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article-100024_0 | Chronic Total Occlusion of the Coronary Artery -- Continuing Education Activity | Chronic total occlusion (CTO) lesions are diagnosed in patients who are undergoing coronary angiography as part of the evaluation of ischemic heart disease, cardiomyopathy, or valvular heart disease. CTO revascularization has not shown benefit in rates of all-cause mortality, myocardial infarction, stroke, and repeat r... | Chronic Total Occlusion of the Coronary Artery -- Continuing Education Activity. Chronic total occlusion (CTO) lesions are diagnosed in patients who are undergoing coronary angiography as part of the evaluation of ischemic heart disease, cardiomyopathy, or valvular heart disease. CTO revascularization has not shown ben... |
article-100024_1 | Chronic Total Occlusion of the Coronary Artery -- Continuing Education Activity | Objectives: Describe the histopathology of a chronic total occlusion (CTO) lesion. Review the risk factors for developing chronic total occlusion (CTO) lesions. Outline the typical presentation of a patient with chronic total occlusion (CTO) lesions. Explain the importance of improving care coordination amongst the int... | Chronic Total Occlusion of the Coronary Artery -- Continuing Education Activity. Objectives: Describe the histopathology of a chronic total occlusion (CTO) lesion. Review the risk factors for developing chronic total occlusion (CTO) lesions. Outline the typical presentation of a patient with chronic total occlusion (CT... |
article-100024_2 | Chronic Total Occlusion of the Coronary Artery -- Introduction | A coronary chronic total occlusion (CTO) is defined as 100% occlusion of a coronary artery for a duration of greater than or equal to 3 months based on angiographic evidence. The TIMI (thrombolysis in myocardial infarction) flow grading system is a scoring classification from 0-3 referring to the levels of coronary blo... | Chronic Total Occlusion of the Coronary Artery -- Introduction. A coronary chronic total occlusion (CTO) is defined as 100% occlusion of a coronary artery for a duration of greater than or equal to 3 months based on angiographic evidence. The TIMI (thrombolysis in myocardial infarction) flow grading system is a scoring... |
article-100024_3 | Chronic Total Occlusion of the Coronary Artery -- Introduction | A "true" CTO is defined as 100% occlusion of a coronary artery with TIMI 0 flow; whereas a "functional" CTO is defined as severely stenotic, yet, less than a 100% occlusion of the coronary artery with TIMI 1 flow for a duration of greater than or equal to 3 months based on angiographic evidence. [2] Moreover, it is dif... | Chronic Total Occlusion of the Coronary Artery -- Introduction. A "true" CTO is defined as 100% occlusion of a coronary artery with TIMI 0 flow; whereas a "functional" CTO is defined as severely stenotic, yet, less than a 100% occlusion of the coronary artery with TIMI 1 flow for a duration of greater than or equal to ... |
article-100024_4 | Chronic Total Occlusion of the Coronary Artery -- Etiology | Risk factors for CTO lesion in patients are as below [3] : Known coronary artery disease or history of myocardial infarction Excessive tobacco use High LDL cholesterol, low HDL cholesterol Diabetes Sedentary lifestyle Hypertension Family history of premature disease End-stage kidney disease Obesity Postmenopausal women | Chronic Total Occlusion of the Coronary Artery -- Etiology. Risk factors for CTO lesion in patients are as below [3] : Known coronary artery disease or history of myocardial infarction Excessive tobacco use High LDL cholesterol, low HDL cholesterol Diabetes Sedentary lifestyle Hypertension Family history of premature d... |
article-100024_5 | Chronic Total Occlusion of the Coronary Artery -- Epidemiology | CTO lesions are found in approximately one-quarter to one-third of patients undergoing diagnostic coronary angiography. The true prevalence, however, in the general population is unknown due to a subset of patients with CTO lesions being asymptomatic or minimally symptomatic and never undergoing diagnostic coronary ang... | Chronic Total Occlusion of the Coronary Artery -- Epidemiology. CTO lesions are found in approximately one-quarter to one-third of patients undergoing diagnostic coronary angiography. The true prevalence, however, in the general population is unknown due to a subset of patients with CTO lesions being asymptomatic or mi... |
article-100024_6 | Chronic Total Occlusion of the Coronary Artery -- Epidemiology | Data from the National Heart, Lung, and Blood Institute (1997–1999) Dynamic Registry showed that CTO lesions are most common in the right coronary artery and least common in the left circumflex artery. Older patients are more likely to have at least one CTO lesion with 37% prevalence in patients under the age of 65 ye... | Chronic Total Occlusion of the Coronary Artery -- Epidemiology. Data from the National Heart, Lung, and Blood Institute (1997–1999) Dynamic Registry showed that CTO lesions are most common in the right coronary artery and least common in the left circumflex artery. Older patients are more likely to have at least one CT... |
article-100024_7 | Chronic Total Occlusion of the Coronary Artery -- Pathophysiology | Pathogenesis of coronary artery disease, which can progress to CTO lesions, has multiple contributing factors, which include upregulation of the immunologic and inflammatory markers (cytokines, leukocytes, high sensitivity C-reactive protein), endothelial dysfunction, and cholesterol accumulation. Most commonly, it st... | Chronic Total Occlusion of the Coronary Artery -- Pathophysiology. Pathogenesis of coronary artery disease, which can progress to CTO lesions, has multiple contributing factors, which include upregulation of the immunologic and inflammatory markers (cytokines, leukocytes, high sensitivity C-reactive protein), endothel... |
article-100024_8 | Chronic Total Occlusion of the Coronary Artery -- Histopathology | Histopathological attributes of a CTO lesion commonly consist of calcium, lipids (both intracellular and extracellular), smooth muscle cells, an extracellular matrix, and neovascularization. Occlusions typically have a dense concentration of collagen-rich fibrous tissue at the proximal and distal ends contributing to a... | Chronic Total Occlusion of the Coronary Artery -- Histopathology. Histopathological attributes of a CTO lesion commonly consist of calcium, lipids (both intracellular and extracellular), smooth muscle cells, an extracellular matrix, and neovascularization. Occlusions typically have a dense concentration of collagen-ric... |
article-100024_9 | Chronic Total Occlusion of the Coronary Artery -- History and Physical | CTO lesions are diagnosed in patients who are undergoing coronary angiography as part of the evaluation of ischemic heart disease, cardiomyopathy, or valvular heart disease. Patients with ischemic heart disease generally present with typical chest pain symptoms (stable or unstable angina), atypical chest pain, NSTEMI, ... | Chronic Total Occlusion of the Coronary Artery -- History and Physical. CTO lesions are diagnosed in patients who are undergoing coronary angiography as part of the evaluation of ischemic heart disease, cardiomyopathy, or valvular heart disease. Patients with ischemic heart disease generally present with typical chest ... |
article-100024_10 | Chronic Total Occlusion of the Coronary Artery -- History and Physical | The history should also include risk factors for cardiovascular disease (diabetes, tobacco abuse, hypertension, hyperlipidemia) and non-cardiac causes of the patient's symptoms, including pulmonary embolism, aortic dissection, pneumothorax, esophageal rupture or perforating peptic ulcer. Physical examination in these p... | Chronic Total Occlusion of the Coronary Artery -- History and Physical. The history should also include risk factors for cardiovascular disease (diabetes, tobacco abuse, hypertension, hyperlipidemia) and non-cardiac causes of the patient's symptoms, including pulmonary embolism, aortic dissection, pneumothorax, esophag... |
