http://WWW.HEARTDIABETESCARE.COM
SAMIKSHAHEARTCARE 57698d5b9ec66b0b6cfb5b6b False 534 1
OK
background image not found
Found Update results for
'information'
5
PAPULAR CARDIOLOGISTS IN HEBBALA ECG interpretation: points to remember 1 ECG reports should be short and based on clinical information where possible. 2 Check that the patient’s name is on the ECG and that the paper speed and calibration markers are correct. 3 Measure or estimate the heart rate—3 large squares = 100/minute. 4 Establish the rhythm. Look for P waves (best seen in L2). Are the P waves followed by QRS complexes? Look for anomalously conducted or ectopic beats. 5 Measure the intervals: PR, QRS duration and QT interval (for the latter, consult tables, but normal is less than 50% of the RR interval). 6 If the QRS complex is wide (> 3 small squares) consider the possibilities: LBBB, RBBB, WPW or ventricular rhythm or beats. If the pattern is of LBBB, there is no need in most cases to attempt further interpretation. 7 Estimate the QRS axis. In LAD, L1 and aVF diverge and L2 is predominantly negative. In RAD, L1 and aVF converge, while L2 matters little. Indeterminate axis is diagnosed when all six frontal leads are (more or less) equiphasic. 8 Check whether the criteria for LAHB or LAFB have been met. 9 Look for pathological Q waves. In general these are longer than 0.04 seconds and are more than 25% of the size of the following R wave.
POPULAR CARDIOLOGISTS IN SAHAKARANAGAR Cardiomyopathies and valvular heart disease Regardless of the status of the coronary arterial tree, both primary and secondary heart muscle disease can produce anginal pain through the imbalance of the oxygen demand and supply. Hypertrophic cardiomyopathy is a relatively common cause of angina in the presence of normal coronary arteries. Aortic stenosis is the most common valvular cause of exertional chest tightness, which is probably due to myocardial ischaemia Exertional chest pain, which may be due to right ventricular angina, is a feature of pulmonary hypertension . Syndrome X There is some confusion regarding the ‘metabolic’ and ‘cardiac’ varieties. The former is a combination of insulin resistance, obesity, pro-inflammatory state and so on, leading to raised cardiovascular risk in the sufferers. The latter is, or should be, a form of stable effort angina that can be ascribed to coronary microvascular malfunction.23 The epicardial coronary tree is normal and the diagnosis is rather difficult to make except by exclusion. Acute coronary syndromes The terminology used to describe acute coronary syndromes (ACSs) continues to evolve as clinicians attempt to adjust to the accumulating evidence of the usefulness of modern cardiac markers and the treatment implications of different results. The most recent terminology is designed to help with treatment decisions based on the earliest clinical information from the patient. This comes from the history and the ECG. When the patient’s symptoms suggest an acute coronary syndrome, the first decisions about diagnosis and treatment are based on the ECG. If there is ST elevation present in a pattern to suggest myocardial infarction, the diagnosis is of ‘ST elevation myocardial infarction’ (STEMI). If there is no ST elevation, the initial diagnosis is of ‘non-ST elevation acute coronary syndrome’ (NSTEACS).24 This elegant phrase has replaced ‘non-ST elevation myocardial infarction’ (non- STEMI). The reason is that the diagnosis of infarction cannot be made in the absence of ST elevation until cardiac marker estimations are available. The decisions about treatment, however, need to be made immediately and are based on symptoms and ECG changes.
