🔴 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

💉💉💉952
10 mmol of IV or 20 mmol of ORAL potassium usually raises SERUM potassium by only 0.1 mmol/L.

#Hyperkalemic_ECG

✍The earliest ECG changes of hyperkalemia are peaking of the T waves and shortening of QT interval
- PR interval is prolonged
-loss of P waves
- widening of the QRS complex is seen with "sine- wave pattern
- asystole.


#Pseudohyperkalemia is an in vitro phenomenon caused by the
1-mechanical release of potassium
from cells during phlebotomy or specimen processing
2-marked leukocytosis and thrombocytosis.

#In_patients with pseudohyperkalemia, the plasma potassium concentration is normal.

#DON'T_BE_TRICKED
Significant hyperkalemia associated with a normal ECG suggests pseudohyperkalemia.

#تعال_استفيد

#Hypokalaemia_ECG

😊 U have no Pot and #no_T, but a long #PR and a long #QT

#Chemotherapy_Heart_failure

✍ Doxorubicin: dose-related HF (irreversible)

✍Trastuzumab: non-dose-related HF (reversible)

#تعال_استفيد

#LTOT_in_COPD

#long_term_oxygen_therapy
✍Patients who receive LTOT should breathe supplementary oxygen for at least 15 hours
a day as this reduce mortality.
Oxygen concentrators are used to provide a fixed supply for LTOT.

#Assess patients if any of the following:
🔸 very severe airflow obstruction (FEV1 < 30% predicted).
🔸 Assessment should be 'considered' for patients with severe airflow obstruction (FEV1 30-49% predicted)
🔸 cyanosis
🔸 polycythaemia
🔸 peripheral oedema
🔸 raised jugular venous pressure
🔸 oxygen saturations less than or equal to 92% on room air

#Assessment is done by measuring arterial blood gases on 2 occasions at least 3 weeks apart in patients with stable COPD on optimal management.

#Offer_LTOT_to :
✍patients with a pO2 of < 55 mm Hg (7.3kpa) or SaO2 less than 88% with or without hypercapnia
or
✍to those with a pO2 of 55 - 60 mm Hg (7.3-8kpa) or SaO2 less than 88% with one of the following:
✔secondary polycythaemia
✔nocturnal hypoxaemia
✔peripheral oedema
✔pulmonary hypertension 

#Goals
Oxygen should be administered by nasal cannula or face mask, at 1 to 2 L/min, which provides 24% to 28% oxygen to #Improve PaO2 >60 mm Hg or SaO2 to 88% to 92%.
#N.B :
✍Improving oxygenation above 92% is not helpful and in patients with chronic hypercarbic respiratory failure hypoxemia can worsen V/Q matching and precipitate worsening hypercarbia.

#تعال_استفيد