article-100024_11 | Chronic Total Occlusion of the Coronary Artery -- Evaluation | A significant component of an assessment for a patient who presents with signs and symptoms of ischemic heart disease is history and physical exam. These should include vital signs (respiratory rate, blood pressure, temperature, and heart rate), review of the patient's medication list, and an electrocardiogram. During ... | Chronic Total Occlusion of the Coronary Artery -- Evaluation. A significant component of an assessment for a patient who presents with signs and symptoms of ischemic heart disease is history and physical exam. These should include vital signs (respiratory rate, blood pressure, temperature, and heart rate), review of th... |
article-100024_12 | Chronic Total Occlusion of the Coronary Artery -- Evaluation | A healthcare provider should consider thyroid function testing, pulmonary function testing, routine blood work, including cardiac enzymes, chest X-ray, and echocardiography as part of their initial evaluation. If the initial assessment and evaluation are performed on an urgent basis, intravenous access should be obtain... | Chronic Total Occlusion of the Coronary Artery -- Evaluation. A healthcare provider should consider thyroid function testing, pulmonary function testing, routine blood work, including cardiac enzymes, chest X-ray, and echocardiography as part of their initial evaluation. If the initial assessment and evaluation are per... |
article-100024_13 | Chronic Total Occlusion of the Coronary Artery -- Treatment / Management | CTO revascularization has not shown to benefit rates of all-cause mortality, myocardial infarction, stroke, or repeat revascularization; however, it has shown to significantly improve patients' quality of life and reduce symptoms of angina. [10] [11] [12] Nuclear medicine stress test or myocardial viability studies are... | Chronic Total Occlusion of the Coronary Artery -- Treatment / Management. CTO revascularization has not shown to benefit rates of all-cause mortality, myocardial infarction, stroke, or repeat revascularization; however, it has shown to significantly improve patients' quality of life and reduce symptoms of angina. [10] ... |
article-100024_14 | Chronic Total Occlusion of the Coronary Artery -- Treatment / Management | In patients who meet the indication for a CTO PCI, informed consent is necessary before the procedure after an extensive discussion about the risks and benefits of CTO PCI for the patient. Due to the challenging nature of the CTO lesions, a successful outcome for PCI in these lesions is when the procedure obtains TIMI-... | Chronic Total Occlusion of the Coronary Artery -- Treatment / Management. In patients who meet the indication for a CTO PCI, informed consent is necessary before the procedure after an extensive discussion about the risks and benefits of CTO PCI for the patient. Due to the challenging nature of the CTO lesions, a succe... |
article-100024_15 | Chronic Total Occlusion of the Coronary Artery -- Treatment / Management | Multiple scoring systems are available to operators to predict technical success in CTO lesions. One of the most commonly used scoring systems is the J-CTO score, developed using the Chronic Total Occlusion Registry in Japan. A J-CTO score is used to predict the probability of crossing the CTO lesion within 30 minutes,... | Chronic Total Occlusion of the Coronary Artery -- Treatment / Management. Multiple scoring systems are available to operators to predict technical success in CTO lesions. One of the most commonly used scoring systems is the J-CTO score, developed using the Chronic Total Occlusion Registry in Japan. A J-CTO score is use... |
article-100024_16 | Chronic Total Occlusion of the Coronary Artery -- Treatment / Management | Another commonly used score to predict the technical success of CTO PCI is the Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS-CTO) score. This predictor uses four independent factors to assess the CTO lesion, which includes CTO lesion proximal cap ambiguity, moderate/severe ... | Chronic Total Occlusion of the Coronary Artery -- Treatment / Management. Another commonly used score to predict the technical success of CTO PCI is the Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS-CTO) score. This predictor uses four independent factors to assess the CTO ... |
article-100024_17 | Chronic Total Occlusion of the Coronary Artery -- Differential Diagnosis | STEMI NSTEMI Pulmonary embolism Aortic dissection Pneumothorax Esophageal rupture Perforating peptic ulcer disease | Chronic Total Occlusion of the Coronary Artery -- Differential Diagnosis. STEMI NSTEMI Pulmonary embolism Aortic dissection Pneumothorax Esophageal rupture Perforating peptic ulcer disease |
article-100024_18 | Chronic Total Occlusion of the Coronary Artery -- Prognosis | In addition to causing symptoms, CTOs have correlations with a worse overall prognosis, with higher rates of death and non-fatal adverse cardiovascular events in several populations. Patients with CTOs tend to be older and have more comorbidities and more significant impairment of left ventricular function. Furthermore... | Chronic Total Occlusion of the Coronary Artery -- Prognosis. In addition to causing symptoms, CTOs have correlations with a worse overall prognosis, with higher rates of death and non-fatal adverse cardiovascular events in several populations. Patients with CTOs tend to be older and have more comorbidities and more sig... |
article-100024_19 | Chronic Total Occlusion of the Coronary Artery -- Complications | Percutaneous coronary intervention (PCI) of a CTO lesion on average requires more fluoroscopy time, higher contrast volume, and carries a lower success rate compared to non-CTO PCI’s. CTO PCIs also have a higher complication rate than non-CTO PCIs with major complications, including myocardial infarction, stroke, vesse... | Chronic Total Occlusion of the Coronary Artery -- Complications. Percutaneous coronary intervention (PCI) of a CTO lesion on average requires more fluoroscopy time, higher contrast volume, and carries a lower success rate compared to non-CTO PCI’s. CTO PCIs also have a higher complication rate than non-CTO PCIs with ma... |
article-100024_20 | Chronic Total Occlusion of the Coronary Artery -- Complications | Data analysis of the National Cardiovascular Data Registry-Cath PCI Registry in the United States showed higher in-hospital major adverse cardiovascular event frequency (1.6 versus 0.8 percent; p<0.001) which included mortality (0.4 % versus 0.3%; p<0.001), stroke (0.1% versus 0.1 %; p = 0.045), tamponade (0.3% versus ... | Chronic Total Occlusion of the Coronary Artery -- Complications. Data analysis of the National Cardiovascular Data Registry-Cath PCI Registry in the United States showed higher in-hospital major adverse cardiovascular event frequency (1.6 versus 0.8 percent; p<0.001) which included mortality (0.4 % versus 0.3%; p<0.001... |
article-100024_21 | Chronic Total Occlusion of the Coronary Artery -- Complications | Another multicenter registry (OPEN-CTO) from 12 CTO-PCI centers of 1,000 consecutive patients undergoing CTO PCI evaluated success rates, complication rates, and health status benefits at one month. CTO PCIs showed a success rate of 86%, with an in-hospital mortality of 0.9%, 1-month mortality of 1.3%. 4.8% of the pat... | Chronic Total Occlusion of the Coronary Artery -- Complications. Another multicenter registry (OPEN-CTO) from 12 CTO-PCI centers of 1,000 consecutive patients undergoing CTO PCI evaluated success rates, complication rates, and health status benefits at one month. CTO PCIs showed a success rate of 86%, with an in-hospi... |
article-100024_22 | Chronic Total Occlusion of the Coronary Artery -- Deterrence and Patient Education | Patient education should include resources such as videos and pamphlets. Teaching should focus on risk factor reduction and lifestyle modification such as smoking cessation, blood pressure management based on guidelines, screening for new-onset diabetes, and exercise as tolerated. | Chronic Total Occlusion of the Coronary Artery -- Deterrence and Patient Education. Patient education should include resources such as videos and pamphlets. Teaching should focus on risk factor reduction and lifestyle modification such as smoking cessation, blood pressure management based on guidelines, screening for n... |