HEART SPECIALISTS IN HEBBALABANGALORE Case-based learning: cardiovascular risk assessment Mr RF is 60 years old and presents for a check-up because he is concerned he may be at risk of heart disease. Objectives for the group to understand How should this type of request be managed What can be done to assess an individual’s future cardiac risk, and what can be done to improve the prognosis for those at increased risk Epidemiology and population health The presenter should ask the group to consider the concept of risk factors for cardiovascular disease and the differences between population risk factors and those for an individual. How did the concept of risk factors arise Presenting symptoms and clinical examination What questions should be asked of Mr RF to begin the risk factor assessment 1 Is there a history of ischaemic heart disease or symptoms of heart disease 2 Has his cholesterol level been checked in the past What was itHas it been treated with diet or drugs, or both Has the level improved 3 Is he a diabetic, or has he had an abnormal blood sugar measurement 4 Is there a history of high blood pressure Has this been treated If so, how 5 Is there a history of heart disease in the familIf so, who has been affected and at what age 6 Does he smoke? How many cigarettes a day If he has ceased smoking, when did he stop 7 Does he exercise regularly 8 Have any cardiac investigations been performed before What were the results 9 Is there a history of peripheral arterial disease (claudication) or erectile dysfunction The group should appreciate that considerable information about risk can be obtained by asking simple questions. What physical examination should be performed
HEART SPECIALISTS IN SILKBOARD BANGALORE Detected vascular abnormalities Calcium scoring High-resolution CT scanners can measure calcium within the coronary arteries in a single breath-hold scan. The measured calcium is given a number, the Agatston score. The presence of calcium within a coronary artery is a marker of coronary disease but not of obstructive disease. It does not give any information about the presence of soft plaque, which is more likely to be associated with an acute coronary event but a 0 score predicts a very low coronary risk. A high score has been shown to be an independent risk factor for future events.29 Prospective studies proving the value of calcium scoring have not been performed. Calcium scoring is likely to be superseded by multi-slice CT coronary angiography which can produce images of the coronary lumen and generate a calcium score. An elevated calcium score in an asymptomatic patient is probably best treated as an indication for aggressive risk factor management; for example, instituting statin treatment for a marginally elevated cholesterol level. Intima-media thickness High-frequency ultrasound transducers can measure accurately the thickness of the carotid intima up to its interface with the media. An intima-media thickness (IMT) of > 1.3 mm is associated with an increased cardiovascular risk, which remains significant after allowing for other risk factors. Ankle brachial index The ankle brachial index (ABI) is relatively easy to measure with a sphygmomanometer and a Doppler ultrasound device. The systolic blood pressure in the arm and in the posterior tibial and dorsalis pedis arteries is compared. An ABI of < 0.9 means a stenosis of at least 50% somewhere between the aorta and the foot. The test is a reliable sign of peripheral arterial disease and thus also coronary disease. Erectile dysfunction Erectile dysfunction is a marker of endothelial dysfunction. Because the penile arteries are smaller (1–2 mm) than the carotids (5–7 mm) and coronary arteries (3 mm), plaque burden and endothelial dysfunction may cause symptoms earlier here than in the other territories
DCardiologist in Vidyaranyapura, Bangalore • etected vascular abnormalities Calcium scoring High-resolution CT scanners can measure calcium within the coronary arteries in a single breath-hold scan. The measured calcium is given a number, the Agatston score. The presence of calcium within a coronary artery is a marker of coronary disease but not of obstructive disease. It does not give any information about the presence of soft plaque, which is more likely to be associated with an acute coronary event but a 0 score predicts a very low coronary risk. A high score has been shown to be an independent risk factor for future events.29 Prospective studies proving the value of calcium scoring have not been performed. Calcium scoring is likely to be superseded by multi-slice CT coronary angiography (p. 136), which can produce images of the coronary lumen and generate a calcium score. An elevated calcium score in an asymptomatic patient is probably best treated as an indication for aggressive risk factor management; for example, instituting statin treatment for a marginally elevated cholesterol level. Intima-media thickness High-frequency ultrasound transducers can measure accurately the thickness of the carotid intima up to its interface with the media. An intima-media thickness (IMT) of > 1.3 mm is associated with an increased cardiovascular risk, which remains significant after allowing for other risk factors. Ankle brachial index The ankle brachial index (ABI) is relatively easy to measure with a sphygmomanometer and a Doppler ultrasound device. The systolic blood pressure in the arm and in the posterior tibial and dorsalis pedis arteries is compared. An ABI of < 0.9 means a stenosis of at least 50% somewhere between the aorta and the foot. The test is a reliable sign of peripheral arterial disease and thus also coronary disease. Erectile dysfunction Erectile dysfunction is a marker of endothelial dysfunction. Because the penile arteries are smaller (1–2 mm) than the carotids (5–7 mm) and coronary arteries (3 mm), plaque burden and endothelial dysfunction may cause symptoms earlier here than in the other territories. hsCRP measurements and risk of vascular events (stroke, myocardial infarction, acute coronary syndrome) Low risk Intermediate High hsCRP level < 1 mg/L 1–3 mg/L > 3 mg/L Note: levels > 10 mg/L suggest acute inflammation and should be repeated after a few week In some studies erectile dysfunction has reliably preceded symptomatic coronary disease in twothirds of patients by an average of three years.30 A history of this problem in men indicates an increased risk of vascular events. It is strongly associated with other risk factors such as smoking and diabetes but remains significant after allowing for these. Infectious agents There is continuing mild interest in the role of infection in promoting atherosclerosis and especially unstable coronary syndromes. Chlamydia pneumoniae and Helicobacter pylori are commonly found in atheromatous plaques. It is possible one or more infectious agents could be the stimulus that sets off the inflammatory process that changes plaque structure, weakens the fibrous cap and unleashes the coagulation cascade that occludes the vessel. The ACADEMIC study was not associated with a reduction in early coronary events
1
false