#Notes:
✍Difference Between Calcium Gluconate and Calcium Chloride in Hyperkalemia
---
Dilution & Administration
Can It Be Given Directly?
👉Calcium Gluconate:
Can be given undiluted IV push over 5–10 minutes (in emergencies)
Can also be diluted in 50–100 mL of D5W or NS and infused over 10–20 minutes
👉Calcium Chloride:
Must be given via a central line (if peripheral, use a large vein)
Can be given undiluted IV push over 5–10 minutes
Can also be diluted in 50–100 mL of D5W or NS and infused over 10–20 minutes
Why Dilution?
Reduces risk of local irritation
Preferred for non-emergency situations
Avoids complications like tissue necrosis with calcium chloride
#تعال_استفيد
✍Difference Between Calcium Gluconate and Calcium Chloride in Hyperkalemia
---
Dilution & Administration
Can It Be Given Directly?
👉Calcium Gluconate:
Can be given undiluted IV push over 5–10 minutes (in emergencies)
Can also be diluted in 50–100 mL of D5W or NS and infused over 10–20 minutes
👉Calcium Chloride:
Must be given via a central line (if peripheral, use a large vein)
Can be given undiluted IV push over 5–10 minutes
Can also be diluted in 50–100 mL of D5W or NS and infused over 10–20 minutes
Why Dilution?
Reduces risk of local irritation
Preferred for non-emergency situations
Avoids complications like tissue necrosis with calcium chloride
#تعال_استفيد
#البرشامة
💠💠Sixty important sticky notes in cardiology
🌸🌸1-RHD : almost always involve mitral valve with or without other Valves
🌸🌸2-HF with impaired LV function: Keep serum Potassium above 4.5meq to avoid precipitation of ventricular arrhythmia
🌸🌸3-Atrial flutter carries the Same thrombo-embolic risk as AF and should managed as AF as regards indication of anticoagulation
🌸🌸4-Always ask for CXR in patient with chest pain and normal ECG
🌸🌸5- Always check for lead AVR in ECG before interpretation (you may activate primary PCI cath team based on wrong ECG)!
🌸🌸6-ECG leads V1-V2 in the fourth intercoastal space (not the second space)
🌸🌸7-In left sided infective endocarditis , ask for multislice CT cerebral angiography to exclude mycotic aneurysm
🌸🌸8-In reading CXR , always look for lung apex it is frequently missed
🌸🌸9-In infective endocarditis,a always ask for serology for aspergillus, Bartonella, Brucella, Coxiella, legionella
🌸🌸10-Hypotension after Coronary angiography
Either due to :
A-Hypovolemic shock:
bleeding from sheath or retroperitoneal hematoma
B-Cardiogenic shock:
Acute instent thrombosis
C-Anaphylactic Shock:
From contrast
D:Vasovagal: pain during sheath removal
🌸🌸11-Any hospitalised patient who develop new onset AF during hospital stay, you should suspect Pulmonary embolism
🌸🌸12-Enoxaprin is contraindicated if GFR is less than 15 m
And if GFR is from 15-30 we give 1mg/Kg every 24 hours as a therapeutic dose
🌸🌸13-Any wide complex tachycardia in patient with ischemic heart disease should be managed as VT until proved other wise
🌸🌸14-Causes of very high ESR(more than 100 In first hour) includes:
🩺🩺-TB
🩺🩺-Connective tissue disordes
🩺🩺-Malignancy
🌸🌸15-D-Dimer is a good negative test in pulmonary embolism but not specific
🌸🌸16-Uro-sepsis is the most common cause of delirium in elderly
🌸🌸17-Anemia in old age carries the possibility of malignancy and ideally upper and lower GIT endoscopy should be done
🌸🌸18-It is recommended to do lipid profile within 48 hours of onset of ACS as after that there is a possibility of false low cholesterol levels due to enhanced sympathetic activity and lipolysis
🌸🌸19-You can calculate the LDL level from this equation (LDL=Total cholesterol -(HDL + Triglycerides/5)
🌸🌸20-You can calculate the creatinine clearance from this equation (140-ageX weight)/
72X serum creatinine
And multiply by 0.85 if female
🌸🌸21-Metolazone is the only thiazide that can be used in Renal impairment
🌸🌸22-It better to avoid Tienam and Tavanic in elderly as the former can causes convulsions and the latter can precipitate encephalopathy
🌸🌸23-The most common congenital heart disease is bicuspid aortic valve
🌸🌸24-Bicuspid aortic valve can be associated with
-Aortopathy and aortic aneurysm
-Aortic coarctation
-Aneurysm in circle of Willis
🌸🌸25-Never wait for cardiac enzymes in patient with STEMI
🌸🌸26-Congenital complete heart block carries the best prognosis among the all causes of CHB and sometimes can be managed conservativly for years