article-100024_23 | Chronic Total Occlusion of the Coronary Artery -- Enhancing Healthcare Team Outcomes | Educating patients at risk for coronary artery disease and making a closed-loop communication between them and their cardiologist for primary and secondary prevention can further improve the management of patients at risk of these CTO lesions. Collaboration with shared decision making (between primary care physician, c... | Chronic Total Occlusion of the Coronary Artery -- Enhancing Healthcare Team Outcomes. Educating patients at risk for coronary artery disease and making a closed-loop communication between them and their cardiologist for primary and secondary prevention can further improve the management of patients at risk of these CTO... |
article-100024_24 | Chronic Total Occlusion of the Coronary Artery -- Enhancing Healthcare Team Outcomes | The interprofessional team care provided to the patient must use an integrated care pathway combined with an evidence-based approach to evaluating CTO lesions. The earlier angiographic and demographic predictors of failure to revascularize are identified in CTO lesions; the better is the prognosis and outcome. | Chronic Total Occlusion of the Coronary Artery -- Enhancing Healthcare Team Outcomes. The interprofessional team care provided to the patient must use an integrated care pathway combined with an evidence-based approach to evaluating CTO lesions. The earlier angiographic and demographic predictors of failure to revascul... |
article-100024_25 | Chronic Total Occlusion of the Coronary Artery -- Review Questions | Access free multiple choice questions on this topic. Comment on this article. | Chronic Total Occlusion of the Coronary Artery -- Review Questions. Access free multiple choice questions on this topic. Comment on this article. |
article-100131_0 | Cardiopulmonary Arrest in Adults -- Continuing Education Activity | Cardiopulmonary arrest is the cessation of adequate heart function and respiration and results in death without reversal. Often this condition is found in patients with coronary artery disease. This activity reviews the management and prevention of cardiopulmonary arrest and highlights the role of the interprofessional... | Cardiopulmonary Arrest in Adults -- Continuing Education Activity. Cardiopulmonary arrest is the cessation of adequate heart function and respiration and results in death without reversal. Often this condition is found in patients with coronary artery disease. This activity reviews the management and prevention of card... |
article-100131_1 | Cardiopulmonary Arrest in Adults -- Continuing Education Activity | Objectives: Outline the typical presentation of a patient who suffers from cardiopulmonary arrest. Summarize the epidemiology of cardiac arrest in the U.S. Summarize the causes of cardiopulmonary arrest. Access free multiple choice questions on this topic. | Cardiopulmonary Arrest in Adults -- Continuing Education Activity. Objectives: Outline the typical presentation of a patient who suffers from cardiopulmonary arrest. Summarize the epidemiology of cardiac arrest in the U.S. Summarize the causes of cardiopulmonary arrest. Access free multiple choice questions on this top... |
article-100131_2 | Cardiopulmonary Arrest in Adults -- Introduction | Cardiopulmonary arrest (CPA) is the cessation of effective ventilation and circulation. It is also known as cardiac arrest or circulatory arrest. In adults, it is most likely to be caused by a primary cardiac event. The most common electrical mechanism which is responsible for 50 to 80% of cardiopulmonary arrest is ven... | Cardiopulmonary Arrest in Adults -- Introduction. Cardiopulmonary arrest (CPA) is the cessation of effective ventilation and circulation. It is also known as cardiac arrest or circulatory arrest. In adults, it is most likely to be caused by a primary cardiac event. The most common electrical mechanism which is responsi... |
article-100131_3 | Cardiopulmonary Arrest in Adults -- Introduction | The American Heart Association's AHA periodically releases updates and recommendations for adult basic life support (BLS) and the quality of cardiopulmonary resuscitation (CPR) on adults. Despite the causes, early induction of cardiopulmonary resuscitation (CPR) along with cardiac monitoring will determine which pulsel... | Cardiopulmonary Arrest in Adults -- Introduction. The American Heart Association's AHA periodically releases updates and recommendations for adult basic life support (BLS) and the quality of cardiopulmonary resuscitation (CPR) on adults. Despite the causes, early induction of cardiopulmonary resuscitation (CPR) along w... |
article-100131_4 | Cardiopulmonary Arrest in Adults -- Etiology | There are various causes for cardiopulmonary arrest in adults which varies by age and population. However, patients diagnosed with cardiac disease are more susceptible to having a cardiac arrest. Furthermore, it can be classified into different categories, which include cardiac, respiratory, and traumatic causes. But 7... | Cardiopulmonary Arrest in Adults -- Etiology. There are various causes for cardiopulmonary arrest in adults which varies by age and population. However, patients diagnosed with cardiac disease are more susceptible to having a cardiac arrest. Furthermore, it can be classified into different categories, which include car... |
article-100131_5 | Cardiopulmonary Arrest in Adults -- Etiology -- Coronary Artery Disease | Coronary artery abnormalities: Anomalous coronary artery anatomy. Acute lesions (platelet aggregation, plaque fissuring, acute thrombosis). Chronic atherosclerosis. coronary artery spasm Myocardial Infarction: Acute Healed | Cardiopulmonary Arrest in Adults -- Etiology -- Coronary Artery Disease. Coronary artery abnormalities: Anomalous coronary artery anatomy. Acute lesions (platelet aggregation, plaque fissuring, acute thrombosis). Chronic atherosclerosis. coronary artery spasm Myocardial Infarction: Acute Healed |
article-100131_6 | Cardiopulmonary Arrest in Adults -- Etiology -- Myocardial Hypertrophy | Secondary Hypertrophic cardiomyopathy Nonobstructive Obstructive | Cardiopulmonary Arrest in Adults -- Etiology -- Myocardial Hypertrophy. Secondary Hypertrophic cardiomyopathy Nonobstructive Obstructive |
article-100131_7 | Cardiopulmonary Arrest in Adults -- Etiology -- Infiltrative and Inflammatory Disorders | Infiltrative diseases Noninfectious inflammatory diseases Myocarditis | Cardiopulmonary Arrest in Adults -- Etiology -- Infiltrative and Inflammatory Disorders. Infiltrative diseases Noninfectious inflammatory diseases Myocarditis |
article-100131_8 | Cardiopulmonary Arrest in Adults -- Etiology -- Inherited Disorders | Early repolarization syndrome. Brugada syndrome Short QT syndrome. Long QT syndrome. Catecholaminergic polymorphic ventricular tachycardia | Cardiopulmonary Arrest in Adults -- Etiology -- Inherited Disorders. Early repolarization syndrome. Brugada syndrome Short QT syndrome. Long QT syndrome. Catecholaminergic polymorphic ventricular tachycardia |
article-100131_9 | Cardiopulmonary Arrest in Adults -- Etiology -- Heart Failure | Ejection fraction less than 35% [3] | Cardiopulmonary Arrest in Adults -- Etiology -- Heart Failure. Ejection fraction less than 35% [3] |
article-100131_10 | Cardiopulmonary Arrest in Adults -- Etiology -- Congenital disease | Tetralogy of Fallot | Cardiopulmonary Arrest in Adults -- Etiology -- Congenital disease. Tetralogy of Fallot |
article-100131_11 | Cardiopulmonary Arrest in Adults -- Etiology -- Respiratory Causes | Airway obstruction: Bronchospasm due to (pulmonary edema, pulmonary hemorrhage, and pneumonia) Severe asthma or Chronic Obstructive Pulmonary Disease (COPD). Pulmonary Embolism Respiratory Muscle Weakness: due to spinal cord injury. | Cardiopulmonary Arrest in Adults -- Etiology -- Respiratory Causes. Airway obstruction: Bronchospasm due to (pulmonary edema, pulmonary hemorrhage, and pneumonia) Severe asthma or Chronic Obstructive Pulmonary Disease (COPD). Pulmonary Embolism Respiratory Muscle Weakness: due to spinal cord injury. |
article-100131_12 | Cardiopulmonary Arrest in Adults -- Etiology -- Traumatic Causes | Overall, the prevalence of cardiac causes is around 50% to 60%. Whilst, the second most common cause that is respiratory insufficiency is around 15% to 40%. [4] | Cardiopulmonary Arrest in Adults -- Etiology -- Traumatic Causes. Overall, the prevalence of cardiac causes is around 50% to 60%. Whilst, the second most common cause that is respiratory insufficiency is around 15% to 40%. [4] |
