د/مصطفى عمران قلب وأوعية دموية وقسطرة تداخليه

09/07/2025

✅Regarding AF and Valvuler Heart disease

🟩NOACs are prefered over VKAs in patient with AF and Aortic stenosis or Aortic and mitral regurgitation [Class I ]

🟩VKAs are indicated in patient with AF and Moderate or Severe Mitral stenosis [Class 1 ]

🟩NOACs are contraindicated in AF patient with Moderate or severe mitral stenosis [Class III]

10/06/2025

🗯️Some important notes about the coronary arteries and their clinical correlation::-

🔶 CHB [Complete Heart block ] is commonly associated with inferior MI as the AV nodal branch is derived from RCA [Right coronary artery ] in ~90 % of people ,and the degree of Heart block depends on the severity of blood supply affection

🔶 CHB [Infranodal ] with Anterior MI is associated with very poor prognosis as it indicates an extensive area of infarction .

🔶CHB is associated with 10 % of MI patients

🔶Right bundle branch block with Anterior MI is associated with bad prognosis and high mortality rate that's why we call it [the widow maker artery] , as it's associated with proximal LAD occlusion [Left anterior descending artery ] , occlusion before the origin of septal perforating branches supplying the Bundle branch and may be associated with left anterior or posterior fasciuler block

🔶 Posterior MI is related mainly to the left ventricular posterior wall and the affected artery is the PDA [posterior descending artery] which is derived mainly from the RCA in ~85 % of people or LCX [left circumflex Artery ] in about 8 % of people or co-dominant in 7% of people .

🔶Flail mitral valve [ Acute mitral Regurge as a complication to MI ] is commonly associated with posterior mitral leaflet affection as the PML recieves a single blood supply from the LCX or The RCA depending on which one is dominant ,while the AML [Anterior mitral leaflet recieves a dual blood supply from the LAD and LCX .

🔶 Anterior + inferior MI is associated with proximal occluded wrapped around LAD .

🔶Inferior MI alone may come in the context of Distally occluded wrapped around LAD .

🔶Inferior MI may be associated with Anterior MI without Wrapping LAD. if LAD occlusion occured in patient with CTO [chronic total occlusion ] of RCA recieving collateral branches from LAD .

🔶 Left main occlusion is associated with ST segment elevation from V1 to V6 +lead I + AVL and may be associated with elevation in AVR and indicates A very bad prognosis and high mortality rate .

🔶 The RCA supply the SA node in 60 % and the AV node in 90 % of people

Dr.Mostafa Omran 🩺

03/06/2025

✍️كل ما تقلل ال interval بين جرعات ال Diuretic هتلاقي response افضل
Increasing the frequency or shortening the interval between Diuretic doses is associated with better response and output
ايه التفسير
بعد ما وقت كل جرعة Diuretic يخلص ،الجسم بيمتص كل ال Na اللي نازل في ال Renal tubules فيما يعرف بال [post Diuretic rebound effect ]وبالتالي هيحبس مايه تاني وهتلاقي ال negative daily balance عندك قليله علي مدار اليوم ...
وعشان كده ال Lasix كل ٨ افضل من كل ١٢ ...ولازكس كل ٦ افضل من كل ٨ ولازكس مستمر افضل من كل ٦ وهكذا ....طبعا ال indication بيكون على حسب ال severity بتاعت ال Volume overload ...

23/05/2025

18/05/2025

ال Ticagrelor [Brilique]
دائما هو ال first choice في ال loading سواء قبل ال PPCI أو ال Elective طالما مفيش Contraindication ليه
طب ايه ال Contraindication بتاعته !
1.advanced liver cirrhosis 👉[impaired metabolism hence ⬆️ risk of bleeding ]
2.previous ICH [for possibility of bleeding again ]
3.Patient on Anticoagulation as Ticagrelor is contraindicated in triple therapy [⬆️risk of bleeding ]

14/05/2025

Left ventricular asses device [LVAD]

14/05/2025

Anemia is not a diagnosis ,it's an abnormal clinical finding requiring an explanation for it's cause

14/05/2025

Don't use Ca gluconate for ttt of Hyperkalemia in patient with lanoxin toxicity

14/05/2025

Digoxin toxicity may develop any Arrhythmia except for Mobitz type 2 and sinus tachycardia

14/05/2025

ازاي ال Digoxin بيشتغل ك[ ve inotrope +]
By inhibition of Na /K ATPase pump 👉⬆️ intracellular Na ions 👉⬆️ intracellular Ca 👉⬆️Muscle contraction