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Showing posts with label Congenital Heart Disease. Show all posts
Showing posts with label Congenital Heart Disease. Show all posts

Tuesday, May 12, 2020

May 12, 2020

Business Guide Useful Resources For Embassy Care Guide

I explain the importance of preparing a business plan to be clear about all aspects of your project. https://maps.google.com/url?q=https://embassycare.com/uk-embassy-ghana/
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It is also essential that you take care of the shape as much as the background, giving a professional image at all times and speaking in the present better than conditional. Another plus point is that you invest your own money, even if you have little.
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  Indian Embassy
  German Embassy

Source: embassycare.com


I also detail the differences between talking to a banker (who only lends you money and wants to make sure you are going to return the principal and pay the interest) and talking to an investor, whose objective is to maximize the profitability of your investment.

Czech Embassy
  https://www.google.de/url?q=https://embassycare.com/iran-embassy-ghana/
  https://www.google.fr/url?q=https://paypalguide.com/equity-bank-paypal-kenya/ In the latter case, you will

have to take great care from the outset of the conditions of collaboration with your capitalist partner.
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 Actually, and even if you have put it in the sixth section of the guide, getting customers is what comes immediately after having defined the idea and the business model.

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  https://www.google.com.tr/url?q=https://customercareguides.com/contact-absa-ghana-customer-care-service/

 Having convinced a few consumers to buy your product or service is the best weapon to persuade potential investors.

  https://images.google.ch/url?q=https://customercareguides.com/contact-mtn-ghana-customer-care/

Embassy In this article, I insist a lot on the importance of being patient and persistent, and taking everything as a hunting party, with some techniques that I detail.

  Embassy One When you have caught your prey, you will still have to convince them, and some of the advice I have prepared will help you.