article-100131_13 | Cardiopulmonary Arrest in Adults -- Epidemiology | Cardiac arrest is divided into out-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA). However, the incidence of cardiopulmonary arrest worldwide is not well described. In the U.S, more than 290,000 IHCA occur in adults annually, whilst 326,000 cases of OHCA among adults occur yearly. Half of these ar... | Cardiopulmonary Arrest in Adults -- Epidemiology. Cardiac arrest is divided into out-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA). However, the incidence of cardiopulmonary arrest worldwide is not well described. In the U.S, more than 290,000 IHCA occur in adults annually, whilst 326,000 cases o... |
article-100131_14 | Cardiopulmonary Arrest in Adults -- Epidemiology | Men and women in middle-age have different susceptibilities to cardiopulmonary arrest; however, the sex differences decrease with increasing age. The difference in risk for cardiopulmonary arrest collateral the variations in age-related risks for other features of coronary heart disease (CHD) between males and females.... | Cardiopulmonary Arrest in Adults -- Epidemiology. Men and women in middle-age have different susceptibilities to cardiopulmonary arrest; however, the sex differences decrease with increasing age. The difference in risk for cardiopulmonary arrest collateral the variations in age-related risks for other features of coron... |
article-100131_15 | Cardiopulmonary Arrest in Adults -- Pathophysiology | Data from postmortem examinations of cardiopulmonary arrest and sudden cardiac death (SCD) victims correlate with the clinical observations on the prevalence of coronary artery disease as the major structural etiologic factor. Higher than 80% of victims have pathologic findings of coronary artery disease. The pathologi... | Cardiopulmonary Arrest in Adults -- Pathophysiology. Data from postmortem examinations of cardiopulmonary arrest and sudden cardiac death (SCD) victims correlate with the clinical observations on the prevalence of coronary artery disease as the major structural etiologic factor. Higher than 80% of victims have patholog... |
article-100131_16 | Cardiopulmonary Arrest in Adults -- History and Physical | In numerous patients, warning signs and symptoms may precede a cardiac arrest. Nevertheless, these features are ignored and unrecognized several times because those who survive after experiencing cardiopulmonary arrest, many of them suffer from amnesia while those patients who suffered cardiopulmonary arrest but surviv... | Cardiopulmonary Arrest in Adults -- History and Physical. In numerous patients, warning signs and symptoms may precede a cardiac arrest. Nevertheless, these features are ignored and unrecognized several times because those who survive after experiencing cardiopulmonary arrest, many of them suffer from amnesia while tho... |
article-100131_17 | Cardiopulmonary Arrest in Adults -- History and Physical | Clinicians examing cardiopulmonary arrest should start head-to-toe assessment immediately which will help to formulate the plan of management. The physical examination will help to diagnose the cardiopulmonary arrest as well as provide the most important information regarding the possible cause and the prognosis. While... | Cardiopulmonary Arrest in Adults -- History and Physical. Clinicians examing cardiopulmonary arrest should start head-to-toe assessment immediately which will help to formulate the plan of management. The physical examination will help to diagnose the cardiopulmonary arrest as well as provide the most important informa... |
article-100131_18 | Cardiopulmonary Arrest in Adults -- Evaluation | Cardiopulmonary resuscitation should not be interrupted for doing blood or radiological investigation. However, point of care testing, like blood glucose or serum potassium may be done if it doesn't interfere with cardiopulmonary resuscitation efforts. Point of care ultrasound can also be used to evaluate the activity ... | Cardiopulmonary Arrest in Adults -- Evaluation. Cardiopulmonary resuscitation should not be interrupted for doing blood or radiological investigation. However, point of care testing, like blood glucose or serum potassium may be done if it doesn't interfere with cardiopulmonary resuscitation efforts. Point of care ultra... |
article-100131_19 | Cardiopulmonary Arrest in Adults -- Treatment / Management | Five stages in the management of the patient with confirmed cardiopulmonary arrest are: Initial evaluation plus Basic Life Support Defibrillation Advanced Life Support Post-resuscitation care Long-term management | Cardiopulmonary Arrest in Adults -- Treatment / Management. Five stages in the management of the patient with confirmed cardiopulmonary arrest are: Initial evaluation plus Basic Life Support Defibrillation Advanced Life Support Post-resuscitation care Long-term management |
article-100131_20 | Cardiopulmonary Arrest in Adults -- Treatment / Management | Once the diagnosis of cardiopulmonary arrest is confirmed, then basic life support (BLS) and defibrillation can be carried out by the public, physicians, paramedical personnel, trained laypersons, and nurses. There is an increasing demand for specialized skills such as Advanced Life Support (ALS), post-resuscitation ca... | Cardiopulmonary Arrest in Adults -- Treatment / Management. Once the diagnosis of cardiopulmonary arrest is confirmed, then basic life support (BLS) and defibrillation can be carried out by the public, physicians, paramedical personnel, trained laypersons, and nurses. There is an increasing demand for specialized skill... |
article-100131_21 | Cardiopulmonary Arrest in Adults -- Treatment / Management -- Initial Evaluation and BLS | Confirming cardiopulmonary arrest need careful examination of the patient's level of consciousness, skin color, breathing movement, and arterial pulse either in the carotid or femoral artery. Just after confirming the arrest, the immediate responsibility of the rescuer is to call Emergency Medical Services and start CP... | Cardiopulmonary Arrest in Adults -- Treatment / Management -- Initial Evaluation and BLS. Confirming cardiopulmonary arrest need careful examination of the patient's level of consciousness, skin color, breathing movement, and arterial pulse either in the carotid or femoral artery. Just after confirming the arrest, the ... |
article-100131_22 | Cardiopulmonary Arrest in Adults -- Treatment / Management -- Initial Evaluation and BLS | It is essential to diagnose the signs of aspirations of a foreign body in the respiratory tract, which includes severe stridor, dyspnea, suprasternal and intercostal retractions. It is recommended to do the Heimlich maneuver if we are suspecting aspiration. | Cardiopulmonary Arrest in Adults -- Treatment / Management -- Initial Evaluation and BLS. It is essential to diagnose the signs of aspirations of a foreign body in the respiratory tract, which includes severe stridor, dyspnea, suprasternal and intercostal retractions. It is recommended to do the Heimlich maneuver if we... |
article-100131_23 | Cardiopulmonary Arrest in Adults -- Treatment / Management -- Initial Evaluation and BLS | Maintaining a patent airway is necessary for successful cardiopulmonary resuscitation. Maneuvers like chin lift, head tilt, and jaw thrust can be used to keep the airway patent. Any visible foreign bodies like displaced dentures should be removed from the oropharynx. Ventilatory aids like oropharyngeal airway (OPA) and... | Cardiopulmonary Arrest in Adults -- Treatment / Management -- Initial Evaluation and BLS. Maintaining a patent airway is necessary for successful cardiopulmonary resuscitation. Maneuvers like chin lift, head tilt, and jaw thrust can be used to keep the airway patent. Any visible foreign bodies like displaced dentures s... |
article-100131_24 | Cardiopulmonary Arrest in Adults -- Treatment / Management -- Automated External Defibrillation | The AEDs are easily handled via nonconventional responders, for instance: ambulance drivers, police officers, firefighters, security guards, and laypersons. Recent studies have suggested that AED use via nonconventional responders could improve the survival rates of cardiopulmonary arrest as the arrival of the ALS team... | Cardiopulmonary Arrest in Adults -- Treatment / Management -- Automated External Defibrillation. The AEDs are easily handled via nonconventional responders, for instance: ambulance drivers, police officers, firefighters, security guards, and laypersons. Recent studies have suggested that AED use via nonconventional res... |
