Knowledge is Power

Brain Sync - Brain Power

2010-02-11T22:52:00.000-08:00

Improve memory and concentrationInitiate “Big Picture” thinkingExpand perceptionGain clarity of thoughtMaster Your MindTrack 1: Meditation Music, Beta, Gamma, Theta WavesTrack 2:Nature Sounds, Beta, Gamma, Theta WavesRunning Time:60 MinutesYour mind is cluttered and no matter how hard you try to focus or find answers, nothing flows easily. Perhaps you know that you’re using only a small portion

Brain Sync - Attract Love

2010-02-11T21:40:00.000-08:00

Increase charismaBecome more available for loveExude a powerful inner-magnetismIncrease Charisma & Attract the Love You DesireTrack 1: Meditation Music and Subliminal MessageTrack 2: Meditation Music, Theta Waves and Subliminal MessagesRunning Time: approximately 60 minutesHow you feel about yourself produces a radiant energy field that influences how others respond to you.Recent research has

Brain Sync - Awakening Kundalini

2010-02-11T21:16:00.000-08:00

Increase health and vitalityRecharge and refresh your brainObtain greater clarity and insightExpand creativity and intuitionA Meditation Practice to Transform Your Life Track 1: IntroductionTrack 2: InstructionsTrack 3: Meditation Music, Guided Meditation, Theta WavesRunning Time: 60 minutesFor centuries secret techniques for awakening Kundalini have been taught in ashrams and Tantric mystery

Mechanical Engineer's Handbook by Dan B. Marghitu

2010-02-11T20:42:00.000-08:00

The purpose of this handbook is to present the reader with a teachable text that includes theory and examples. Useful analytical techniques provide the student and the practitioner with powerful tools for mechanical design. This book may also serve as a reference for the designer and as a source book for the researcher.This handbook is comprehensive, convenient, detailed, and is a guide for the

Programmable Logic Controller Ebooks

2010-02-11T20:25:00.000-08:00

Automation of many different processes, such as controlling machines or factory assembly lines, is done through the use of small computers called a programmable logic controller (PLC). This is actually a control device that consists of a programmable microprocessor, and is programmed using a specialized computer language. Before, a programmable logic controller would have been programmed in

Questions and Answers compilation for Quiz activities

2010-02-10T02:15:00.000-08:00

Compilation of nearly 10,000 questions and answers on various topics for any quiz enthusiastic. Jump in and take the quiz!Quiz 10,000 Questions And AnswerView the document in full screen for a better reading

Speed Math - Math for Kids

2010-02-09T20:24:00.000-08:00

Speed Math, Math for KidsPublisher: Bill Handley | PDF | 2.88 MB | 256 pages Learn how to easily do quick mental math calculationsSpeed Math for Kids is your guide to becoming a math genius--even if you have struggled with math in the past. Believe it or not, you have the ability to perform lightning quick calculations that will astonish your friends, family, and teachers. You'll be able to

Speed Mathematics - Secret Skills for Quick Calculation

2010-02-09T20:11:00.000-08:00

Speed Mathematics - Secret Skills for Quick CalculationPublisher: Wiley | PDF | 58.2 MB | 272 pages Using this book will improve your understanding of math and have you performing like a genius!People who excel at mathematics use better strategies than the rest of us; they are not necessarily more intelligent.Speed Mathematics teaches simple methods that will enable you to make lightning

5 AMAZING Ebooks on how to learn PHP

2010-02-03T00:27:00.000-08:00

SAMS Teach Yourself PHP in 10 MinutesPHP/MySQL Programming for the Absolute BeginnerProfessional PHP programmingLearning PHP and MySQLPHP Game CreationSAMS Teach Yourself PHP in 10 Minutesby Chris NewmanAre you one of those people who think there isn't anything substantial that you can do in only 10 minutes? Think again. Sams Teach Yourself PHP in 10 Minutes is a no-fluff, just-the-answers guide

All Apress Books of PHP

2010-02-03T00:14:00.000-08:00

All Apress Books of PHPPublisher: Apress | PDF | Archive 118 MB And here is the rest of it.List of books:- Beginning Ajax with PHP: From Novice to Professional- Beginning Google Maps Applications with PHP and Ajax: From Novice to Professional- Beginning PHP and MySQL: From Novice to Professional, Third Edition- Beginning PHP and Oracle: From Novice to Professional- Beginning PHP and PostgreSQL 8:

ORACLE DBA - The Complete Video Course [CBT]

2010-02-02T23:11:00.000-08:00

3 1/2 hours of video instruction PLUS the Oracle DBA Interactive Workbook e-Book,by the Columbia University instructors, Melanie Caffrey & Douglas Scherer.Master the basics of Oracle database administration—now!Managing the database and its physical layout, ensuring security and data integrity,providing for backups, PLUS the History of Oracle Networking.See it, hear it, do it !Don't just read

Windows 7 - Step By Step

2010-02-02T04:20:00.000-08:00

Windows 7 - Step By StepPublisher: Microsoft Press | Pages: 544 | 2009-09-16 | ISBN 9780735626676 | PDF | 29 MB The smart way to learn Windows 7—one step at a time!Experience learning made easy—and quickly teach yourself the essentials of working with Windows 7. With STEP BY STEP, you set the pace—building and practicing the skills you need, just when you need them! Learn to manage windows and