  Embassy Two

  Embassy Three Finally, I think it is essential that you organize monitoring of the effectiveness of your commercial activity. A common mistake is spending too much energy on methods that don't work when adjustments can change your results. Embassy Location Embassy Contact In Spain, the future entrepreneur sooner or later faces the doubt of starting as an individual (self-employed) entrepreneur or of setting up a company. Embassy Address Find Embassy Embassy Finder I have prepared an article for you that reviews the advantages and disadvantages of each legal form according to various criteria: administrative simplicity, limited liability, tax advantages, and the aspect of capital transfer. Locate Embassy Embassy Locator Fing Embassy Here As you can imagine, there is no fixed answer. Depending on the type of business, one way or the other will be better for you. Check Our Embassy Locate Consular UK Embassy For some businesses, it is a fundamental choice; for others, it has more limited importance, but the name of your company is usually the first thing that your future clients and the rest of your business partners see. Your Embassy Share Embassy Therefore it is always wise to stop time. Necessary to reflect on how you are going to call your company. UK Consular Embassy Locations Of Embassy Embassy Page High Commission You are going to want to find a short name, easy to remember, positive, if it is possible that it reveals what your value proposition is and that it cannot be confused with other brands or have strange meanings in other languages. High Commission Location Consular service Location In the article, we will tell you in detail about various clues to find a good name for your company. Emvassy Contact Check Embassy Here In this post, we explain what a business plan is made for and how to do it step by step. We also give you a guide for a business plan that you can always have on hand. Commission Office You cannot launch your project without a marketing plan. UK Embassy You cannot develop without a business plan, and you cannot have the foundations of your startup well laid without a well-defined business plan. Location Embassy Consular Location Guide So bet on this document. It will also allow you to: Set your business goals You can detail its structure. Make an opening, operation, and advertising budget. Define the amount of financing you need to finance your project Establish some solutions to solve conceivable future problems But there is much more! Commission Guide Embassy Guidelines The elaboration of a business plan is essential to seek financing, partners, or investors; and serves as a guide for those who are in charge of the company. UK Commission Location Guide Well, pay particular attention because in this post, we explain step by step how to make a business plan . And if you want to expand this content, you can download our complete GUIDE for free (you have the link at the end of the article). See also Another Embassy Guide The business plan is a document that allows the entrepreneur to analyze the current situation of the market, sector, and environment. The business plan collects such information and allows the entrepreneur to present his business to investors, accelerators, etc ., and explain how its startup and next steps. It is a living document that must always be updated. EmbassyCare Recommended reading The business plan, for its part, describes and analyzes the opportunities available to the company according to the viability of the sector. It also establishes the goals and expectations in the short, medium, and long term, well, and the strategies to follow to reach them. Read also Why should you make a business plan? Consular Service Locator Ghana Embassy Africa Embassy We start by giving six reasons why every startup should have a good business plan before launching their project, there they go! Read More Embassy Check Out More Here The business strategy will serve as a roadmap and important analysis. It allows you to know the division and the competition. It helps you check the inherent coherence of the project. You study the technical and business feasibility of the project. It promotes the communication of the approach to potential investors, partners, clients. A business plan serves to be able to envision the future in the short term. Embassy Checker As always, we encourage you to participate, so if you think you would add one more reason, tell us! 8 steps to know how to make a (good) business plan Information Another Guide Now, here we explain what the steps that every business plan document should include so that entrepreneurs work in the same direction, capable of leading their startup to achieve success more efficiently, take note are! Ghana Embassy Finder Embassy At this point, you should review the essential aspects that you will include in the business plan (later explained in more detail). Think that with this first point, you will have to be able to capture the attention and interest of future investors, so go for it! Commission Checker Continue Reading This is where you will have to correctly explain the product: its concept, origin of the idea, and main characteristics. Once those interested already know what we offer, you must specify what target it is aimed at, why, and the needs that satisfy them. Relevant Guide Important Guide This point is key to our business plan. In this we will analyze, on the one hand, the market in which the product will be introduced, its size, the success factors that characterize it, what entry and exit barriers we can find, what is its evolution and natural growth, its consequent pace and current trends. Excellent Guide Suggested Guide Here we will define the business model and the financial plan, which will detail the commercial agreements, the central collection of products or services that the organization offers, and will offer based on the actions necessary to achieve the strategic goals and objectives, among other aspects. Relevant. Another Useful Embassy Guide Great Embassy guidelines It is essential to explain the human team that makes up the startup. Investors attach great importance to this point to check if these entrepreneurs are capable of successfully conducting the business. Suggested Embassy Guides Embassy Checking Regarding corporate issues, it is necessary to state what is the company's social and business name, its corporate mission, the name of the founders, the share resources, specify the administrative bodies that the company has and what obligations it has the partnership with the Public Administrations. Africa Embassy Locations Amazing Embassy It is important to specify here what stage the product is in, if it has been tested (application of the Lean Startup methodology ) or if there is a developed prototype, etc. Amazing Collection Great Embassy Collections At this point, we will begin detailing the decisions on actions and resources to be used both online and offline, which will allow us to achieve the final objectives of the company or organization, as well as specifying whether we are going to work with any communication, advertising or online marketing consulting. Ghana Embassy Suggestions As in any new project that is launched, risks have a place, and they must be counted on. Therefore, it is crucial that we take them into account and put them on the table in this document, in this way, investors, partners. They will be able to know from our side what the risks they would face could be. Best Embassy Collections Chinese Embassy If you want to expand these points even further, we encourage you to download our guide on how to make a step-by-step business plan below. Hungary Embassy Ghana Turkey Embassy Kenya This guide will come in handy for making your own business plan. It is a PDF document that will be useful to have on hand because the business plan is something that is continually being updated, and that accompanies you throughout your life as an entrepreneur. South Africa Embassy Adapt the business plan according to the recipient Something fundamental when preparing a business plan is to take into account your recipient. Turkey Ghana Embassy Iran Embassy You must adjust your speech to your audience. Talking to a bank is not the same as talking to the public administration or an investor. Therefore, depending on who receives your business plan, you must include some nuances or others. Czech Republic Embassy German Ghana Embassy Banking. For example, if you go to a bank, make it clear how you can get your money back. A bank needs money-back guarantees, so we recommend that you talk about the profitability of the business, the company's properties, etc. India Embassy Australia Embassy Location Public administration. On the other hand, if you go to the public administration, it is best to emphasize the objective pursued: job creation? Territory development? Read the bases well, analyze your business, and highlight the part that aligns with the aim of the call. Cuba Ghana Embassy Investors. On the other hand, if you go to a venture capital fund or a business angel because you are looking for investment, you will have to make it clear how they can get out of business (what we call "exit" in finance). They are investors, with which one of the things they value when making the investment decision is to be clear on how to divest (go out of business). Besides, if you are a business angel, you may want to be involved at the executive level, so we recommend that you highlight the attractiveness of your sector or business, and how it can add value. UK Ghana Embassy A clear and concise description of the project, and the problems that the business project or startup idea solves.