article-100131_25 | Cardiopulmonary Arrest in Adults -- Treatment / Management -- Advanced Cardiac Life Support | Providers can use basic life support along with advanced airway aid and medication like epinephrine and amiodarone for CPR. The advanced airway may include supraglottic airway devices and endotracheal tubes. ACLS team has the further advantage of cardiac rhythm interpretation and using defibrillation when indicated. | Cardiopulmonary Arrest in Adults -- Treatment / Management -- Advanced Cardiac Life Support. Providers can use basic life support along with advanced airway aid and medication like epinephrine and amiodarone for CPR. The advanced airway may include supraglottic airway devices and endotracheal tubes. ACLS team has the f... |
article-100131_26 | Cardiopulmonary Arrest in Adults -- Treatment / Management -- Advanced Cardiac Life Support | ADVANCED CARDIAC LIFE SUPPORT (ACLS) is designed to deliver adequate ventilation, stabilize the blood pressure along with the cardiac output, control cardiac arrhythmias, and restore organ perfusion. Maneuvers needed to accomplish these goals include- Defibrillation and pacing. Endotracheal tube intubation and mechani... | Cardiopulmonary Arrest in Adults -- Treatment / Management -- Advanced Cardiac Life Support. ADVANCED CARDIAC LIFE SUPPORT (ACLS) is designed to deliver adequate ventilation, stabilize the blood pressure along with the cardiac output, control cardiac arrhythmias, and restore organ perfusion. Maneuvers needed to accomp... |
article-100131_27 | Cardiopulmonary Arrest in Adults -- Treatment / Management -- Advanced Cardiac Life Support | Cardiopulmonary resuscitation should be carried out whilst the AED is being charged Immediate early defibrillation should be given preference over intubation and intravenous line insertion A defibrillator with a biphasic waveform is preferred over monophasic. Manufacturers recommended energy dose should be used for the... | Cardiopulmonary Arrest in Adults -- Treatment / Management -- Advanced Cardiac Life Support. Cardiopulmonary resuscitation should be carried out whilst the AED is being charged Immediate early defibrillation should be given preference over intubation and intravenous line insertion A defibrillator with a biphasic wavefo... |
article-100131_28 | Cardiopulmonary Arrest in Adults -- Treatment / Management -- Advanced Cardiac Life Support | After failed defibrillation, epinephrine, 1mg I/V, should be given. Furthermore, the dose of this drug may be repeated after periods of three to five minutes. Additionally, vasopressin has been recommended as an alternative. [12] | Cardiopulmonary Arrest in Adults -- Treatment / Management -- Advanced Cardiac Life Support. After failed defibrillation, epinephrine, 1mg I/V, should be given. Furthermore, the dose of this drug may be repeated after periods of three to five minutes. Additionally, vasopressin has been recommended as an alternative. [1... |
article-100131_29 | Cardiopulmonary Arrest in Adults -- Treatment / Management -- Advanced Cardiac Life Support | After 2 or 3 failed attempts, immediate intubation and arterial blood gas analysis should be carried out. Those patients who still remain acidotic even after intubation and successful defibrillation should be given 1 new/ kg of NaHCO3 initially, and further 50 percent of the dose may be repeated after 10 minutes. | Cardiopulmonary Arrest in Adults -- Treatment / Management -- Advanced Cardiac Life Support. After 2 or 3 failed attempts, immediate intubation and arterial blood gas analysis should be carried out. Those patients who still remain acidotic even after intubation and successful defibrillation should be given 1 new/ kg of... |
article-100131_30 | Cardiopulmonary Arrest in Adults -- Treatment / Management -- Advanced Cardiac Life Support | Antiarrhythmic therapy with amiodarone may be started after recurrent electrical instability and failed defibrillation. 150 mg amiodarone should be given over 10 minutes, followed by 1 mg/ hr for 6 hours and 0.5 mg/ hour for the next 18 hours. Procainamide is rarely used nowadays. Calcium gluconate is not considered sa... | Cardiopulmonary Arrest in Adults -- Treatment / Management -- Advanced Cardiac Life Support. Antiarrhythmic therapy with amiodarone may be started after recurrent electrical instability and failed defibrillation. 150 mg amiodarone should be given over 10 minutes, followed by 1 mg/ hr for 6 hours and 0.5 mg/ hour for th... |
article-100131_31 | Cardiopulmonary Arrest in Adults -- Treatment / Management -- Postresucitation Care | This phase starts with the successful return of spontaneous circulation. Generally, the Primary ventricular fibrillation after acute myocardial infarction( AMI) are highly responsive to treatment and are readily controlled while in secondary ventricular fibrillation after AMI, resuscitative efforts are usually less su... | Cardiopulmonary Arrest in Adults -- Treatment / Management -- Postresucitation Care. This phase starts with the successful return of spontaneous circulation. Generally, the Primary ventricular fibrillation after acute myocardial infarction( AMI) are highly responsive to treatment and are readily controlled while in se... |
article-100131_32 | Cardiopulmonary Arrest in Adults -- Treatment / Management -- Postresucitation Care | The outcomes and the clinical picture after In-hospital cardiopulmonary arrest (IHCA) associated with the noncardiac diseases are very poor, and in some successfully resuscitated cases, the post-resuscitation course is controlled by the nature of the underlying illness. Patients with cancer, central nervous system dise... | Cardiopulmonary Arrest in Adults -- Treatment / Management -- Postresucitation Care. The outcomes and the clinical picture after In-hospital cardiopulmonary arrest (IHCA) associated with the noncardiac diseases are very poor, and in some successfully resuscitated cases, the post-resuscitation course is controlled by th... |
article-100131_33 | Cardiopulmonary Arrest in Adults -- Treatment / Management -- Long-Term Management After The Survival Of OHCA | Patients who survive cardiopulmonary arrest without irreversible damage to the brain must undergo proper investigation in order to know the etiology and definite intervention so that such episodes can be prevented in the future. | Cardiopulmonary Arrest in Adults -- Treatment / Management -- Long-Term Management After The Survival Of OHCA. Patients who survive cardiopulmonary arrest without irreversible damage to the brain must undergo proper investigation in order to know the etiology and definite intervention so that such episodes can be preve... |
article-100131_34 | Cardiopulmonary Arrest in Adults -- Treatment / Management -- Long-Term Management After The Survival Of OHCA | Patients with cardiopulmonary arrest due to myocardial ischemia should be managed by surgical, pharmacological ( anti ischemia therapy), and radiological intervention so that long term survival can be improved. | Cardiopulmonary Arrest in Adults -- Treatment / Management -- Long-Term Management After The Survival Of OHCA. Patients with cardiopulmonary arrest due to myocardial ischemia should be managed by surgical, pharmacological ( anti ischemia therapy), and radiological intervention so that long term survival can be improved... |
article-100131_35 | Cardiopulmonary Arrest in Adults -- Treatment / Management -- Long-Term Management After The Survival Of OHCA | Survivors of cardiopulmonary arrest due to diseases, like hypertrophic cardiomyopathies, rare inherited disorders, right ventricular dysplasia, catecholaminergic polymorphic VT, Brugada syndrome, and long QT syndrome, are the candidates for Implantable cardioverter-defibrillator (ICD). | Cardiopulmonary Arrest in Adults -- Treatment / Management -- Long-Term Management After The Survival Of OHCA. Survivors of cardiopulmonary arrest due to diseases, like hypertrophic cardiomyopathies, rare inherited disorders, right ventricular dysplasia, catecholaminergic polymorphic VT, Brugada syndrome, and long QT s... |
article-100131_36 | Cardiopulmonary Arrest in Adults -- Differential Diagnosis | Patients with cardiopulmonary arrest will be pulseless and unresponsive. But there are certain conditions having clinical manifestations similar to cardiopulmonary arrest. It includes syncope, seizure, and overdose of certain medications like opioids. [1] We should try to recognize and treat reversible causes of cardio... | Cardiopulmonary Arrest in Adults -- Differential Diagnosis. Patients with cardiopulmonary arrest will be pulseless and unresponsive. But there are certain conditions having clinical manifestations similar to cardiopulmonary arrest. It includes syncope, seizure, and overdose of certain medications like opioids. [1] We s... |
