the patient, and differentiating the maternal and fetal heart rates. It then describes how to interpret various features of the CTG tracing such as the baseline fetal heart rate, variability, accelerations, decelerations, and overall patterns. Recommendations are provided on the actions to take based on whether the CTG reading is normal, suspicious, or pathological.
Cardiotocography (CTG) involves using ultrasound and pressure transducers on a pregnant woman's abdomen to monitor the fetal heart rate and uterine contractions. It is used in the third trimester, especially during labor, to detect fetal distress. Abnormal CTG readings may indicate the need for further investigation or emergency c-section. Key elements of CTG interpretation include assessing the baseline fetal heart rate, variability, accelerations, and decelerations in response to contractions. Late or variable decelerations can suggest fetal hypoxia requiring interventions like fetal blood sampling.
This document discusses various patterns seen on cardiotocography (CTG) monitoring of fetal heart rate. It describes normal baseline heart rate ranges and variability. It also defines different periodic changes seen such as accelerations and decelerations including early decelerations, late decelerations, variable decelerations and prolonged decelerations. Various abnormal patterns are also described such as tachycardia, bradycardia, reduced variability and sinusoidal patterns. Causes and clinical significance of these findings are discussed.
The document discusses various aspects of fetal heart rate monitoring including:
1. Types of fetal heart rate tests including NST, CST, and acoustic stimulation test.
2. Components of fetal heart rate tracings including baseline rate, variability, accelerations, and decelerations.
3. Interpretation of normal, suspicious, and abnormal fetal heart rate tracing patterns.
4. Management recommendations based on the interpretation including continued monitoring, amniotomy, or discontinuing labor stimulating agents.
This document discusses various abnormal fetal heart rate patterns seen on a cardiotocography (CTG) tracing during labor and delivery. It describes fetal tachycardia as a heart rate over 160 bpm and potential causes like infection or drugs. Fetal bradycardia below 120 bpm is ominous and can be caused by hypoxia. Early decelerations occur with contractions and recover after, while late decelerations begin with contractions but recover slowly, indicating hypoxia. Variable decelerations can be caused by cord compression. Reduced variability may indicate fetal sleep, acidosis, or drugs. Management depends on whether the CTG is reassuring or pathological, with pathological cases requiring specialist evaluation and potential urgent delivery.
Intra Partum Cardiotocography - dr vivek patkardrvivekpatkar
Cardiotocography ( CTG )
is a procedure of graphically ( graph) recording fetal heart activity and uterine contractions ( Toco ) – both recorded in the same time scale simultaneously and continuously through uterine quiscience and contractions
CTG involves monitoring the fetal heart rate and uterine contractions during pregnancy using ultrasound and sensors placed on the maternal abdomen. It allows indirect assessment of fetal well-being but cannot directly measure oxygen levels or pH. The trace is analyzed based on baseline heart rate, variability, presence of accelerations or decelerations, and characteristics of uterine contractions. CTG interpretation involves categorizing the trace as normal, non-reassuring, or abnormal based on these features and guiding appropriate clinical management.
This document provides guidance on interpreting cardiotocography (CTG) readings during labor and delivery. It discusses how to prepare for and perform CTG monitoring, including setting up the machine, positioning the patient, and differentiating the maternal and fetal heart rates. It then describes how to interpret various features of the CTG tracing such as the baseline fetal heart rate, variability, accelerations, decelerations, and overall patterns. Recommendations are provided on the actions to take based on whether the CTG reading is normal, suspicious, or pathological.
Cardiotocography (CTG) involves using ultrasound and pressure transducers on a pregnant woman's abdomen to monitor the fetal heart rate and uterine contractions. It is used in the third trimester, especially during labor, to detect fetal distress. Abnormal CTG readings may indicate the need for further investigation or emergency c-section. Key elements of CTG interpretation include assessing the baseline fetal heart rate, variability, accelerations, and decelerations in response to contractions. Late or variable decelerations can suggest fetal hypoxia requiring interventions like fetal blood sampling.
This document discusses different methods of fetal monitoring during labor, including electronic fetal monitoring (EFM) and intermittent auscultation. While EFM is commonly used, it has high rates of false positives and variable interpretations. Intermittent auscultation is a simpler, less invasive method that is well-liked by patients and may reduce rates of cesarean section. The document also questions whether EFM has been proven to effectively prevent brain damage, as its central hypotheses have never been tested. It argues intermittent auscultation is an acceptable alternative for low-risk patients. The document provides guidelines for appropriate fetal monitoring and interpreting EFM tracings.
The document provides an overview of electronic fetal monitoring, including:
1. It defines the objectives of explaining fetal heart rate patterns using standard terminology and identifying normal and abnormal patterns on fetal heart rate tracings.
2. It reviews elements of the fetal heart rate tracing like baseline rate, variability, accelerations, and decelerations using standard definitions from NICHD.
3. It provides examples of fetal heart rate tracings and asks the reader to interpret them using the described terminology.
This document provides an overview of a course on fetal monitoring and CTG interpretation. It discusses:
- The physiology and pathophysiology of fetal heart rate regulation.
- The four key features of a CTG trace: baseline rate, variability, accelerations, and decelerations. It defines each feature and provides examples of normal and abnormal readings.
- Fetal acid-base status, including the differences between acute and chronic hypoxia. It discusses how to interpret cord blood gas results.
- The use of ultrasound in fetal monitoring, including cardiac ultrasound, biophysical profile, and Doppler assessments of umbilical and middle cerebral artery blood flow.
