me being a cardiac anesthesiologist...watching this video cos i am chairing a ms case presentation tomorrow...superb sir....a kmc Mangalore alumni here..
this line is from harrison page 1981: Most patients with pure or predominant AS have gradually increasing obstruction over years but do not become symptomatic until the sixth to eighth decades. Adult patients with BAV disease, however, develop significant valve dysfunction and symptoms one to two decades sooner. Because the CO at rest is usually well maintained until late in the course, marked fatigability, weakness, peripheral cyanosis, cachexia, and other clinical manifestations of a low CO are usually not prominent until this stage is reached. Orthopnea, paroxysmal nocturnal dyspnea, and pulmonary edema, i.e., symptoms of LV failure, also occur only in the advanced stages of the disease
given in sir's prep manual 3rd edition that all types of RHF, for eg: valvular heart disease, constrictive pericarditis or cor pulmonale of long duration ( *more than 10 years* ) can develop cardiac cirrhosis
Thankyou sir. Doubt about the mechanism of PND.In our college ,we were taught that PND occurs due to 5 reasons 1.increased venous return 2.fluid redistribution to lungs 3.Increased LA pressure during sleep 4.fluid redistribution from tissues into plasma 5.increased vagal tone during sleep which decrease the heart rate and Cardiac output. But you said its due to increased sympathetic tone sir??
Hi Had it been increased venous return it would have manifested immediately when you sleep that is mechanism for advanced heart failure manifested as orthopnea not PND
@@dr.gaming6004 redistribution of fluid from extra vascular to intravascular compartment is the most important mechanism. This takes around 2 hrs hence after 2-3hrs of sleep PND occurs. Also in sleep there is reduced sympathetic activity which cases decrease in cardiac contractility therefore the already failing heart can not accept the increased amount of blood due to increased venous return. Also during REM phase of sleep there is increased sympathetic activity which cases tachycardia and the failing heart will not be able to pump blood effectively in this phase leading to PND Increased venous return is the mechanism for Orthopnea. Here the blood that is already in the intravascular compartment increases the venous return, not the redistribution of blood. Hence it occurs in about 10 mins after lying supine. Again all these mechanisms are postulated, there is not just one single mechanism that can explain PND or orthopnea
Thank you very very much for this great discussion. Really there is new information for me. Yet I wonder if we give a high dose of salicylates to a young patient; isn't there a risk of developing RYE syndrome?
PND occur during REM stage of sleep ..... REM stage comes after 2-2.5 hours of sleep And Mostly we don't sleep that duration in day ... That's why ...BUT if you take full sleep at day like night ... you may have PND !!
what a knowledgeable person boloor sir just i m enjoying the lecture..
me being a cardiac anesthesiologist...watching this video cos i am chairing a ms case presentation tomorrow...superb sir....a kmc Mangalore alumni here..
this line is from harrison page 1981: Most patients with pure or predominant AS have gradually increasing obstruction over years but do not become symptomatic until the
sixth to eighth decades. Adult patients with BAV disease, however,
develop significant valve dysfunction and symptoms one to two
decades sooner. Because the CO at rest is usually well maintained until late in the
course, marked fatigability, weakness, peripheral cyanosis, cachexia,
and other clinical manifestations of a low CO are usually not prominent until this stage is reached. Orthopnea, paroxysmal nocturnal
dyspnea, and pulmonary edema, i.e., symptoms of LV failure, also
occur only in the advanced stages of the disease
Sir is a living legend 🙏🏻
Great session every one who spoke.
Special mention to kishan rao sir. He is too good in handling .
God level teaching sir🥺❤
🔥 loved each minute .... Thank you white army,Dr archit balloor sir and abhineeth for this!!🙏🙏
Excellent session, please attach ppt as well
Imbibed the confidence to present cardiology case🙏🏻
We are so grateful for these classes sir, really really has helped us a lot
Absolutely incredible 👏🏾👏🏾👏🏾👏🏾
Really amazing to hear you sir🙏🏻
very helpful presentation and discussion sir
Wow I learnt so much from Dr Boloor sir, thank you so much!
The great gautami rao
Hats offf to white armyyyyyy
Thank you so muchhh
Sairammm ( from ALIKE)
Lile if u know alike😜
Great session,loved it! The student was so dumb,he kept interrupting sir while he was asking him questions!
