The Heart

The Heart Promote Cardiovascular Education and Research
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🔴Basics of ECG ⤵️ 🔹🐸🐸🐸
27/07/2025

🔴Basics of ECG ⤵️

🔹🐸🐸🐸

🔴SGLT2 Inhibitors⤵️🔹"The Rise of Cardiometabolic Medicine and its Therapeutic Revolution"🚨 inhibitors ? , and mee...
27/07/2025

🔴SGLT2 Inhibitors⤵️
🔹"The Rise of Cardiometabolic Medicine and its Therapeutic Revolution"

🚨 inhibitors ? , and meets

🔑 Key Clinical Pearls —

🧪💊 SGLT2 Inhibitors: Multisystem Benefits

✅ Improve glycemic control, slow CKD progression, and reduce HF hospitalizations

Effective in both HFrEF and HFpEF

Now class I recommendation in heart failure guidelines
👉 Remember: "SGLT2i = Sweet + Salt + Systolic Support"

🧪💊SGLT2 inhibitors
* Act on SGLT-2 proteins expressed in renal PCT to⬇️reabsorption of filtered glucose, ⬇️renal threshold for glucose & ⬆️urinary glucose excretion.
* ⬇️risk of CV adverse events in DM2 with underlying CV illness &⬇️risk of ESRD, CV mortality, hospitalization for HF.

🔴Metabolic rewiring and inter-organ crosstalk in diabetic HFpEF⤵️ 🔹The liver-heart axis links nonalcoholic steatohe...
27/07/2025

🔴Metabolic rewiring and inter-organ crosstalk in diabetic HFpEF⤵️

🔹The liver-heart axis links nonalcoholic steatohepatitis and HFpEF through shared lipid accumulation, inflammation, and fibrosis pathways, gut-heart axis involves dysbiosis-driven metabolites

🔹https://cardiab.biomedcentral.com/articles/10.1186/s12933-025-02707-7

🔴Oxygen Therapy in COPD: myths & facts⤵️ 🔹How to Avoid Oxygen Induced Hypercapnia.🔹In patients with COPD, the target o...
27/07/2025

🔴Oxygen Therapy in COPD: myths & facts⤵️
🔹How to Avoid Oxygen Induced Hypercapnia.

🔹In patients with COPD, the target oxygen saturation (SpO₂) is typically maintained between 88-92% to prevent both hypoxemia and hypercapnia.

🔹In chronic obstructive pulmonary disease (COPD), ventilation drive is primarily dependent on the levels of carbon dioxide (CO₂) and oxygen (O₂) in the blood. Normally, CO₂ levels stimulate breathing, but in COPD, chronic hypercapnia (elevated CO₂) can desensitize this drive. Instead, these patients rely on hypoxic drive, where low oxygen levels trigger breathing.

🔹When oxygen is administered, especially at high concentrations, it can reduce the hypoxic drive, leading to CO₂ retention or hypercapnic respiratory failure (also called CO₂ narcosis). This condition can cause confusion, lethargy, and ultimately, respiratory arrest if not monitored carefully. Therefore, in COPD, oxygen therapy should be carefully titrated to maintain a target SpO₂ of 88-92%, preventing hypoxia without suppressing ventilation.

🔹Ventilation refers to the movement of air in and out of the lungs to remove CO₂, while oxygenation involves the transfer of oxygen from the lungs to the blood. A patient may have adequate oxygenation but impaired ventilation, or vice versa, indicating the need for different interventions.

🔹Oxygen delivery can be achieved using various devices depending on the required FiO₂ (fraction of inspired oxygen):
•Nasal cannula: Delivers FiO₂ of 24-40%, suitable for mild hypoxia.
•Simple face mask: Provides FiO₂ of 40-60%.
•Non-rebreather mask (NRM): Delivers FiO₂ of up to 95% for severe hypoxia.
•Venturi mask: Offers precise FiO₂ (24-60%) and is ideal for COPD patients to avoid CO₂ retention.

🔹In summary, managing COPD patients requires a careful balance between oxygenation and ventilation to avoid complications like hypercapnia while ensuring adequate tissue oxygenation. Titration of oxygen therapy involves adjusting the FiO₂ to achieve a target SpO₂, typically 88-92% in COPD patients to avoid CO₂ retention. Nasal prongs can deliver FiO₂ up to approximately 40% but are less effective for severe hypoxia. Careful selection and monitoring of devices ensure safe and effective oxygen delivery. ↘️ Chart shows much oxygen in liters and FiO2 that can be achieved with different devices

🔹https://pmc.ncbi.nlm.nih.gov/articles/PMC3682248/

🧠🔥 The Ultimate DOACs Neurology Breakdown (2020–2025) 🔥🧠🚨 Stop guessing—Master DOACs for Neurology with this explosive v...
26/07/2025

🧠🔥 The Ultimate DOACs Neurology Breakdown (2020–2025) 🔥🧠

🚨 Stop guessing—Master DOACs for Neurology with this explosive visual thread! 🚀📈

🧬 1. DOACs Simplified:

🎯 Dabigatran ➡️ Thrombin Inhibitor (🚫 IIa)

🎯 Factor Xa Inhibitors: • Rivaroxaban • Apixaban • Edoxaban

➡️ All act by blocking Factor Xa (🚫 Xa) to prevent thrombin generation.

