❌What are the contraindications to thrombolysis?
.Intracranial neoplasm
.Stroke < 3 months
.Aortic dissection
.Recent head injury
.Pregnancy
.Severe hypertension
.Active internal bleeding
.Recent haemorrhage,
.Trauma or surgery (including dental extraction)
.Coagulation and bleeding disorders

🛡Beta-blockers should not be prescribed concurrently with verapamil (risk of complete heart block)

🪄Water hammer

🔴

.Aspirin
Antiplatelet - inhibits the production of thromboxane A2
.Clopidogrel
Antiplatelet - inhibits ADP binding to its platelet receptor

🏡As per NICE 2020 guideline:
.PCI + anticoagulant = Clopidogrel + Aspirin
.PCI and NO anticoagulant = Prasugrel + Aspirin
.NO PCI = Ticagrelor + Aspirin

‼️Anaphylaxis

Patients should be offered a prescription for 2 adrenaline injectors before discharge and advised to carry these with them at all times.

😁The following ECG changes are considered normal in athletes:
.Junctional rhythm
.First degree heart block
.Wenckebach phenomenon
.Sinus bradycardia

😭  In Acute myocardial infarction (MI)

.The first sign is hyperacute T waves but often only persists for a few minutes
.ST elevation will then develop
.The T wave usually gets inverted within the first 24 hours. The inversion of the T waves can last for days to months
.Pathological Q waves will develop after several hours to days. This change will usually persists indefinitely

💘Axis deviation in ECG

🫰Mnemonic

WiLLiaM MaRRoW 
.in LBBB there is a 'W' in V1 and a 'M' in V6
.in RBBB there is a 'M' in V1 and a 'W' in V6

😈INR means the ratio of the prothrombin time for the patient over the normal prothrombin time.

😇Statins should be administered at night because this is when most cholesterol synthesis occurs. This is especially true for simvastatin which has a shorter half-life than other statins.

📌Antiplatelets
Below is the summary of the latest guidelines

.NSTEMI
1st line: Aspirin (lifelong) & clopidogrel or ticagrelor (12 months)

.STEMI
1st line: Aspirin (lifelong) & clopidogrel or ticagrelor (1m if no/bare stent, 12 m if drug-eluting stent)
2nd line: If aspirin is contraindicated, clopidogrel (lifelong)

.TIA
1st line: Clopidogrel (lifelong)
2nd line: Aspirin (lifelong) & dipyridamole (lifelong)

.Ischaemic stroke
1st line: Clopidogrel (lifelong)
2nd line: Aspirin (lifelong) & dipyridamole (lifelong)

.Peripheral arterial disease
1st line: Clopidogrel (lifelong)
2nd line: Asprin (lifelong)

🤯Treating Hypertension - step 4 --K+ < 4.5 then spironolactone --K+ > 4.5 then higher-dose thiazide-like diuretic

👨‍💻Torsades de pointes

📞Mnemonic

Aortic stenosis

SAD
-Syncope
-Angina
-Dyspnoea on exertion

👾Chrons vs UC

😎Multiple endocrine neoplasia

Multiple endocrine neoplasia (MEN) is an autosomal dominant disorder.

Remember the rule of P’s

MEN type I (3 P’s)
.Parathyroid (95%): Hyperparathyroidism due to parathyroid hyperplasia (70%)
.Pancreas (50%): Insulinoma, gastrinoma (leading to recurrent peptic ulceration)
.Pituitary
.Genetics: MEN1 gene
.Presentation (common) = hypercalcemia

MEN type IIa (2 P’s)
.Parathyroid (60%)
.Phaeochromocytoma
.Medullary thyroid cancer (70%) 

MEN type IIb (1 P)
.Phaeochromocytoma
.Marfanoid body habitus
.Neuromas
.Medullary thyroid cancer (70%) 
.Genetics: RET oncogene

🫥Complications of Epidurals in Labour

.Low BP → 1/50
.Severe headache → 1/100
.Nerve damage → 1/1000 (lasting less than 6 months) and 1/13,000 lasting more than 6 months
.Epidural abscess → 1/50,000
.Meningitis → 1/100,000
.Severe injury including paralysis 1/250,000

😏Dosage chart for TB treatment