article-100131_37 | Cardiopulmonary Arrest in Adults -- Prognosis | Witnessed cardiopulmonary arrest along with immediate CPR and defibrillation have better patient survival and outcome. [15] Healthy and young patients are more likely to obtain the return of spontaneous circulation as compared to elderly patients with known co-morbidities such as IHD. | Cardiopulmonary Arrest in Adults -- Prognosis. Witnessed cardiopulmonary arrest along with immediate CPR and defibrillation have better patient survival and outcome. [15] Healthy and young patients are more likely to obtain the return of spontaneous circulation as compared to elderly patients with known co-morbidities ... |
article-100131_38 | Cardiopulmonary Arrest in Adults -- Complications | Various complications can occur during cardiopulmonary resuscitation. AED failure is the most common complication. Other complications include the inability to obtain venous access, rib fracture, pneumothorax, pneumomediastinum, hemothorax, lung laceration, pulmonary hemorrhage, injury to the major vessel, and cardiac ... | Cardiopulmonary Arrest in Adults -- Complications. Various complications can occur during cardiopulmonary resuscitation. AED failure is the most common complication. Other complications include the inability to obtain venous access, rib fracture, pneumothorax, pneumomediastinum, hemothorax, lung laceration, pulmonary h... |
article-100131_39 | Cardiopulmonary Arrest in Adults -- Deterrence and Patient Education | Most of the cardiopulmonary arrest occur outside hospitals. Immediate cardiopulmonary resuscitation and defibrillation are the two main intervention which has shown to improve patient outcomes. [16] [17] Hence, even laypersons with adequate CPR skills and training can save lives. But, sometimes even the trained person ... | Cardiopulmonary Arrest in Adults -- Deterrence and Patient Education. Most of the cardiopulmonary arrest occur outside hospitals. Immediate cardiopulmonary resuscitation and defibrillation are the two main intervention which has shown to improve patient outcomes. [16] [17] Hence, even laypersons with adequate CPR skill... |
article-100131_40 | Cardiopulmonary Arrest in Adults -- Enhancing Healthcare Team Outcomes | The vast majority of patients who experience cardiopulmonary arrest are known cases of coronary artery disease. Cardiopulmonary arrest in such patients can be prevented by reducing the progression of the disease by altering modifiable risk factors and regular medication. In addition, healthcare professionals should edu... | Cardiopulmonary Arrest in Adults -- Enhancing Healthcare Team Outcomes. The vast majority of patients who experience cardiopulmonary arrest are known cases of coronary artery disease. Cardiopulmonary arrest in such patients can be prevented by reducing the progression of the disease by altering modifiable risk factors ... |
article-100131_41 | Cardiopulmonary Arrest in Adults -- Review Questions | Access free multiple choice questions on this topic. Click here for a simplified version. Comment on this article. | Cardiopulmonary Arrest in Adults -- Review Questions. Access free multiple choice questions on this topic. Click here for a simplified version. Comment on this article. |
article-100318_0 | Amantadine Keratopathy -- Continuing Education Activity | Amantadine keratopathy is a rare dose-dependent disease process in which the drug amantadine causes damage to corneal endothelial cells through unknown mechanisms. Damage to the endothelium can ultimately lead to severe corneal edema with decreased visual acuity. Edema is typically reversible with discontinuation of th... | Amantadine Keratopathy -- Continuing Education Activity. Amantadine keratopathy is a rare dose-dependent disease process in which the drug amantadine causes damage to corneal endothelial cells through unknown mechanisms. Damage to the endothelium can ultimately lead to severe corneal edema with decreased visual acuity.... |
article-100318_1 | Amantadine Keratopathy -- Continuing Education Activity | Objectives: Review the pathophysiology of amantadine keratopathy. Explain the risk factors for developing amantadine keratopathy. Identify the treatment options available for amantadine keratopathy. Describe the importance of collaboration and communication among the interprofessional team to advance the care of amanta... | Amantadine Keratopathy -- Continuing Education Activity. Objectives: Review the pathophysiology of amantadine keratopathy. Explain the risk factors for developing amantadine keratopathy. Identify the treatment options available for amantadine keratopathy. Describe the importance of collaboration and communication among... |
article-100318_2 | Amantadine Keratopathy -- Introduction | Amantadine was originally discovered as an anti-viral to treat influenza in the 1950s. In the late 1960s, it was discovered to be useful in treating tremors and dyskinesia associated with Parkinson's disease and began to be widely used for this purpose. Today amantadine is prescribed for some chronic neurodegenerative ... | Amantadine Keratopathy -- Introduction. Amantadine was originally discovered as an anti-viral to treat influenza in the 1950s. In the late 1960s, it was discovered to be useful in treating tremors and dyskinesia associated with Parkinson's disease and began to be widely used for this purpose. Today amantadine is prescr... |
article-100318_3 | Amantadine Keratopathy -- Etiology | The acute onset of corneal edema with amantadine treatment and the resolution with discontinuation of the drug shows a causal relationship. [1] [2] [3] [4] Studies show that amantadine keratopathy occurs in a cumulative and dose-dependent manner. [5] [6] There is a negative correlation between the duration of treatment... | Amantadine Keratopathy -- Etiology. The acute onset of corneal edema with amantadine treatment and the resolution with discontinuation of the drug shows a causal relationship. [1] [2] [3] [4] Studies show that amantadine keratopathy occurs in a cumulative and dose-dependent manner. [5] [6] There is a negative correlati... |
article-100318_4 | Amantadine Keratopathy -- Etiology | Although ECD is not a highly reliable marker of clinical outcomes, patients with decreased baseline ECD may be at increased risk of amantadine keratopathy. ECD decreases linearly throughout one's lifetime, and the standard deviation of ECD increases in later decades of life. [8] [9] A study of corneas from a large corn... | Amantadine Keratopathy -- Etiology. Although ECD is not a highly reliable marker of clinical outcomes, patients with decreased baseline ECD may be at increased risk of amantadine keratopathy. ECD decreases linearly throughout one's lifetime, and the standard deviation of ECD increases in later decades of life. [8] [9] ... |
article-100318_5 | Amantadine Keratopathy -- Epidemiology | The incidence and prevalence of amantadine keratopathy in the general population are not known as the majority of studies exclude patients with ocular comorbidities (e.g., glaucoma, prior history of corneal edema) where amantadine keratopathy may have an increased prevalence. Amantadine keratopathy has an equal prepond... | Amantadine Keratopathy -- Epidemiology. The incidence and prevalence of amantadine keratopathy in the general population are not known as the majority of studies exclude patients with ocular comorbidities (e.g., glaucoma, prior history of corneal edema) where amantadine keratopathy may have an increased prevalence. Ama... |
article-100318_6 | Amantadine Keratopathy -- Epidemiology | There is an increased incidence of amantadine keratopathy within months of treatment initiation, but cases have been reported as late as 6 years after starting therapy, so the relative risk is likely greater than this. [6] [10] [11] The largest retrospective cohort study conducted on amantadine keratopathy showed that ... | Amantadine Keratopathy -- Epidemiology. There is an increased incidence of amantadine keratopathy within months of treatment initiation, but cases have been reported as late as 6 years after starting therapy, so the relative risk is likely greater than this. [6] [10] [11] The largest retrospective cohort study conducte... |
