EasY Medical

24/06/2025

Acute anterior MI+ complete AV block = straight to Temporary pacemaker

Inferior MI + Complete AV block = Observe , revascularize ,
and try Atropine if hemodynamically unstable .If no response to atropine + unstable = Temporary pacemaker.

21/06/2025

Perioperative cardiovascular drugs

Class 1
Continue beta-blockers in patients taking them chronically

Class 2a
Consider starting beta-blockers in high risk patients provided ample time to assess safety and tolerability

Class 3
Don't start beta-blockers on day of surgery ..poise trial

STATINS

CLASS 1
Continue statins in patients taking them chronically

Class 2a
Preoperative initiation of statins is reasonable in patients undergoing vascular surgery

DualAntiplatelets in post pci patients
After BMS wait for 30 days elective non cardiac surgery class 1

For DES wait for 3 to 6 months Class 2b

After 6 months with hold p2y12 and continue aspirin and go for surgery class 1

After 1 year post pci...continue aspirin while going for elective non cardiac surgery

ANTICOAGULANTS

Warfarin

Check INR 1 week before elective non cardiac surgery

If INR above 3
Stop warfarin more than or 5 days before sheduled surgery

If INR bw 2 to 3
Stop warfarin 5 days before surgery

If INR less than 2
Stop warfarin 3 days before surgery

NOACS
For neuraxial surgery
DABIGATRAN...WITH HOLD 4 TO 5 DAYS BEFORE SURGERY

FOR APIXIBAN AND RIVAROXABAN WITHHOLD 3 TO 5 DAYS BEFORE SURGERY

21/06/2025

HEART FAILURE IN CKD

How will you manage a ckd patient having HFerEF?????

🛑🛑ACEI/ARBS If potassium is below 5.5 you can start ACEI/ARBs...bcz some ACEI or ARB is better than no ACEI

🛑🛑Some rise in Urea crt and k is expected to after an ACEI no action necessary for that
50 percent rise n urea crt or 3mg eGFR if gfr below 25 is acceptable
Rise in k below or equal to 5.5 is acceptable in ckd pts

🛑🛑Stop concomitant nephrotoxic drugs like NSAIDs or other k raising drugs
If K more than 5.5 or creatinine increases more than 100 percent then stop ACEI ARBs
I generally go with tab tretan(candesartan) 4mg od if BP above 90 mmhg

🛑🛑For ARNI sacubitril /valsartan
If Gfr 30 to 59 then no starting dose adjustment required if Gfr below 30 then reduce starting dose to 24/26 mg bid then double dose in 2-4weeks if tolerated in bid
I go with tab savesto 50 mg bid if BP above 100 mmhg

🛑🛑MINERALOCORTICOID RECEPTOR ANTAGONISTS
Regarding MRA...
Can be used if Gfr above or equal to 30 or creatinine below or equal to 2.5 mg per dL in males for females less than or equal to 2 nd patient in nhya class II to IV
Monitor electrolytes nd rfts after 2to 3 days after starting and then 7 days after initiation titration then every 3 monthly

🛑🛑BETA-BLOCKERS
Regarding betablockers if patient is not in shock or Not in acute decompensation ie ask the patient to lie flat with no pillow for 1 minute or Bend the patient for 15 seconds like tiing shoe laces if not get short of breath then ...
In stage 4 to 5 ckd u can start tab carvidilol 3.125 mg bid

🛑🛑 Regarding SGLT2i
If Gfr above or equal to 30 ml per min then dapagliflozin
Tab daplyza 10 mg od

If gfr below or 20 then Empagliflozin
Tab erli 10mg od
Provided pt is not in shock or has recurrent uti or history of dka

🛑🛑IVABRADINE For ivabradine If in sinus rhythm and on max tolerated dose of Beta-blockers or intolerant
And creatinine clearance 15 to 60 ml per min
U can start 5 mg bid according to heart rate

🛑🛑LANOXIN
Fo

18/06/2025

*at serum potasuim level>5.5meq/l
1-peak t-waves (the earliest sign)
*serum potasuim level>6.5meq/l:
1-p waves widens and flattenes
2-pr segement lengthens
3-p waves evantually disappear
*potasuim level>7meq/l:(conduction abnormalities and bradycardia):
1-prolonged qrs intervals with bizzar qrs morphology
2-high grade a-v block
3-ventricular escape rhythem
4-sinus bradycardia or slow at.fibr,
5-devlopment of sine waves appearance(a preterminal rhythem)
*potasium level>9meq/l:cardiac arrest occur due to:
1- asystole
2-ventricular fib.

17/06/2025

Yellow discoloration of the skin may be associated with
*carotenemia,
* hypothyroidism
,*diabetes mellitus,
*liver disease, and
*renal disease.

23/05/2025

Metoprolol succinate dose:
The target dose in HFrEF:200mg daily.
The maximum dose for rate control in AF:400mg daily.

23/05/2025

19/05/2025

CLINICAL SCENARIO
Male, aged 29 years. Presenting complaint Chest pain. History of presenting complaint Usually fit and well. Patient was at a party with friends and had consumed quite a lot of alcohol – more than he usually drank. Friends reported that he then developed severe central chest pain which got progressively worse. They were concerned so called for an ambulance. Admitted to coronary care unit with a suspected acute myocardial infarction.
Past medical history Nil of note. Heavy smoker. Examination Pulse: 48/min, some variation with respiration. Blood pressure: 148/96. JVP: not elevated. Heart sounds: normal. Chest auscultation: unremarkable. No peripheral oedema. Investigations FBC: Hb 139, WCC 8.1, platelets 233. U&E: Na 137, K 4.2, urea 5.3, creatinine 88. Troponin I: negative. Chest X-ray: normal heart size, clear lung fields. Echocardiogram: normal valves. Left ventricular function normal (ejection fraction 67%).

14/05/2025

:_
Raised BP
Structural heart disease
DM
Smookings
Past h.o.TIAs
Oral contraceptives
Increased RBCs
Hyperlipidaemia
Lack of excercises
Obesity
Exess alcohol intake
Gender:more in men than women

02/05/2025

🔴Anti-hypertensive medications for Severe Hypertension in pregnancy: ⤵️ 🩸🩸🩸

🔹Target is systolic blood pressure 130-150 mm Hg and diastolic blood pressure 80-100 mm Hg.

🔹Avoid ACE inhibitors and ARBs in pregnant patients due to renal issues in the fetus.