Source: https://embassycare.com

Those are the basic steps you need to follow.

Monday, January 29, 2018

January 29, 2018

Tetralogy Of Fallot

Tetralogy Of Fallot: Definition

Congenital cardiac malformation characterised by:
Right ventricular out flow tract obstruction
Right ventricular hypertrophy
VSD
Overriding aorta

TOF: Pathophysiology

RVOTO + VSD creates ↓ in pulmonary blood flow
RVOTO is progressive and dynamic
Pulmonary oligaemia leads to systemic hypoxemia and invites polycythaemia
RV hypertrophies in response to RVOTO
Polycythaemia increases blood viscosity and promotes thromboses in various vascular beds

 

 

 TOF: Clinical Features

Cyanosis is present by 6wks to 6mths of life.
Dyspnoea on exertion
Squatting
Hypoxic spells
Growth retardation
RV predominance on palpation
Systolic thrill / murmur LSE
Cyanosis and clubbing

TOF: Diagnosis

History
Physical examination
CXR
ECG
ECHO
FBC  + haematocrit

TOF: Treatment

Hypercyanotic attacks
Knee-chest position
Oxygen inhalation ( limited benefit )
Morphine sulphate 0.1- 0.2mg/kg
Phenylephrine 0.02mg/kg IV to increase systemic vascular resistance
Palliative treatment
Systemic pulmonary shunt e.g modified BT shunt.
Definitive treatment
Total intracardiac correction under cardiopulmonary bypass.
January 29, 2018

Coactation Of The Aorta

COARCTATION: Definition

Congenital narrowing of the aorta  (usually at the isthmus ) that creates a pressure gradient


COARCTATION: Classification

Preductal
JuxtaDuctal
Postductal
COARCTATION: pathophysiology
Raised LV afterload → LV hypertrophy
Collateral circulation between aorta proximal and distal to the coarctation
Inflow
Subclavian arteries
Internal mammaries
Vertebral
Costocervical
Thyrocervical trunk
Outflow
Intercostal arteries distal to the coarctation (esp.3rd and 4th ) into the descending thoracic aorta
Aneurysm formation- intercostal, Berry aneurysms

COARCTATION: clinical features 1

Vary according to age
Infancy
Usually in heart failure
Tachypnoea
Feeding problems
Sweating
Signs
Gallop rhythm
Systolic murmur LSE and also posteriorly ( over coarctation site)
Radio-femoral delay or absence of femoral pulse.

COARCTATION: Clinical features 2

Childhood ( 1-14yrs )
Most are asymptomatic
Upper extremity hypertension occur in 90%
CXR – cardiomegaly and rib notching
ECG – Left Ventriclar hypertrohpy

COARCTATION: Clinical features 3

Adolescence and Adult life ( >14yrs )
Many still asymptomatic
Hypertension very common and more severe
Heart failure usually occurs at ≥30yrs
Palpable collateral circulation posteriorly
Rib notching on CXR
Figure 3 sign in CXR left upper mediastinal shadow

COARCTATION: Treatment

Medical
Treatment of heart failure
Control of hypertension when present
Surgical
Definitive treatment
Coarctetomy + end to end anastomosis
Subclavian flap aortoplasty
Prosthetic patch graft aortoplasty

