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اخصائي اول امراض القلب والقسطرة

للحجز والاستفسار
تلفون: 771777765
العنوان صنعاء
عيادة الدكتور ناصر الوايلي
المستشفى السعودي الالماني
Saudi German Hospital Sana'a
شارع الستين الشمالي_ مابين جولة الجمنة وجولة عمران

Tombstone Sign in ECGIt is a morphologically abnormal extensive ST elevation in the anterior chest leads & some times in...
08/01/2026

Tombstone Sign in ECG
It is a morphologically abnormal extensive ST elevation in the anterior chest leads & some times in the septal & lateral leads depending on extent of the MI because the STE are convex upwards overwheming
the T waves, they look likes the tombstone.

Morphology:
The STE are convexed upwards & the peak of convexed STE > The preceeding R waves.

Cause:
due to severe proximal LAD occlusion ➠ large area of myocardial damage

Prognosis:
They are associated with extensive myocardial damage, reduced left ventricular function, and poorer clinical outcomes.

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Cardiovascular Changes in Pregnancy ❸ Things that Increase during pregnancy: ...
08/01/2026

Cardiovascular Changes in Pregnancy

❸ Things that Increase during pregnancy:
⇑ Plasma volume
⇑ Cardiac output
⇑ Heart rate

❷ Things that Decrease during pregnancy:
⇓ Peripheral vascular resistance
⇓ Systolic BP & Diastolic BP

Source : 2025 ESC Guidelines
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Screening for Features Suggesting Secondary HypertensionDoes the patient have any of the following conditions associated...
08/01/2026

Screening for Features Suggesting Secondary Hypertension

Does the patient have any of the following conditions associated with secondary HTN?
➺ Abrupt onset of HTN
➺ Onset of HTN at < 30 y
➺ Onset of diastolic HTN in older adults (≥ 65 y)
➺ History of early-onset stroke

➺ Accelerated HTN/malignant HTN
➺ Drug-resistant HTN/induced HTN
➺ Exacerbation of previously controlled HTN
➺ Disproportionate TOD for degree of HTN

➺ Insomnia or daytime sleepiness
➺ Concomitant adrenal nodule
➺ Family history of primary aldosteronism
➺ Excessive or unprovoked hypokalemia.

YES ➠ Screen for primary aldosteronism and other secondary forms of HTN
NO ➠ Screening not indicated.

Source : AHA/ACC 2025 Guideline
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ACC/AHA Classification of HFStage A ➠ At risk for HF but no structural heart disease or HF symptomsStage B ➠ Pre-HF (Str...
07/01/2026

ACC/AHA Classification of HF

Stage A ➠ At risk for HF but no structural heart disease or HF symptoms
Stage B ➠ Pre-HF (Structural heart disease but no symptoms or signs of HF)
Stage C ➠ Symptomatic HF (Structural heart disease & symptoms or signs of HF)
Stage D ➠ Advanced or refractory HF requiring advanced therapies.

Source : ACC/AHA 2022 HF Guideline
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INOCA (Ischemia with Non obstructive CAD)
06/01/2026

INOCA (Ischemia with Non obstructive CAD)

MINOCAMINOCA (Myocardial Infarction with Non-Obstructive Coronary Arteries)According to the American Heart Association, ...
06/01/2026

MINOCA
MINOCA (Myocardial Infarction with Non-Obstructive Coronary Arteries)
According to the American Heart Association, MINOCA is a working diagnosis that requires all of the following:
❶ Criteria for Acute MI (Based on the 4th Universal Definition of MI) :
◐ Acute myocardial injury with Detection of rise &/or fall of cTn value
◐ At least 1 value above the 99th percentile URL &
◐ Clinical evidence of acute myocardial ischemia with
◐ At least 1 of the following:
⓵ Symptoms of myocardial ischemia
⓶ New ischemic ECG changes
⓷ Development of pathologic Q waves
⓸ Imaging evidence of new loss of viable myocardium or new RWMA in a pattern consistent with ischemic etiology
⓹ Identification of coronary thrombus by angiography or autopsy
❷ Nonobstructive coronary arteries on angiography:
Defined as the absence of obstructive disease on angiography
(ie, no coronary artery stenosis ≥ 50%) in any major epicardial vessel.
❸ No specific alternate diagnosis for the clinical presentation.


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Heart Failure with Preserved EFHFpEF is clinical syndrome characterized by ⓵ HF symptoms ± signs⓶ LVEF ≥ 50%⓷ Objective ...
06/01/2026

Heart Failure with Preserved EF

HFpEF is clinical syndrome characterized by
⓵ HF symptoms ± signs
⓶ LVEF ≥ 50%
⓷ Objective evidence of cardiac structural &/or functional abnormalities
consistent with the presence of LV diastolic dysfunction/raised LV
.filling pressures including ⇑ natriuretic peptide.

Structural & Functional Abnormalities
Parameters Threshold
E/é ratio at rest > 9
PA systolic pressure > 35 mmHg
TR velocity at rest > 2.8 m/s

RWT > 0.42
LV mass index ≥ 95 g/m² in femal or ≥ 115 g/m² in male
LA volume index > 34 ml/m² in SR But in AF > 40 ml/m²

BNP > 35 in SR But in AF > 105
NT proBNP > 125 in SR But in AF > 365 in AF

Source : ESC Congress 2024
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أتقدم بجزيل الشكر والتقدير للدكتور مطهر الدرويش Motahar Aldarwish على هذه الفعالية الخيرية المباركة، وأتمنى من جميع الم...
05/01/2026

أتقدم بجزيل الشكر والتقدير للدكتور مطهر الدرويش Motahar Aldarwish على هذه الفعالية الخيرية المباركة، وأتمنى من جميع المستشفيات والمراكز الطبية أن تحذو حذوه في تنظيم مثل هذه المبادرات الإنسانية التي تُسهم في التخفيف من تكاليف الخدمات الطبية، لا سيما وأن أكثر المستفيدين منها هم المرضى الفقراء والمعدمون، ممن هم بأمسّ الحاجة إلى هذا الدعم.

