🔖 #آموزشی

⚠️ #سوال کوتاه ، #پاسخ کوتاه

❤️ #ECG QUICK QUIZ 112 ?

🔸19 year old male with complaints of palpitations

What would you do next based on this EKG?
a. Reassure and discharge
b. Refer for electrophysiology study
c. Begin a beta-blocker

👈 #تصویر ECG نشان دهنده ی کدامیک از گزینه های زیر میباشد؟

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‍ 📚 #دانلود_کتاب 📚

📙 Oxford Press :
Challenging Concepts in #Cardiovascular Medicine:
A Case-Based Approach with Expert Commentary👇👇👇

🚩 #Download❣️

💌 #مقالات و #گایدلاین های روز دنیا
🏩مطالب و آزمون های بروزرسانی اطلاعات
👀 عکس ها و #کلیپ های #آموزشی
❣️اطلاع رسانی #همایش ها با امتیاز بازآموزی
💓 آخرین #اخبار دنیای #قلب و #عروق

❤️💛با ما همراه باشید ❤️💛 👇👇👇

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📖 #آموزشی :

👈 به #بیماران خود آموزش دهیم :

🚩 علائم هشدار دهنده حمله ی #قلبی

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🚩#Quiz Of The Week

*ESCardioEd challenge by Claudine Dumandan and team, Geisinger Medical Center, Danville, USA.

✳️ A 72-year-old patient presented w progressive dyspnea and orthopnea over two weeks duration accompanied by weight gain. Physical examination revealed bibasilar crackles, jugular venous distention and distended abdomen. ECG showed atrial fibrillation with rapid ventricular response. Chest X-ray showed pulmonary edema and enlargement of cardiac silhouette. TTE showed biventricular systolic dysfunction with ejection fraction of 25-29%, diffuse hypokinesis of the left ventricle, and moderate functional mitral regurgitation. TTE and CT are shown below. What is the diagnosis?

A. Fistula
B. Aneurysm
C. Dissection
D. None

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🚩#Questions and #answers on the 2019 ESC Guidelines

👉Know your #ESCGuidelines?

A 28-year-old female at nine weeks gestation arrives at ER with shortness of breath, weak and rapid arterial pulses. BP is 70/40 mmHg. ECG shows sinus tachycardia at 120 bpm, s1q3t3 pattern. Chest X-Ray is abnormal.

🔸According to the 2019 ESC Guidelines on Acute Pulmonary Embolism, what should be done next?


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🚩#Questions and #answers on the 2019 ESC #Guidelines

👉Know your #ESCGuidelines?

According to the 2019 #ESCGuidelines on Dyslipidaemia, ApoB analysis is recommended (Class I recommendation) : ...

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🚩#Quiz Of The Week

* ESCardioEd challenge by Pierre Baudinaud et al., Hospital La Pitié Salpétrière, Institute of Cardiology, – Paris.

✳️A 42-year-old Caucasian male presented to the ER with exertional dyspnea and asthenia with 2 weeks duration. ECG showed a complete AVB with a junctional escape rhythm at 29 bpm. The patient lived in Cameroon, Mexico and in Asia. He had returned to France 2 months prior. His past medical history was malaria in 2016, giardiasis in 2016, amoebiasis, a streptococcal skin infection in 2014, conjunctivitis ten years ago and a bacterial meningitis in 1998. He didn’t have any medication at home nor drug consumption. No familial history was found. He received 2mg of atropine without success and was referred to the EP Intensive Care Unit. The standard laboratory tests were unremarkable. Autoimmune profiles, serologies and quantyferon were negative, the Angiotensin-converting enzyme level was low. The biopsy of the accessory salivary gland was normal. The transthoracic echocardiography at admission was normal.
EPS below. Where is the block?
A. AV node block
B. No conduction block
C. Intra Hissian block
D. Infra Hissian block

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🚩#Questions and #answers on the 2019 ESC #Guidelines

👉Know your #ESCGuidelines?

🔸According to the 2019 #ESCGuidelines for the management and treatment of patients with supraventricular tachycardia, which of the below is recommended for patients with atrial tachycardia:

A. Catheter ablation
B. Beta-blockers
C. Amiodarone
D. None of these.

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🚩#Quiz Of The Week

* #ESCardioEd challenge by Pimpimol Yooprasert and team, Faculty of Medicine Ramathibodi Hospital, Mahidol University - Bangkok