Windows 7 Secrets - Wiley

2010-02-02T03:27:00.000-08:00

Windows 7 SecretsPublisher: Wiley | Pages: 1080 | 2009-09-08 | ISBN 0470508418 | PDF | 25 MBTips, tricks, treats, and secrets revealed on the latest operating system from Microsoft: Windows 7You already know the ups and downs of Windows Vista–now it′s time to learn the ins and outs of Windows 7! Internationally recognized Windows experts, Microsoft insiders, and authors Paul Thurrott and Rafael

30 Recepies in Tamil with Ginger and Garlic

2010-01-12T03:36:00.000-08:00

"என்னவோ தெரியல... பசியே எடுக்க மாட்டேங்குது" - என்றதுமே... "இதை சுடச்சுட சாதத்துல போட்டுச் சாப்பிடு சரியாயிடும்" என்றபடியே அம்மா அரைத்துக் கொடுக்கும் இஞ்சித் துவையல், அடுத்த சில மணி நேரங்களில் 'கபகப'வென பசிக்க வைத்துவிடும்.''கை, காலெல்லாம் பிடிச்சிக்கிட்ட மாதிரி இருக்கு..." - இப்படிச் சொன்ன அடுத்த நிமிடமே... "வேற ஒண்ணுமில்ல... வாயு பிடிப்பா இருக்கும். இந்தா... இதைச் சாப்பிடு!" என்றபடி உங்கள்

30 Soup Recepies in Tamil

2010-01-07T20:06:00.000-08:00

முழுமையான உற்சாகத்துக்கு நீங்க அசத்தலா சமைச்சு, 'ஆஹா...ஓஹோ'னு மோதிரக்கையால உங்க வீட்டுல தங்கக் குட்டு வாங்கியிருப்பீங்க. இருந்தாலும் எப்பவாவது, 'டிஃபரன்ட்டா ஒரு சூப் வச்சுக் கொடேன்'னு உங்க ஆசை கணவரோ, பிள்ளைகளோ கேட்கிறப்ப 'திருதிரு துறுதுறு'னு முழிப்பீங்க.'பஜ்ஜி, சொஜ்ஜி கேட்டா அஞ்சு நிமிஷத்துல வகை வகையா செஞ்சுடலாம்... என்கிட்ட போயி டிஃபரன்ட்டான சூப் கேட்டா என்ன செய்வேன்?'னு நீங்க கையைப் பிசைஞ்சு

30 days 30 Recipes - 15012010 - Home

2010-01-06T01:24:00.000-08:00

மண் மணக்கும் 30 வகை கிராமத்து சமையல்!"எங்க அம்மா எண்ணெய் கத்திரிக்கா கொழம்பு வச்சா... ஊரே மணக்கும். அதுதான் கிராமத்து மணம்.''"எங்க பாட்டி, பால் கொழுக்கட்டை செஞ்சுத் தருவாங்க பாரு... எத்தனைச் சப்பிட்டாலும் வேணும் வேணும்னு நாக்கு கேட்டுக்கிட்டே இருக்கும்."- இதையெல்லாம் வீட்டில் உள்ளவர்கள் ஆசை ஆசையாகச் சொல்லிக் கொண்டிருக்கும்போது, 'அடடா... இந்தக் கிராமத்துச் சமையல் பத்தி நமக்குத் தெரியாமப் போச்சே...

Sardar Jokes

2010-01-03T20:06:00.000-08:00

Selectd Sardar Jokes for this 2010 ... Keep Smiling for this year and many more years ahead ...Sardar: I haven't slept all night in the train.Friend: Why?Sardar: Because I got upper berth.Friend: Why didn't you exchange it with someone from the lower berth?Sardar: Oye, there was nobody to exchange in the lower berth..--------------------------------------------------------------------------------

Read Tamil Weekly Magazines Online - 05OCT2009

2009-10-08T05:27:00.000-07:00

Kungumam , Mutharam and Vannathirai tamil weeklies dated 05OCT2009

Anandha Vikatan Tamil Weekly Magazine Supplement 30SEP2009

2009-10-05T07:04:00.000-07:00

http://rapidshare.com/files/288714453/Secret_V30092009.rar

Read Tamil Weekly Magazines Online - 28SEP2009

2009-10-02T07:45:00.000-07:00

Kungumam , Mutharam and Vannathirai tamil weeklies dated 28SEP2009

Free Informatica Training Materials Online

2009-10-01T08:30:00.000-07:00

Informatica Training Materials Online

Data Warehousing Materials Online

2009-10-01T08:23:00.000-07:00

Data Warehousing and OLAP | Data Warehousing Overview, Terminology, and Research Issues

Data Mining Materials Online

2009-10-01T04:32:00.000-07:00

Data Mining Concepts and Techniques Online | Data Warehousing and Data Mining

Read Tamil Weekly Magazines Online - 21SEP2009

2009-09-25T01:18:00.000-07:00

Kungumam , Mutharam and Vannathirai tamil weeklies dated 21SEP2009

Read Tamil Weekly Magazines Online - 17SEP2009

2009-09-24T03:30:00.000-07:00

Kungumam , Mutharam and Vannathirai tamil weeklies dated 17SEP2009

Read Tamil Weekly Magazines Online - 10SEP2009

2009-09-15T07:37:00.000-07:00

Kungumam , Mutharam and Vannathirai tamil weeklies dated 10SEP2009

Read Anandha Vikatan Supplement- Online Download (16-SEP-2009)

