بورد قلب ایران

دماوند
تهران
از مرکز قلب

🔹 داروی tirzepatide (مونجارو) محصول شرکت Eli Lilly، برای بیماران با شاخص توده بدنی (BMI) بالای ۳۵ و حداقل یک بیماری مرتبط با وزن، نظیر بیماری قلبی یا دیابت نوع ۲، تجویز می‌شود.

🔹 مونجارو که به صورت تزریقات هفتگی استفاده می‌شود، از گروه داروهای GLP-1 است. این دسته از داروها ابتدا برای کنترل قند خون در بیماران مبتلا به دیابت نوع ۲ توسعه یافتند، اما در ادامه تأثیر شگفت‌انگیزی در کاهش اشتها و ایجاد حس سیری نشان دادند.

🔹 نتایج کارآزمایی‌های بالینی نشان می‌دهد که این دارو به طور میانگین موجب کاهش وزن ۲۳ درصدی در بیماران شده است.

‘Double Transition’ Pattern to Discriminate Right Endocardial Posterior/Posteroseptal Accessory Pathways
(100% specificity, 28% sensitivity)

Narrow Complex Tachycardia

Note A<V feature

Answer: B 👆👆👆

👆👆👆Answer: E

Explanation
The ECG reveals a wide complex tachycardia with an inferiorly directed axis, right bundle branch block (RBBB) morphology in lead V1, and precordial concordance without any evidence of any late precordial S waves.
This is consistent with ventricular tachycardia (VT) arising from the aortomitral continuity (AMC), and thus choice E is the correct answer.
VTs arising from the AMC are sometimes described to have a qR pattern in lead V1 due to leftward electrical forces from fibrous tissue between the aortic and mitral valve annulus (from where it arises), but it does not always have to display this feature.
Choices A and B are incorrect as VT arising from the right ventricle would have a left bundle branch block (LBBB) morphology.
Choice C is incorrect as the right coronary cusp is in very close proximity to the posterior aspect of the right ventricular outflow tract (RVOT), and as such, the ECG also usually reveals a LBBB morphology in lead V1 with small R waves in lead V2 and an early precordial QRS transition, usually at or before lead V3.
Choice D is also incorrect as VT arising from the left coronary cusp often manifests with QRS complex notching in lead V1 with a characteristic “W” or “M” pattern which is not seen here. This QRS notching pattern in lead V1 is likely related to transseptal activation after initial left ventricular activation.

Orally Inhaled Flecainide for Conversion of Atrial Fibrillation to Sinus Rhythm INSTANT Phase 2 Trial

Orally Inhaled Flecainide for Conversion of Atrial Fibrillation to Sinus Rhythm: INSTANT Phase 2 Trial

Orally Inhaled Flecainide for Conversion of Atrial Fibrillation to Sinus Rhythm: INSTANT Phase 2 Trial

Arruda Algorithm (Step by Step)

EASY-WPW

Optimal angiographic views for invasive coronary angiography: a guide for trainees - The British Journal of Cardiology
https://bjcardio.co.uk/2016/08/optimal-angiographic-views-for-invasive-coronary-angiography-a-guide-for-trainees/

Optimal angiographic views for invasive coronary angiography: a guide for trainees

The British Journal of Cardiology

Pad placement for standard defibrillation, vector-change (VC) defibrillation, and double sequential external defibrillation (DSED) is shown. In the bottom panel, defibrillation pads 2A and 2B are those of the second defibrillator, with the pads placed in the posterior and anterior positions. For all strategies, the first three shocks occurred with pads placed in the configuration used for standard defibrillation.

این مقاله مربوط به نوامبر ۲۰۲۲ است در مجله NEJM است.
و خیلی خلاصه اش اینه که
در موارد VF مقاوم به درمان( تعریف = در جریان cpr و‌پس از سه شوک) انجام
Double sequential external defibrilation
( بفاصله یک ثانیه از هم یکی به روش معمول و دومی انتروپوستریور) به مقدار بسیار قابل ملاحظه ای نجات بخش بوده است.

♦️یک مقاله عالی از NEJM♦️
(تکرار)

در مورد نقش:
Double sequential external defibrilation
در درمان:
Refractory Ventricular Fibrillation

با عنوان:

Defibrillation Strategies for Refractory Ventricular Fibrillation

این مقاله مربوط به نوامبر ۲۰۲۲ است در مجله NEJM است.
و خیلی خلاصه اش اینه که
در موارد VF مقاوم به درمان( تعریف = در جریان cpr و‌پس از سه شوک) انجام
Double sequential external defibrilation
( بفاصله یک ثانیه از هم یکی به روش معمول و دومی انتروپوستریور) به مقدار بسیار قابل ملاحظه ای نجات بخش بوده است.

👇👇👇👇

Defibrillation Strategies for Refractory Ventricular Fibrillation
2022 NEJM

Optimal angiographic views for invasive coronary angiography: a guide for trainees - The British Journal of Cardiology
https://bjcardio.co.uk/2016/08/optimal-angiographic-views-for-invasive-coronary-angiography-a-guide-for-trainees/

E. Where the ECG is suggestive of typical atrial flutter it is reasonable to consider catheter ablation as a first- line treatment given high success rates and low risk of complication. There is no need to anticoagulate prior to cardioversion as the onset of symptoms is less than 48 hours and management is therefore the same as AF. For the same reason he would not need a TOE if external DC cardioversion is performed. The use of antiarrhythmic drugs to chemically cardiovert flutter, as in AF, has limitations. Amiodarone may take a long time to chemically cardiovert even if administered intravenously. Flecainide has the potential risk of paradoxically accelerating the ventricular rate (because of its potential for slowing the cycle length of the atrial flutter and therefore increasing the possibility of 1:1 conduction to the ventricles).

