Dr. Usman's Cardiology Notes

Highlights of the first day of the 2023 ESC Congress:  1- SGLT2 inhibitors are recommended as class I in HF mrEF and HFpEF (dapagliflozin and empagliflozin)  2- there is no change in the strategies of antithrombotic treatment in patients with ACS : Aspirin + P2Y12 inhibtirs for 12 months flooded by aspirin alone for life long (class I).  3- Surgery is recommended for early Prosthetic valve endocarditis (less than 6 months) with new valve replacement and complete debridement (class IC) 4- ACS management in cancer patients: Invasive strategy if the life expectancy >6 months  Conservative management if poor prognosis  Antithrombotic therapy according to platelet count 5- SGLT2 inhibitors are recommended as first line treatment ( class I) in type 2 diabetic patients with established ASCVD (to reduce CV risk independent of glucose control , in type2 diabetic patients with HF(to reduce HF hospitalizations ), and in type 2 diabetic patients with CKD (to reduce ...

BRADI mnemonic for reversible causes of bradycardia 1. BRASH/hyperkalemia Isolated hyperkalemia  BRASH syndrome (Bradycardia, Renal failure, AV node blockade, Shock and Hyperkalemia) 2. Reduced vital signs Hypoxia Hypoglycemia Hypothermia +/- hypothyroid 3. Acute coronary occlusion Inferior MI: nodal ischemia and vagal response, self-limiting or responds to atropine Anterior MI: infranodal ischemia, often requires pacing 4. Drugs: withdraw if stable, reverse if unstable Beta-blockers Calcium channel blockers Digoxin 5. Intracranial pressure, Infection (Lyme, endocarditis): treat underlying

BRASH Syndrome B - Bradycardia R - Renal failure A - AV nodal blockade S - Shock H - Hyperkalemia Typical ECG in BRASH: HR 30, peaked T waves, flattening of P waves (Bradycardia out of proportion to other findings of hyperkalemia) BRASH Treatment:  • Aggressive treatment of hyperkalemia  • Consider epinephrine (↑HR and drives K+ intracellularly)  • If hypovolemic, give IV fluids ("balanced fluids" > normal saline)  • If on a Ca2+ channel blocker, ß blocker, or digoxin, consider reversal strategy

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