This document provides information on intrapartum fetal monitoring techniques including fetal heart rate monitoring, indications for continuous electronic fetal monitoring, interpretation of fetal heart rate patterns, and management of non-reassuring fetal status. It discusses techniques like intermittent auscultation, electronic fetal monitoring, fetal scalp pH testing, pulse oximetry, and lactate testing. The goal of intrapartum monitoring is timely identification and rescue of fetuses at risk for neonatal morbidity from hypoxic insult during labor and delivery.
Electronic fetal monitoring (EFM) is used during labor to monitor the fetal heart rate and detect any changes that could indicate impaired oxygenation. It analyzes the fetal heart rate baseline, variability, and any accelerations or decelerations in response to contractions. While EFM provides useful data, it has limitations as it does not reliably identify compromised fetuses and can increase rates of operative intervention. When abnormalities are detected, interventions like turning the patient, administering oxygen, or stopping oxytocin infusion may be performed to attempt to improve the fetal heart rate tracing through intrauterine resuscitation.
This document provides an overview of basic life support (BLS) protocols for adults. It defines BLS as emergency treatment for cardiac or respiratory arrest, including cardiopulmonary resuscitation (CPR) and use of an automated external defibrillator (AED). The BLS sequence is described as airway, breathing, circulation, defibrillation. Steps for each element are outlined, including techniques for opening the airway, providing rescue breaths, performing chest compressions, and using an AED. Statistics on cardiac arrests and the importance of rapid BLS response are also presented.
CTG in simple methods in fetal assessment according to RCOG guidelines.
easy and concise
feel free to download
by OSAMA AKL
MRCOG instructor
contact me on WhatsApp 00201008067383
The document provides guidelines for interpreting intrapartum fetal heart rate tracings using the NICHD nomenclature system, which classifies tracings as Category I, II, or III based on characteristics such as baseline rate, variability, and presence of decelerations. Category I tracings are normal, Category II indeterminate, and Category III abnormal and predictive of fetal acidosis. The guidelines aim to standardize interpretation of tracings and guide clinical management.
The document discusses cardiotocography (CTG), which involves using transducers to simultaneously monitor the fetal heart rate and uterine contractions during childbirth. It describes how CTG is used to identify signs of fetal distress. CTG can be performed externally or internally and is indicated for patients with certain risk factors or complications. The document outlines how to interpret CTG traces, including normal versus non-reassuring versus abnormal classifications based on factors like baseline heart rate, variability, and types of decelerations observed.
Cardiotocography (CTG) is a technique used to monitor the fetal heart rate and uterine contractions during pregnancy using an electronic fetal monitor. It involves using two transducers, one to measure the fetal heart rate and another to measure uterine contractions. The monitor provides data on the baseline fetal heart rate, variability, presence of accelerations or decelerations associated with contractions. Abnormal patterns in these readings can indicate fetal hypoxia or stress requiring delivery.
This document discusses cardiotocography (CTG), which monitors fetal heart rate and uterine contractions during pregnancy. CTG is performed in the third trimester using external transducers on the abdomen or internal monitors during labor. Recordings are interpreted using the DR C BRAVADO method: defining risk, assessing contractions, baseline rate, variability, accelerations, decelerations, and the overall impression. Abnormal findings like late decelerations or a sinusoidal pattern indicate fetal distress requiring emergency measures.
This document discusses intrapartum fetal heart rate (FHR) monitoring. It finds that while continuous electronic FHR monitoring increases cesarean rates compared to intermittent auscultation, neither approach improves neonatal outcomes. For low-risk women, routine electronic monitoring is not recommended. High-risk pregnancies should be continuously monitored. FHR patterns are categorized as reassuring, nonreassuring, or indeterminate. Nonreassuring patterns may indicate fetal acidosis and require interventions like oxygen, fluids, or discontinuing uterotonic drugs.
Cardiotocography (CTG) involves recording the fetal heartbeat and uterine contractions on a graph. It is used to assess fetal wellbeing and monitor uterine activity. Two transducers are placed on the mother's abdomen to measure fetal heart rate and uterine contractions. Features of the CTG tracing including baseline heart rate, variability, accelerations, and decelerations are analyzed to determine if the tracing is reassuring, suspicious, or abnormal. While a normal CTG provides a high level of reassurance for fetal wellbeing, an abnormal CTG does not always indicate fetal distress.
This document summarizes the medical case of a 17-day-old male neonate born at 37 weeks gestation by vaginal delivery. The baby was reluctant to feed since birth and had one episode of convulsions. On examination, the baby was lethargic, pale, and hypotonic. Tests revealed sepsis and obstructive hydrocephalus. The baby was diagnosed with neonatal sepsis and hydrocephalus as a small for gestational age infant and treated with antibiotics, fluids, blood transfusion, and a surgical consultation.
This document provides guidance on cardiotocography (CTG), which assesses fetal well-being by monitoring the fetal heart rate and uterine contractions. It outlines the indications for CTG, how to perform and interpret a CTG, management based on CTG findings, and conservative measures that can be tried to improve abnormal tracings before expediting delivery. Key aspects of CTG include assessing the baseline heart rate, variability, accelerations, decelerations, and developing an overall impression of normal, suspicious, or pathological to guide management decisions.
