peripartum cardiomyopathy is an idiopathic cardiomyopathy
data is taken from most recent guidelines
local incidence of disease is also included
a brief history of this disease is also included
a proper mangement plan based on most recent guidelines is also given
prognosis clearly stated
balanced slides, easily readable
Low dose aspirin is a wonderful drug in the management of cerebrovascular and cardiovascular disease.However ther is lot of controversies about its use in obstetrics largely due to conclusions drawn on trials with flawed methodology, a reader must always view the evidence critically especially when the not harmful interventions are likely to benefit the patient....
peripartum cardiomyopathy is an idiopathic cardiomyopathy
data is taken from most recent guidelines
local incidence of disease is also included
a brief history of this disease is also included
a proper mangement plan based on most recent guidelines is also given
prognosis clearly stated
balanced slides, easily readable
Low dose aspirin is a wonderful drug in the management of cerebrovascular and cardiovascular disease.However ther is lot of controversies about its use in obstetrics largely due to conclusions drawn on trials with flawed methodology, a reader must always view the evidence critically especially when the not harmful interventions are likely to benefit the patient....
What Cancer Patients Need to Know about Cardio-Oncologybkling
Dr. Anita Arnold, cardio-oncologist at Lee Health, discusses about what cardio-oncology is, how cancer treatment can impact patients' heart health, and what cancer patients can do to help protect themselves from heart conditions arising from treatment. You'll come away from this webinar with a better understanding of how to take care of your heart during cancer treatment and why cardio-oncology is important.
Right use of Pulse Oximetry must be Used as a Screening Test for Early Detect...crimsonpublishersOJCHD
Preventive medicine is the ideal way in dealing with frequent and fatal diseases. Congenital heart disease (CHD) are responsible for the largest proportion of mortality caused by birth defects, in the first year of life. Actual numbers and mortality from CHD is increasing. In the developed world the treatment of CHD has escalating costs for health care systems and private covered patients, while in low-income countries the resources are minimal. Prevention/early detection, is urgently needed to tackle the increasing needs. Aim: To justify why pulse oximetry (pox) is the best available, early detecting postnatal screening test currently. Conclusion: Although CHD's are both frequent and carry a high morbidity and mortality, we still lack a single, easy to apply, non-invasive and low-cost screening test, worldwide. The most advantageous method for minimizing CHD deaths worldwide seems to be currently, the combination of clinical assessment with pox.
Clinical Profile of Acute Coronary Syndrome among Young AdultsPremier Publishers
Acute Coronary Syndrome accounts for 30% of hospital admissions with cardiovascular diseases. The risk of this syndrome is increasing among the younger adults, and a deep insight into the clinical profile among these patients will help in devising a preventive strategy, in order to alleviate the morbidity and mortality due to the syndrome. A cross sectional study was done among 125 subjects admitted to our tertiary care hospital with Acute Coronary Syndrome. Their risk factors were assessed and a 12 Lead electrocardiogram and 2D Echocardiogram were taken. Cardio III panel which consists of Troponin I, CK MB, BNP by COBAS meter machine was also measured. STEMI was present in 73.6% of the patients, while unstable angina was present in 16%. About 90% of STEMI patients were males and 62% of them were hypertensives. LV Ejection Fraction <30% was found in 9% of STEMI patients. This study elucidates the need for a preventive strategy for primordial prevention of cardiovascular events among young adults. The study envisaged the male, urban preponderance towards these events.
What Cancer Patients Need to Know about Cardio-Oncologybkling
Dr. Anita Arnold, cardio-oncologist at Lee Health, discusses about what cardio-oncology is, how cancer treatment can impact patients' heart health, and what cancer patients can do to help protect themselves from heart conditions arising from treatment. You'll come away from this webinar with a better understanding of how to take care of your heart during cancer treatment and why cardio-oncology is important.
Right use of Pulse Oximetry must be Used as a Screening Test for Early Detect...crimsonpublishersOJCHD
Preventive medicine is the ideal way in dealing with frequent and fatal diseases. Congenital heart disease (CHD) are responsible for the largest proportion of mortality caused by birth defects, in the first year of life. Actual numbers and mortality from CHD is increasing. In the developed world the treatment of CHD has escalating costs for health care systems and private covered patients, while in low-income countries the resources are minimal. Prevention/early detection, is urgently needed to tackle the increasing needs. Aim: To justify why pulse oximetry (pox) is the best available, early detecting postnatal screening test currently. Conclusion: Although CHD's are both frequent and carry a high morbidity and mortality, we still lack a single, easy to apply, non-invasive and low-cost screening test, worldwide. The most advantageous method for minimizing CHD deaths worldwide seems to be currently, the combination of clinical assessment with pox.