2009-09-11T15:35:00.000-07:00

Next Issue

101 Cardiology Questions Home Page

2009-09-04T18:00:00.000-07:00

A guide to the management of common cardiological scenarios, this questions and answers offers the response of leading experts in each field to the more common, and often poorly dealt with problems of cardiology. It is a very useful 'how-to' guide, based on sound evidence.1. What are the cardiovascular risks of hypertension?.2. Is 24 hour blood pressure monitoring necessary, and what do I do with

Interactive Anatomy of the Brain

2009-09-04T15:12:00.000-07:00

An interactive study guide to the structures and functions of the brain.After reviewing the study section of this interactive tutorial, the learner will be able to do the following:Name or list the structures of the brainDescribe the functions of various brain regionsName the cranial nervesInteractive Anatomy of the Brain(Click on the above link for Interactive Anatomy of the Brain)

Which factors predict cardiac risk from general surgery?

2009-09-04T08:29:00.000-07:00

Which factors predict cardiac risk from general surgery and what is the magnitude of the risks associated with each factor?Mangano and colleagues reported an in-hospital adverse cardiac event rate of 17.5% among patients undergoing major noncardiac surgery. Four factors require consideration:1 Clinical predictors2 Functional status3 Surgical magnitude4 Results of non-invasive

Which patients should undergo preoperative non-invasive investigations or coronary angiography?

2009-09-04T08:22:00.000-07:00

Which patients should undergo preoperative non-invasive investigations or coronary angiography?Non-invasive testing refers to investigations other than angiography such as dipyridamole thallium scanning or dobutamine stress echocardiography. The literature on this question is overwhelming. It is best approached by nine simple steps. These are based on the recommendations of the joint consensus

Which patients should receive antibiotic prophylaxis for endocarditis, and which procedures should be covered in this way?

2009-09-04T08:19:00.000-07:00

Which patients should receive antibiotic prophylaxis for endocarditis, and which procedures should be covered in this way?There is little firm scientific evidence for present advice on antibiotic prophylaxis for endocarditis, mainly because of the rarity of the disease. Only 10% of cases are related to bacteraemia caused by invasive procedures. Prevention of endocarditis in patients with abnormal

What percentage of blood cultures will be positive in endocarditis?

2009-09-04T08:15:00.000-07:00

What percentage of blood cultures will be positive in endocarditis?The great majority of patients with endocarditis have positive blood cultures within a few days of incubation and only a few cases will become positive on further incubation for 1–2 weeks. The proportion of culture-negative cases depends on the volume of blood and method of culture but a common estimate is 5% with a range from

What is the morbidity and mortality of endocarditis with modern day management?

2009-09-04T08:12:00.000-07:00

What is the morbidity and mortality of endocarditis with modern day management (and how many relapse)?Despite progress in management, morbidity and mortality remain major problems for the patient with endocarditis, both during the acute phase and as the result of long term complications after a bacteriological cure. Improvements in microbiological diagnosis, types of antibiotic treatment and

What are the indications for surgical management of endocarditis?

2009-09-04T08:06:00.000-07:00

What are the indications for surgical management of endocarditis?The indications for surgical management of endocarditis fall into six categories.1. Congestive heart failurePatients with moderate-to-severe heart failure require urgent surgical intervention. With mitral regurgitation, afterload reduction and diuretic therapy can improve symptoms and may make it possible to postpone surgical repair

How should the anticoagulation of a patient with a mechanical heart valve be managed for elective surgery?

2009-09-04T08:03:00.000-07:00

How should the anticoagulation of a patient with a mechanical heart valve be managed for elective surgery?Mechanical heart valves are associated with an annual risk of arterial thromboembolism of less than 8%. Although warfarin greatly reduces the risk, it is at the expense of an INR-related risk of serious haemorrhage. This constitutes an unacceptable risk for patients undergoing major surgery,

A patient is on life-long warfarin and wishes to become pregnant. How should she be managed?

2009-09-04T07:59:00.000-07:00

A patient is on life-long warfarin and wishes to become pregnant. How should she be managed?All anticoagulant options during pregnancy are associated with potential risks to the mother and fetus. Any woman on warfarin who wishes to become pregnant should ideally be seen for prepregnancy counselling and should be involved in the anticoagulation decision as much as possible. Potential risks to the

Which cardiac patients should never get pregnant? Which cardiac patients should undergo elective Caesarean section?

2009-09-04T07:53:00.000-07:00

Which cardiac patients should never get pregnant? Which cardiac patients should undergo elective Caesarean section?Which women should never get pregnant?1 Those with significant pulmonary hypertension (pulmonary vascular resistance >2/3 of systemic), especially cyanotic patients and those with Eisenmenger reaction (maternal mortality ~50%) and those with residual pulmonary hypertension after e.g.

How do I manage the pregnant woman with valve disease?

2009-09-04T07:40:00.000-07:00

How do I manage the pregnant woman with valve disease?Native or tissue valvesIn general, regurgitant lesions are well tolerated during pregnancy, whereas left sided stenotic lesions are not (increased circulating volume and cardiac output lead to a rise in left atrial pressure). Tissue valves can deteriorate rapidly during pregnancy.Management of patients with significant mitral and aortic

How do I manage the pregnant woman with dilated cardiomyopathy?

