Dr Hadi Maljawi

  1) statins ( simvastatin ) : used if LDL is elevated   SE: myopathy and rhabdomyolysis  2) fibrates : used if TG is elevated  meme SE  3) cholesteramine  4 ) omega oil fatty acid  5 ) niacin 

Indication :  1) 3 vessels disease 2) occlusion of the  left main coronary artery 3) occlusion of the left proximal anterior descending coronary artery 4) chronic disabling angina vessels used :  1) great saphenous vein  2) internal thoracic artery ( the best )

1) ventricular fibrillation : m.c.c of death in the first hr post MI  2) cardiogenic shock  3) left ventricular failure  4) bradycardia , AV block : inferior  5) ventricular aneurysm : 3-7 d post MI ( persistent ST elevation )  6) ventricular rupture : 1st week  7) mitral regurgitation : more with inferior  8) VSD : anteroseptal , 3-7 d 9) acute cardiac tamponade  10) RV dysfunction : inferior , give dobutamine  11) pericarditis : 2 weeks post MI 

1 ) inferior MI : right coronary artery ( RCA )       more favorable prognosis , ST elevation on lead II , III , aVF     risk of bradycardia due to AV block , right ventricular dysfunction and hypotension . 2) anterior MI : m.c  LAD artery , lead v1-v4   3) posterior MI : R wave in leads v1-v3  4) lateral MI  5) Anteroseptal MI 

include unstable angina , STEMI , NSTEMI . cardiac enzymes slevated in STEMI , NSTEMI  signs :  1) typical chest pain more in duration >20mn  2) N , V , sweeting  diagnosis :  1) cardiac enzymes .     a) myoglobin : 1st enzyme to appear 1-4 hrs and first to disappear 24 hrs ( best to recurrence )      b) troponin-I : the best , rise in 3-12hrs and return to normal in 7 days .     c) CK-MB : rise in 3-12 hrs and return in 2-3 days      d) LDH : last one appear and last one disappear . 2) ECG : show ST elevation in STEMI and ST depression in NSTEMI .  treatment : MONA-B + anticouagulate +emergency reperfusion therapy ( PCI and stenting the best or fibrinolytic )  morphine  O2 nitrate aspirin B-blockers 

typical chest pain : retrosternal ( central )  heaviness  radiate to left arm shoulder or neck  relieved by rest or sublingual nitrate  risk factors : 1)hypercholesterolemia ( increased LDL ,TG , cholesterol , decreased HDL )  2) smoking  3) hypertension  4) hyperglycemia  5) lack of exercise  6) alcohol , stress  7) diet rich in saturated fat ( animal )  8) obesity  9)men over 60 women over 65  10) male sex  11) aortic stenosis  12) hypermocystinuria found in megaloblastic anemia . types : 1) stable angina  2) unstable angina  3) STEMI MYOCARDIAL INFRACTION  4)NSTEMI MYOCARDIAL INFRACTION  coronary artery sd ( 1 , 2 , 3 )  

1) carotid massage unilateral because bilateral can cause sever bradycardia . 2) valsalva maneuver  3) occular massage   4) adenosin IV : the drug of choice . CI in asthma and systolic BP < 90 because it can cause bronchospasm and hypotension so give calcium channel blockers .

common cause : 2I2P2CAH   1) ischemic heart disease  2) idiopathic  3) pneumonia 4) pericarditis  5) congenital heart disease  6) cardiac surgery  7) alcohol  8) hyperthyroidism  treatment  less than 48 hrs if stable give b-blockers or calcium channel blockers if unstable cardioversion  more than 48 hrs risk for thrombosis so give anticoagulation for 4-6 weeks before correction of AF.

1) atrial fibrillation : no P wave , irregular , narrow QRS 2) atrial flutter : saw tooth 3) supraventricular tachycardia : no P wave regular  , narrow QRS 4) venricular tachycardia : no P and T waves regular , wide QRS 5) ventricular fibrillation 6) wolf parkinson white syndrome : delta wave usually associated with AF .