This document discusses cardiotocography (CTG), a method of electronic fetal monitoring during labor that analyzes the fetal heart rate (FHR) to detect hypoxia. While CTG was initially used in the 1970s to link FHR abnormalities to cerebral palsy, the results were contradictory. Later methods like fetal scalp pH testing and pulse oximetry were introduced to improve CTG. More recently, fetal ECG and ST segment analysis (STAN) was introduced to analyze other alterations in hypoxia beyond just the FHR. STAN examines the T/QRS ratio to determine if the fetus is using anaerobic metabolism episodically, at baseline for an extended period, or cannot respond to hypoxia
Invented in 1958 by DR.EDWARD H.HON, a fetal Doppler monitors or baby heart beat monitors is a hand-held ultrasound transducer used to detect the fetal heartbeat for prenatal care.
It uses the Doppler effect to provide an audible simulation of the heart beat.
Doppler fetal monitor or baby heart beat monitors is a handheld ultrasound baby heart beat monitor used to hear an embryo or fetus heart beat.
Originally intended for use by health care professionals,despite this fetal Doppler devices have become extremely popular for personal use.
The document discusses the use of fetal heart rate monitoring (EFM) during labor and delivery. While EFM reduced perinatal mortality, it also increased rates of surgical intervention. The addition of ST analysis (STAN) to EFM provides more precise information about the fetal state by detecting abnormalities in the fetal ECG. Large randomized controlled trials in the UK and Sweden found that combining EFM with STAN significantly reduced fetal metabolic acidosis and operative delivery rates, and decreased rates of neonatal encephalopathy. STAN allows for better grading of fetal condition between the extremes of very healthy and very sick.
This document discusses cardiotocography (CTG), which is a method for electronic fetal monitoring. It outlines the basic patterns seen on a CTG including baseline heart rate, variability, accelerations, and decelerations. It then describes how to interpret each component of a CTG reading based on whether findings are reassuring, non-reassuring, or abnormal. Management recommendations are provided depending on the CTG category of normal, suspicious, pathological, or need for urgent intervention. Conservative measures that can be tried include changing the mother's position, giving intravenous fluids, and reducing uterine contractions.
This document discusses ventricular septal rupture (VSR) which is a mechanical complication of myocardial infarction. It provides details on:
- The history, incidence, timing, anatomy and clinical presentation of VSR
- Diagnostic tools including echocardiography and hemodynamic monitoring
- Treatment approaches including medical management, percutaneous device closure and surgical repair
- Outcomes of different treatment options which show high mortality despite improvements, though percutaneous closure may be a viable alternative to surgery in some cases.
- Current guidelines which recommend urgent surgical repair for VSR complicating STEMI.
This study evaluated outcomes of 26 patients who underwent surgical repair of post-myocardial infarction ventricular septal defect (VSD) at Nizams Institute of Medical Sciences between 1997-2012. 20 patients underwent VSD repair with concomitant coronary artery bypass grafting, while 6 had VSD closure alone. The mean time between MI and VSD appearance was 7.2 days, and between VSD appearance and surgery was 27.2 days. Overall in-hospital mortality was 30.9% and 30-day mortality was 33%. Patients who underwent emergency surgery within 3 days of MI had 100% mortality, while those operated on after 3 weeks had 100% survival. Concomitant CABG during VSD repair was associated with lower
This document discusses different methods of fetal monitoring during labor, including electronic fetal monitoring (EFM) and intermittent auscultation. While EFM is commonly used, it has high rates of false positives and variable interpretations. Intermittent auscultation is a simpler, less invasive method that is well-liked by patients and may reduce rates of cesarean section. The document also questions whether EFM has been proven to effectively prevent brain damage, as its central hypotheses have never been tested. It argues intermittent auscultation is an acceptable alternative for low-risk patients. The document provides guidelines for appropriate fetal monitoring and interpreting EFM tracings.
The document provides an overview of electronic fetal monitoring, including:
1. It defines the objectives of explaining fetal heart rate patterns using standard terminology and identifying normal and abnormal patterns on fetal heart rate tracings.
2. It reviews elements of the fetal heart rate tracing like baseline rate, variability, accelerations, and decelerations using standard definitions from NICHD.
3. It provides examples of fetal heart rate tracings and asks the reader to interpret them using the described terminology.
This document provides an overview of a course on fetal monitoring and CTG interpretation. It discusses:
- The physiology and pathophysiology of fetal heart rate regulation.
- The four key features of a CTG trace: baseline rate, variability, accelerations, and decelerations. It defines each feature and provides examples of normal and abnormal readings.
- Fetal acid-base status, including the differences between acute and chronic hypoxia. It discusses how to interpret cord blood gas results.
- The use of ultrasound in fetal monitoring, including cardiac ultrasound, biophysical profile, and Doppler assessments of umbilical and middle cerebral artery blood flow.
This document provides information on intrapartum fetal monitoring techniques including fetal heart rate monitoring, indications for continuous electronic fetal monitoring, interpretation of fetal heart rate patterns, and management of non-reassuring fetal status. It discusses techniques like intermittent auscultation, electronic fetal monitoring, fetal scalp pH testing, pulse oximetry, and lactate testing. The goal of intrapartum monitoring is timely identification and rescue of fetuses at risk for neonatal morbidity from hypoxic insult during labor and delivery.
Electronic fetal monitoring (EFM) is used during labor to monitor the fetal heart rate and detect any changes that could indicate impaired oxygenation. It analyzes the fetal heart rate baseline, variability, and any accelerations or decelerations in response to contractions. While EFM provides useful data, it has limitations as it does not reliably identify compromised fetuses and can increase rates of operative intervention. When abnormalities are detected, interventions like turning the patient, administering oxygen, or stopping oxytocin infusion may be performed to attempt to improve the fetal heart rate tracing through intrauterine resuscitation.
