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Internal medicine Cardiology Heart Failure: Is a complex clinical syndrome caused by structural or functional impairment of ventricular filling and/or ejection of blood. Causes: Coronary artery disease Diabetes mellitus Hypertension Clinical features: Dyspnea Peripheral edema Fatigue Tachycardia...

Internal medicine Cardiology Heart Failure: Is a complex clinical syndrome caused by structural or functional impairment of ventricular filling and/or ejection of blood. Causes: Coronary artery disease Diabetes mellitus Hypertension Clinical features: Dyspnea Peripheral edema Fatigue Tachycardia Murmurs Irregular pulse Diagnosis: ECG NT-proBNP Troponin Echo Treatment: ➔ Beta blockers ( metoprolol, bisoprolol 5 mg ) ➔ Plus ARBs inhibitors ( valsartan ) or ACE inhibitors ( ramipril ) ➔ SGLT2 ( Jardiance, dapagliflozin)  ➔ Diuretics ( furosemide ) VALSARTAN Acute coronary syndrome ACS: the suspension or confirmed acute myocardial infarction ACS classified into two groups: 1) NSTE-ACS: acute coronary syndrome manifested without ST-elevation - NSTEMI: associated with rest angina symptoms that lasts >20 min & rise in troponin - Unstable angina: absence of detectable myocardial injury biomarkers 2) STE-ACS: acute coronary syndrome manifesting with ST-elevation Clinical features: ❖ Retrosternal pain ➔ Dull, squeezing pressure & or tightness ➔ Commonly radiates to left chest, arm shoulder & neck, jaw or epigastrium ➔ Provoked by excretion or stress ➔ Symptoms relieved after administering nitrates ➔ The peak of time is usually in the morning ❖ Dyspnea ❖ Nausea & vomiting ❖ Dizziness ❖ Syncope Diagnosis: ECG: STEMI or NSTEMI Troponin Coagulation panel ( INR, APT, APPT ) Treatment Triple therapy: ❖ Anticoagulation ( warfarin , heparin) ❖ Dual antiplatelets Aspirin + Clopidogrel Chronic coronary artery disease: ischemic heart disease due to narrowing or blockage of coronary arteries Clinical features: ❖ Paroxysmal attacks of retrosternal chest discomfort ❖ Angina ❖ Provoked by coronary stenosis when it reaches > 70% Treatment: ❖ Antiplatelets therapy ( aspirin ) ❖ Statins ( atorvastatin ) ❖ Antianginal therapy calcium channel blockers ( amlodipine) Atrial fibrillation: Diagnosis ECG: absent p-waves Treatment: Anticoagulation ( enoxaparin ) Beta blockers Digoxin PZY12 - Inhibitors ( antiplatelets)  Clopidogrel Ticlopidine Ticagrelor Cangrelor Differential diagnosis of chest pain: Pulmonary embolism Pneumonia Myocarditis Pericarditis - diffuse st-elevation & p-q interval shortened Aortic dissection Primary MI Anginal treatment: ❖ Betablocokers ❖ Nitroglycerin ❖ CCB: dilate the arteries, considered as antianginal agents ( prevent vasospasm) ❖ Metazidine: ( metabolic agent, blockers of potassium channel & improve contractility) Hypertrophic cardiomyopathy: Has increased demand and low blood supply due to too much muscles & not enough arteries to supply the muscles. Symptom: Angina CHF Requerence of syncopes Treatment 1) Beta blockers ( highest dose) → CCB verapamil 2) Pacemaker 3) Myomectomy ( partial removal of septum or ablation)