Acute Coronary Artery Syndrome:

-Unfavourable features include

1-Poor left ventricular function
2-AV block
3-Persistent ventricular arrhythmias.
4-The prognosis is worse for anterior than for inferior infarcts.
5-Bundle branch block
6-High cardiac marker levels both indicate extensive myocardial damage. 7-Old age
8-Depression and social isolation are also associated with a higher mortality.

-Of those who survive an acute attack, more than 80% live for a further year, about 75% for 5 years, 50% for 10 years and 25% for 20 years.

#Cardiology

Electrical alternans:

-Consecutive, normally-conducted QRS complexes that alternate in height

-Occurs when the heart swings backwards and forwards within a large fluid-filled pericardium "acute pericarditis".

#Cardiology

Remember:

-The most sensative investigation for diagnosis of hypertrophic pulmonary osteoarthropathy is th isotope bone scan.

#Rheumatology

Remember:

-FVC is used to monitor respiratory function in Guillain-Barre syndrome.

#Neurology

Remember:

-Hepatitis D virus has the highest mortality in all peoples exept in pregnant women hepatitis E is the most lethal.

#Liver

Remember

Amiodarone is considered dangerous for :
- Pregnancy
- Long QT
- Hyperkalemia
- Accelerated idioventricular rhythm
- NA channel blockers poisoning
And
- AF in patients with WPW ..the IV form and not the oral one for those patients.

#Cardiology

BETA BLOCKERS;

1-All betablockers can cause reduction in HDL level except CARVEDILOL

2-All betablockers can cause hypertriglyceridaemia except CARVEDILOL

3-The betablocker of the choice in renal patients on dialysis+HF is CARVEDILOL

4-Target dose of CARVEDILOL in patients with HFrEF is 25mg twice (50mg twice if body weight 85Kg or more )

5-The best antihypertensive effect among betablockers is observed with CARVEDILOL and nebivilol

6-The best rate controlling effect among betablockers is observed with bisoprolol and metoprolol

7-The most selective beta1 blocker is nebivilol, so it the most suitable for patients with asthma or COPD

8-The lowest incidence of erectile dysfunction among betablockers is observed with Nebivilol

9-Betablocker can control HR in AF during rest and exercise(while digoxin control HR at rest only)

10-Betablockers are considered the fifth antihypertensive drug (after ACEI, ARBs, CCB, thiazide diuretics) except in pregnancy, Arrhythmias(AF), angina or HF ; in these cases, Betablocker can be used as first line for hypertension.

#Cardiology

Remember:

First line therapy in HTN in ESRD Patient on Dialysis are ACEI &ARBS.

#Cardiology

Hypertensive Encephalopathy

-In hypertensive encephalopathy, the treatment guidelines are to reduce the MAP 25% over 8 hours. Labetalol, nicardipine, esmolol are the preferred medications; nitroprusside and hydralazine should be avoided.

#Cardiology

Pathologic Q waves in ECG.

#Cardiology

DD for pathological Q waves in ECG.

#Cardiology

Remember:

-The diagnosis of Miller Fisher syndrome can be confirmed by a positive anti-GQ1b iGg antibody testing.

#Genetic

Asthma

Step 1. Always start the treatment of asthma with an inhaled short-acting
beta agonist (SABA) as needed.

-Examples of SABA are:
• Albuterol
• Pirbuterol
• Levalbuterol

-USMLE
#Respiratory

Asthma

Step 2. Add a long-term control agent to a SABA. Low-dose inhaled corticosteroids.
-(ICS) are the best initial long-term control agent.

-Example of ICS are:
• Beclomethasone, budesonide, flunisolide, fluticasone, mometasone,
triamcinolone.

#Respiratory

Asthma

Step 3. Add a long-acting beta agonist (LABA) to a SABA and ICS, or increase
the dose of the ICS.

-LABA medications are salmeterol or formoterol.

#Respiratory

Asthma

Step 4. Increase the dose of the ICS to maximum in addition to the LABA
and SABA.

#Respiratory

Asthma

Step 5. Omalizumab may be added to the SABA, LABA, and ICS in those who
have an increased IgE level.

#Respiratory

•Anti hypertensives drug of choice:

-In CKD/DM/proteinuria-ACEi/ARB

-In Gout-Losartan-Uricosuri, lowers uric acid levels

-With CAD/myocardial dysfunction-Beta blocker

-In Post renal Tx-CCB

-Pregnancy-Methyldopa/Labetolol/CCB.

#Cardiology

Degree of anaemia depending on Hb%

Hb >12 g/dl : Not anemic
Hb 10–11 g/dl : Mild anemia
Hb 8–9 g/dl : Moderate anemia
Hb 6–7 g/dl : Marked anemia
Hb 4–5 g/dl : Severe anemia
Hb < 4 g/dl : Critical.

#Anemia

HLA associations

- HLA DR3 is associated with diabetes mellitus, autoimmune hepatitis, dermatitis herpetiformis, Graves' disease, membranous glomerulonephritis, myasthenia gravis, Addison's disease, Sjogren syndrome and systemic lupus
erythematosus (SLE).
-HLA B47 is associated with congenital adrenal hyperplasia.
-HLA B27 is associated with seronegative arthropathies such AS, RS.
-HLA A28 is associated with schizophrenia.
-HLA DR7 is associated with minimal-change disease (nephrotic syndrome).

#General

Remember:

Endocrine causes of HTN include:

-Acromegaly
-Cushing's syndrome
-Conn's syndrome
-Pheochromocytoma
-Hyperthyroidism
-Hypothyroidism
-P.Hyperparathyroidisim.

#Cardiology