This document provides an overview of basic life support (BLS) protocols for adults. It defines BLS as emergency treatment for cardiac or respiratory arrest, including cardiopulmonary resuscitation (CPR) and use of an automated external defibrillator (AED). The BLS sequence is described as airway, breathing, circulation, defibrillation. Steps for each element are outlined, including techniques for opening the airway, providing rescue breaths, performing chest compressions, and using an AED. Statistics on cardiac arrests and the importance of rapid BLS response are also presented.
CTG in simple methods in fetal assessment according to RCOG guidelines.
easy and concise
feel free to download
by OSAMA AKL
MRCOG instructor
contact me on WhatsApp 00201008067383
The document provides guidelines for interpreting intrapartum fetal heart rate tracings using the NICHD nomenclature system, which classifies tracings as Category I, II, or III based on characteristics such as baseline rate, variability, and presence of decelerations. Category I tracings are normal, Category II indeterminate, and Category III abnormal and predictive of fetal acidosis. The guidelines aim to standardize interpretation of tracings and guide clinical management.
The document discusses cardiotocography (CTG), which involves using transducers to simultaneously monitor the fetal heart rate and uterine contractions during childbirth. It describes how CTG is used to identify signs of fetal distress. CTG can be performed externally or internally and is indicated for patients with certain risk factors or complications. The document outlines how to interpret CTG traces, including normal versus non-reassuring versus abnormal classifications based on factors like baseline heart rate, variability, and types of decelerations observed.
Cardiotocography (CTG) is a technique used to monitor the fetal heart rate and uterine contractions during pregnancy using an electronic fetal monitor. It involves using two transducers, one to measure the fetal heart rate and another to measure uterine contractions. The monitor provides data on the baseline fetal heart rate, variability, presence of accelerations or decelerations associated with contractions. Abnormal patterns in these readings can indicate fetal hypoxia or stress requiring delivery.
This document discusses cardiotocography (CTG), which monitors fetal heart rate and uterine contractions during pregnancy. CTG is performed in the third trimester using external transducers on the abdomen or internal monitors during labor. Recordings are interpreted using the DR C BRAVADO method: defining risk, assessing contractions, baseline rate, variability, accelerations, decelerations, and the overall impression. Abnormal findings like late decelerations or a sinusoidal pattern indicate fetal distress requiring emergency measures.
This document discusses intrapartum fetal heart rate (FHR) monitoring. It finds that while continuous electronic FHR monitoring increases cesarean rates compared to intermittent auscultation, neither approach improves neonatal outcomes. For low-risk women, routine electronic monitoring is not recommended. High-risk pregnancies should be continuously monitored. FHR patterns are categorized as reassuring, nonreassuring, or indeterminate. Nonreassuring patterns may indicate fetal acidosis and require interventions like oxygen, fluids, or discontinuing uterotonic drugs.
Cardiotocography (CTG) involves recording the fetal heartbeat and uterine contractions on a graph. It is used to assess fetal wellbeing and monitor uterine activity. Two transducers are placed on the mother's abdomen to measure fetal heart rate and uterine contractions. Features of the CTG tracing including baseline heart rate, variability, accelerations, and decelerations are analyzed to determine if the tracing is reassuring, suspicious, or abnormal. While a normal CTG provides a high level of reassurance for fetal wellbeing, an abnormal CTG does not always indicate fetal distress.
This document summarizes the medical case of a 17-day-old male neonate born at 37 weeks gestation by vaginal delivery. The baby was reluctant to feed since birth and had one episode of convulsions. On examination, the baby was lethargic, pale, and hypotonic. Tests revealed sepsis and obstructive hydrocephalus. The baby was diagnosed with neonatal sepsis and hydrocephalus as a small for gestational age infant and treated with antibiotics, fluids, blood transfusion, and a surgical consultation.
This document provides guidance on cardiotocography (CTG), which assesses fetal well-being by monitoring the fetal heart rate and uterine contractions. It outlines the indications for CTG, how to perform and interpret a CTG, management based on CTG findings, and conservative measures that can be tried to improve abnormal tracings before expediting delivery. Key aspects of CTG include assessing the baseline heart rate, variability, accelerations, decelerations, and developing an overall impression of normal, suspicious, or pathological to guide management decisions.
This document discusses cardiotocography (CTG), a method of electronic fetal monitoring during labor that analyzes the fetal heart rate (FHR) to detect hypoxia. While CTG was initially used in the 1970s to link FHR abnormalities to cerebral palsy, the results were contradictory. Later methods like fetal scalp pH testing and pulse oximetry were introduced to improve CTG. More recently, fetal ECG and ST segment analysis (STAN) was introduced to analyze other alterations in hypoxia beyond just the FHR. STAN examines the T/QRS ratio to determine if the fetus is using anaerobic metabolism episodically, at baseline for an extended period, or cannot respond to hypoxia
Invented in 1958 by DR.EDWARD H.HON, a fetal Doppler monitors or baby heart beat monitors is a hand-held ultrasound transducer used to detect the fetal heartbeat for prenatal care.
It uses the Doppler effect to provide an audible simulation of the heart beat.
Doppler fetal monitor or baby heart beat monitors is a handheld ultrasound baby heart beat monitor used to hear an embryo or fetus heart beat.
Originally intended for use by health care professionals,despite this fetal Doppler devices have become extremely popular for personal use.