January 29, 2018

Patent Ductus Arteriosus (PDA)

Patent Ductus Arteriosus (PDA): Definition

Abnormality that results from persistence of the foetal ductus arteriosus in the post natal period


PDA: Anatomy

Ductus arteriosus
Foetal vascular structure
Originates from pulmonary confluence
Terminates in the left sided descending aorta just beyond origin of the left subclavian artery.
Serves as a conduit connecting pulmonary artery to aorta

 

 

PDA: maintenance of patency

High levels of circulatory and locally derived PGE2 and PGI2
These cause relaxation of ductal smooth muscle and maintain ductal patency
O2 exerts a constrictive effect
Low Po2 in ductal blood also maintain patency.

PDA: Closure of the ductus

Changes begins at birth
Closure is in two stages


Early phase

Constriction of smooth muscles in ductal wall occur in first few hours after birth
Triggered by increase in ductal blood PO2 and a rapid fall in PG levels ( removal of placental source )

Late phase

Results from fibrosis of the ductus, evolves over the next few weeks.
Usually completed by 8weeks of postnatal life.


PDA: Pathophysiology

Effects due to L → R shunt

Small shunt

Flow is low volume and haemodynamic effects minimal
Turbulence of the high velocity jet however predisposes to infective endocarditis

Large shunt

Large increase in pulmonary blood flow
Severe left ventricle volume overload  → CHF

Moderate shunt

Effects are intermediate

PDA: Clinical features

Small ductus

Asymptomatic
Incidental finding on routine examination

Large ductus

Failure to thrive
Congestive heart failure
Repeated respiratory infections

Physical examination

LV volume overload
Large pulse pressure
Collapsing pulse
Machinery murmur in pulmonary area

 

 

 PDA: Diagnosis

History
Physical examination
CXR
ECG
ECHO
Cardiac catheterisation

PDA: Treatment

Medical
Treatment of CHF
Treatment of infection
Pharmacological inducement of ductal closure in preterm infants
Indomethacin 0.1 – 0.2mg/kg 8hrly x 3doses
Surgical
Open/ conventional surgical ligation
Thoracoscopic techniques
Interventional catheter techniques

January 29, 2018

Ventricular Septal Defect (VSD)

Ventricular Septal Defect (VSD)

VSD: Definition

A defect in the interventricular septum allowing  communication between the left and right ventricles
It may be single or multiple

VSD: Types

Perimembranous            >80%
Margins includes membranous septum
Subarterial                 5-10%
Muscular                
A-V canal                <5%



VSD: Pathophysiology

Determined by the size of the defect and pulmonary vascular resistance
- Non restrictive
- Restrictive
- Intermediate

VSD: Pathophysiology- Non Restrictive

Little resistance to flow
Size approximates the diameter of the aortic root
The increase in PBF is large
Volume overload of both RV and LV occurs
Congestive heart failure usually results
Progressively increasing Pulmonary Vascular Resistance (PVR)→→ irreversible without Rx and shunt reversal occurs when pulmonary pressures exceed systemic pressures

VSD: Pathophysiology- Restrictive/ Intermediate

Create significant resistance to flow across them
Are usually less than 50% of the aortic root size
The increase in PBF is therefore minimal
Patient may survive long without symptoms
The intermediate severity also occurs

VSD: Clinical features

Small restrictive VSDs
Usually asymptomatic
Harsh pansystolic murmur LSE
Large non-restrictive VSDs
Symptoms are variable
Congestive heart failure
Failure to thrive
Repeated respiratory tract infections
Endocarditis
Characteristic pansystolic murmur ± thrill
Crepitations at the lung bases

VSD: Diagnosis

History
Physical examination
CXR
ECG
ECHO

VSD: Treatment

Medical Rx
For heart failure
Improve nutrition
Treat infections
Surgical Rx
Timing of surgery influenced by tendency to spontaneous closure
Surgical closure for infants with severe intractable congestive cardiac failure despite optimal medical Rx
Methods
Direct suturing
Pericardial patch
Goretex patch

January 29, 2018

Atrial Septal defect (ASD)

Atrial Septal Defect: Definition

A communication between the atria across a defect in the interatrial septum.