Is the normal heart rate , normally is 60-100 beat / minute . every P wave is followed by QRS and every QRS followed by T wave with regular interval . P wave represents atrial contraction ( depolarisation ) QRS represents ventricular contraction . T wave represents ventricular repolarization .   sinus tachycardia :  HR more than 100 but normal rhythm . causes : pain , fever , exercise , anemia , fear , hyperthyroidism , atropine  , adrenaline sinus bradycardia : HR less than 60 but normal rhythm . causes : hypothyroidism , athletes , B-blockers . if symptomatic need atropine .  

gram- dont develop resistence eaisly 1st generation ( cephalexin , cefazolin )  mainly gram+, strepto and staph so important for skin infection  can be used to treat some cases of UTI  2nd generation ( cefuroxime , cefoxitin )  more gram- than 1st and also cover gram+ , so mainly used to treat UTI gram- and some gram+ strepto infection like tosillitis otitis media ... cefoxitin also cover anaerobics ( GI flora ) best choice of GI surgery prophylaxis ... 3rd generations (ceftrixone , cefotaxime ceftazidim ) excellent gram- so used to treat UTI  encapsulated bacteria such as pnemo ,meningo , Hib  cross blood brain barrier so its important for meningitis  gonorrhea  dont cover staph dont cover anaerobics  ceftazidine the only that covers pseudomonas aerogenosa ...

1) aminopenicillin ( amoxicillin )  2) piperacillin  3) ticarcillin                    broad spectrum of activity gram- and gram+, but gram- can develop resistence rapidly to penicillin by producing the enzyme B-lactimase .                   amoxicillin + clavulinic acid = augmentin to decrease gram- resistenve ..                   all of the penicillin are active against strepto ( gram+ ) but not staph ( gram+ ) because staph has penicillinase enzyme that destruct these types of penicillin .the only type are active against penicilline is called penicillinase resistence include ( methicillin , oxacillin )        mainly used for skin infection     important side effect is allergy 

mecanisme of action: 1) inhibit bacterial cell wall (  B-lactamantibiotics , vancomycin ) 2) inhibit bacterial cell membrane ( daptomycin ) 3) inhibit bacterial protein synthesis (  aminoglycoside , tetracycline , macrolids ) 4) inhibit bacterial DNA synthesis ( flouroquinolones  )              ciprofloxacin , levofloxacin , norfloxacin  5) antifolate ( trimethoprime , cotrimaxazole )              cotrimaxazole = trimethoprime+sulfamethaxazole 

definition :  ( CD20 ) antibody mediated which is the function of B-cells , it is converted into plasma cells taht produce antibody IgA IgM IgG IgD IgE . IgA : surface antibody attack bacteria on the body surface like GI lumen respiratory lumen IgM : the largest and first one produced in responce to bacteria means acute infection . IgG : the smallest , only that cross the placenta , remains in serum as memory for old infection . IgE : responsible fpr allergy stimulate mast cells to release histamine . IgD : least important deficiency in humoral immunity increase risk of infection mainly bacteria ( encapsulated ) 

definition : Folate-deficiency anemia is the lack of folic acid in the blood. Folic acid is a B vitamin that helps your body make red blood cells. If you don’t have enough red blood cells, you have anemia. Red blood cells carry oxygen to all parts of your body. When you have anemia, your blood can’t bring enough oxygen to all your tissues and organs. Without enough oxygen, your body can’t work as well as it should. Low levels of folic acid can cause megaloblastic anemia. With this condition, red blood cells are larger than normal. There are fewer of these cells. They are also oval-shaped, not round. Sometimes these red blood cells don’t live as long as normal red blood cells causes : You don’t eat enough foods that have folic acid. These include green leafy vegetables, fresh fruits, fortified cereals, yeast, and meats (including liver). You drink too much alcohol You have certain diseases of the lower digestive tract, such as celiac disease. This type of anemia also occurs

Pathophysiology .   Iron  is essential for the production of hemoglobin. The depletion of  iron  stores may result from blood loss, decreased intake, impaired absorption, or increased demand. ...  Iron deficiency  will lead to microcytic hypochromic  anemia  on the peripheral blood smear

definition   :  a condition in which there is a deficiency of red cells or of haemoglobin in the blood, resulting in pallor and weariness symptome : Easy fatigue and loss of energy. Unusually rapid heart beat, particularly with exercise. Shortness of breath and headache, particularly with exercise. Difficulty concentrating. Dizziness. Pale skin. Leg cramps. inominua                                                                                                                              causes : iron deficiency b12 deficiency and folate deficiency decrese blood cell production  blood loss red blood cell destruction ( extra and intra hemolysis )