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 .