🌸🌸27-Always check for BP equality on both sides in patient with acute Coronary syndromes to exclude dissection
🌸🌸28-Alway ask about history of sildenafil use before using nitrates
🌸🌸29-Never use sublingual Nifedipine
🌸🌸30-Do not diagnose Rheumatic fever based on arthralgia that is associated with elevated ESR
You should use modified Jones criteria
🌸🌸31-Diagnosis of DM
-FBS more or equal to 126 mg/dl in two separate occasions
Or
-Postprandial blood glucose more or equal to 200mg /dl on two separate occasions
Or
-HbA1c is more or equal to 6.5%
or
-Random blood glucose more or equal to 200 mg/dl in presence of symptoms (Polyurea,polyphagia and loss of weight)
🌸🌸32-Targets in DM control
💠💠Sixty important sticky notes in cardiology
🌸🌸1-RHD : almost always involve mitral valve with or without other Valves
🌸🌸2-HF with impaired LV function: Keep serum Potassium above 4.5meq to avoid precipitation of ventricular arrhythmia
🌸🌸3-Atrial flutter carries the Same thrombo-embolic risk as AF and should managed as AF as regards indication of anticoagulation
🌸🌸4-Always ask for CXR in patient with chest pain and normal ECG
🌸🌸5- Always check for lead AVR in ECG before interpretation (you may activate primary PCI cath team based on wrong ECG)!
🌸🌸6-ECG leads V1-V2 in the fourth intercoastal space (not the second space)
🌸🌸7-In left sided infective endocarditis , ask for multislice CT cerebral angiography to exclude mycotic aneurysm
🌸🌸8-In reading CXR , always look for lung apex it is frequently missed
🌸🌸9-In infective endocarditis,a always ask for serology for aspergillus, Bartonella, Brucella, Coxiella, legionella
🌸🌸10-Hypotension after Coronary angiography
Either due to :
A-Hypovolemic shock:
bleeding from sheath or retroperitoneal hematoma
B-Cardiogenic shock:
Acute instent thrombosis
C-Anaphylactic Shock:
From contrast
D:Vasovagal: pain during sheath removal
🌸🌸11-Any hospitalised patient who develop new onset AF during hospital stay, you should suspect Pulmonary embolism
🌸🌸12-Enoxaprin is contraindicated if GFR is less than 15 m
And if GFR is from 15-30 we give 1mg/Kg every 24 hours as a therapeutic dose
🌸🌸13-Any wide complex tachycardia in patient with ischemic heart disease should be managed as VT until proved other wise
🌸🌸14-Causes of very high ESR(more than 100 In first hour) includes:
🩺🩺-TB
🩺🩺-Connective tissue disordes
🩺🩺-Malignancy
🌸🌸15-D-Dimer is a good negative test in pulmonary embolism but not specific
🌸🌸16-Uro-sepsis is the most common cause of delirium in elderly
🌸🌸17-Anemia in old age carries the possibility of malignancy and ideally upper and lower GIT endoscopy should be done
🌸🌸18-It is recommended to do lipid profile within 48 hours of onset of ACS as after that there is a possibility of false low cholesterol levels due to enhanced sympathetic activity and lipolysis
🌸🌸19-You can calculate the LDL level from this equation (LDL=Total cholesterol -(HDL + Triglycerides/5)
🌸🌸20-You can calculate the creatinine clearance from this equation (140-ageX weight)/
72X serum creatinine
And multiply by 0.85 if female
🌸🌸21-Metolazone is the only thiazide that can be used in Renal impairment
🌸🌸22-It better to avoid Tienam and Tavanic in elderly as the former can causes convulsions and the latter can precipitate encephalopathy
🌸🌸23-The most common congenital heart disease is bicuspid aortic valve
🌸🌸24-Bicuspid aortic valve can be associated with
-Aortopathy and aortic aneurysm
-Aortic coarctation
-Aneurysm in circle of Willis
🌸🌸25-Never wait for cardiac enzymes in patient with STEMI
🌸🌸26-Congenital complete heart block carries the best prognosis among the all causes of CHB and sometimes can be managed conservativly for years
🌸🌸27-Always check for BP equality on both sides in patient with acute Coronary syndromes to exclude dissection
🌸🌸28-Alway ask about history of sildenafil use before using nitrates
🌸🌸29-Never use sublingual Nifedipine
🌸🌸30-Do not diagnose Rheumatic fever based on arthralgia that is associated with elevated ESR
You should use modified Jones criteria
🌸🌸31-Diagnosis of DM
-FBS more or equal to 126 mg/dl in two separate occasions
Or
-Postprandial blood glucose more or equal to 200mg /dl on two separate occasions
Or
-HbA1c is more or equal to 6.5%
or
-Random blood glucose more or equal to 200 mg/dl in presence of symptoms (Polyurea,polyphagia and loss of weight)
🌸🌸32-Targets in DM control
👉👉-HbA1c less than 7%
👉👉-FBS bw 80 -130mg/dl