⚡ Neurology Power-up:
Rapid action (⏳ 1–4 hrs)
Short duration (⏲️ ~12 hrs avg)
No routine labs! 🚫🩸

🧩 2. AF & Stroke Prevention:

🚀 DOAC vs Warfarin:

⬇️ Stroke Risk: ~19%

⬇️ Brain Bleeds: ~50% 🚫🩸🧠

🌀 3. CVST Breakthrough:

✅ DOACs emerging strong!

RE-SPECT CVT & ACTION-CVT: Equally safe, possibly fewer bleeds.

📝 Ref: JAMA Neurol ‘19

⚠️ 4. Anticoagulation Post-ICH:

💡 Decision-maker:

✅ Deep ICH: Restart DOAC ~6 weeks

🚫 Lobar (CAA): NO anticoagulation

🎨 Interactive Decision-Flow (Visual) 📲

📝 Ref: AHA/ASA ‘22

🔍 5. ESUS: The Truth Revealed!

❌ No routine DOACs:

NAVIGATE ESUS & RE-SPECT ESUS ➡️ 🚫 Benefit, ⬆️ Bleed risk!

📝 Ref: NEJM ‘18/‘19

👥 6. Special Cases Simplified:

👵 Elderly ➡️ Apixaban 🏅

🚿 CKD ➡️ Apixaban 🏅

💊 Polypharmacy ➡️ Avoid DOACs with phenytoin & carbamazepine 🚫

🛠️ 7. Neurosurgery Peri-procedure:

⏳ Hold DOAC: 1–2 days (low-risk), 3–5 days (high-risk)

🚦 Restart: ~48–72 hrs post-op ✅

📝 Ref: Chest Guidelines ‘22

🆘 8. Rapid Reversal Toolkit:

🎯 Dabigatran ➡️ Idarucizumab (Instant) ⚡

🎯 Xa inhibitors ➡️ Andexanet alfa or 4-factor PCC ⚡
📝 Ref: ANNEXA-4, RE-VERSE AD

📌 9. Guidelines & Real-Life Hacks:

✅ AHA, ESO, AAN favor DOAC for AF.

❌ Avoid: Mechanical valves, ESUS

🚀 10. Future Neurology:

🔮 Factor XI inhibitors (Asundexian/Milvexian) promise ⬇️ bleed risk!

🔬 Personalized DOAC dosing coming soon!

📝 Ref: PACIFIC-Stroke, APACHE-AF

🎯 Neurology Takeaway:

DOACs = Safe Brains + Simpler Lives 🧠✅

🔴How to Localize the Origin of Ventricular Tachycardia (VT) Using the ECG?⤵️🔹This two-part guide helps you estimate wher...
26/07/2025

🔴How to Localize the Origin of Ventricular Tachycardia (VT) Using the ECG?⤵️

🔹This two-part guide helps you estimate where a VT is coming from in the heart, based on the QRS pattern seen on the ECG.

Step 1: Check the limb leads (frontal plane)
These leads help you guess the general wall of the left ventricle where the VT is exiting:
🔺V1 + Lead I = Septal exit
🔺Lead II + III positive = Inferior wall exit
🔺Lead II + III negative = Superior wall exit
🔺V1 negative + Lead I positive = Lateral wall exit

Step 2: Check precordial (chest) leads (horizontal plane)
These leads help localize the level of the VT in the left ventricle
🔻V1–V3 dominance = Basal (top part of LV)
🔻V3–V4 dominance = Mid LV
🔻V4 or beyond = Apical (tip of LV)

Bottom Panel: Real-life ECGs + Scar Mapping
These examples show how VT morphologies match infarcted (scarred) areas:
🔵 Anterior infarct (LAD) → VT from the front wall
🔵 Lateral infarct (LCx) → VT from the side
🔵 Inferior infarct (RCA) → VT from the bottom

This approach is helpful in VT ablation procedures, as it guides the electrophysiologist to the likely location of the arrhythmia circuit or scar.

A strong visual tool for EP fellows and anyone learning VT mapping!


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