The document discusses the use of fetal heart rate monitoring (EFM) during labor and delivery. While EFM reduced perinatal mortality, it also increased rates of surgical intervention. The addition of ST analysis (STAN) to EFM provides more precise information about the fetal state by detecting abnormalities in the fetal ECG. Large randomized controlled trials in the UK and Sweden found that combining EFM with STAN significantly reduced fetal metabolic acidosis and operative delivery rates, and decreased rates of neonatal encephalopathy. STAN allows for better grading of fetal condition between the extremes of very healthy and very sick.
This document discusses cardiotocography (CTG), which is a method for electronic fetal monitoring. It outlines the basic patterns seen on a CTG including baseline heart rate, variability, accelerations, and decelerations. It then describes how to interpret each component of a CTG reading based on whether findings are reassuring, non-reassuring, or abnormal. Management recommendations are provided depending on the CTG category of normal, suspicious, pathological, or need for urgent intervention. Conservative measures that can be tried include changing the mother's position, giving intravenous fluids, and reducing uterine contractions.
This document discusses ventricular septal rupture (VSR) which is a mechanical complication of myocardial infarction. It provides details on:
- The history, incidence, timing, anatomy and clinical presentation of VSR
- Diagnostic tools including echocardiography and hemodynamic monitoring
- Treatment approaches including medical management, percutaneous device closure and surgical repair
- Outcomes of different treatment options which show high mortality despite improvements, though percutaneous closure may be a viable alternative to surgery in some cases.
- Current guidelines which recommend urgent surgical repair for VSR complicating STEMI.
This study evaluated outcomes of 26 patients who underwent surgical repair of post-myocardial infarction ventricular septal defect (VSD) at Nizams Institute of Medical Sciences between 1997-2012. 20 patients underwent VSD repair with concomitant coronary artery bypass grafting, while 6 had VSD closure alone. The mean time between MI and VSD appearance was 7.2 days, and between VSD appearance and surgery was 27.2 days. Overall in-hospital mortality was 30.9% and 30-day mortality was 33%. Patients who underwent emergency surgery within 3 days of MI had 100% mortality, while those operated on after 3 weeks had 100% survival. Concomitant CABG during VSD repair was associated with lower
Ventricular septal defect after myocardial infarctionRamachandra Barik
This document discusses ventricular septal defects (VSDs) that occur after a myocardial infarction. It provides several key points:
1. Surgical repair is the gold standard treatment for post-infarction VSD, but patients are at high risk for complications and mortality rates remain poor.
2. Transcatheter device closure of VSDs is an emerging alternative to surgery, with studies showing high rates of technical success but also risks of major complications and death within 30 days.
3. Factors associated with increased mortality from both surgical repair and device closure include older age, cardiogenic shock, renal dysfunction, and larger defect size. Overall, post-infarction VSD continues to carry
An inferior post infarct ventricular septal defect (VSD) repair procedure is described. The surgeon makes an incision through the infarct area to locate the VSD. Once located, the VSD is defined using a suction tip. A patch is sutured to the mitral valve annulus and papillary muscle base, and a continuous suture is used to close the septum above the VSD. The patch's inferior margin is sutured to the myocardium with pledgets to exclude the VSD. Soft felt is used to reinforce the left ventricular closure.
This document discusses the definition, diagnosis, complications, and treatment of myocardial infarction. Some key points include:
- Myocardial infarction is defined as myocardial necrosis due to ischemia that is detected by elevated cardiac biomarkers and clinical signs.
- Common complications include arrhythmias, mechanical issues like septal rupture, heart failure, and reinfarction. Electrical complications are usually treated with medications while mechanical issues often require surgery.
- Proper rehabilitation and long-term follow-up is important to monitor for complications in post-infarction patients. Anticipating complications can help ensure early detection and management.
Post Myocardial infarction vsd repair by infarct exclusion techniqueJyotindra Singh
This case study examines outcomes of 26 patients who underwent surgical repair of a post-myocardial infarction ventricular septal defect (PMIVSD) over a 15-year period. 20 patients underwent defect closure with concomitant coronary artery bypass grafting (CABG), while 6 had defect closure alone. In-hospital mortality was 30.9%, with higher mortality seen in those with cardiogenic shock, posterior defects, and surgery over 3 weeks after infarction. 15 of the 20 patients who had CABG survived, compared to 3 of the 6 who had defect closure alone. Residual shunts occurred in 5 patients but did not require reoperation. Predictors of poor prognosis included cardiogenic shock, timing of surgery, and total
Natural history of post myocardial infarction ventricular septal defectRamachandra Barik
Post-myocardial infarction ventricular septal defect (PI-VSD) carries a high risk of death, especially within the first 24 hours as heart failure from the infarction and left-to-right shunting compromises systemic perfusion. For patients who survive the initial event, 1, 2, and 4-week survival rates are 50%, 35%, and 20% respectively. A small percentage of patients, around 7%, have been reported to survive for up to 1 year without treatment if the physiological impact of the defect is minimal.
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 document discusses surgical treatment of complications from acute myocardial infarction (MI). It describes various complications that can occur post-MI including ventricular septal rupture, papillary muscle rupture, and ventricular free wall rupture which can lead to pseudoaneurysm formation. For each complication, the document outlines signs and symptoms, diagnostic techniques, surgical repair procedures, indications for operation, and factors impacting survival. Early surgical intervention is recommended for complications before additional organ damage or failure occurs.