2009-09-04T07:34:00.000-07:00

How do I manage the pregnant woman with dilated cardiomyopathy?The management of a pregnant woman with dilated cardiomyopathy should be considered in terms of maternal risk, and risk to the fetus.Maternal riskThis relates to the degree of ventricular dysfunction and the ability to adapt to altered haemodynamics. Risk and management can therefore be discussed in relation to New York Heart

What do I do if an ICD keeps discharging?

2009-09-04T06:10:00.000-07:00

What do I do if an ICD keeps discharging?Most patients who experience a single ICD shock do so for successful conversion of a malignant ventricular arrhythmia. However, it must be remembered that the default programming in an ICD is designed to maximise sensitivity at the expense of specificity. Consequently, a significant number of ICD shocks can be inappropriate. For example, multiple shocks in

How do I follow up the patient with the implantable cardioverter defibrillator?

2009-09-04T06:04:00.000-07:00

How do I follow up the patient with the implantable cardioverter defibrillator?Follow up of the patient with an implantable cardioverter defibrillator (ICD) demands an integrated team approach. The cardiologist, technical staff and nurses involved should have a wide experience and knowledge of pacemakers and general cardiac electrophysiology. Current generation ICDs do not just shock the heart

How do I manage the patient with an ICD?

2009-09-04T05:59:00.000-07:00

How do I manage the patient with an ICD?An implantable cardioverter defibrillator (ICD) serves as prophylaxis against sudden collapse and death from rapid ventricular arrhythmias. In general, all ICDs sense the heart rate and provide anti-tachycardia pacing or deliver synchronised (cardioversion) or unsynchronised (defibrillation) shocks. Some of the modern ICDs also incorporate dedicated pacing

What are the indications for implantable cardioverter defibrillator (ICD) implantation and what are the survival benefits?

2009-09-04T05:52:00.000-07:00

What are the indications for implantable cardioverter defibrillator (ICD) implantation and what are the survival benefits?Studies in the early 1980s showed that recurrence rates were high for patients presenting with a malignant arrhythmia unrelated to myocardial ischaemia or infarction. Survivors of cardiac arrest, those presenting with sustained monomorphic VT and unexplained syncope in the

Who should have a VT stimulation study? What are the risks and benefits?

2009-09-04T05:47:00.000-07:00

Who should have a VT stimulation study? What are the risks and benefits?Contrary to conventional wisdom, a significant number of sudden arrhythmic deaths result from re-entrant ventricular tachycardia that occurs in patients with chronic heart disease in the absence of acute infarction. These arrhythmias can be safely studied in a controlled setting using electrophysiological testing. Programmed

How do I assess thyroid function in someone on amiodarone therapy?

2009-09-04T05:32:00.000-07:00

What percentage of patients will suffer the complications of amiodarone therapy, and how reversible are the eye, lung, and liver changes? How do I assess thyroid function in someone on amiodarone therapy?Amiodarone therapy is associated with a number of serious toxicities which primarily involve the lung, heart, liver or thyroid gland. The drug is also associated with a wide array of other side

How do I investigate the relatives of a patient with sudden cardiac death?

2009-09-04T05:28:00.000-07:00

How do I investigate the relatives of a patient with sudden cardiac death?In patients aged over 30 years by far the commonest cause of sudden cardiac death is coronary disease (80%). In patients younger than this, inherited disorders play a major role, with hypertrophic cardiomyopathy accounting for approximately 50% of these deaths. Although perhaps not entirely representative of the general

How do I assess the patient with long QT? Should I screen relatives, and how? How do I treat them?

2009-09-04T05:24:00.000-07:00

How do I assess the patient with long QT? Should I screen relatives, and how? How do I treat them?Patients affected by the congenital long QT syndrome (LQT) are often first assessed when syncope, documented ventricular arrhythmia or aborted cardiac arrest affects them or a family member. The diagnostic cut-offs (<100%>0.46 sec (children <16>0.45 sec (adult males), and >0.47 sec (adult females),

How do I treat torsade de pointes at a cardiac arrest?

2009-09-04T05:22:00.000-07:00

How do I treat torsade de pointes at a cardiac arrest?Consideration of the electrophysiological disturbances predisposing to the development of torsade de pointes provides a logical approach to management. Experimental and clinical evidence implicates abnormal prolongation of cardiac action potential as a critical factor. Under these conditions early after-depolarisations may occur and lead to

What do I do about non-sustained ventricular tachycardia on a 24 hour tape?

2009-09-04T04:11:00.000-07:00

What do I do about non-sustained ventricular tachycardia on a 24 hour tape?The term non-sustained ventricular tachycardia (VT) is used conventionally to describe salvos lasting a minimum of four consecutive ventricular beats and a maximum of 30 seconds in the absence of intervention. The concerns are that the non-sustained VT may itself cause symptoms of palpitation, presyncope or syncope and

What do I do if a patient has a pacemaker and needs cardioversion?

2009-09-04T03:29:00.000-07:00

What do I do if a patient has a pacemaker and needs cardioversion?Patients with pacemakers often require cardioversion, particularly with the increasing use of pacing techniques in the management of paroxysmal atrial fibrillation.Some centres reprogramme or inactivate pacemakers prior to cardioversion. The decision regarding this should be made on an individual basis, depending on the type of

Can a patient with a pacemaker touch an electric fence? …have an MRI scan? …go through airport metal detectors? …use a mobile phone?