👉👉-2Hours post prandial less than 180mg
🌸🌸33-Light's criteria for diagnosis of etiology of pleural effusion
-Pleural fluid protein/serum protein more than 0.5
-Pleural Fluid LDH/Serum LDH more than 0.6
-Pleural fluid LDH more than 2/3 of the upper normal value for the serum LDH
One criteria is sufficient to diagnose exudate
And all the three criteria must be negative to say that it is transudate
🌸🌸34-The most common cause of convulsions in elderly is stroke
🌸🌸35-unilateral Horner syndrome with ipsilateral neck pain is suggestive of Carotid dissection until proved other wise
🌸🌸36-Mitral valve prolapse should diagnosed only in Parasternal long axis view not apical 4chamber view
🌸🌸37-Drop out of the interatrial septum in Apical 4 chamber is not suggestive of ASD except after confirmation with colour flow across and further assessment in subcostal view
🌸🌸38-Dynamic LVOT obstruction with significant LVOT gradient could be seen in elderly dehydrated tachycardiac patients(especially if hypertensive withLVH and small LV cavity(
After rehydration and control of HR
The gradient across the LVOT disappear
🌸🌸39-Verapamil increase the digitalis toxicity and it is better to combine Diltiazem rather than verapamil with digitalis
🌸🌸40-Digoxin toxicity can occur inspite of normal digoxin level
And can be diagnosed only based on clinical basis and ECG
🌸🌸41-ACE inhibitors can be considered for all patients with CAD if no contraindictions
🌸🌸42-In patients with CHF and there is contraindiction for ACE inhibitors, you can give instead:Hydralazine (Arteriolar dilator) with isosorbide dinitrate(venodilator)
🌸🌸43-Spironolactone should be given for patients with resistant hypertension as it act as aldosterone antagonist
🌸🌸44-Spironolactone should be given for patients with right sided HF (congestive hepatomegaly and Ascites ) as one of the mechanisms of fluid retention in these patients is failure of the liver to metabolise the aldosterone , so we give anti aldosterone
🌸🌸45-Enoxaparin should not be given for pregnant women with prosthesis without monitoring of antifactor X level
🌸🌸46-Lidocaine and phenytoin are the antiarrhythmic drugs of choice in patients with ventricular arrhythmia secondary to digitalis toxicity
🌸🌸47-Causes of Bidirectional VT are CPVT and digitalis toxicity
🌸🌸48-Spodick's sign in ECG:
is downsloping TP segment in lead II can help to differentiate pericarditis from other causes of ST elevation
🌸🌸49-Dewinter Sign in ECG: is hyperacute T waves with upsloping ST depression in anterior precordial leads ; indicative of acute proximal LAD occlusion and considered as STEMI equivalent
🌸🌸50-The Safest drugs that can be given for patients with pericarditis and ACS are Ibuprofen (as it increases Coronary blood flow) or high dose acetyl salicylic acid
🌸🌸51-As regard second degree heart block, there is a distinct subtype called 2:1AV block
Can be either Mobitz type I or type II
If it improves with atropine and narrow complex, most probably it is type I
If it worsen with atropine or wide complex , most probably it is type II
🌸🌸52-Reciprocal ST depression in I and AVL may preceed frank ST elevation in Inferior MI
🌸🌸53-To diagnose MI in paced rhythm with LBBB morphology, we apply sgarbossa criteria
🌸🌸54-Anteroseptal STEMI and isolated RV infarction both can causing ST elevation from V1-V3
But the difference is
If the ST elevation is maximum in V1 and decreases gradually to V3 ,then it is RV infarction
If the ST elevation is gradually increasing towards V3 , then it is anteroseptal MI
🌸🌸55-To differentiate Course AF from Atrial flutter with variable block,
You should notice that the flutter waves are identically the same morphology, so if the atrial activity waves are different, then it is course AF
🌸🌸56-In Echocardiography, we assess pericardial effusion in diastole (as regards measurement)
🌸🌸57-In patient with Interatrial septal aneurysm, you should exclude PFO
👉👉-FBS bw 80 -130mg/dl
👉👉-2Hours post prandial less than 180mg
🌸🌸33-Light's criteria for diagnosis of etiology of pleural effusion
-Pleural fluid protein/serum protein more than 0.5
-Pleural Fluid LDH/Serum LDH more than 0.6
-Pleural fluid LDH more than 2/3 of the upper normal value for the serum LDH
One criteria is sufficient to diagnose exudate
And all the three criteria must be negative to say that it is transudate
🌸🌸34-The most common cause of convulsions in elderly is stroke