Tips to know which Type of Tachycardia6 Questions ❶ What is the rate ? ❷ Regul...
05/01/2026

Tips to know which Type of Tachycardia

6 Questions
❶ What is the rate ?
❷ Regular or irregular rhythm ?
❸ Narrow or wide QRS complex ?
❹ What is the atrial activity ?
❺ What is the relationship of P to QRS ?
❻ Is the onset abrupt or gradual ? Does the rate vary ?

❶ What is the rate ?
Most tachyarrhythmias have largely overlapping possible rates, limiting
the usefulness of this characteristic, however a few observations:
o Ventricular rate 150 suggestive of atrial flutter with 2:1 AVB
o Most SVTs have rates of 150-220 bpm
o MAT is almost always < 160 bpm

Maximum predicted sinus rate : 220 - age

❷ Regular or irregular rhythm ?
Regular ?
Regularly irregular ?
☑ Atrial flutter with fixed AV block
☑ Any SVT with 2nd degree AV Block mobitz 1

Irregularly irregular rhythm ?
❶ AF
❷ Atrial flutter with variable AV Block
❸ MAT
❹ Polymorphic VT

❸ Narrow or wide QRS complex ?
Narrow QRS complex < 120 ms excludes VT
Wide QRS complex can be consistent with either
◣ VT
◣ SVT with:
√ Aberrancy (BBB)
√ Preexcitation (WPWS)
√ Using antiarrhythmic drug class I (a or c)
√ Severe hyperkalemia

❹ What is the atrial activity ?
▲ Same P wave morphology ➠ Sinus tachycardia
▲ Different shape P waves ≥ 3 ➠ MAT
▲ Retrograde P wave ➠ SVT (-ve P wave in II &/or +ve in aVR)
▲ Flutter waves ? ➠ Atrial flutter (Best seen in inferior lead & V1)
▲ No Clear P wave
➺ if irregular AF
➺ if regular Suggests SVT or VT

❺ What is the relationship of P to QRS ?
✓ P waves after the QRS ➠ SVT
✓ Is there evidence of AV dissociation ➠VT
➸ Fusion beats
➸ Capture beats


❻ Is the onset abrupt or gradual ? Does the rate vary ?
▼ Very abrupt onset without rate variation is consistent with:
☛ Atrial flutter
☛ SVT
☛ VT
▼ Very abrupt onset with rate variation is consistent with:
☛ AF
☛ MAT
☛ Atrial flutter with variable block

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Dead Man Sign = Inferior STEMI
04/01/2026

Dead Man Sign = Inferior STEMI

الطريقة الصحيحة المختصرة للقياس الصحيح لضغط الدم:✓ راحة 5 دقائق قبل قياس الضغط✓ الذراع مسندة على مستوى القلب✓ الظهر والق...
03/01/2026

الطريقة الصحيحة المختصرة للقياس الصحيح لضغط الدم:
✓ راحة 5 دقائق قبل قياس الضغط
✓ الذراع مسندة على مستوى القلب
✓ الظهر والقدمين مسنودين
✓ عدم التدخين أو شرب كافيين قبل القياس بـ 30 دقيقة
✓ استخدام كُف مناسب للحجم
✓ عدم الكلام اثناء قياس الضغط

الخلاصة المهمة:
كثير من مرضى الضغط قد يُشخَّصون خطأ أو يُعالجون بجرعات أعلى من اللازم بسبب قياس غير صحيح.

الأخطاء الشائعة وتأثيرها على قراءة الضغط:
القياس اثناء امتلاء المثانة ☚ يرفع الضغط 4–33 mmHg
أول سيجارة في اليوم ☚ قد ترفع الضغط حتى 20 mmHg
الذراع غير مسندة (معلقة) ☚ يرفع الضغط 5–20 mmHg
استخدام كُف صغير الحجم ☚ يُبالغ في قراءة الضغط 5–20 mmHg
الكلام أثناء القياس ☚ يرفع الضغط 4–19 mmHg
تشابك الساقين ☚ يرفع الضغط 3–15 mmHg
شرب الكافيين خلال 30 دقيقة قبل القياس ☚ يرفع الضغط 3–15 mmHg
القياس فوق الملابس ☚ يرفع الضغط 3–5 mmHg
عدم إسناد الظهر أو القدمين ☚ يرفع الضغط حوالي 5 mmHg

المصدر: الكلية الأمريكية لأمراض القلب
فضـــلآ وليـــس أمـــرآ شـــارك المنــشــــور لـعــل غـيـرك يــســتـفـيـد 🔁

أحمد عبدالحافظ

Important TraidsCUSHING'S TRIAD (Increased ICP): ❶ ⇑ SBP ...
03/01/2026

Important Traids

CUSHING'S TRIAD (Increased ICP):
❶ ⇑ SBP
❷ ⇓ HR
❸ ⇓ RR

BECK'S TRIAD (Cardiac Tamponade):
❶ JVD
❷ Muffled Heart Sounds
❸ Hypotension

VIRCHOW'S TRIAD (DVT):
⓵ Stasis venous circulation
⓶ Hypercoagulability
⓷ Endothelial Damage

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Address

شارع الستين الشمالي مابين جولة , الجمنة وجولة عمران
Sanaa
NASSERABOMAGED@GMAIL.COM

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