2009-09-04T03:24:00.000-07:00

Can a patient with a pacemaker touch an electric fence? …have an MRI scan? …go through airport metal detectors? …use a mobile phone?Pacemakers have increasingly sophisticated circuitry to prevent damage or interference from external magnetic interference.Electric fencesNobody should touch an electric fence but should electric shock occur it would be wise to have the system checked by formal

Who should have VVI pacemakers and who should have dual chamber pacemakers? What are the risks of pacemaker insertion?

2009-09-04T03:21:00.000-07:00

Who should have VVI pacemakers and who should have dual chamber pacemakers? What are the risks of pacemaker insertion?Many pacing enthusiasts argue that there are very few indications for VVI pacing, perhaps confining its role to the very elderly with established atrial fibrillation and documented pauses. Dual chamber pacing (or more accurately physiological pacing which may include single

Should the patient with trifascicular disease be routinely paced? If not, why not?

2009-09-04T03:18:00.000-07:00

Should the patient with trifascicular disease be routinely paced? If not, why not?Normal activation of the ventricles below the bundle of His occurs by way of three “fascicles” – the right bundle branch and the anterosuperior and posteroinferior divisions of the left bundle branch. Conduction block in two of the three fascicles is bifascicular block. Additional prolongation of the PR interval

What are the chances of a 24 hour tape detecting the causes for collapse in a patient? What other alternative monitoring devices are now available?

2009-09-04T03:13:00.000-07:00

What are the chances of a 24 hour tape detecting the causes for collapse in a patient? What other alternative monitoring devices are now available?Syncope is a common medical problem accounting for up to 6% of emergency medical admissions. In older patients presenting to casualty this may be as high as 20% when evaluated with a full cardiovascular work up. The annual recurrence rate is as high as

How should I investigate the patient with collapse? Who should have a tilt test, and what do I do if it is positive?

2009-09-03T08:16:00.000-07:00

How should I investigate the patient with collapse? Who should have a tilt test, and what do I do if it is positive?Investigation of a patient with collapseThe history from the older patient may be less reliable, however a careful history often allows syncopal episodes to be classified into broad diagnostic categories (Table 75.1). Elderly patients may have amnesia for their collapse. A witness

Which patient with a patent foramen ovale should be referred for closure?

2009-09-03T08:13:00.000-07:00

Which patient with a patent foramen ovale should be referred for closure?A patent foramen ovale (PFO) occurs in approximately one quarter of the population. It is a vestige of the fetal circulation, with an orifice varying in size from 1 to 19mm, allowing right-toleft or bidirectional shunting at atrial level and the potential for paradoxical embolism. The development of better imaging techniques

What are the roles of transthoracic and transoesophageal echocardiography in patients with a TIA or stroke?

2009-09-03T08:06:00.000-07:00

What are the roles of transthoracic and transoesophageal echocardiography in patients with a TIA or stroke?Approximately 80% of strokes are ischaemic in origin, of which 20–40% have a cardiac basis. TIAs have a cardiac cause in ~15% of cases. Common cardiac abnormalities associated with neurological events include atrial fibrillation, mitral valve disease, left atrial enlargement, left

How sensitive are transthoracic and transoesophageal echocardiography for the detection of thrombus in the left atrium?

2009-09-03T08:04:00.000-07:00

How sensitive are transthoracic and transoesophageal echocardiography for the detection of thrombus in the left atrium?The ability of echocardiography to detect left atrial clot is determined by the sophistication of the equipment, the ease with which the left atrium and left atrial appendage can be scanned and the skill and experience of the operator. Historically, at best, the sensitivity of

How do I assess the risk of CVA or TIA in a patient with chronic atrial fibrillation and in a patient with paroxysmal atrial fibrillation?

2009-09-03T07:40:00.000-07:00

How do I assess the risk of CVA or TIA in a patient with chronic atrial fibrillation and in a patient with paroxysmal atrial fibrillation?Age is an important determinant of the risk of thromboembolism, and hence of transient ischaemic attack (TIA) and of cerebrovascular accident (CVA) in patients with atrial fibrillation. If the patient is aged less than 60 years, and has no evidence of other

Are patients with atrial flutter at risk of embolisation when cardioverted? Do they need anticoagulation to cover the procedure?

2009-09-03T07:35:00.000-07:00

Are patients with atrial flutter at risk of embolisation when cardioverted? Do they need anticoagulation to cover the procedure?Although common clinical practice and guidelines do not advocate routine anticoagulation of patients with atrial flutter undergoing cardioversion, there are no data to support this practice. Rather, recent studies suggest the prevalence of intraatrial thrombus in

What are the risks of elective DC cardioversion from atrial fibrillation?

2009-09-03T07:33:00.000-07:00

What are the risks of elective DC cardioversion from atrial fibrillation?There are relatively few recent published data on the risks of elective DC cardioversion. The risks include those relating to an, albeit brief, general anaesthetic which will reflect the overall health of the patient, and those relating to the application of synchronised direct current shock. The latter include the

What factors determine the chances of successful elective cardioversion from atrial fibrillation?