🌸🌸35-unilateral Horner syndrome with ipsilateral neck pain is suggestive of Carotid dissection until proved other wise
🌸🌸36-Mitral valve prolapse should diagnosed only in Parasternal long axis view not apical 4chamber view
🌸🌸37-Drop out of the interatrial septum in Apical 4 chamber is not suggestive of ASD except after confirmation with colour flow across and further assessment in subcostal view
🌸🌸38-Dynamic LVOT obstruction with significant LVOT gradient could be seen in elderly dehydrated tachycardiac patients(especially if hypertensive withLVH and small LV cavity(
After rehydration and control of HR
The gradient across the LVOT disappear
🌸🌸39-Verapamil increase the digitalis toxicity and it is better to combine Diltiazem rather than verapamil with digitalis
🌸🌸40-Digoxin toxicity can occur inspite of normal digoxin level
And can be diagnosed only based on clinical basis and ECG
🌸🌸41-ACE inhibitors can be considered for all patients with CAD if no contraindictions
🌸🌸42-In patients with CHF and there is contraindiction for ACE inhibitors, you can give instead:Hydralazine (Arteriolar dilator) with isosorbide dinitrate(venodilator)
🌸🌸43-Spironolactone should be given for patients with resistant hypertension as it act as aldosterone antagonist
🌸🌸44-Spironolactone should be given for patients with right sided HF (congestive hepatomegaly and Ascites ) as one of the mechanisms of fluid retention in these patients is failure of the liver to metabolise the aldosterone , so we give anti aldosterone
🌸🌸45-Enoxaparin should not be given for pregnant women with prosthesis without monitoring of antifactor X level
🌸🌸46-Lidocaine and phenytoin are the antiarrhythmic drugs of choice in patients with ventricular arrhythmia secondary to digitalis toxicity
🌸🌸47-Causes of Bidirectional VT are CPVT and digitalis toxicity
🌸🌸48-Spodick's sign in ECG:
is downsloping TP segment in lead II can help to differentiate pericarditis from other causes of ST elevation
🌸🌸49-Dewinter Sign in ECG: is hyperacute T waves with upsloping ST depression in anterior precordial leads ; indicative of acute proximal LAD occlusion and considered as STEMI equivalent
🌸🌸50-The Safest drugs that can be given for patients with pericarditis and ACS are Ibuprofen (as it increases Coronary blood flow) or high dose acetyl salicylic acid
🌸🌸51-As regard second degree heart block, there is a distinct subtype called 2:1AV block
Can be either Mobitz type I or type II
If it improves with atropine and narrow complex, most probably it is type I
If it worsen with atropine or wide complex , most probably it is type II
🌸🌸52-Reciprocal ST depression in I and AVL may preceed frank ST elevation in Inferior MI
🌸🌸53-To diagnose MI in paced rhythm with LBBB morphology, we apply sgarbossa criteria
🌸🌸54-Anteroseptal STEMI and isolated RV infarction both can causing ST elevation from V1-V3
But the difference is
If the ST elevation is maximum in V1 and decreases gradually to V3 ,then it is RV infarction
If the ST elevation is gradually increasing towards V3 , then it is anteroseptal MI
🌸🌸55-To differentiate Course AF from Atrial flutter with variable block,
You should notice that the flutter waves are identically the same morphology, so if the atrial activity waves are different, then it is course AF
🌸🌸56-In Echocardiography, we assess pericardial effusion in diastole (as regards measurement)
🌸🌸57-In patient with Interatrial septal aneurysm, you should exclude PFO
🌸🌸58-Central venous pressure is a poor indicator of volume status and we should IVC collapsibility index better
🌸🌸59-In assessment of Aortic prosthesis, Dimensionless velocity index is a useful tool
(LVOT VTI/Aortic VTI) if this ratio is Lee than 0.25 it denote significant stenosis
🌸🌸60-In assessment of mitral prosthesis , MV VTI/LVOT VTI
If this ratio more than 2.5
It denote significant stenosis
#تعال_استفيد
🌸🌸59-In assessment of Aortic prosthesis, Dimensionless velocity index is a useful tool
(LVOT VTI/Aortic VTI) if this ratio is Lee than 0.25 it denote significant stenosis
🌸🌸60-In assessment of mitral prosthesis , MV VTI/LVOT VTI
If this ratio more than 2.5
It denote significant stenosis
#تعال_استفيد
*🚨 Latest ACS Guideline Released!*
*👉 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for Acute Coronary Syndromes*
Key Updates 🏥
✅ DAPT for ACS – Ticagrelor/prasugrel preferred over clopidogrel for PCI patients.