✳️A 22-year-old, 34 weeks pregnant, was referred due to massive hemoptysis.
Personal history: first episode when aged 17 and 7 months pregnant, patient gave birth to a preterm baby who died 2 weeks later of unknown cause, no autopsy.
Five months prior to this admission, she had hemoptysis and acute dyspnea after traveling on a long-distant bus and diagnosed with pneumonia.
Examination: Tachypnea with desaturation, diagnosed with heart failure. Pulse oximetry measured from her left hand showed a saturation of 91 % on room air, and 96 % while on 10 LPM oxygen mask. There was no central or peripheral cyanosis and no clubbing of fingers or toes , but pulse oximetry showed more degree of desaturation of her feet, measured 74 %. On auscultation, there was loud P2 and pansystolic murmur grade III/VI at left lower parasternal border area. Lungs were clear and minimal pedal oedema was noted.
Chest x-ray: cardiomegaly, enlarged pulmonary trunk and right pulmonary artery, increased pulmonary vasculature, and a patchy infiltration at left upper lung zone. ECG: normal sinus rhythm with evidence of right ventricular hypertrophy and right axis deviation.
Blood test: mild normocytic anaemia (Hb 11.4 g/dL, Hct 38.0 %, MCV 81.7 fL), thrombocytopenia with platelet count 88000 /mm3, and normal white blood cell series.
🔸Echocardiogram is below.👇

🔻What would you do next?

A. Emergency baby delivery
B. Right heart catheterization
C. Counseling with multidisciplinary team
D. Bedrest and therapy until delivery


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🚩#Quiz Of The Week

* #ESCardioEd challenge by Marco Spartera and team, University of Oxford, England.

✳️ A 58-year-old female with worsening effort dyspnoea and fatigue. Clinical examination was notable for jugular venous distension and pitting oedema of the feet and ankles.
Past medical history: Persistent AF 2 years previously and heart failure symptoms, two catheter ablation procedures for AF, including pulmonary vein isolation and roof and mitral isthmus lines. However, symptoms of effort dyspnoea and fatigue had progressed despite maintenance of sinus rhythm.
Family history: dilated cardiomyopathy in the patient’s mother, but further details were not available.
Therapy : Warfarin, Bisoprolol 10 mg od, Ramipril 5 mg od, Spironolactone 37.5 mg od, Furosemide 20 mg od.
ECG: sinus rhythm with no evidence of ischaemia.
TTE: mild left ventricular (LV) dilation, with preserved LV systolic function and normal wall thickness, grade II diastolic dysfunction, mild right ventricle dilatation with preserved systolic function, sPAP 60mmHg. Both atria were moderate-severely dilated.
NT-proBNP: 1967 pg/mL. A 28 gene panel for DCM was negative.
At this stage, despite extensive investigations, no definite aetiology of heart failure was found. CMR is below.👇
The patient’s clinical condition slowly worsened with orthopnoea and NYHA class III heart failure requiring a brief hospital admission for intravenous diuretics. This culminated in a cardiac arrest whilst the patient was driving to attend an outpatient appointment, resulting in a serious motor vehicle accident on the motorway. Brought in hospital by ambulance, patient fully recovered neurologically. Repeat echocardiography revealed a dilated right ventricle with severe pulmonary hypertension. A further cardiac magnetic resonance scan is showed below. No change in the pattern of LGE was observed.

🔻What investigation is most appropriate?

A. Coronary angiography
B. Ventilation-perfusion scintigraphy
C. Right Heart catheterization
D. 7-day Holter ECG
E. Endomyocardial biopsy


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🚩#Questions and #answers on the 2019 ESC #Guidelines

👉Know your #ESCGuidelines?

🔸A 41-year-old lady continues to show tachycardiomyopathy despite beta blockers and an attempt of ablation. According to the 2019 ESC Guidelines on Supraventricular Tachycardia.
What is the correct management of this patient?

A. Ablate and pacing
B. Add amiodarone
C. Continue monitoring
D. All of these

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📚📖#آموزشی : 📚📖

🚩#Questions and #answers on the 2019 ESC #Guidelines

👉Know your #ESCGuidelines?

🔸A 41-year-old lady continues to show tachycardiomyopathy despite beta blockers and an attempt of ablation. According to the 2019 ESC Guidelines on Supraventricular Tachycardia.
What is the correct management of this patient?

A. Ablate and pacing
B. Add amiodarone
C. Continue monitoring
D. All of these

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📚📖#آموزشی : 📚📖

🚩#Questions and #answers on the 2019 ESC #Guidelines

👉Know your #ESCGuidelines?

🔸According to the 2019 ESC/EAS Dyslipidaemia Guidelines, the addition of a PCSK9 inhibitor is recommended for patients already taking a maximally tolerated statin dose and ezetimibe if the LDL-C goal is not achieved:

A. After 4-6 weeks
B. In very-high-risk FH patients
C. For secondary prevention ,in patients at very-high-risk
D. All these patients

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🚩#Quiz Of The Week

🔸Clinical case challenge by Andreas Bugge Tinggaard et al, Aarhus University Hospital, Aarhus, Denmark.

