Choosing the antihypertensive drugs based on specific comorbidities , age , sex, race

ACS - STEMI criteria:

- Chest pain ≥ 20 mins and

ECG in ≥ 2 contiguous leads:
1. ≥ 2.5mm ST ↑ in leads V2-3 in men < 40 years
2. ≥ 2.0 mm ST ↑ in leads V2-3 in men > 40 years
3. ≥ 1.5 mm ST ↑ in V2-3 in women
4. ≥ 1 mm ST ↑ in other leads
5. new LBBB

#ECG

Clinical features related to Secondary causes of hypertension

Diabetic nephropathy:

Management
-dietary protein restriction
-tight glycaemic control
- aim for Bp < 130/80 mmHg

-ACE inhibitor or angiotensin-II receptor antagonist
should be start if urinary ACR of 3 mg/mmol or more

-control dyslipidaemia e.g. Statins

Unexplained serum creatinine rise > 30% after starting ACE inhibitors
=
think renovascular hypertension.

RBBB +left anterior or posterior hemiblock + 1st-degree heart block

= trifasicular block

#ECG

Atrial Fibrillation
If unstable
=
synchronised DC cardioversion

Atrial fibrillation + Post PCI for acute coronary syndrome:

Generally patients are given triple therapy (2 antiplatelets + 1 anticoagulant) for
4 weeks-6 months after the event
and
dual therapy (1 antiplatelet + 1 anticoagulant) to complete 12 months

In Atrial Fibrillation, Anticoagulation should be continued for at least 4 weeks after cardioversion.

Many patients need chronic anticoagulation depending on the CHA(2)DS(2)-VASc score.

#ECG

Paroxysmal atrial fibrillation is atrial fibrillation that lasts < 1week having converted spontaneously.

Persistent atrial fibrillation is continuous atrial fibrillation that lasts > 1 week.

Long-standing persistent atrial fibrillation lasts > 1 year, but there is still the possibility of restoring sinus rhythm.

Permanent atrial fibrillation cannot be converted to sinus rhythm

#ECG