2009-09-03T07:06:00.000-07:00

What factors determine the chances of successful elective cardioversion from atrial fibrillation?Elective cardioversion should only be undertaken when the precipitant (e.g. hypoxia, ischaemia, thyrotoxicosis, hypokalaemia and hypoglycaemia) has been treated and the patient is metabolically stable. With this proviso, the success of cardioversion depends not so much on the ability to restore sinus

How long should someone with atrial fibrillation be anticoagulated before DC cardioversion, and how long should this be continued afterwards?

2009-09-03T06:46:00.000-07:00

How long should someone with atrial fibrillation be anticoagulated before DC cardioversion, and how long should this be continued afterwards?For years, the rationale for a period of anticoagulation prior to cardioversion was that the anticoagulation would either stabilise or abolish any thrombus, the assumption being that thromboemboli associated with cardioversion occurred when effective atrial

What drugs should I use for chemically cardioverting atrial fibrillation and when is DC cardioversion preferable?

2009-09-03T06:36:00.000-07:00

What drugs should I use for chemically cardioverting atrial fibrillation and when is DC cardioversion preferable?Drugs are more likely to be effective when used relatively early following the onset of atrial fibrillation. However, when a clear history of recent onset atrial fibrillation has been obtained it is important to establish and treat the likely precipitants. In many instances this will

Which patients with SVT should be referred for an intracardiac electrophysiological study (EP study)?

2009-09-03T06:32:00.000-07:00

Which patients with SVT should be referred for an intracardiac electrophysiological study (EP study)? What are the success rates and risks of radiofrequency (RF) ablation?The management of supraventricular tachycardia (SVT) has changed dramatically with the development of curative radiofrequency ablation (RF ablation). For most patients, the technique offers a clear alternative to long term

Which patients with paroxysmal or chronic atrial fibrillation should I treat with aspirin, warfarin or neither?

2009-09-03T06:29:00.000-07:00

Which patients with paroxysmal or chronic atrial fibrillation should I treat with aspirin, warfarin or neither?Patients in whom the risk of thromboembolism is considered to be greater than the risk of a serious bleed due to warfarin should be considered for formal anticoagulation. In published clinical trials of anticoagulation the risk of stroke was reduced from 4.3% per year to 1.3% per year

What drugs should be used to maintain someone in sinus rhythm who has paroxysmal atrial fibrillation? Is there a role for digoxin?

2009-09-03T06:27:00.000-07:00

What drugs should be used to maintain someone in sinus rhythm who has paroxysmal atrial fibrillation? Is there a role for digoxin?The natural history of patients with paroxysmal atrial fibrillation is that over a period of time (and often many years) there is a gradual tendency to an increased frequency and duration of attacks. A proportion of patients will develop chronic atrial fibrillation.

Can a cardiac transplant patient get angina?How is this investigated?

2009-09-03T06:25:00.000-07:00

Can a cardiac transplant patient get angina?How is this investigated?Post-transplant cardiac denervation theoretically abolishes the perception of cardiac chest pain. However, some patients may develop postoperative typical anginal chest pain precipitated by exercise or by increasing heart rate. This has been associated with ECG evidence of ischaemia and coronary angiography has confirmed

What drugs do post-transplant patients require,and what are their side effects? How should I follow up such patients?

2009-09-03T06:18:00.000-07:00

What drugs do post-transplant patients require,and what are their side effects? How should I follow up such patients?Following successful cardiac, cardiopulmonary or pulmonary transplantation, patients require life-long immunosuppressivetherapy. Routine immunosuppression consists of cyclosporin-A and azathioprine, occasionally supplemented bycorticosteroids. Episodes of acute allograft rejection

Read Tamil Weekly Magazines Online - 03SEP2009

2009-09-03T05:06:00.000-07:00

Kungumam , Mutharam and Vannathirai tamil weeklies dated 03SEP2009

What are the survival figures for heart and heart-lung transplantation?

2009-09-02T04:06:00.000-07:00

What are the survival figures for heart and heart-lung transplantation?In the International Registry for Heart and Lung Transplantation, the one year actuarial survival following cardiac transplantation is approximately 80%. Thereafter there is an annual attrition rate of 2 to 4% so that five year actuarial survival and ten year actuarial survival is approximately 65% and 50% respectively. One

Who is eligible for a heart or heart-lung transplant?

2009-09-02T03:59:00.000-07:00

Who is eligible for a heart or heart-lung transplant? How do I assess suitability for transplantation?Cardiac and pulmonary transplantation are potential options for selected patients with end stage cardiac or pulmonary disease, unresponsive to conventional medical or surgical therapies. The majority of patients referred for cardiac transplantation have end stage cardiac failure as a consequence

What are LVADs and BIVADS, and who should have them?

2009-09-02T03:56:00.000-07:00

What are LVADs and BIVADS, and who should have them?Over the past 30 years, there have been efforts to produce a mechanical device that can replace the human heart. Extracorporeal univentricular and biventricular implantable devices are available, which can support the failing heart following conventional cardiac surgery, or while awaiting transplantation. The number of potential recipients

What is mean and model life expectancy in NYHA I-IV heart failure?

2009-09-02T03:29:00.000-07:00

What is mean and model life expectancy in NYHA I-IV heart failure?The New York Heart Association (NYHA) first published its Criteria for diagnosis and treatment of heart disease in 1928. The ninth and latest edition, published in 1994, retains an assessment of the functional capacity of the patient with heart disease (see Table 57.1). The NYHA functional capacity score is an entirely subjective

Which patients with heart failure should have a beta blocker?