article-100318_7 | Amantadine Keratopathy -- Pathophysiology | Amantadine causes permanent damage to the corneal endothelium and a decrease in corneal endothelial cell density by unknown mechanisms. [4] [11] [12] Bovine cornea cell cultures showed no signs of corneal endothelial cell apoptosis, although the duration of incubation may not have been sufficient to induce such a chang... | Amantadine Keratopathy -- Pathophysiology. Amantadine causes permanent damage to the corneal endothelium and a decrease in corneal endothelial cell density by unknown mechanisms. [4] [11] [12] Bovine cornea cell cultures showed no signs of corneal endothelial cell apoptosis, although the duration of incubation may not ... |
article-100318_8 | Amantadine Keratopathy -- Pathophysiology | Because damage to the corneal endothelium is permanent, edema may persist even after discontinuation of the drug, and a corneal transplant may be necessary to restore vision. [12] The primary action of amantadine as a neurologic drug is through an indirect increase in extracellular dopamine by non-competitive inhibitio... | Amantadine Keratopathy -- Pathophysiology. Because damage to the corneal endothelium is permanent, edema may persist even after discontinuation of the drug, and a corneal transplant may be necessary to restore vision. [12] The primary action of amantadine as a neurologic drug is through an indirect increase in extracel... |
article-100318_9 | Amantadine Keratopathy -- Pathophysiology | Another recent case study showed that the dopaminergic agonists ropinirole, methylphenidate, and resiniferatoxin induced corneal edema with a similar clinical presentation to amantadine keratopathy. [15] Dopamine D1 receptors (DRD1) have been found on corneal endothelial cells, and dopamine sensitivity has been linked ... | Amantadine Keratopathy -- Pathophysiology. Another recent case study showed that the dopaminergic agonists ropinirole, methylphenidate, and resiniferatoxin induced corneal edema with a similar clinical presentation to amantadine keratopathy. [15] Dopamine D1 receptors (DRD1) have been found on corneal endothelial cells... |
article-100318_10 | Amantadine Keratopathy -- Pathophysiology | Endothelial cell size variation (CoV) demonstrates that some endothelial cells are enlarging to fill gaps and compensate for the loss of surrounding endothelial cells. The percentage of hexagonal cells decreases in response to chemical, mechanical, or hypoxic stress. These parameters are frequently used as markers of e... | Amantadine Keratopathy -- Pathophysiology. Endothelial cell size variation (CoV) demonstrates that some endothelial cells are enlarging to fill gaps and compensate for the loss of surrounding endothelial cells. The percentage of hexagonal cells decreases in response to chemical, mechanical, or hypoxic stress. These par... |
article-100318_11 | Amantadine Keratopathy -- History and Physical | In almost all case reports of amantadine keratopathy, the patient describes a sudden onset of painless, bilateral blurring of vision with progressive worsening in the following months. Many patients have a visual acuity of 20/200 or worse at the time of presentation to an ophthalmologist. This history in patients with ... | Amantadine Keratopathy -- History and Physical. In almost all case reports of amantadine keratopathy, the patient describes a sudden onset of painless, bilateral blurring of vision with progressive worsening in the following months. Many patients have a visual acuity of 20/200 or worse at the time of presentation to an... |
article-100318_12 | Amantadine Keratopathy -- History and Physical | In a patient with vision loss taking amantadine, possible comorbid ocular pathologies should be ruled out by extensive slit lamp examination of the anterior segment, retina, and optic nerve. Slit-lamp examination of the cornea shows diffuse stromal edema with Descemet's folds and absent guttae. Microcystic epithelial e... | Amantadine Keratopathy -- History and Physical. In a patient with vision loss taking amantadine, possible comorbid ocular pathologies should be ruled out by extensive slit lamp examination of the anterior segment, retina, and optic nerve. Slit-lamp examination of the cornea shows diffuse stromal edema with Descemet's f... |
article-100318_13 | Amantadine Keratopathy -- Evaluation | Further studies, such as pachymetry, can be used to confirm the presence of corneal edema, monitor disease progression and resolution with discontinuation of amantadine. Specular microscopy studies can be performed to assess the extent of endothelial damage and ECD. | Amantadine Keratopathy -- Evaluation. Further studies, such as pachymetry, can be used to confirm the presence of corneal edema, monitor disease progression and resolution with discontinuation of amantadine. Specular microscopy studies can be performed to assess the extent of endothelial damage and ECD. |
article-100318_14 | Amantadine Keratopathy -- Treatment / Management | The majority of reported cases of amantadine keratopathy have shown complete resolution of corneal edema and visual acuity with discontinuation of amantadine. [2] [3] [4] [11] There have been a few reported cases where corneal edema did not resolve after discontinuation of amantadine. [7] [12] In these cases, visual ac... | Amantadine Keratopathy -- Treatment / Management. The majority of reported cases of amantadine keratopathy have shown complete resolution of corneal edema and visual acuity with discontinuation of amantadine. [2] [3] [4] [11] There have been a few reported cases where corneal edema did not resolve after discontinuation... |
article-100318_15 | Amantadine Keratopathy -- Treatment / Management | Currently, there is little to no evidence to stratify a patient’s risk of developing amantadine keratopathy. Decreased vision following initiation of treatment should undoubtedly prompt a referral to an ophthalmologist by the prescribing neurologist. Patients with a history of ocular trauma, ocular surgery, corneal or ... | Amantadine Keratopathy -- Treatment / Management. Currently, there is little to no evidence to stratify a patient’s risk of developing amantadine keratopathy. Decreased vision following initiation of treatment should undoubtedly prompt a referral to an ophthalmologist by the prescribing neurologist. Patients with a his... |
article-100318_16 | Amantadine Keratopathy -- Differential Diagnosis | Fuchs endothelial dystrophy (FECD): Fuchs endothelial dystrophy has the most similar pathophysiology and presentation to amantadine keratopathy. Differentiating features include the presence of guttata on slit-lamp examination and persistence following discontinuation of amantadine. | Amantadine Keratopathy -- Differential Diagnosis. Fuchs endothelial dystrophy (FECD): Fuchs endothelial dystrophy has the most similar pathophysiology and presentation to amantadine keratopathy. Differentiating features include the presence of guttata on slit-lamp examination and persistence following discontinuation o... |
article-100318_17 | Amantadine Keratopathy -- Differential Diagnosis | Band keratopathy: Calcium deposition in the anterior stroma can look similar to the stomal edema associated with amantadine keratopathy, and the epidemiology is similar due to the age-related progression and association with chronic disease. Patients will generally have a sub-acute or chronic progression of corneal opa... | Amantadine Keratopathy -- Differential Diagnosis. Band keratopathy: Calcium deposition in the anterior stroma can look similar to the stomal edema associated with amantadine keratopathy, and the epidemiology is similar due to the age-related progression and association with chronic disease. Patients will generally have... |
article-100318_18 | Amantadine Keratopathy -- Prognosis | The majority of reported cases have shown a complete resolution of corneal edema and return of visual acuity to baseline upon discontinuation of amantadine, especially in those with no prior ocular history. In patients with an already decreased endothelial cell density, corneal transplant or Descemet membrane endotheli... | Amantadine Keratopathy -- Prognosis. The majority of reported cases have shown a complete resolution of corneal edema and return of visual acuity to baseline upon discontinuation of amantadine, especially in those with no prior ocular history. In patients with an already decreased endothelial cell density, corneal tran... |