Clinical Profile of Acute Coronary Syndrome among Young AdultsPremier Publishers
Acute Coronary Syndrome accounts for 30% of hospital admissions with cardiovascular diseases. The risk of this syndrome is increasing among the younger adults, and a deep insight into the clinical profile among these patients will help in devising a preventive strategy, in order to alleviate the morbidity and mortality due to the syndrome. A cross sectional study was done among 125 subjects admitted to our tertiary care hospital with Acute Coronary Syndrome. Their risk factors were assessed and a 12 Lead electrocardiogram and 2D Echocardiogram were taken. Cardio III panel which consists of Troponin I, CK MB, BNP by COBAS meter machine was also measured. STEMI was present in 73.6% of the patients, while unstable angina was present in 16%. About 90% of STEMI patients were males and 62% of them were hypertensives. LV Ejection Fraction <30% was found in 9% of STEMI patients. This study elucidates the need for a preventive strategy for primordial prevention of cardiovascular events among young adults. The study envisaged the male, urban preponderance towards these events.
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
We understand the unique challenges pickleball players face and are committed to helping you stay healthy and active. In this presentation, we’ll explore the three most common pickleball injuries and provide strategies for prevention and treatment.
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.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
QA Paediatric dentistry department, Hospital Melaka 2020Azreen Aj
QA study - To improve the 6th monthly recall rate post-comprehensive dental treatment under general anaesthesia in paediatric dentistry department, Hospital Melaka
1. Challenges in Management of Advanced Heart Disease
“ YTP UPDATE 2020”
Author - Dr Indranil Dutta
MBBS, MS(OBG), FIAOG, FAGE, FIAMS
Dip in Advanced Gynae Endoscopy(Germany)
Associate Prof, IQCMC, Durgapur
President KOGS
Dr. Neharika M Bora
MD(obgyn), DRM Germany
Rainbow IVF, Agra
BROUGHT TO YOU BY
YTP CHAIRPERSON
Cardiovascular disease is a leading cause of maternal death. The normal cardiovascular hemodynamic
adaptations to pregnancy are remarkable, but tolerated without difficulty in the majority of women. However, in women
with cardiovascular dysfunction, these adaptations may precipitate cardiovascular decompensation. Risk stratification of
pregnancy risk should preferably take place before conception. Management of these women requires multidisciplinary
involvement of all key areas, including cardiology, nursing, maternal/fetal medicine and obstetric anesthesia. For higher-
risklesions,pregnancyshouldbemanagedincenterswithexpertiseinthisfield.
There are numerous contributors of this rising risk, including advancing maternal age, pre-existing
cardiovascular risk factors, the rise in multifetal pregnancies and survival to fertility age among childhood cancer
survivors and women with congenital heart disease. Unlike most cardiovascular conditions, there are no large randomized
controlledtrialstoguidedecision-making,andguidelinesarebasedprincipallyonexpertconsensus.
It is increasingly likely that a cardiologist will be called upon to manage these women, so it is incumbent upon
them to understand the basic cardiovascular hemodynamics of pregnancy and fundamental risk stratification and
management oftheseconditions.
In the United States, disease and dysfunction of the heart and vascular system as “cardiovascular disease” is
now the leading cause of death in pregnant women and women in the postpartum period accounting for 4.23 deaths per
100,000 live births, a rate almost twice that of the United Kingdom. The most recent data indicate that cardiovascular
1
diseasesconstitute 26.5%ofU.S.pregnancy-relateddeaths .