2009-09-02T02:47:00.000-07:00

Which patients with heart failure should have a beta blocker? How do I start it and how should I monitor therapy?More than 25 years ago it was proposed that beta blockers may be of benefit in heart failure1 and yet, until recently, there has been a general reluctance amongst the medical profession to prescribe them for this indication. This is not entirely surprising, as not too long ago heart

Should I give digoxin to patients with heart failure if they are in sinus rhythm?

2009-09-02T02:07:00.000-07:00

Should I give digoxin to patients with heart failure if they are in sinus rhythm? If so, to whom? Are there dangers to stopping it once started?This is a very contentious issue. It is well known that the only prospective trial that was powered for mortality, failed to show that digoxin could lessen deaths. On the other hand, hospitalisation from all causes, including cardiovascular, was reduced

What is the role of vasodilators in chronic heart failure?

2009-09-02T02:02:00.000-07:00

What is the role of vasodilators in chronic heart failure? Who should receive them?There are three main groups of vasodilator therapies used in the treatment of chronic heart failure.Nitrates aloneNitrates on their own can be used intermittently for relief of dyspnoea – not well documented, but logical to try. For example, intermittent sublingual or oral nitrates may benefit a patient already on

Which patients with impaired ventricles should receive an ACE inhibitor?

2009-09-02T01:56:00.000-07:00

Which patients with impaired ventricles should receive an ACE inhibitor? What are the survival advantages? Do AT1-receptor antagonists confer the same advantages?Not all impaired left ventricular (LV) function is an indication for ACE-inhibitor treatment. Specifically, left ventricular hypertrophy due to hypertension or aortic stenosis may be associated with diastolic dysfunction, yet ACE

What investigation protocol should a patient with dilated cardiomyopathy undergo?

2009-09-02T01:46:00.000-07:00

What investigation protocol should a patient with dilated cardiomyopathy undergo?A protocol for the investigation of dilated cardiomyopathy should aim to confirm the diagnosis, rule out treatable causes, prevent potential complications and determine prognosis. The following investigations are routinely used:1 Echocardiography. Two-dimensional echocardiography is the major diagnostic test. Cardiac

How do I investigate the relative of a patient with hypertrophic cardiomyopathy?

2009-09-02T01:38:00.000-07:00

How do I investigate the relative of a patient with hypertrophic cardiomyopathy? How should they be followed up?Diagnostic criteria for the diagnosis of hypertrophic cardiomyopathy in first degree relatives have been proposed as shownin Table 51.1.Hence first degree relatives should undergo history, physical examination, standard 2-D echocardiography, and 12-lead electrocardiography. Relatives

What is the role of permanent pacing in hypertrophic cardiomyopathy?

2009-09-01T08:04:00.000-07:00

What is the role of permanent pacing in hypertrophic cardiomyopathy?There are broadly two categories of indications for permanent pacemaker insertion in patients with hypertrophic cardiomyopathy:• Standard indications for pacing which apply to any patient.• Reduction of left ventricular outflow tract gradient.Indications for the use of dual chamber pacing with a short programmed atrioventricular

What is the medical therapy for patients with hypertrophic cardiomyopathy, and what surgical options are of use?

2009-09-01T08:00:00.000-07:00

What is the medical therapy for patients with hypertrophic cardiomyopathy, and what surgical options are of use?About 40% of patients with hypertrophic cardiomyopathy (HCM) are symptomatic and a third have risk factors for sudden death. Each situation must be individually assessed. Asymptomatic patients do not need treatment routinely unless they are at risk of sudden death.Treatment of

How should I investigate a patient with hypertrophic cardiomyopathy (HCM)?

2009-09-01T07:55:00.000-07:00

How should I investigate a patient with hypertrophic cardiomyopathy (HCM)?The first step in the investigation of a patient with hypertrophic cardiomyopathy (HCM) is to establish the diagnosis and determine whether the case is sporadic or familial.HistoryThe investigation should begin with the taking of a detailed history. This should include the construction of a family tree with at least three

How do I follow up a patient who has had correction of aortic coarctation?

2009-09-01T07:53:00.000-07:00

How do I follow up a patient who has had correction of aortic coarctation? What should I look for and how should they be managed?Long term follow up has demonstrated an increased cardiovascular morbidity and mortality following repair of coarctation of the aorta. Repair at an older age has been associated with worse complications. Recoarctation may occur and produces upper body hypertension and

How should I treat atrial septal defects in adults?

2009-09-01T07:48:00.000-07:00

How should I treat atrial septal defects in adults?A significant secundum atrial septal defect (ASD) will result in volume and pressure overload of the right heart and may be associated with reduced exercise tolerance, shortness of breath and palpitations from atrial arrhythmias especially atrial fibrillation/ flutter. Pulmonary vascular disease is a late complication, rarely seen before the

When and how should a ventricular septal defect be closed in adults?

2009-09-01T06:14:00.000-07:00

When and how should a ventricular septal defect be closed in adults?Indications for surgical closure of a ventricular septal defect in childhood include congestive cardiac failure, pulmonary hypertension, severe aortic insufficiency and prior bacterial endocarditis. It is unlikely that a significant ventricular septal defect will be missed in childhood and therefore ventricular septal defects

What is the risk of stroke?

