STEMI in paced rhythm or LBBB:

Sgarbossa Criteria

1. Concordant ST elevation ≥ 1mm in a lead with a positive QRS (5pts)

2. ST depression ≥ 1 mm in V1, V2 or V3 (3pts)

3. Discordant ST elevation ≥ 5 mm in a lead with a negative QRS (2pts)

≥3points = 98% specific for ACS

#تعال_استفيد

#DOACs and Surgery/Procedures

*Minor (cath,derm,dental,eye): do not stop DOACs

*Moderate (Gallbladder,hernia, hysterectomy, hand/foot surgery): Stop ONE day in advance. Resume ONE day after

*High Bleed risk (joint replace, aortic, kidney): Hold TWO days in advance, Restart 2 after

#تعال_استفيد

أتعرف على مواصفات الرقية الشرعية الصحيحة :
https://tatwwiraldhat.blogspot.com/2024/09/arkehalshraih.html

#Cardiology_Notes

✍️Two key elements are associated with a successful transition to home following hospitalization for heart failure:
👉follow-up phone call within 2 to 3 days of discharge and
👉an office visit within 7 to 14 days of hospital discharge .

✍️In patients with atrial fibrillation, rivaroxaban is noninferior to warfarin in the prevention of stroke or systemic embolism and is associated with less intracranial and fatal bleeding.

✍️Premature ventricular contractions (PVCs) without high-risk features (syncope, family history of premature sudden cardiac death, structural heart disease) are managed with reassurance , treatment is reserved for bothersome symptoms or frequent PVCs.

#MKSAP_19
#تعال_استفيد

#Mitral_stenosis (MS)_anticoagulation is indicated in the following scenarios:

✍️ Atrial Fibrillation (AF): Since MS increases the risk of atrial fibrillation, which in turn increases the risk of thromboembolism, anticoagulation is essential.


✍️History of Thromboembolism: If a patient with MS has had a previous thromboembolic event (e.g., stroke), anticoagulation is recommended.

✍️Left Atrial Thrombus: If imaging shows a thrombus in the left atrium, anticoagulation is indicated.

✍️Severe Mitral Stenosis with Large Left Atrium: A large left atrium (generally ≥ 5.5 cm) increases the risk of clot formation, and anticoagulation may be indicated even if AF is not present.



#note :
👉Only warfarin use as anticoagulant in patient with moderate and sever MS with previous indication .

هذا البوست موجة لكل اطباء الجهاز الهضمي في مصر والوطن العربي

🗒️2024 ECCO
Guidelines on Therapeutics in Crohn’s Disease: Medical Treatment

1️⃣ 5-ASA is not recommended🚫for the induction or maintenance therapy in CD➡️consistent lack of evidence.

2️⃣ Budesonide is recommended for inducing clinical remission in patients with active, mild-to-moderate CD limited to the ileum / ascending colon

👉Additionally, systemic corticosteroids are suggested for induction therapy in patients with active, moderate-to-severe CD

3️⃣Thiopurine monotherapy is not recommended for induction therapy in CD, but it can be considered for maintenance

4️⃣Parenteral
methotrexate
is suggested for both induction and maintenance therapy in moderate-to-
severe CD

5️⃣ Infliximab➡️induction and maintenance for mod/sev active CD
👉Use combination with thiopurine during the induction and continue 6–12 months

Patients who achieve long-term remission with this combination ➡️de-escalation to infliximab monotherapy and withdrawal of thiopurines

6️⃣ Adalimumab is recommended as both induction and maintenance therapy for patients with moderate-to-severe CD

👉For those bionaïve, Adalimumab monotherapy 💪is preferred over combination therapy with thiopurines during induction and maintenance.

7️⃣Certolizumab
is suggested for both induction and maintenance therapy in moderate-to-severe CD.

🎱 There is insufficient evidence to recommend proactive therapeutic drug monitoring over reactive monitoring or standard care for anti-TNF agents
🔥Controversy here

!9️⃣Ustekinumab is recommended for both induction and maintenance therapy in moderate-to-severe CD

🔟Adalimumab and ustekinumab 🆚 are suggested to be equally effective🟰 for both induction and maintenance therapy in biologic-naïve patients with moderate-to-
severe CD


#منقول
#تعال_استفيد

#Low_Voltage_ECG :
✍️Definition:
The QRS is said to be low voltage when:
👉The amplitudes of all the QRS complexes in the limb leads are < 5 mm; OR
👉The amplitudes of all the QRS complexes in the precordial leads are < 10 mm
✍️Mechanisms
Low voltage is produced by…
The “damping” effect of increased layers of fluid, fat or air between the heart and the recording electrode.
Loss of viable myocardium.
Diffuse infiltration or myxoedematous involvement of the heart.

✍️Causes
Specific causes of low voltage include:
👉Fluid: Pericardial effusion; Pleural effusion
👉Fat: Obesity
👉Air: Emphysema; Pneumothorax
👉Infiltrative / Connective Tissue Disorders: Myxoedema; infiltrative myocardial diseases — i.e. restrictive cardiomyopathy due to amyloidosis, sarcoidosis, haemochromatosis; constrictive pericarditis; and scleroderma.
👉Loss of viable myocardium: Previous massive MI; end-stage dilated cardiomyopathy

✍️Most important cause:
Massive pericardial effusion with triad of:
Low voltage
Tachycardia
Electrical alternans
Patients with this triad need to be immediately assessed for clinical or echocardiographic evidence of tamponade


#ECG_note
#تعال_استفيد

#ESGE_guidelines on the management of lower GI bleeding 🩸