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كل مايهم الطب والصيدله والتحليلات والتمريض
Video
What is endometriosis?🤔
💜Endometriosis is the abnormal growth of endometrial tissue similar to that which lines the interior of the uterus, but in a location outside of the uterus.
💜Endometrial tissue is shed each month during menstruation.
💜Areas of endometrial tissue found in ectopic locations are called endometrial implants. These lesions are most commonly found on the ovaries, the Fallopian tubes, the surface of the uterus, the bowel, and on the membrane lining of the pelvic cavity (i.e. the peritoneum).
💜They are less commonly found to involve the vagina, cervix, and bladder
💜Rarely, endometriosis can occur outside the pelvis. Endometriosis has been reported in the liver, brain, lung, and old surgical scars.
💜Endometrial implants, while they may become problematic, are usually benign (i.e. non-cancerous)
✿♬ﾟ+.(#آلُُۆتٌٌــــــــيََــــــــنْْ)♪.+ﾟ♬✿💜
💜Endometriosis is the abnormal growth of endometrial tissue similar to that which lines the interior of the uterus, but in a location outside of the uterus.
💜Endometrial tissue is shed each month during menstruation.
💜Areas of endometrial tissue found in ectopic locations are called endometrial implants. These lesions are most commonly found on the ovaries, the Fallopian tubes, the surface of the uterus, the bowel, and on the membrane lining of the pelvic cavity (i.e. the peritoneum).
💜They are less commonly found to involve the vagina, cervix, and bladder
💜Rarely, endometriosis can occur outside the pelvis. Endometriosis has been reported in the liver, brain, lung, and old surgical scars.
💜Endometrial implants, while they may become problematic, are usually benign (i.e. non-cancerous)
✿♬ﾟ+.(#آلُُۆتٌٌــــــــيََــــــــنْْ)♪.+ﾟ♬✿💜
Complete heart block with significant CAD
How will you manage ?
CHB with CAD is a common combination especially in the elderly.
Which will you Intervene first ?
Is the AV block related to CAD ?
How to differentiate Ischemic from degenerative AV block ?
Differentiating is often difficult.Even coronary angiogram may not answer the query unless it is totally normal . For AV block to occur usually LCX / RCA lesion is required. LAD lesion in isolation are rare to cause CHB .
How often Re-vascularisation reverses ischemic CHB ?
Logically you expect more reversals.In real world it rarely happens.
Therapeutic options in combined CAD and CHB
1-PCI and pace maker in the same sitting .
2-PCI first followed by pace-maker at a later date.
3-Pace maker first followed by PCI at a later date if required.
4-CABG and epicardial pacemaker ( best option In all critical TVD and CHB)
5-Pace maker followed by CABG later
6-Pacemaker followed by medical management (CHB with Insignificant CAD)
Can worsening of ischemia occur after pacemaker ?
Very much possible . Since the patient has been benefited by low heart rate in terms of MVO2 consumption .(Inserting a pacemaker is like sudden withdrawal of beta blocker !)
Rate adoptive pacing can confer chronotropic competence which may bring back the angina.So,what was a insignificant lesion can become hemodynamicaly relevant and may require angioplasty later.
*The above clinical issue is applicable for sinus node dysfunction and CAD as well.
Final message
There is no fixed rule in the management strategy in combined CHB and CAD .
Generally , electrical therapy should be given preference .Symptom guided approach may be practical.
In this scientific era , one may argue to deal both issues together by simultaneous PCI and pacemaker , still option 3 and 6 remain clear favorites !
If angina occurs even in baseline bradycardia it is obvious the obstructive CAD is significant and needs immediate fixing .
Finally , though it looks an attractive concept , It is very rare for CHB to get reverted by PCI or CABG.
How will you manage ?
CHB with CAD is a common combination especially in the elderly.
Which will you Intervene first ?
Is the AV block related to CAD ?
How to differentiate Ischemic from degenerative AV block ?
Differentiating is often difficult.Even coronary angiogram may not answer the query unless it is totally normal . For AV block to occur usually LCX / RCA lesion is required. LAD lesion in isolation are rare to cause CHB .
How often Re-vascularisation reverses ischemic CHB ?
Logically you expect more reversals.In real world it rarely happens.
Therapeutic options in combined CAD and CHB
1-PCI and pace maker in the same sitting .
2-PCI first followed by pace-maker at a later date.
3-Pace maker first followed by PCI at a later date if required.
4-CABG and epicardial pacemaker ( best option In all critical TVD and CHB)
5-Pace maker followed by CABG later
6-Pacemaker followed by medical management (CHB with Insignificant CAD)
Can worsening of ischemia occur after pacemaker ?
Very much possible . Since the patient has been benefited by low heart rate in terms of MVO2 consumption .(Inserting a pacemaker is like sudden withdrawal of beta blocker !)
Rate adoptive pacing can confer chronotropic competence which may bring back the angina.So,what was a insignificant lesion can become hemodynamicaly relevant and may require angioplasty later.
*The above clinical issue is applicable for sinus node dysfunction and CAD as well.
Final message
There is no fixed rule in the management strategy in combined CHB and CAD .
Generally , electrical therapy should be given preference .Symptom guided approach may be practical.
In this scientific era , one may argue to deal both issues together by simultaneous PCI and pacemaker , still option 3 and 6 remain clear favorites !
If angina occurs even in baseline bradycardia it is obvious the obstructive CAD is significant and needs immediate fixing .
Finally , though it looks an attractive concept , It is very rare for CHB to get reverted by PCI or CABG.