Cardiology online, Peshawar (2026)

31/12/2025

New Year’s Eve = higher cardiac risk
Vi**ra + holiday stress/alcohol = potential trigger for ACS or arrhythmias

31/12/2025

This diagram interpret thyroid function tests mainly TSH and Free T4. These two hormones help determine if thyroid problems are primary (thyroid gland), central/secondary (pituitary), or subclinical (early stage).

⭐ First Step: Look at TSH
⭐ Second Step: Look at Free T4

31/12/2025

📌 Which Beta-blocker is Preferred in Each Case?

Your choice depends on the patient’s condition 👇
1️⃣ 👨‍⚕️ HOCM (Hypertrophic Obstructive Cardiomyopathy):
🔹 Preferred type:
Non-vasodilating Beta-blocker
➡️ e.g., Metoprolol – Bisoprolol

2️⃣ 🤰 Pregnant with Hypertension:
🔹 Preferred type:
Labetalol ✅ (safe during pregnancy)

3️⃣ 🦵 Peripheral Vascular Disease:
🔹 Preferred type:
Vasodilating Beta-blocker
➡️ e.g., Nebivolol – Carvedilol

4️⃣ 🧔 Erectile Dysfunction:
🔹 Preferred type:
Nebivolol ✅

5️⃣ ❤️ Heart Failure with Reduced Ejection Fraction (HFrEF):
🔹 Preferred options:
Metoprolol – Bisoprolol – Carvedilol – Nebivolol
(evidence-based choices)

6️⃣ 🌬️ Bronchial Asthma:
🔹 Preferred type:
Nebivolol ✅ (safer due to β1-selectivity)

7️⃣ 🎯 If your primary goal is to control heart rate (HR):
🔹 Preferred type:
Bisoprolol – Metoprolol

8️⃣ 📉 If your main target is blood pressure (BP) control:
🔹 Preferred type:
Nebivolol – Carvedilol

9️⃣ ❌ Avoid Atenolol in Hypertension:
🔹 Less protective against stroke

🔟 ❌ Avoid Atenolol in Pregnancy:
🔹 May cause intrauterine growth retardation

👨‍⚕️ Each case has its best choice… Not all Beta-blockers are the same!

If you found this post helpful, share it 💡 or save it for later 📲

31/12/2025

🔴 Top 10 Diuretic mistakes ❌️❌

If you prescribe lasix you need to read these key mistakes👇

💉1: Not getting the job finished.. don't stop diuresis too early. If you fail to decongest, outcomes are worse and there is a higher risk of readmission to hospital.

💉2: Being distracted by serum Creatinine.. rising Cr does NOT indicate dying kidneys!!

💉3: Giving oral loop diuretics for in-hospital pts. with clear fluid overload (instead of IV diuretics)...

When dosing loop diuretics, there is a threshold effect that until above that you get no effect, and then a ceiling effect where any more diuretics don't increase diuresis.

💉4: Underdosing (loop) diuretics and compensating with increasing maintenance outpatients doses instead.

Lasix dose = 1-2 times oral maintenance dose only makes sense IF the maintenance dose was appropriate... might not be the best place to start.

Does house of god (book) have it right? Adjust based on GFR. If you have poor kidney function need higher dosing... general gestalt
GFR>45 --> 80 IV lasix
GFR 30-45--> 120 IV lasix
GFR 120 IV lasix

💉5: Too infrequent dosing of loop diuretics
LaSIX --> lasts six hours.
If you dose too infrequently then you get Na resorption in-between diuretic doses.
Start BID or TID with Lasix, not once daily! (sometimes even QID)

💉6: Using loop diuretic drips (No lasix infusions!)
Higher plasma-renin activity with diuretic infusions...

💉7: Failure to recognize fluid overload when cardiac filling pressures are normal / not terribly elevated

You can be overloaded with normal filling pressures. Volume does NOT equal pressure.

If overload + high filling pressures --> diurese fast

If overload + low filling pressures --> diurese slow

💉8: Mistaking one size fits all for diuretic resistance
Steps to treat diuretic resistance:
1. Maximize Loop Diuretic
2. Add thiazide like diuretic (e.g Metolazone)
3. Add other nephro segment blocker (Acetazolamide, Spiro, Empagliflozin, Amiloride)
4. Consider hyperdiuresis (3% saline with diuretics)
5. Consider diuresis

💉9: Don't be afraid of combination diuretic therapy
ADVOR trial: acetazolamide added to loop diuretic improved decongestion. We need to start thinking about multi-modal diuresis!

💉10: Don't mistake decongestion for dehydration
Decongestion is about removing sodium.

Positive sodium balance with net fluid loss still portends worse survival (Hodson et al 2019).

The key is in the p*e
Check urine sodium concentration 1-2 hours post diuretic ... want a urine Na > 100 ideally (

31/12/2025

Diagnosis of DM ✅

30/12/2025

💊 Drug of Choice in ✅with Comorbidities
A quick, high-yield clinical guid..