✅ Radial access for PCI – Reduces bleeding & vascular complications.
✅ Complete revascularisation – Recommended for STEMI & NSTEMI.
✅ Cardiogenic shock – Select use of microaxial flow pumps.
✅ Lipid management – High-intensity statins + ezetimibe for LDL ≥70 mg/dL.
✅ Diabetes & ACS – SGLT-2 inhibitors/GLP-1 RAs recommended.
✅ Cardiac rehab – Prioritised, including home-based programs.
📢 Stay updated with the latest evidence!
https://www.ahajournals.org/doi/pdf/10.1161/CIR.0000000000001309?download=true
*👉 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for Acute Coronary Syndromes*
Key Updates 🏥
✅ DAPT for ACS – Ticagrelor/prasugrel preferred over clopidogrel for PCI patients.
✅ Radial access for PCI – Reduces bleeding & vascular complications.
✅ Complete revascularisation – Recommended for STEMI & NSTEMI.
✅ Cardiogenic shock – Select use of microaxial flow pumps.
✅ Lipid management – High-intensity statins + ezetimibe for LDL ≥70 mg/dL.
✅ Diabetes & ACS – SGLT-2 inhibitors/GLP-1 RAs recommended.
✅ Cardiac rehab – Prioritised, including home-based programs.
📢 Stay updated with the latest evidence!
https://www.ahajournals.org/doi/pdf/10.1161/CIR.0000000000001309?download=true
Forwarded from Clinical🎓Pharmacy
قال رسول الله ﷺ : "من نام وفي يده غمر فعرض له عارض فلا يلومن إلا نفسه " ما معنى غمر ؟
👇👇👇
https://tatwwiraldhat.blogspot.com/2025/03/blog-post_2.html
👇👇👇
https://tatwwiraldhat.blogspot.com/2025/03/blog-post_2.html
Forwarded from Clinical🎓Pharmacy
كيف تحافظ على تركيزك أثناء المذاكرة تجدون هنا المقالة وفقكم 👇👇
https://tatwwiraldhat.blogspot.com/2024/09/tarkezmatk.html
https://tatwwiraldhat.blogspot.com/2024/09/tarkezmatk.html
Self Development
كيف تحافظ على تركيزك أثناء المذاكرة ؟
فنرى الكثير من الطلبة يشكون من سوء الحفظ والفهم والإشكال في حقيقة الأمر هو ليس في صعوبة المادّة الدراسيّة بقدر ما هو ضياع الذهن وشروده عند البدء بالمذ
Forwarded from Clinical🎓Pharmacy
كيف تذاكر بدون ملل تجدون هنا مقالاتي وفقكم الله وسدد خطاكم 👇👇👇🌹
https://tatwwiraldhat.blogspot.com/2024/09/almtha.html
https://tatwwiraldhat.blogspot.com/2024/09/almtha.html
Self Development
كيف تذاكر بتركيز بدون ملل؟
تتسبب المذاكرة بالملل لكثير من الناس ، فهي تحتاج من الإنسان إلى قضاء أوقات طويلة في الدراسة ، والتفرغ التام لها، كونها من الأنشطة المصيرية
- علاج التشتت الذهني والسرحان .
- خطوات الحفظ بسرعة وعدم النسيان
-خطوات علاج القلق وتفكير الزائد .
- كيف تحافظ على صحتك النفسية.
-علاج الهذيان وأعراض وعلاجة .
تجدون كل مقالاتي هنا وفقكم الله وسدد خطاكم ❤⤵️
https://tinyurl.com/tatwerdat1
- خطوات الحفظ بسرعة وعدم النسيان
-خطوات علاج القلق وتفكير الزائد .
- كيف تحافظ على صحتك النفسية.
-علاج الهذيان وأعراض وعلاجة .
تجدون كل مقالاتي هنا وفقكم الله وسدد خطاكم ❤⤵️
https://tinyurl.com/tatwerdat1
- علاج التشتت الذهني والسرحان .
- خطوات الحفظ بسرعة وعدم النسيان
-خطوات علاج القلق وتفكير الزائد .
- كيف تحافظ على صحتك النفسية.
-علاج الهذيان وأعراض وعلاجة .