A 35-year-old female presented with a 2-week history of generalized throbbing headache. Examinations revealed bilateral papilledema but no other neurological abnormalities. Opening pressure in a lumbar puncture was high at over 250 mm of water. Brain imaging and other tests did not show any abnormalities. She was diagnosed with idiopathic intracranial hypertension based on her symptoms, signs and test results. She was treated with acetazolamide and lumbar puncture and her symptoms improved.
Long case pregnancy with mitral stenosis sandeep kumar karisakakinada
This document describes the case of a 25-year-old pregnant woman with mitral stenosis who is admitted in active labor. She has a history of rheumatic fever as a child and has been diagnosed with mitral stenosis since age 15. On examination, she has signs of mild mitral stenosis including a diastolic thrill and murmur. Her pregnancy is considered high risk due to the increased burden on her heart from the enlarged uterus and blood volume. She requires careful anesthetic management during delivery due to the risk of decompensation from her mitral stenosis.
Case presentation: Myesthenia Gravis and Lung cancerBSMMU
Mr. Y, a 47-year-old diabetic man, was admitted with weakness on his right side and difficulty swallowing for 10 days. His neurological examination showed partial third nerve palsy, lower motor facial palsy, and ninth and tenth nerve palsy. Imaging and tests found consolidation in his left lung and denervation in his lower limbs and tongue. A chest wall mass was diagnosed as small cell lung cancer metastasis by FNAC.
This document discusses the anatomy, embryology, classification, pathophysiology, clinical features, diagnosis, and management of esophageal atresia with tracheo-esophageal fistula (TEF). It notes that TEF occurs due to incomplete separation of the foregut during embryological development. The classification system describes the different types of atresia and fistula presentations. Surgical repair aims to divide the fistula and perform an end-to-end anastomosis of the esophageal pouches. Long-term complications can include tracheomalacia, gastroesophageal reflux, and swallowing and motility issues.
This document discusses the anatomy, embryology, classification, clinical features, diagnosis, and management of esophageal atresia with tracheo-esophageal fistula (TEF). Key points include:
1) TEF results from incomplete separation of the foregut from the laryngotracheal groove during embryological development.
2) There are various classifications of TEF including the Vogt and Gross system. Type C, with upper pouch atresia and lower pouch fistula, accounts for 85% of cases.
3) Clinical features include frothing at the mouth, choking, and cyanosis with feeding. Diagnosis is made with chest x-rays and es
This patient presented with fever, neck swelling, nausea, vomiting and generalized weakness for several weeks. Tests found acute hepatitis E infection which exacerbated her underlying chronic liver disease. Her condition deteriorated with hepatic encephalopathy. Further neurological decline included new upper motor neuron signs and metabolic acidosis. Imaging found diffuse cerebral edema. She was treated aggressively including intubation, antibiotics, and anti-encephalopathy measures. Her mental status improved within 48 hours, though she had residual high alkaline phosphatase. The diagnosis was non-herpetic encephalitis secondary to hepatitis E-induced decompensation of chronic liver disease.
A 35-year-old female presented with a history of palpitations and shortness of breath for the past 6 hours. She has a history of hypertension for the past 3 months and is on medication. On examination, her blood pressure was elevated and heart rate was rapid. An ECG showed Wolff-Parkinson-White syndrome. WPW is a condition where there is an extra pathway between the atria and ventricles that can cause rapid heart rates. Treatment options include medications, cardioversion, catheter ablation to destroy the extra pathway, or surgery.
The document discusses several clinical case scenarios presented by "Dr. Bad" and "Dr. Good" to illustrate the importance of thorough clinical examination and consideration of alternative diagnoses rather than relying solely on initial impressions or test results. In Case 1, "Dr. Good" identifies pericarditis rather than reinfarction based on the nature of chest pain and auscultation findings. In Case 2, "Dr. Good" suspects and confirms upper GI bleed as the cause of syncope rather than assuming a cardiac cause. The document emphasizes looking for non-cardiac explanations and relying on clinical assessment over initial impressions.
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2. Khalida parveen w/o Moula dad 55 yrKhalida parveen w/o Moula dad 55 yr
old, resident of Afzal Town, Khanewalold, resident of Afzal Town, Khanewal
presented to us in Emergencypresented to us in Emergency
department with complaint of :department with complaint of :
IntroductionIntroduction
4. History of presenting illnessHistory of presenting illness
My patient was alright 5 hour back whenMy patient was alright 5 hour back when
she developed chest pain,she developed chest pain,
sudden in onset,sudden in onset,
severe in intensity,severe in intensity,
located centrally,located centrally,
non-radiating,non-radiating,
compressing in charactercompressing in character
5. History of presenting illnessHistory of presenting illness
Associated with sweating and nausea butAssociated with sweating and nausea but
not associated with palpitations, shortnessnot associated with palpitations, shortness
of breath.of breath.
There was no history of fever , headache,There was no history of fever , headache,
cough, hemoptysis, constipation, diarrhea,cough, hemoptysis, constipation, diarrhea,
melena , polyuria, oliguria , dysuria,melena , polyuria, oliguria , dysuria,
hematuria.hematuria.
6. Past HistoryPast History
There was no past history of suchThere was no past history of such
complaints.complaints.
No history of hospitalization due to anyNo history of hospitalization due to any
other cause.other cause.
7. Family HistoryFamily History
She has 2 brothers and 3 sisters , allShe has 2 brothers and 3 sisters , all
healthyhealthy
She has 2 sons and 3 daughters, allShe has 2 sons and 3 daughters, all
healthyhealthy
No history of any chronic illness in herNo history of any chronic illness in her
parents as wellparents as well
8. Personal HistoryPersonal History
She belongs to middle socioeconomicShe belongs to middle socioeconomic
status.status.
