Cardiology online

Cardiology online MBBS ✅
MCPS ✅
FCPS 2 Cardiology (continue)✅
Registrar Cardiology

08/07/2025

✅ Key Principles of a Cardiac Diet:

1. Low in saturated and trans fats

2. Low in sodium (salt)

3. Rich in fiber

4. Moderate in portion size

5. Includes heart-protective nutrients like omega-3 fatty acids, potassium, magnesium, and antioxidants

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🥗 Foods Included in a Cardiac Diet:

1. Fruits & Vegetables (High in antioxidants, potassium, and fiber)

Berries, oranges, bananas, leafy greens, carrots, tomatoes, broccoli, etc.

Aim: 5–7 servings/day

2. Whole Grains

Oats, brown rice, whole wheat, quinoa, barley

Provide soluble fiber which helps lower LDL (bad cholesterol)

3. Lean Proteins

Fish (especially fatty fish like salmon, mackerel – omega-3 rich)

Skinless chicken/turkey, tofu, legumes (beans, lentils)

Eggs (in moderation)

4. Healthy Fats

Olive oil, avocado, nuts (especially walnuts and almonds), seeds (flax, chia)

Avoid: Butter, margarine, shortening, fried foods

5. Low-Fat or Non-Dairy Products

Skim milk, yogurt, cheese (watch for added sodium)

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❌ Foods to Avoid or Limit:

Processed meats (sausages, bacon, deli meats)

Fast food, fried food

Full-fat dairy

Packaged snacks (chips, cookies)

Sugary drinks (colas, juices)

White bread and refined carbs

Excess salt (limit sodium to

ECG in ElectrolytesSource : Tips and Tricks in ECGBy Prof Ahmed Mohsen
03/07/2025

ECG in Electrolytes
Source : Tips and Tricks in ECG
By Prof Ahmed Mohsen

02/07/2025

📌 What to do if CK is elevated in a patient on statins?

✅ CK > 10× ULN
➡️ Stop statin
➡️ Check renal function
➡️ Monitor CK every 2 weeks

✅ CK ≥4 but < 10× ULN, No symptoms
➡️ Continue statin
➡️ Monitor CK every 2–6 weeks

✅ CK ≥4 but < 10× ULN, With symptoms
➡️ Stop statin
➡️ Monitor CK until normalization
➡️ Rechallenge with lower dose

🔁 Also consider:
🔸 Transient CK rise (exertion)
🔸 Possible myopathy
🔸 Switching statin or using combination therapy

🔹 If CK < 4× ULN:

✅ No symptoms
➡️ Continue statin + educate to report symptoms

✅ With symptoms
➡️ Monitor CK and symptoms
➡️ If persistent: stop statin → reassess in 6 weeks
➡️ Consider rechallenge or switch statin
➡️ Try low dose / alternate-day dosing / once or twice weekly dosing regimen/combination therapy

📖 Reference:
🔗 ESC Guidelines for the Management of Dyslipidemias, 2019

30/06/2025

Stone Heart Syndrome:

Definition:
Stone Heart Syndrome is a rare, life-threatening complication most commonly associated with cardiac surgery. It is characterized by a rigid, non-compliant heart muscle (myocardium) that fails to contract effectively, leading to severe cardiac dysfunction.
The term metaphorically describes the heart's stone-like rigidity.

Pathophysiology:
- Calcium Overload: Prolonged ischemia (lack of blood flow) during surgery disrupts cellular ion balance, causing excessive calcium influx into myocardial cells.
This leads to sustained contraction (contracture) and stiffness.
- Ischemic Injury: Inadequate cardioplegia (solution used to stop the heart during surgery) or prolonged aortic cross-clamping exacerbates ischemia, damaging myocardial cells.
- Energy Depletion: ATP depletion impairs calcium reuptake, worsening contracture and rigidity.

Clinical Context:
- Occurrence: Primarily during or after open-heart surgery, especially with complex procedures or poor cardioplegic technique.
- Risk Factors: Prolonged surgery, inadequate myocardial protection, pre-existing heart disease.

Symptoms/Signs:
- Ineffective cardiac output post-surgery (hypotension, organ failure).
- Rigid myocardium observed via Echo or direct surgical palpation.

Management:
- Immediate:
- Pharmacologic:
CCB (e.g., verapamil) to reduce intracellular calcium
Inotropes (e.g., milrinone) to support function.

- Mechanical Support: Intra-aortic balloon pump (IABP) or extracorporeal membrane oxygenation (ECMO) to maintain circulation.

- Long-term: Ventricular assist devices (VADs) or heart transplantation in refractory cases.

Prevention:
- Optimized cardioplegia delivery (temperature, composition, timing).
- Minimizing ischemic time and ensuring adequate myocardial protection.
- Advanced monitoring techniques during surgery (e.g., myocardial pH, temperature).

Prognosis:
- High mortality due to refractory heart failure.
Early recognition and aggressive intervention improve outcomes.

Synonym:
- Also referred to as
Ischemic myocardial contracture or
Rigid heart syndrome
in medical literature.

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