تجدون كل مقالاتي هنا وفقكم الله وسدد خطاكم ❤⤵️
https://tinyurl.com/tatwerdat1
- خطوات الحفظ بسرعة وعدم النسيان
-خطوات علاج القلق وتفكير الزائد .
- كيف تحافظ على صحتك النفسية.
-علاج الهذيان وأعراض وعلاجة .
تجدون كل مقالاتي هنا وفقكم الله وسدد خطاكم ❤⤵️
https://tinyurl.com/tatwerdat1
- علاج التشتت الذهني والسرحان .
- خطوات الحفظ بسرعة وعدم النسيان
-خطوات علاج القلق وتفكير الزائد .
- كيف تحافظ على صحتك النفسية.
-علاج الهذيان وأعراض وعلاجة .
تجدون كل مقالاتي هنا وفقكم الله وسدد خطاكم ❤⤵️
https://tinyurl.com/tatwerdat1
- خطوات الحفظ بسرعة وعدم النسيان
-خطوات علاج القلق وتفكير الزائد .
- كيف تحافظ على صحتك النفسية.
-علاج الهذيان وأعراض وعلاجة .
تجدون كل مقالاتي هنا وفقكم الله وسدد خطاكم ❤⤵️
https://tinyurl.com/tatwerdat1
#Cardiac_note
✍️most cardiac tumors are metastatic
✍️primary tumor is rare :
-70% of primary is benign
-50% of primary is myxoma
-myxoma mostly arise fossa ovalis of left atrium
-constitutional symptoms of myxoma due to interleukin production
- angiosarcoma most common primary malignant mostly arise in right atrium
#تعال_استفيد
✍️most cardiac tumors are metastatic
✍️primary tumor is rare :
-70% of primary is benign
-50% of primary is myxoma
-myxoma mostly arise fossa ovalis of left atrium
-constitutional symptoms of myxoma due to interleukin production
- angiosarcoma most common primary malignant mostly arise in right atrium
#تعال_استفيد
في عيادة القلب (١١)
مريض ماشي على amiodarone (cordarone) ،
هنتابعه ازاي في العيادة؟
تتلخص مشاكله الكبرى في تاثيراته
📔على الغدة الدرقية
📔على الكبد
📔على الرئه
📔على العيون
📔على الاعصاب
📔والجلد (blue man syndrome)
✍️بالنسبة للغدة
كل ١٠٠ مج كوردارون فيهم ٣ مج ايودين
يعني القرص الواحد فيه تقريبا ٢٠ ضعف الأيودين المطلوب يوميا ودا بيخلي المريض عرضة لمشاكل الغدة
هنتابع وظايف الغدة بعد ٣ او ٦ شهور من بدء العلاج ثم كل سنة
ممكن يعمل hypothyroidism ودا الأشهر
أو يعمل hyperthyroidism ودا الاقل انتشارا
هنتصرف معاهم ازاي؟
مش هنوقف الدواء
الا لو فيه بديل اكثر امانا منه او الدواء غير فعال اصلا
ونحول المريض لطبيب غدد (بيعالج مشاكل الغدة والدواء مستمر).
✍️بالنسبة للكبد، المشكلة اقل حدوثا من مشاكل الغدة
هنعمل وظايف كبد كل ٦ شهور ايضا
لو انزيمات الكبد زادت اكتر من الضعف او حصل اعرض hepatitis هنوقف العلاج، ويحول لطبيب كبد
نسبة كبيرة من المرضى بترتفع عندهم انزيمات الكبد نسبة بسيطة وبدون اعراض ولا تستدعي ايقاف العلاج.
✍️بالنسبة للرئة بييعمل pulmonary toxicity باشكال عديدة (المريض ممكن يشتكي من كحة unexplained او كرشة نفس او سخونية) علشان كدا بنتابع باشعة عادية ولو فيه اعراض بنضيف وظايف تنفس (PFT) كل سنة على الأقل
بتحصل بكثرة لو المريض اخد ٤٠٠ مج او اكتر يوميا
اما مع الجرعات المستخدمة حاليا فهي نادرة اقل من ٢٪ وبتحصل متاخر بعد شهور لسنوات علشان بتعتمد اكتر على ال
Total coumulative dose
لو حصلت العلاج بيقف
ويحول المريض لطبيب صدر
✍️بالنسبة للعيون
فالكوردارون بيعمل corneal microsdeposits وي من اشهر الاعراض الجانبية
هنتابع فحص رمد كل سنة على الاقل
وغالبا لا تستدعي ايقاف العلاج طالما بدون اعراض
✍️بالنسبة للاعصاب
وتشمل
Tremors, ataxia, sleep problems, peripheral neuropathy
وهي نادرة الحدوث مع الجرعات الصغيرة.