She is hypertensive for 10 years with poorShe is hypertensive for 10 years with poor
compliance.compliance.
No history of Smoking , D.M. ,T.B. ,No history of Smoking , D.M. ,T.B. ,
Asthma , drug addiction or alcohol .Asthma , drug addiction or alcohol .
10. General Physical ExaminationGeneral Physical Examination
An old woman looking distressed , lying inAn old woman looking distressed , lying in
bed with cannula attached to right hand ,bed with cannula attached to right hand ,
well-oriented in time ,place andwell-oriented in time ,place and
person with following vitals :person with following vitals :
Pulse : 80/minPulse : 80/min
B.P. : 110/70 mm HgB.P. : 110/70 mm Hg
R.R. : 16/minR.R. : 16/min
Temperature : 98 FTemperature : 98 F
12. CardiovascularCardiovascular
System ExaminationSystem Examination
Pulse is 80/min,regular,normal volume ,normalPulse is 80/min,regular,normal volume ,normal
character,no radiofemoral delay,radial pulsescharacter,no radiofemoral delay,radial pulses
bilaterally equally palpable, vessel wall notbilaterally equally palpable, vessel wall not
palpable.palpable.
On inspection, shape of precordium is normal,noOn inspection, shape of precordium is normal,no
scar, no pulsationsscar, no pulsations
On palpation,apex beat is palpable in 5On palpation,apex beat is palpable in 5thth
intercostal space medial to mid-clavicular line, ofintercostal space medial to mid-clavicular line, of
normal character, no thrill,no left parasternalnormal character, no thrill,no left parasternal
heaveheave
On auscultation, both heart sounds are ofOn auscultation, both heart sounds are of
normal intensity,no added sound, no murmur .normal intensity,no added sound, no murmur .
13. RespiratoryRespiratory
System ExaminationSystem Examination
On inspection, respiratory rate is 20/min, thoraco-On inspection, respiratory rate is 20/min, thoraco-
abdominal . shape of chest is normal. no scar ,abdominal . shape of chest is normal. no scar ,
prominent veins or pulsations visible. Chest is movingprominent veins or pulsations visible. Chest is moving
equally on both sidesequally on both sides
On palpation, trachea is central, no tenderness orOn palpation, trachea is central, no tenderness or
crepitus. Movement of chest is equal on both sides.crepitus. Movement of chest is equal on both sides.
Chest expansion is 4 cm. vocal fremitus is equal on bothChest expansion is 4 cm. vocal fremitus is equal on both
sidessides
On percussion, upper border of liver is in 5On percussion, upper border of liver is in 5thth
intercostalintercostal
space. Percussion note is resonant and equal on bothspace. Percussion note is resonant and equal on both
sidessides
On auscultation, breathing sounds are vesicular and ofOn auscultation, breathing sounds are vesicular and of
normal intensity. No added sounds.normal intensity. No added sounds.
14. GastrointestinalGastrointestinal
System ExaminationSystem Examination
On inspection,shape of abdomen is normal.On inspection,shape of abdomen is normal.
Abdomen is moving with respiration. UmbilicusAbdomen is moving with respiration. Umbilicus
is central and of normal shape. No pulsationsis central and of normal shape. No pulsations
are visible. No scar mark,striae,prominent veins.are visible. No scar mark,striae,prominent veins.
Hernial orifices are intactHernial orifices are intact
On palpation, there is no rigidity or tendernessOn palpation, there is no rigidity or tenderness
on palpation. No viscera or mass palpableon palpation. No viscera or mass palpable
On percussion, there is no dullness or fluid thrillOn percussion, there is no dullness or fluid thrill
On auscultation, bowel sounds are 3-5 /min,ofOn auscultation, bowel sounds are 3-5 /min,of
normal intensity. No bruit sound audiblenormal intensity. No bruit sound audible
15. Cental NervousCental Nervous
System ExaminationSystem Examination
GCS 15/15GCS 15/15
Behavior is normal, no delusions/Behavior is normal, no delusions/
hallucinations. Memory is goodhallucinations. Memory is good
Speech is normalSpeech is normal
Cranial nerves are intactCranial nerves are intact
Sensory system is intactSensory system is intact
Motor system is intactMotor system is intact
No cerebellar signs foundNo cerebellar signs found
17. Patient was treated on the line of Acute Anterior
wall M.I. and thrombolyzed by streptokinase.
Blood samples were drawn and send for CBC,
Cardiac Enzymes ,RPM, RBS ,S/E
19. After 2 daysAfter 2 days
The patient started to become short of breath.The patient started to become short of breath.
Her B.P. dropped from 110/70 to 90/60 mmHgHer B.P. dropped from 110/70 to 90/60 mmHg
Systolic thrill was palpable in 3Systolic thrill was palpable in 3rdrd
/4/4thth
intercostal spaceintercostal space
Cardiac auscultation revealed aCardiac auscultation revealed a
pan-systolic grade IV murmur, harsh in character, heardpan-systolic grade IV murmur, harsh in character, heard
all over the precordium with maximum intensity at leftall over the precordium with maximum intensity at left
lower sternal border, radiating to right side of sternum,lower sternal border, radiating to right side of sternum,
loud during expiration suggesting Ventricular Septalloud during expiration suggesting Ventricular Septal
Rupture after AWMI.Rupture after AWMI.