🔹A 57-year-old male was hospitalised with an ischemic stroke verified on MRI. ECG showed AF. Echocardiography revealed a structurally normal heart. The patient was discharged with dabigatran. Another MRI-verified stroke led to re-hospitalisation 19 days later. Transesophageal echocardiography excluded intracardiac thrombi. Dabigatran was substituted with warfarin and the patient was referred for transcatheter left atrial appendage occlusion.
What does the CT show?

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🚩#Questions and #answers on the 2019 ESC #Guidelines

👉Know your #ESCGuidelines?

🔸According to the 2019 ESC/EAS Dyslipidaemia Guidelines, the addition of a PCSK9 inhibitor is recommended for patients already taking a maximally tolerated statin dose and ezetimibe if the LDL-C goal is not achieved:

A. After 4-6 weeks
B. In very-high-risk FH patients
C. For secondary prevention ,in patients at very-high-risk
D. All these patients

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🚩#Quiz Of The Week

* #ESCardioEd challenge by Dr Umberto Barbero and team, Santissima Annunziata Hospital of Savigliano, ASLCN1, Savigliano, Italy.

✳️ After two days from an episode of acute pain in the left shoulder, which radiated posteriorly and lasted one hour then slowly vanished, a 74 years-old lady reported the episode to her General Practioner who asked for an ECG (figure below). She was referred to the emergency department where echocardiography showed severe impairment of left ventricular function with mid-apical akinesia and hyperkinetic basal segments, with a giant thrombus in the apex (video in the comments section). She was taken in our Intensive Cardiac Unit and she was treated with diuretics, heparin, aspirin, beta-blockers and ticagrelor and prepared for coronary angiography.

What's the diagnosis?

1. Late anterior #STEMI presentation, by then asymptomatic
2. #Brugada Syndrome
3. #Takotsubo syndrome
4. Dilated #Cardiomyopathy with embolizing left ventricular apical thrombus

✅ #مشاهده_تصویر 👇

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🚩#Quiz Of The Week

* #ESCardioEd challenge by Dr Francesco Petracca and team, Cardiocentro Ticino Institute, Lugano, Switzerland.

✳️ A 44-year-old woman with history of drug addiction and cirrhosis related to chronic hepatitis C infection, presented to the out-patient clinic with severe right-sided heart failure. She underwent partial tricuspid valve resection and De Vega annuloplasty in 2001 for infective endocarditis and in 2009 a tricuspid #valve_replacement with a Carpentier-Edwards Perimount Magna 31 mm valve, for symptomatic severe tricuspid regurgitation recurrence.
Transthoracic #echocardiography on admission showed degeneration of the bioprosthetic valve.
The heart team decided to proceed with a trans-jugular implantation of a new valve in view of the patient’s overall frailty and significant comorbid conditions.
The preoperative computed tomography showed total occlusion of the internal jugular vein up to the subclavian vein confluence (figure 2 below), making this vascular access route unsuitable.

What #vascular access would you choose?

✅ #مشاهده_تصویر 👇

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🚩#Quiz Of The Week

✅ #EHRA2021 #ECG competition session :

67 yo patient with no history of heart disease presents to the ER with dizziness and palpitations.

What’s the most likely diagnosis?

1. Atrial fibrillation with LBBB
2. Atrial flutter with LBBB
3. Ventricular tachycardia
4. AVNRT with aberration
5. Antidromic AVRT

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✅ #وبینار_علمی با عنوان Heart and Antiplatelets در روز پنج شنبه 1400/4/3 برگزار گردید . جهت مشاهده این وبینار علمی -آموزشی در وب سایت انجمن آترو اسکلروز ایران به ادرس http://fa.iranathero.ir/ به قسمت برنامه های #آموزشی و #بازآموزی ، بخش وبینارهای آموزشی انجمن یا کانال آپارات انجمن مراجعه فرمایید .

🔻لینک های دسترسی #وبینار 👇


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✅ #مشاهده_کلیپ #وبینار در آپارات👇

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📚📖#آموزشی : 📚📖

🚩#Quiz Of The Week

✅ warm-up : #EHRA2021

A 19-year old male was admitted after aborted sudden cardiac death, with ongoing mechanical ventilation and stable haemodynamic parameters without the need for inotropic or vasopressor agents. There was no relevant comorbidity in the history, the patient was a heavy smoker (5 pack-year) and used cannabinoids occasionally. Before the event the patient consumed an excessive amount of alcohol, he fainted suddenly while dancing. After 5 minutes of immediately started BLS, ALS was initiated by the Ambulance Service. Ventricular fibrillation was recorded, after repeated defibrillations, ROSC occurred after 20 minutes. During ALS 300 mg amiodarone and 4 mg epinephrine was administered. Resting ECG showed 80 BPM sinus rhythm with suspected pre-excitation.

What's the most likely cause of aborted sudden cardiac arrest in this patient?


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