زكاة العلم الدكتور محمد البيضاني

Unstable angina can occur due to - anemia - fever - hypertension with LVH - severe aortic stenosis

10%__20% of patient with unstable angina who undergo PCI , the coronary arteries appear normal or minimal disease. I see one case presented with typical chest pain and T wave inversion At the PCI the coronary appear completely normal

Chest pain with normal ECG and positive S troponine is a an indication of angiography

History of chest pain since three days ECG show -sinus rhythm heart about 90 bpm - Q wave and ST elevation in V1,2 - mild st elevation with biphasic T wave in V3,4 - st depression in lead II and avF Roughly the patient had chest pain, with st change and reciprocal st depression I give - aspirin 300 mg - clopidogrel 300 mg - heparin 1 mL IV - atenolol 50 mg - GTN - atrovastatin 80 mg - captoprel 12.5 mg And referred to the specialist.

Large atrial septal defect appear clearly in subcostal view

Ivabradine - drug that act of SA node by certain mechanisms lead to decrease the heart rate without affecting the repolorisation and ventricular contractility. - use in patient with heart failure ( HF with EF less than 30% and heart rate more than 70 on maximal dose of beta blocker or when beta blocker is contraindicated - also use in angina as not controlled by beta blocker or beta blo blockers contraindicated - side effects ( may develop hyper, bradycardia, luminous phenomena,,,,) - start at low dose 2.5 mg two time daily and check the patient after two weeks

Treatment of hypertension in the Postnatal period 1- if the patient not breastfeeding treat as hypertension in general 2- if the patient breastfeeding avoid ARBS and diuretics.

Inferior MI with complete heart block

Causes of short QT interval 1- hypermagnsemia 2-hypercalcemia 3- digoxin effect or toxic 4- thyrotoxicosis

First comment

- regular irregularity - in beats with red arrows P wave appears clearly and normal PR interval. - beats with yellow arrows come early, not preceded by P wave and have the same shape of preceded QRS with post ectopic wide distance. This called supranodal ectopic beat ( junctional ectopic beats ). Each normal Beat proceeded by ectopic beats this called junctional bigemeni. - AF has feature of irregular irregularity not regular irregularity.

هذي الفسيولوجي شارحهه قبل سنه بس ما ادري ما المصداقيه بالشرح هههه https://youtu.be/6ur8fKWZUUQ

Most common arrhythmia in Myocardial infarction is ventricular ectopic beats 🙃. So my advice if you have patients with chest pain and vague ST and T wave change with ventricular ectopic beats take the complain significantly.