30/12/2025

✅✅SURVEILLANCE IMAGING IN DIFFERENT AORTIC CONDITIONS

🩺🫀: 🔵 Post Surgical AVR / TAVR
📌 Baseline TTE:
• SAVR: 6–12 weeks post-op
• TAVR: before discharge or ≤30 days
📌 Mechanical AVR: No routine echo if asymptomatic
📌 Bioprosthetic AVR: Echo at 5 yrs, 10 yrs, then yearly
📌 TAVR: Annual lifelong echo
🔍 Use TEE / CT / CMR / PET-CT if thrombosis, PVL, SVD, or endocarditis suspected

🩺🫀: 🟢 Bicuspid Aortic Valve (BAV)
📌 Echo at diagnosis (valve + aorta)
📌 Aorta 5 mm/year) or strong family history
🟢 Bicuspid Aortic Valve (BAV)
📌 Surgery if ≥55 mm (no risk factors)
📌 ≥50 mm if risk factors present:
⚠️ Family history of dissection
⚠️ Rapid growth
⚠️ Coarctation
📌 ≥45 mm if undergoing AVR
🔵 Marfan Syndrome
📌 Surgery at ≥50 mm
📌 ≥45 mm if:
⚠️ Family history of dissection
⚠️ Rapid growth
⚠️ Pregnancy planned
🟣 Loeys–Dietz Syndrome
📌 Early surgery at ≥42–45 mm
📌 Lower threshold due to aggressive disease
🟠 Turner Syndrome
📌 Surgery if Indexed aortic size ≥27.5 mm/m²
📌 Or rapid growth
🔴 Post Aortic Dissection (Chronic)
📌 Surgery if ≥55 mm
📌 ≥50 mm with symptoms, growth, or connective tissue disease
⚠️ General High-Risk Features (Lower Thresholds)
• Rapid expansion (>5 mm/year)
• Family history of dissection
• Pregnancy or planning pregnancy
• Genetic aortopathy

29/12/2025

Highly Helpful notes for Exams

Iron Deficiency Anemia

Low Hb + Low MCV + High RDW + Low Ferritin = Iron Deficiency
Low Hb + Low MCV + Normal RDW + Normal/High Ferritin = Thalassemia trait (not iron deficiency)

Anemia of Chronic Disease

Low Hb + Low Serum Iron + Low TIBC + Normal/High Ferritin = ACD (iron trapped in storage)
*If CRP/ESR raised → supports inflammatory block of iron

Thalassemia

Low Hb + Very Low MCV + Normal RDW + High RBC count = Thalassemia Trait
If Mentzer Index (MCV/RBC) < 13 → Thalassemia likely
>13 → Iron deficiency

Autoimmune Hemolytic Anemia (AIHA)

High LDH + High Bilirubin + High Retics + Positive Direct Coombs = AIHA
Warm AIHA → IgG | Cold AIHA → IgM (C3 positive)

G6PD Deficiency

Acute hemolysis after drugs/infection/fava beans + High Retics + Heinz bodies = G6PD
Test G6PD after crisis resolves (false normal during acute attack)

Aplastic Anemia

Pancytopenia + Low Retics + Normal MCV → Think Aplastic
Bone marrow biopsy → Hypocellular, fatty replacement

Cold Agglutinin Disease

Hemolysis + MCV artificially high + RBC clumping on smear + Positive Coombs (C3) = CAD
Symptoms worse in cold exposure

29/12/2025

Signs That You May Have PCOS (Polycystic O***y Syndrome)

🩺 What is PCOS?
→ PCOS is a common hormonal condition affecting women of reproductive age
→ It happens due to hormonal imbalance, especially increased male-type hormones (androgens)
→ It can affect periods, skin, hair, weight, and fertility
→ Not all women with PCOS look the same, so symptoms can vary

🩺 Irregular or Missed Periods
→ One of the most common signs of PCOS
→ Periods may come very late, skip for months, or stop completely
→ Some women get only 2–4 periods in a year
→ This happens because ovulation does not occur regularly

🩺 Excess Facial or Body Hair (Hirsutism)
→ Hair growth in male-pattern areas such as upper lip, chin, jawline, chest, abdomen, or thighs
→ Caused by increased androgen (male hormone) levels
→ Hair may be thick, coarse, and darker than usual

🩺 Acne and Oily Skin
→ Persistent acne beyond teenage years
→ Acne commonly appears on face, jawline, chest, and upper back
→ Skin becomes oily and prone to breakouts
→ Hormonal imbalance increases oil production in skin glands

🩺 Thinning Hair or Hair Loss from Scalp
→ Hair fall from the front or top of the scalp
→ Hair becomes thin and less dense over time
→ Pattern resembles male-type hair thinning
→ Caused by increased sensitivity to androgens

🩺 Weight Gain or Difficulty Losing Weight
→ Sudden or gradual weight gain, especially around the abdomen
→ Difficulty losing weight despite diet and exercise
→ Often linked with insulin resistance
→ Central obesity worsens hormonal imbalance

🩺 Dark Patches on Skin (Acanthosis Nigricans)
→ Dark, thickened skin seen on neck, underarms, groin, or under breasts
→ Skin may look velvety
→ Indicates insulin resistance
→ Strong warning sign of future diabetes risk

🩺 Multiple Small Cysts in Ovaries (On Ultrasound)
→ Ovaries may appear enlarged with multiple small follicles
→ Often described as “string of pearls” appearance
→ These are immature follicles, not true cysts
→ Ultrasound finding alone does not confirm PCOS

🩺 Difficulty in Getting Pregnant
→ Irregular or absent ovulation makes conception difficult
→ Many women with PCOS ovulate occasionally
→ With proper treatment, pregnancy is possible

🩺 Mood Changes and Low Energy
→ Increased stress, anxiety, or low mood
→ Fatigue and lack of motivation
→ Hormonal imbalance and insulin resistance play a role

🩺 Increased Risk of Other Health Problems
→ Prediabetes or type 2 diabetes
→ High cholesterol levels
→ High blood pressure
→ Increased risk of heart disease in the long term

🩺 Important Things to Remember
→ Not all women with PCOS have all symptoms
→ Severity varies from person to person
→ Early diagnosis helps prevent long-term complications
→ Lifestyle changes and medical treatment can control symptoms effectively

29/12/2025

✅✅✅✅✅✅✅✅✅

29/12/2025

Ablation of arrhythmias ✅

29/12/2025

ICD INDICATIONS

Cardiology online

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