ASD: Types

- Secundum ASD
- Primum ASD
- Sinus venosus defect
- Inferior vena caval defect
- Common atrium

ASD: Associated lesions

Pulmonary stenosis        10%
Partial anomalous pulmonary venous connection                7%
VSD                    5%
PDA                    3%
Mitral stenosis            2%

 

 

 ASD: Pathophysiology

Left to right shunt
Pulmonary blood flow increases
Volume over load of right ventricle and pulmonary vascular bed results
May be well tolerated for long periods
Pulmonary vascular resistance progressively rises
Pulmonary hypertension and shunt reversal may ultimately result without treatment.

ASD: Clinical features( symptoms)

- Symptoms depend on the shunt fraction
- Most are usually asymptomatic in the first 2 decades
- Cardiac murmur on routine physical examination
- Dyspnoea
- Easy fatigability with limited exercise tolerance especially when shunt fraction is large.

ASD: Clinical features( signs)

Prominent right ventricular impulse LSE

Systolic ejection murmur LSE due to increased flow across pulmonary vein
Fixed splitting of S2

ASD: Diagnosis

ECG
CXR
ECHO
ASD: Treatment
Surgical closure under CPB
Direct suturing
Pericardial patch

January 29, 2018

CONGENITAL HEART DISEASE (CHD)


CONGENITAL HEART DISEASE (CHD)


DEFINITION

Structural abnormalities of the heart and proximal part of the great blood vessels present at birth. Congenital heart disease (CHD) also called congenital heart defects usually manifests in childhood but may pass unrecognized and not present until adult life. Defects that are well tolerated such as atrial septal defects (acyanotic),  may cause no symptoms  until adult life, or may be detected incidentally on routine examination or chest x-ray.



ETIOLOGY or CAUSES


The causes of congenital heart diseases are as outlined below:
Mostly unknown
Defective genes
Environmental teratogenes e.g. radiation
Chromosomal aberrations e.g. Down's syndrome
Maternal rubella
Maternal drugs & alcoholism

CLASSIFICATIONS OF CHD

The classifications of CHD is mostly based on the presence or absence of cyanosis and the pulmonary blood flow (PBF)
Cyanosis can be assessed clinically
Pulmonary blood flow can be assessed by chest X-ray.

CATEGORY 1 CHD

Acyanotic CHD with increased PBF
Usually left to right shunt lesions
Ventricular Septal Disease
Atrial Septal Disease
Patent Ductus Arteriosus
Uncommon lesions
Atrioventricular septal defect
Aortopulmonary window
Ruptured sinus of valsava aneurysm
Coronary artery fistula
Partial anomalous pulmonary venous connection

CATEGORY 2 CHD

Acyanotic lesions with normal Pulmonary Blood Flow
Coarctation of aorta
Interrupted aortic arch
Congenital aortic stenosis/ insufficiency
Congenital pulmonary stenosis/ insufficiency

CATEGORY 3 CHD

Cyanotic lesions with decreased Pulmonary blood flow
Normal heart size
Fallot’s tetralogy and variant
Increased heart size
Ebstein’s anomaly
Tricuspid atresia
Pulmonary stenosis with Atrial Septal Defect

CATEGORY 4 CHD

Cyanotic heart disease with increased PBF
Usually there is admixture of systemic and pulmonary blood.
Total anomalous pulmonary venous connection
Truncus arteriosus
Transposition of great vessels
Single ventricle
Double outlet right ventricle


Common types of Congenital Heart Disease
  1. Atrial Septal Defect
  2. Ventricular Septal Defect
  3. Patent Ductus Aarteriosus
  4. Coarctation of the aorta
  5. Tetralogy of Fallot ( TOF )