CHD was the most common form of heart disease complicating pregnancy in the Western world (accounting for
74% of cases in the Canadian Cardiac Disease in Pregnancy [CARPREG] registry and 66% of cases in the European
Registry on Pregnancy and Cardiac Disease [ROPAC] registry), whereas in less developed countries, rheumatic heart
2,3
diseaseplaysalargerrole
The normal cardiovascular hemodynamic adaptations to pregnancy are remarkable but tolerated without
difficulty in the majority of women. In women with cardiovascular dysfunction, however, these adaptations may precipitate
cardiovascular decompensation. Hemodynamic changes begin in the first trimester, with a 30–50 % rise in cardiac output,
driven by an increase in stroke volume and, to a lesser extent, heart rate. Systemic vascular resistance falls as a result of
endogenous vasodilators, as well as flow into the low-resistance uteroplacental unit. During labor and delivery, cardiac
output is further increased because of auto transfusion from the contracting uterus as well as an increase in heart rate
becauseofmaternalpainduring labor.
Hemodynamics of Pregnancy
The care of pregnant women with heart disease involves several stakeholders with different perspectives but
common goals: pre-conceptional counselling is important followed by delivery of a healthy baby and a mother free of
cardiac complications. This team should include an obstetric anesthesiologist, maternal fetal medicine specialist, nursing
staffandacardiologistwithexpertiseinthemanagement ofpregnantwomen
Multidisciplinary Care
2. Women with mechanical heart valves have an elevated risk of complications during pregnancy and only a 58 %
chance of a having an uncomplicated pregnancy with a live birth. The use of anticoagulants during pregnancy is
challengingandinfluencedbyahypercoagulablestateandchangesinthevolumeofdistribution andcreatinine clearance
Anticoagulation for Mechanical Heart Valves
Fortunately, pregnancy-associated acute MI (PAMI) is uncommon, although its incidence is increasing and inhospital
mortality remains high at 4.5 %The management of PAMI is individualized. However, in the presence of hemodynamic
instability, heart failure or refractory chest pain, angiography is warranted. As a high proportion of PAMI cases are caused
by SCAD, in which coronary angiography can propagate dissection, methods to reduce coronary manipulation are
recommended such as avoiding deep catheter engagement of the coronary ostia and gentle contrast injections. Coronary
CT may have an emerging role in the population of patients who are at a lower risk with suspected CAD, and provides
additionaldataonthevesselwallsuchaspresenceofplaque,intramuralhematomaordissection.
Acute MI During Pregnancy
Despite the increased hemodynamic burden of labor and delivery, including a further increase in heart rate, stroke volume
and cardiac output, vaginal delivery remains the optimal method of delivery. Cesarean section increases the risk of
maternal infection, leads to great hemodynamic shifts and blood loss, brings a risk of surgical injury and raises the
likelihood of thrombotic events. Although there is no consensus over absolute contraindications for vaginal delivery,
cesarean section can be considered for some women with certain cardiac conditions, including preterm labor in those
receiving full oral anticoagulation, Marfan's syndrome with an aorta over 45 mm, acute or chronic aortic dissection, and
intractableheartfailure.Generally,cesareansectionisreservedforobstetricalindications
Mode of Delivery
Fetaloutcomesarealsoimpaired in somemotherswith CHD.Higher chancesofIUGRwith LowBurth Weight babies.More
incidences of preterm labour, increased risk of miscarriage or intrauterine demise, and increased perinatal mortality.
Decreased maternal cardiac output and maternal cyanosis are significantly associated with an increase in fetal
4,5
complications .
Impact on Fetal Outcomes
Cardiovascular disease is a leading cause of maternal death. Cardiovascular training programs are increasingly providing
education on the management of cardiovascular disorders during pregnancy and it is increasingly likely that cardiologists
willbecalledupontomanagethesewomen.
Conclusion
1. ACOG Practice Bulletin No. 212: Pregnancy and Heart Disease, Author Information, Obstetrics & Gynecology: May
2019-Volume133-Issue5-pe320-e356,doi:10.1097/AOG.0000000000003243
2. Siu S, Sermer M, Colman J, Alvarez N, Mercier L, Morton B, Kells C, Bergin L, Kiess M, Marcotte F, Taylor D, Gordon E,
Spears J, Tam J, Amankwah K, Smallhorn J, Farine D, Sorensen S. Prospective multicenter of pregnancy outcomes in
womenwithheartdisease.Circulation.2001;104:515–521.