Loved it...thanks for uploading.. its my 10th video from this channel.. loads of love . 😍🙏😍
Soo grateful for these presentations! :D THANKYOU SIR.
Thank u so much for such a informative discussion
Thank u sir☺☺☺☺thanks to Abhinith.Thanks kishan sir.
Excellent Sir. Sir would you please explain If mitral stenosis can cause left ventricular failure.
It can occur in the severe ms , leading to decreased cardiac output leading to lvf
Yes bcz of myocarditis due to rheumatic carditis
Thanks you so much Dr Archith, Whitearmy ❤ 🙏
Thank you so much for these discussions, a boon for all students from various colleges
Thank you so much.. excellent talk
Bhai ppt toh daal dete
Thank you sir for the lecture
Great sir hope you can introduce a new app for medicine also 💯
Isn’t is class 1 and not grade 1 in nyha
Thank you so much sir. So much information.
16 dislike are made by MS patients
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Good discussion
1:23 eye opener teaching lesson
Sir after how many years of cardiac disease does the cirrhosis occurs?
You were asking the question but answer was not told.
given in sir's prep manual 3rd edition that all types of RHF, for eg: valvular heart disease, constrictive pericarditis or cor pulmonale of long duration ( *more than 10 years* ) can develop cardiac cirrhosis
Why is the moderator interrupting bolor sir...??
Loved this. Thank you team , Thank you sir !
Thankyou sir.
Doubt about the mechanism of PND.In our college ,we were taught that PND occurs due to 5 reasons
1.increased venous return
2.fluid redistribution to lungs
3.Increased LA pressure during sleep
4.fluid redistribution from tissues into plasma
5.increased vagal tone during sleep which decrease the heart rate and Cardiac output.
But you said its due to increased sympathetic tone sir??
Hi
Had it been increased venous return it would have manifested immediately when you sleep that is mechanism for advanced heart failure manifested as orthopnea not PND
Yes in every book its written that mechanism of PND is due to decrease sympathetic drive not by increase in sympathetic activity
But according to sir's explanation of its in rem sleep then it's not fitting properly...... anyone can explain this?
@@dr.gaming6004 redistribution of fluid from extra vascular to intravascular compartment is the most important mechanism. This takes around 2 hrs hence after 2-3hrs of sleep PND occurs. Also in sleep there is reduced sympathetic activity which cases decrease in cardiac contractility therefore the already failing heart can not accept the increased amount of blood due to increased venous return.
Also during REM phase of sleep there is increased sympathetic activity which cases tachycardia and the failing heart will not be able to pump blood effectively in this phase leading to PND
Increased venous return is the mechanism for Orthopnea. Here the blood that is already in the intravascular compartment increases the venous return, not the redistribution of blood. Hence it occurs in about 10 mins after lying supine.
Again all these mechanisms are postulated, there is not just one single mechanism that can explain PND or orthopnea
Amazed....!!!
IS Bicuspid aortic valve so common? i have never seen even 1 in 15 year of engaging in this field
Very common
@@LEARNING-MEDICAL-EDUCATION They remain asymptomatic.
Great!!!
Very nice...
wonderful.... lajavaab
Loved it from Egypt
Very helpful 👍
Thank you very very much for this great discussion. Really there is new information for me. Yet I wonder if we give a high dose of salicylates to a young patient; isn't there a risk of developing RYE syndrome?
Excellency Sir
Very helpful
Rivorixiban is available in India kerla since more than 4 years
Thank you sir🎉
How many years for cardiac cirrhosis??
?
Beautiful
Excellent medicine text book my dr archith
Mitral stenosis
Sir can you explain clearly why PND accur at night not daytime ?
REM sleep only occurs at night not in day time so PND only occurs in night time and not in day time
What is the reference to say that REM sleep is not occuring in daytime?
Why shouldn’t rem occur during day, is there any reference .
@@aayushbishnoi1846 it's probably because our day time naps aren't long or deel enough to reach rem sleep
PND occur during REM stage of sleep ..... REM stage comes after 2-2.5 hours of sleep
And Mostly we don't sleep that duration in day ... That's why ...BUT if you take full sleep at day like night ... you may have PND !!
Schimmel Shoals
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01:54:36
How to become a memeber of this group?
Superb
1:47:40
May I join as a sr in kmc?
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Indolent carditis
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Presenter is not good
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