✍️ اخر مشكلة وهي مش مشهورة مع الكوردارون عكس باقي
الclass III antiarrhythmic انه ممكن يعمل QT prolongation
دا هيحتاج عمل رسم قلب كل سنة او في حالة اضافة دواء اخر بيزود ال QT interval
دي مشاكل الكوردارون مع ال long-term use
📁لو متوقع نستخدمه فترة طويلة، هنعمل الفحوصات دي قبل بدء العلاج ونتابع بشكل روتيني.
📁لو متوقع نستخدمه فترة طويلة، هنعمل الفحوصات دي قبل بدء العلاج ونتابع بشكل روتيني.
#cardionotes
مريض ماشي على amiodarone (cordarone) ،
هنتابعه ازاي في العيادة؟
تتلخص مشاكله الكبرى في تاثيراته
📔على الغدة الدرقية
📔على الكبد
📔على الرئه
📔على العيون
📔على الاعصاب
📔والجلد (blue man syndrome)
✍️بالنسبة للغدة
كل ١٠٠ مج كوردارون فيهم ٣ مج ايودين
يعني القرص الواحد فيه تقريبا ٢٠ ضعف الأيودين المطلوب يوميا ودا بيخلي المريض عرضة لمشاكل الغدة
هنتابع وظايف الغدة بعد ٣ او ٦ شهور من بدء العلاج ثم كل سنة
ممكن يعمل hypothyroidism ودا الأشهر
أو يعمل hyperthyroidism ودا الاقل انتشارا
هنتصرف معاهم ازاي؟
مش هنوقف الدواء
الا لو فيه بديل اكثر امانا منه او الدواء غير فعال اصلا
ونحول المريض لطبيب غدد (بيعالج مشاكل الغدة والدواء مستمر).
✍️بالنسبة للكبد، المشكلة اقل حدوثا من مشاكل الغدة
هنعمل وظايف كبد كل ٦ شهور ايضا
لو انزيمات الكبد زادت اكتر من الضعف او حصل اعرض hepatitis هنوقف العلاج، ويحول لطبيب كبد
نسبة كبيرة من المرضى بترتفع عندهم انزيمات الكبد نسبة بسيطة وبدون اعراض ولا تستدعي ايقاف العلاج.
✍️بالنسبة للرئة بييعمل pulmonary toxicity باشكال عديدة (المريض ممكن يشتكي من كحة unexplained او كرشة نفس او سخونية) علشان كدا بنتابع باشعة عادية ولو فيه اعراض بنضيف وظايف تنفس (PFT) كل سنة على الأقل
بتحصل بكثرة لو المريض اخد ٤٠٠ مج او اكتر يوميا
اما مع الجرعات المستخدمة حاليا فهي نادرة اقل من ٢٪ وبتحصل متاخر بعد شهور لسنوات علشان بتعتمد اكتر على ال
Total coumulative dose
لو حصلت العلاج بيقف
ويحول المريض لطبيب صدر
✍️بالنسبة للعيون
فالكوردارون بيعمل corneal microsdeposits وي من اشهر الاعراض الجانبية
هنتابع فحص رمد كل سنة على الاقل
وغالبا لا تستدعي ايقاف العلاج طالما بدون اعراض
✍️بالنسبة للاعصاب
وتشمل
Tremors, ataxia, sleep problems, peripheral neuropathy
وهي نادرة الحدوث مع الجرعات الصغيرة.
✍️ اخر مشكلة وهي مش مشهورة مع الكوردارون عكس باقي
الclass III antiarrhythmic انه ممكن يعمل QT prolongation
دا هيحتاج عمل رسم قلب كل سنة او في حالة اضافة دواء اخر بيزود ال QT interval
دي مشاكل الكوردارون مع ال long-term use
📁لو متوقع نستخدمه فترة طويلة، هنعمل الفحوصات دي قبل بدء العلاج ونتابع بشكل روتيني.
📁لو متوقع نستخدمه فترة طويلة، هنعمل الفحوصات دي قبل بدء العلاج ونتابع بشكل روتيني.
#cardionotes
✍️Thrombolytic therpay in PE :
1- if hemodynamically unstable (high risk PE )
2- Rescue thrombolytic in pt with intermediate risk Consider Rescue Reperfusion if
-Persistent hypoxemia (Sa0, <90 on room air) with symptoms
-Persistent hypotension (SBP< 100 mm Hg)
-Low Bleeding risk
-Significant RV dysfunction
-Large thrombus burden
✍️We can use
- 👉Alteplase is given over 2 hours (100mg over 2hours) and can given Half dose thrombolytics Alteplase 50 mg 1V over 2 hrs (rescue intermediate risk )
👉Streptokinase 2 regimens :
-First is accelerated regimen: 1.5 million 1U over 2 hours
-Second regimen :250, 000 IU over 30minutes, then 100, 000 IU per hour for 12-24
hours.