2009-09-01T06:04:00.000-07:00

What is the risk of stroke each year after a)tissue or b) mechanical MVR or AVR? What is the annual risk of bacterial endocarditis on these prosthetic valves?The risk of stroke after valve replacement is higher in mechanical than tissue valves (in spite of best efforts at anticoagulation) and is higher after mitral than aortic valve replacement. The risk is very much higher in the first year. To

What is the Ross procedure? When is it indicated and what are the advantages?

2009-09-01T05:50:00.000-07:00

What is the Ross procedure? When is it indicated and what are the advantages?What is the Ross procedure?The Ross procedure, or pulmonary autograft procedure, was introduced by Mr Donald Ross in 1967. The operation is performed via median sternotomy on cardiopulmonary bypass. The principle is to replace the diseased aortic valve with the autologous pulmonary valve. The pulmonary autograft is

When to repair the mitral valve?

2009-09-01T05:25:00.000-07:00

When to repair the mitral valve?Mitral valve repair has been popularised by Carpentier and others and now represents a recognised option in the treatment of mitral valve disease. Advocates argue that all mitral valves should be considered for repair first, and only those that are not suitable should be replaced. Mitral valve repair offers real advantages over replacement, chiefly low operative

When should we operate to relieve mitral regurgitation?

2009-09-01T05:18:00.000-07:00

When should we operate to relieve mitral regurgitation?There are three circumstances when surgery is required for mitral regurgitation:1 To save life in the acute caseSudden mitral regurgitation following rupture of degenerative chordae tendineae, papillary muscle rupture, or endocarditis may be very poorly tolerated. The surgeon may be presented with a patient in pulmonary oedema, even

Anandha Vikatan Tamil Weekly Magazine Supplement 02SEP2009

2009-09-01T05:03:00.000-07:00

http://rapidshare.com/files/273132705/Thihil_Vikatan_02-09-2009_.rar

Anandha Vikatan Tamil Weekly Magazine Supplement 19AUG2009

2009-09-01T04:52:00.000-07:00

http://rapidshare.com/files/274014198/Samiyar_Vikatan_19AUG2009.rar

How soon before cardiac surgery should aspirin be stopped?

2009-08-28T03:42:00.000-07:00

How soon before cardiac surgery should aspirin be stopped?Aspirin irreversibly inhibits platelet function by blocking the cyclooxygenase pathway. It is a vital adjunct in the prevention of coronary thrombosis and is known to reduce the risk of acute bypass graft closure. Unfortunately it also causes increased bleeding after cardiac surgery and increases the risk of emergency re-sternotomy in the

How does recent myocardial infarction affect the perioperative risks of coronary artery bypass grafting?

2009-08-28T03:38:00.000-07:00

How does recent myocardial infarction affect the perioperative risks of coronary artery bypass grafting?Common sense suggests that the more recent the infarction, the higher the operative risk. This is because the infarcted area is surrounded by a critically ischaemic zone. The ultimate survival of this zone depends on many factors, not least of which is the global function of the remaining

Are there benefits to switching from sulphonylureas to insulin after coronary artery bypass grafting?

2009-08-28T03:30:00.000-07:00

Are there benefits to switching from sulphonylureas to insulin after coronary artery bypass grafting?Sulphonylureas help to control blood glucose levels by binding to adenosine-5-triphosphate(ATP)-sensitive potassium channels (KATP-channels) in the beta-cells of the pancreas. This inhibits potassium flux across the cell membrane, leading to depolarisation of the plasmalemma and subsequently the

How common are neuropsychological complications after cardiopulmonary bypass (CPB)? How predictable and severe are they? Can they be prevented?

2009-08-28T03:20:00.000-07:00

How common are neuropsychological complications after cardiopulmonary bypass CPB)? How predictable and severe are they?Can they be prevented?Neuropsychological complications have been found to occur in a proportion of patients following CPB. These problems reveal themselves as impaired cognitive function, i.e. difficulties with memory, attention, concentration, and speed of motor and mental

Coronary artery bypass grafting: what is the case for total arterial revascularisation?

2009-08-28T03:03:00.000-07:00

Coronary artery bypass grafting: what is the case for total arterial revascularisation?The clinical and prognostic benefits of coronary artery bypass grafting (CABG) for certain subgroups of patients with ischaemic heart disease are well established. Most patients have three vessel coronary artery disease and the conventional CABG operation uses a single internal mammary artery (IMA) and two vein

What patterns of coronary disease are associated with improved short and long term survival after CABG compared with medical therapy?

2009-08-28T02:37:00.000-07:00

What patterns of coronary disease are associated with improved short and long term survival after CABG compared with medical therapy?Many factors have influenced the short and long term results of bypass surgery, not least the improvements in surgical techniques and experience, changes in the population of patients undergoing surgery, many of whom would never have been deemed suitable for

Which patients with post-infarct septal rupture should be treated surgically, and what are the success rates?

2009-08-28T02:27:00.000-07:00

Which patients with post-infarct septal rupture should be treated surgically, and what are the success rates?Myocardial rupture is a more common cause of death after infarction than is generally appreciated. It complicates about 3% of all myocardial infarctions and is the cause of death in about 17% of fatal infarcts. Myocardial rupture can involve the LV wall, the septum and the papillary