So inotropic support was started and Bed side ECHOSo inotropic support was started and Bed side ECHO
was done.was done.
21.
So our final diagnosis isSo our final diagnosis is ACUTEACUTE
Anterior wall M.I.Anterior wall M.I. complicated bycomplicated by
VSR.VSR.
22. PlanPlan
Plan was to surgically correct the defectPlan was to surgically correct the defect
so coronary angiography was planned.so coronary angiography was planned.
25. OverviewOverview
High mortality despite variousHigh mortality despite various
improvements in therapyimprovements in therapy
The mortality rate isThe mortality rate is
24% at 72 hours24% at 72 hours
75% at 3 weeks75% at 3 weeks
26. OverviewOverview
Relative Improvement in survival due toRelative Improvement in survival due to
Earlier diagnosisEarlier diagnosis
Earlier flow restorationEarlier flow restoration
More aggressive surgical interventionMore aggressive surgical intervention
27. OverviewOverview
Predictors of VSRPredictors of VSR
Advanced age,Advanced age,
Anterior location of infarction,Anterior location of infarction,
Female sexFemale sex
HTNHTN
28. OverviewOverview
Average time to ruptureAverage time to rupture
2-5 days2-5 days
Range: few hoursRange: few hours 2 weeks2 weeks
29. OverviewOverview
Coronary anatomy and VSRCoronary anatomy and VSR
Post MI VSRs more commonlyPost MI VSRs more commonly
associated with 100% occlusion of theassociated with 100% occlusion of the
infarct related arteryinfarct related artery
30. Anatomy of VSRsAnatomy of VSRs
Two types of VSRTwo types of VSR
SimpleSimple: through and through defect usually: through and through defect usually
located anteriorlylocated anteriorly
ComplexComplex: serpentiginous dissection tract: serpentiginous dissection tract
remote from the primary septal defect- mostremote from the primary septal defect- most
commonly an inferior VSRcommonly an inferior VSR
31. Anatomy of VSRsAnatomy of VSRs
Apical septal ruptureApical septal rupture
Comprise approximately 60-80% ofComprise approximately 60-80% of
casescases
LAD occlusion is always the culpritLAD occlusion is always the culprit
32. Anatomy of VSRsAnatomy of VSRs
Basal septal ruptureBasal septal rupture
Approximately 20-40% of casesApproximately 20-40% of cases
Occlusion ofOcclusion of
Dominant RCADominant RCA =>=> extensive RV infarctionextensive RV infarction
33. Anatomy of VSRsAnatomy of VSRs
Multiple defects (5-11% of cases)Multiple defects (5-11% of cases)
Secondary to infarct extensionSecondary to infarct extension
Evolve within days of each otherEvolve within days of each other
34. DiagnosisDiagnosis
Loud/harsh pansystolic murmurLoud/harsh pansystolic murmur
Within the first week post AMIWithin the first week post AMI
Best heard at Lt. Lower sternal borderBest heard at Lt. Lower sternal border
Less loud at the apexLess loud at the apex
Associated with a thrillAssociated with a thrill
35. DiagnosisDiagnosis
Up to 50% of patients experience chestUp to 50% of patients experience chest
pain associated with the development ofpain associated with the development of
murmurmurmur
CHF and shock often associated with theCHF and shock often associated with the
development of murmurdevelopment of murmur
36. DiagnosisDiagnosis
Color Flow DopplerColor Flow Doppler
100% sensitive and specific in100% sensitive and specific in
differentiating VSR from acute MRdifferentiating VSR from acute MR
37. DiagnosisDiagnosis
Need for cardiac catheterizationNeed for cardiac catheterization
2/3 of the patients have multivessel coronary artery2/3 of the patients have multivessel coronary artery
diseasedisease
Cardiogenic shock not a hurdle to CatheterizationCardiogenic shock not a hurdle to Catheterization
=>=> Coronary angiographyCoronary angiography
should be performedshould be performed
VSR demonstrate a “step up” in oxygen saturation in
blood samples from the right ventricle and
pulmonary artery compared with those from the
right atrium.
38. ManagementManagement
Hemodynamically stable patients should haveHemodynamically stable patients should have
surgery on an urgent basis ( Class Isurgery on an urgent basis ( Class I
recommendation)recommendation)
In patients who are hemodynamically unstable,
the circulation should at first be supported by
intra-aortic balloon pulsation and a positive
inotropic agent such as dopamine or
dobutamine . IABP should be inserted as early
as possible as a bridge to a surgical procedure.
39. ManagementManagement
Cardiogenic shock is associated with highCardiogenic shock is associated with high
surgical mortality , further supporting earliersurgical mortality , further supporting earlier
operations on these patients beforeoperations on these patients before
complications develop.complications develop.
Mortality in patients with cardiogenic shockMortality in patients with cardiogenic shock
and VSR was 81% ( SHOCK trial )and VSR was 81% ( SHOCK trial )
40. Percutaneous therapyPercutaneous therapy
Percutaneous closure of a post-MI VSR as
a bridge to surgery is a therapeutic option
in patients with high surgical risk, allowing
hemodynamic stabilization and thus
gaining time for a further surgical
intervention if needed, improving patients
prognosis
41. Urgent Hybrid ApproachUrgent Hybrid Approach
In selected cases, with high operative risk
and unstable hemodynamic state due to
AMI complicated by VSR, urgent hybrid
approach consisting of the initial PCI
followed by surgical closure of VSR may
represent an acceptable treatment option
and contribute to the treatment of this
complex group of patients.