1- if hemodynamically unstable (high risk PE )
2- Rescue thrombolytic in pt with intermediate risk Consider Rescue Reperfusion if
-Persistent hypoxemia (Sa0, <90 on room air) with symptoms
-Persistent hypotension (SBP< 100 mm Hg)
-Low Bleeding risk
-Significant RV dysfunction
-Large thrombus burden
✍️We can use
- 👉Alteplase is given over 2 hours (100mg over 2hours) and can given Half dose thrombolytics Alteplase 50 mg 1V over 2 hrs (rescue intermediate risk )
👉Streptokinase 2 regimens :
-First is accelerated regimen: 1.5 million 1U over 2 hours
-Second regimen :250, 000 IU over 30minutes, then 100, 000 IU per hour for 12-24
hours.
#RBBB_Note :
لما تعمل رسم قلب لمريض بالصدفة لاي سبب والمريض معندوش اعراض
وتلاقيه Right bundle branch block
ممكن تبقى حاجة طبيعية ف عيانين كتير..
لكن لازم تطلبله ايكو..
ولو لقيت echo RV dilated او حتى اشتباه انه dilated
لازم rule out intracardiac shunt..واشهرهم undiagnosed ASD بانواعها
وده ممكن تبتديه ب
Bubble study with Transthoracic echo
Or Transesophageal echo
Or up to Cardiac MRI and Right heart catheterisation
اخر حاجة..
👉Septum primum ASD by ECG= RBBB +LEFT axis deviation .
👉Septum secundum ASD by ECG=RBBB+RIGHT axis deviation.
✍️2017 ESC guidelines for management of STEMI
لو عيان عنده
Acute typical chest pain
More than 20 minutes
Associated with sweating and vomiting
Suggestive of acute MI
وخصوصا لو فيه
Classic cardiovascular risk factors
DM, HTN, smoker, Dyslipidemia
ورسم القلب موضح انه فيه
Left bundle branch block
Or
Right bundle branch block
The appropriate management is Primary PCI
#تعال_استفيد
لما تعمل رسم قلب لمريض بالصدفة لاي سبب والمريض معندوش اعراض
وتلاقيه Right bundle branch block
ممكن تبقى حاجة طبيعية ف عيانين كتير..
لكن لازم تطلبله ايكو..
ولو لقيت echo RV dilated او حتى اشتباه انه dilated
لازم rule out intracardiac shunt..واشهرهم undiagnosed ASD بانواعها
وده ممكن تبتديه ب
Bubble study with Transthoracic echo
Or Transesophageal echo
Or up to Cardiac MRI and Right heart catheterisation
اخر حاجة..
👉Septum primum ASD by ECG= RBBB +LEFT axis deviation .
👉Septum secundum ASD by ECG=RBBB+RIGHT axis deviation.
✍️2017 ESC guidelines for management of STEMI
لو عيان عنده
Acute typical chest pain
More than 20 minutes
Associated with sweating and vomiting
Suggestive of acute MI
وخصوصا لو فيه
Classic cardiovascular risk factors
DM, HTN, smoker, Dyslipidemia
ورسم القلب موضح انه فيه
Left bundle branch block
Or
Right bundle branch block
The appropriate management is Primary PCI
#تعال_استفيد
في عيادة القلب (٢٤١)
لو بتقيم حالة قبل دخول عملية جراحية
هتعرف المريض بالتعليمات
لو هتبدا beta blocker بلاش تكون البداية في يوم العلمية
لو فيه indication لل statin تبدا قبل العملية
لو فيه اي
Cardiovascular risk factor
نعمله control قبل الجراحة لو الوقت يسمح
انصح المريض بايقاف التدخين ( هيفرق لو وقف التدخين قبل العملية باربع اسابيع او اكتر)
لو فيه انيميا يبقى تتصلح قبل ال
Moderate or high risk surgery
#cardionotes
لو بتقيم حالة قبل دخول عملية جراحية
هتعرف المريض بالتعليمات
لو هتبدا beta blocker بلاش تكون البداية في يوم العلمية
لو فيه indication لل statin تبدا قبل العملية
لو فيه اي
Cardiovascular risk factor
نعمله control قبل الجراحة لو الوقت يسمح
انصح المريض بايقاف التدخين ( هيفرق لو وقف التدخين قبل العملية باربع اسابيع او اكتر)
لو فيه انيميا يبقى تتصلح قبل ال
Moderate or high risk surgery
#cardionotes