#Clinical_Practice guidelines:
#Cardiogenic_shock (CS)
is a clinical syndrome characterized by a primary cardiac disorder that results in both clinical and biochemical evidence of tissue hypoperfusion due to an inadequate cardiac output (CO), that may result in multi-organ failure and death.

✅ The presence of clinical signs of hypoperfusion (i.e. cold clammy extremities, oliguria, mental confusion, dizziness and narrow pulse pressure)

✅ biochemical manifestations of hypoperfusion (i.e. elevated serum creatinine, metabolic acidosis and elevated serum lactate)👉 is crucial for the diagnosis, while hypotension (systolic blood pressure [BP] <90mmHg), 👉that is often the primary clinical manifestation of CS.

اي مريض AF بترجعه ل sinus rhythm بيمشي على AC على الاقل لمدة اربع اسابيع ثم يتم تقييم الحالة علشان نحدد هتوقف دواء السيولة ولا يكمل حسب ال
CHA2DS2VA score

المريض الوحيد اللي ممكن مياخدش دواء سيولة
هو المريض اللي بيرجع في خلال ٢٤ ساعه والاسكور بتاعه زيرو

#cardionotes

🔴 Finerenone in Heart Failure with Mildly Reduced or Preserved Ejection Fraction
https://www.nejm.org/doi/full/10.1056/NEJMoa2407107

⚫️ Background
• Steroidal antagonists improve outcomes in HFrEF.
• Efficacy in mildly reduced or preserved ejection fraction is unknown.

⚫️ Methods
• Double-blind trial with patients having ejection fraction ≥40%.
• Patients were randomly assigned to finerenone (20 or 40 mg daily) or placebo.
• Primary outcome: composite of worsening heart failure events and cardiovascular death.

⚫️ Results
• Median follow-up: 32 months.
• Primary outcome events: 1083 (finerenone) vs. 1283 (placebo); rate ratio 0.84 (P=0.007).
• Worsening heart failure events: 842 (finerenone) vs. 1024 (placebo); rate ratio 0.82 (P=0.006).
• Cardiovascular deaths: 8.1% (finerenone) vs. 8.7% (placebo).

⚫️ Conclusions
• Finerenone significantly reduced heart failure events and cardiovascular deaths compared to placebo.
• Increased risk of hyperkalemia, reduced risk of hypokalemia.

@Cardiology_Updates

​​🔴 2024 ESC Guidelines on management of Atrial Fibrillation

The 2024 guidelines stress the importance of optimal care according to the new AF-CARE pathway, which has been designed to ensure that each and every patient with AF can benefit from recent scientific advances:

▪️ C - Comorbidity & risk factor management
▪️ A - Avoid stroke and thromboembolism
▪️ R - Reduce symptoms by rate & rhythm control
▪️ E - Evaluation & dynamic reassessment. 


@ESC_2024

Interpretation Carcinoembryonic Antigen, CEA

Normal
Non-smokers: <2.5 mg/ml
Smokers: <5 ng/ml

Increased
Benign disease unlikely if >10 ng/ml
Distant metastasis most likely if >100 ng/ml

13#_حاله يفضل فيها الماريفان عن الادويه الحديثه
#Conditions_where warfarin is still preferred over DOACs
1.mechanical valve
2. Rheumatic Mitral valve stenosis (MS) with Atrial Fibrillation
3. Rheumatic MS with previous cardioembolic episode
4. Rheumatic MS with left atrial thrombus
5. Non Rheumatic MS (moderate/severe) with Atrial Fibrillation
6.Switching from DOAC for anticoagulation in pregnancy if managed with a dose of warf <5mg/day.
7. Very High BMI
8. Frail elderly who is stable on warf to be continued on warf ( FRAIL-AF & AGS Beers 2023)
9. DOAC failure
10.Antocoagulation during breastfeeding.
11. Anticougulation for thromboembolism in CIRRHOSIS Child Pugh C- warfarin
For Child Pugh A & B - DOAC
12.Antiphospholipid syndrome
13. post LVAD


#تعال_استفيد

فضلا وليس امرا تابعو هذي صفحه معلومات طبية 👇

https://www.facebook.com/share/p/b7Gt4uRFnM1mtY2U/?mibextid=WC7FNe

#Just_remember
#Hypokalaemia_with_hypertension
 🔰 Cushing's syndrome    
 🔰Conn's syndrome (primary  hyperaldosteronism)  
 🔰 Liddle's syndrome  autosomal dominant disorder that mimics hyperaldosteronism
 🔰renal artery stenosis
 🔰11-beta hydroxylase  deficiency*
 🔰Carbenoxolone, an anti ulcer drug, and liquorice excess can potentially cause hypokalaemia associated with  hypertension

#Hypokalaemia_without_hypertension
 ✏️diuretics
 ✏️GI loss (e.g. Diarrhoea,  vomiting)
 ✏️renal tubular acidosis (type 1 and 2 )
 ✏️Bartter's syndrome
 ✏️Gitelman syndrome



Protect your kidneys ,save your heart ❤️.
#Love_Medicine

@Mmaqqy777_bot
@Medical_Channel_222

مازلنا مع آخر guidelines في علاج جرثومة المعده
ثاني الخطوط العلاجية

العلاج الثلاثي مع rifbutan
مضاد حيوي
عبارة عن
اومبيرازول او ايزموبرازول 40 مجم كبسولة كل 8ساعات
مع
Rifbutan 50mg
كبسولة كل 8ساعات
مع
اموكسيل 1جم ك كل 12ساعة

يتواجد في الاسواق في كبسولات
Talicia
الجرعة 4 كبسول كل 8 ساعات
12كبسولة يوميا لمدة اسبوعين

مازلنا مع آخر guidelines في علاج جرثومة المعده
ثالث الخطوط العلاجية

مجموعة العلاج الثلاثي المحتوي علي vonprazan لمدة 14 يوم
عبارة عن

Clarithromycin 500
كبسول كل 12ساعة
مع

اموكسيسلين 1 ك جم كل 12ساعة
أو 500 مجم 2ك كل 12ساعة
مع

Vonprazan 20mg
قرص كل 12ساعة
في الدول العربيه يؤخذ كل نوع لوحدة
في الخارج
متوفر كل الانواع في عقار واحد اسمة voquenza كما في الصورة

#Antithrombotic_therapy in
patients with obesity

1.No dose adjustment is required for antiplatelet medications in patients with vs. without obesity.

2.In patients who have indication for chronic oral anticoagulation therapy and have undergone bariatric surgery, it is reasonable to prefer VKAs over DOACs.

3.In patients receiving warfarin and a GLP-1 RA, the INR should be carefully monitored.

4.It is reasonable to avoid edoxaban and dabigatran for prevention or treatment of VTE in patients with a BMI >40 kg/mor body weight > 120 kg.

#ESC_2024