article-100318_19 | Amantadine Keratopathy -- Complications | Misdiagnosis could lead to unnecessary surgeries and medical interventions as well as significant distress for patients who fail to improve. Because amantadine keratopathy causes permanent damage to the corneal endothelium, failure to recognize this disease or individuals who are susceptible could lead to permanent los... | Amantadine Keratopathy -- Complications. Misdiagnosis could lead to unnecessary surgeries and medical interventions as well as significant distress for patients who fail to improve. Because amantadine keratopathy causes permanent damage to the corneal endothelium, failure to recognize this disease or individuals who ar... |
article-100318_20 | Amantadine Keratopathy -- Deterrence and Patient Education | Amantadine keratopathy is swelling of the cornea secondary to damage of cells responsible for keeping the cornea deturgescent and transparent. Although the damage is irreversible, the swelling usually resolves with discontinuation of the drug. If symptoms that were previously controlled with amantadine therapy worsen w... | Amantadine Keratopathy -- Deterrence and Patient Education. Amantadine keratopathy is swelling of the cornea secondary to damage of cells responsible for keeping the cornea deturgescent and transparent. Although the damage is irreversible, the swelling usually resolves with discontinuation of the drug. If symptoms that... |
article-100318_21 | Amantadine Keratopathy -- Enhancing Healthcare Team Outcomes | Greater awareness of keratopathy as an adverse effect of amantadine therapy is needed by the interprofessional team that cares for patients with neurodegenerative or neurocognitive disorders. This team includes neurologists, ophthalmologists, and primary care clinicians. Ophthalmologists should understand the pathophys... | Amantadine Keratopathy -- Enhancing Healthcare Team Outcomes. Greater awareness of keratopathy as an adverse effect of amantadine therapy is needed by the interprofessional team that cares for patients with neurodegenerative or neurocognitive disorders. This team includes neurologists, ophthalmologists, and primary car... |
article-100318_22 | Amantadine Keratopathy -- Review Questions | Access free multiple choice questions on this topic. Click here for a simplified version. Comment on this article. | Amantadine Keratopathy -- Review Questions. Access free multiple choice questions on this topic. Click here for a simplified version. Comment on this article. |
article-100323_0 | Stable Angina -- Continuing Education Activity | Angina affects 10 million people in the United States. Providers must be able to differentiate between stable angina and other causes of chest pain to care for their patients appropriately. The recognition and appropriate management of stable angina is critical in reducing the risks of future myocardial infarction. Thi... | Stable Angina -- Continuing Education Activity. Angina affects 10 million people in the United States. Providers must be able to differentiate between stable angina and other causes of chest pain to care for their patients appropriately. The recognition and appropriate management of stable angina is critical in reducin... |
article-100323_1 | Stable Angina -- Continuing Education Activity | Objectives: Identify and appropriately diagnose stable angina. Determine the pathophysiology behind myocardial ischemia to assist in treatment options. Identify and manage risk factors to decrease mortality risk with coronary heart disease. Communicate the importance of utilizing an interdisciplinary approach with indi... | Stable Angina -- Continuing Education Activity. Objectives: Identify and appropriately diagnose stable angina. Determine the pathophysiology behind myocardial ischemia to assist in treatment options. Identify and manage risk factors to decrease mortality risk with coronary heart disease. Communicate the importance of u... |
article-100323_2 | Stable Angina -- Introduction | Stable angina, also known as typical angina or angina pectoris, is a symptom of myocardial ischemia. Stable angina is characterized by chest discomfort or anginal equivalent that is provoked with exertion and alleviated at rest or with nitroglycerin. This is often 1 of the first manifestations or warning signs of under... | Stable Angina -- Introduction. Stable angina, also known as typical angina or angina pectoris, is a symptom of myocardial ischemia. Stable angina is characterized by chest discomfort or anginal equivalent that is provoked with exertion and alleviated at rest or with nitroglycerin. This is often 1 of the first manifesta... |
article-100323_3 | Stable Angina -- Etiology | The mechanism behind stable angina is the result of a supply-demand mismatch. The myocardial oxygen demand transiently exceeds the myocardial oxygen supply, often leading to symptoms. Several factors contribute to stable angina; the most common etiology is coronary artery stenosis. This is further discussed below in th... | Stable Angina -- Etiology. The mechanism behind stable angina is the result of a supply-demand mismatch. The myocardial oxygen demand transiently exceeds the myocardial oxygen supply, often leading to symptoms. Several factors contribute to stable angina; the most common etiology is coronary artery stenosis. This is fu... |
article-100323_4 | Stable Angina -- Epidemiology | Coronary heart disease impacts over 17 million adults in the United States. Of the 17 million Americans affected, 55% of those are male. It contributes to over 500,000 deaths each year in the US. At age 40 years, the lifetime risk of developing coronary disease is estimated at 49% for men and 32% for women. The inciden... | Stable Angina -- Epidemiology. Coronary heart disease impacts over 17 million adults in the United States. Of the 17 million Americans affected, 55% of those are male. It contributes to over 500,000 deaths each year in the US. At age 40 years, the lifetime risk of developing coronary disease is estimated at 49% for men... |
article-100323_5 | Stable Angina -- Epidemiology | Coronary heart disease can also cause significant debility. This debility can manifest in several ways, 1 of which is angina. Angina affects over 10 million people in the US, with over 500,000 new cases diagnosed each year. [1] [3] | Stable Angina -- Epidemiology. Coronary heart disease can also cause significant debility. This debility can manifest in several ways, 1 of which is angina. Angina affects over 10 million people in the US, with over 500,000 new cases diagnosed each year. [1] [3] |
article-100323_6 | Stable Angina -- Pathophysiology | Simply put, angina results from an imbalance between the myocardial oxygen supply and the myocardial oxygen demand. Understanding the factors that contribute to each of these measures is important. | Stable Angina -- Pathophysiology. Simply put, angina results from an imbalance between the myocardial oxygen supply and the myocardial oxygen demand. Understanding the factors that contribute to each of these measures is important. |
article-100323_7 | Stable Angina -- Pathophysiology | Endothelial cells line the coronary arteries, regulate vascular tone, and prevent intravascular thrombosis. Any disruption in these 2 functions can lead to coronary heart disease. Multiple mechanisms can result in injury or impairment of the endothelial lining. These mechanisms include, but are not limited to, stress, ... | Stable Angina -- Pathophysiology. Endothelial cells line the coronary arteries, regulate vascular tone, and prevent intravascular thrombosis. Any disruption in these 2 functions can lead to coronary heart disease. Multiple mechanisms can result in injury or impairment of the endothelial lining. These mechanisms include... |
article-100323_8 | Stable Angina -- Pathophysiology | Coronary artery stenosis is the most common cause of myocardial ischemia. During increased myocardial oxygen demand, the stenosis prevents adequate myocardial oxygen supply. Four main factors contribute to oxygen demand: heart rate, systolic blood pressure, myocardial wall tension, and myocardial contractility. In stat... | Stable Angina -- Pathophysiology. Coronary artery stenosis is the most common cause of myocardial ischemia. During increased myocardial oxygen demand, the stenosis prevents adequate myocardial oxygen supply. Four main factors contribute to oxygen demand: heart rate, systolic blood pressure, myocardial wall tension, and... |
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