Entrainment:
AVNRT

Entrainment:
Type of response

Typical counter-clockwise flutter
Typical clockwise flutter

2024 ESC Guidelines for the management of elevated blood pressure and hypertension

Blood Pressure Classification
ESC 2024

بورد قلب ایران pinned «❤️ اساتید عزیز و دوستان گرانقدرم با سلام و آرزوی سلامتی و سرافرازی برای اینکه انسجام مطالب در تلگرام حفظ شود و ابتدا  و انتهای یک مطلب مشخص شود با دو عنوان 🔴ابتدای مبحث... و 🔵پایان مبحث... مباحث از هم تفکیک می شود. کافی است برای مشخص شدن ابتدای یک مبحث…»

❤️ اساتید عزیز و دوستان گرانقدرم
با سلام و آرزوی سلامتی و سرافرازی

برای اینکه انسجام مطالب در تلگرام حفظ شود و ابتدا  و انتهای یک مطلب مشخص شود با دو عنوان

🔴ابتدای مبحث... و

🔵پایان مبحث...

مباحث از هم تفکیک می شود.
کافی است برای مشخص شدن ابتدای یک مبحث کلمه ( ابتدای مبحث) و برای پایانش کلمه ( پایان مبحث) را سرچ کنید.
این قضیه  فعلا در مورد چندین مبحث اخیر رعایت شده است:

♦️تومورهای قلبی

♦️مبحث ST elevation بعد از احیا

♦️Cardiac Catheterization 
in Congenital Heart Disease
(course of catheter)

♦️ASD

♦️VSD

♦️Right Bundle Branch Block in Right Ventricular Apical Pacing

♦️Congenital AVB

♦️Isorhythmic AV dissociation

♦️کیست های پریکاردی

♦️Case presentation CMR 1

♦️ HCM و Apical aneurysm

♦️تاکوتسوبو

♦️Pulmonary hypertension


♦️CTEPH


♦️ Antiphospholipid syndrome


♦️ Mechanical heart valve thrombosis


♦️ Aortic Valve Regurgitation

♦️ AIVR

♦️Isolated Right Ventricular Myocardial Infarction Presenting With Anterior ST-Segment Elevation

♦️ Coronary blood flow

♦️ Early Repolarization Syndrome

♦️ECG TRIADS

♦️ Syncope

♦️ CAC coronary artery  calcium scoring

♦️ Acute Mi in pregnancy

♦️ Chest x-ray Criteria for shunt vascularity

♦️ Acute Aortic Syndrome

♦️ Coarctation of the aorta

♦️ PDA

♦️ STEMI

♦️ Mechanical complications of STEMI
عوارض مکانیکی STEMI

 
♦️ Cardio-oncology کاردیوانکولوژی


♦️EASY-WPW: a novel ECG-algorithm for easy and reliable localization of manifest accessory pathways in children and adults 2023

♦️ Myotonic Dystrophy

♦️Congenital absence of the pericardium (Pericardial agenesis)

AVNRT
Note: AVL notch

AVNRT

The presence of pseudo-r′ in lead aVR appears to be more accurate than other ECG criteria in one study.

♦️ HUANG ♦️

There are electrocardiographic (ECG) features that suggest AVNRT:

(a) pseudo s wave in inferior leads and/or pseudo r′ wave in V1;

(b) notch in aVL;

(c) no retrograde P waves visible during tachycardia;

(d) pseudo r′ wave in lead aVR; and

(e) notch in lead I

The presence of pseudo-r′ in lead aVR appears to be more accurate than other ECG criteria in one study.

♦️ HUANG ♦️

2023 HRS expert consensus statement on the management of arrhythmias during pregnancy,2023

International Clinical Practice Guideline Recommendations for Acute Pulmonary Embolism,JACC 2024

2024 ESC Guidelines for the management
of atrial fibrillation developed in collaboration
with the European Association
for Cardio-Thoracic Surgery (EACTS)

Negative and positive QRS concordance

Differentiating fascicular VT from SVT with bifascicular block (RBBB and left anterior hemiblock) is very challenging. Features that indicate SVT in this context include QRS greater than 140 ms, r' in V1, overall negative QRS in aVR, and R/S ratio greater than 1 in V6

VAGAL MANEUVERS AND ADENOSINE

Responses of narrow complex tachycardias to adenosine

ARTRESIA TRIAL
SCAF: subclinical AF

This image is in a shallow RAO, in which the II ( image intensifier ) on the c-arm (x-ray) is angled towards the patient’s right side of the body. Notice the catheter placement and it is color coded to demonstrate catheter placement in the heart model.
RAO may be helpful in differentiating between what is atrial and what is on the ventricular aspect as seen here with the dotted line running through the AV groove which corresponds with the CS catheter placement. In a more traditional RAO view the CS catheter would be more foreshortened. Notice the HRA catheter is turned back towards the SA nodal area and the RV catheter is reaching out towards the RV apex.

This image is in LAO. In this view the His catheter and RV catheter are foreshortened as they are pointing out “towards you” in this angulation. The HRA catheter was not used in this study but was placed on the image to demonstrate what placement may look like in this view. The CS catheter is no longer foreshortened in this angulation.
The LAO view is helpful in determining what is on the left side of the heart vs the right as seen here in the illustration. In LAO, we are “looking” through the AV valves (tricuspid and mitral).

RAO

RAO view is helpful in dividing the heart into the atrium or ventricle. The coronary sinus is found in the posterior aspect of the AV groove, in between the LA and LV. The CS catheter, therefore, helps in visually identifying what is on the atrial aspect vs. the ventricular. From RAO, we are unable to be determined if the catheter did indeed cross over to the left side of the heart or is simply looping up the septal wall. This is why a physician will often switch back and forth between RAO and LAO.