3. Roos-Hesselink JW, Ruys TP, Stein JI, Thilén U, Webb GD, Niwa K, Kaemmerer H, Baumgartner H, Budts W, Maggioni
AP, Tavazzi L, Taha N, Johnson MR, Hall R; ROPAC Investigators. Outcome of pregnancy in patients with structural or
ischaemicheartdisease:resultsofaregistryoftheEuropeanSocietyofCardiology.EurHeartJ.2013;34:657–665.
4. Presbitero P, Somerville J, Stone S, Aruta E, Spiegelhalter D, Rabajoli F. Pregnancy in cyanotic congenital heart
disease.Outcomeofmotherandfetus.Circulation.1994;89:2673–2676.
5. Gelson E, Curry R, Gatzoulis MA, Swan L, Lupton M, Steer P, Johnson M. Effect of maternal heart disease on fetal
growth.ObstetGynecol.2011;117:886–891.
References
![Challenges in Management of Advanced Heart Disease
“ YTP UPDATE 2020”
Author - Dr Indranil Dutta
MBBS, MS(OBG), FIAOG, FAGE, FIAMS
Dip in Advanced Gynae Endoscopy(Germany)
Associate Prof, IQCMC, Durgapur
President KOGS
Dr. Neharika M Bora
MD(obgyn), DRM Germany
Rainbow IVF, Agra
BROUGHT TO YOU BY
YTP CHAIRPERSON
Cardiovascular disease is a leading cause of maternal death. The normal cardiovascular hemodynamic
adaptations to pregnancy are remarkable, but tolerated without difficulty in the majority of women. However, in women
with cardiovascular dysfunction, these adaptations may precipitate cardiovascular decompensation. Risk stratification of
pregnancy risk should preferably take place before conception. Management of these women requires multidisciplinary
involvement of all key areas, including cardiology, nursing, maternal/fetal medicine and obstetric anesthesia. For higher-
risklesions,pregnancyshouldbemanagedincenterswithexpertiseinthisfield.
There are numerous contributors of this rising risk, including advancing maternal age, pre-existing
cardiovascular risk factors, the rise in multifetal pregnancies and survival to fertility age among childhood cancer
survivors and women with congenital heart disease. Unlike most cardiovascular conditions, there are no large randomized
controlledtrialstoguidedecision-making,andguidelinesarebasedprincipallyonexpertconsensus.
It is increasingly likely that a cardiologist will be called upon to manage these women, so it is incumbent upon
them to understand the basic cardiovascular hemodynamics of pregnancy and fundamental risk stratification and
management oftheseconditions.
In the United States, disease and dysfunction of the heart and vascular system as “cardiovascular disease” is
now the leading cause of death in pregnant women and women in the postpartum period accounting for 4.23 deaths per
100,000 live births, a rate almost twice that of the United Kingdom. The most recent data indicate that cardiovascular
1
diseasesconstitute 26.5%ofU.S.pregnancy-relateddeaths .
CHD was the most common form of heart disease complicating pregnancy in the Western world (accounting for
74% of cases in the Canadian Cardiac Disease in Pregnancy [CARPREG] registry and 66% of cases in the European
Registry on Pregnancy and Cardiac Disease [ROPAC] registry), whereas in less developed countries, rheumatic heart
2,3
diseaseplaysalargerrole
The normal cardiovascular hemodynamic adaptations to pregnancy are remarkable but tolerated without
difficulty in the majority of women. In women with cardiovascular dysfunction, however, these adaptations may precipitate
cardiovascular decompensation. Hemodynamic changes begin in the first trimester, with a 30–50 % rise in cardiac output,
driven by an increase in stroke volume and, to a lesser extent, heart rate. Systemic vascular resistance falls as a result of
endogenous vasodilators, as well as flow into the low-resistance uteroplacental unit. During labor and delivery, cardiac
output is further increased because of auto transfusion from the contracting uterus as well as an increase in heart rate
becauseofmaternalpainduring labor.
Hemodynamics of Pregnancy
The care of pregnant women with heart disease involves several stakeholders with different perspectives but
common goals: pre-conceptional counselling is important followed by delivery of a healthy baby and a mother free of
cardiac complications. This team should include an obstetric anesthesiologist, maternal fetal medicine specialist, nursing
staffandacardiologistwithexpertiseinthemanagement ofpregnantwomen
Multidisciplinary Care](https://image.slidesharecdn.com/5-200829073251/85/ytp-newsletter-indranil-dutta-pdf-1-320.jpg)
