CARDIO-NOTES

2026 ACC/ACC ECDP for management of HFpEF

اختيار مضاد الصفائح في مرضى ال ACS النقطة الاولى كل المرضى بياخذوا اسبرين (ما لم يكن ممنوع) النقطة التانيه هنضيف واحد من ال P2Y12 inhibitors واحد من التلاته Clopidogrel Ticagrelor Prasugrel لو مريض ازمة قلبية، ACS و هيدخل قسطرة يبقى نضيف ال Ticagrelor or prasugrel يفضل عن ال Clopidogrel اللي هو البلافكس ودا مبني على ال PLATO trial TRITON-TIMI 38 trial اذا كان واحد من الاتنين مش متاح او ممنوع يتم استخدام البلافكس مريض ال STEMI اللي بياخد مذيب بياخد في الاساس بلافكس (مش بريليك) #cardionotes

Thromboembolism prophylaxis (e.g. with LMWH) is recommended in acute HF patients not already anticoagulated and with no contraindication to anticoagulation. #cardionotes

لو استخدمت Triple antithrombotic therapy or dual antithrombotic therapy وفيهم NOAC اللي ممكن تقلل جرعته هو ال Rivaroxaban or dabigatran ‏For both TAT and DAT regimens, the recommended doses for the NOACs are as follows: Apixaban 5 mg b.i.d., Dabigatran 110 mg or 150 mg b.i.d., Edoxaban 60 mg o.d., Rivaroxaban 15 mg or 20 mg o.d. #cardionotes

Diabetes mellitus Chronic kidney disease Systemic lupus erythematosus Rheumatoid arthritis Hypothyroidism دول اشهر الامراض اللي بترفع الدهون الثلاثية #cardionotes

β-blockers, preferably non-selective β-blockers (nadolol or propranolol), are recommended in patients with Long QT Syndrome (LQTS) and documented QT interval prolongation to reduce the risk of arrhythmic events. #cardionotes

The maximal daily dose for i.v. loop diuretics is generally considered to be: * Furosemide: 400–600 mg/day (i.v.) * Up to 1000 mg/day may be considered in patients with severely impaired kidney function. #cardionotes

When AV surgery is indicated Concomitant replacement of the aortic root or ascending aorta should be considered if the maximal diameter is ≥45 mm and the predicted surgical risk is low. #cardionotes

In acute HF Inotropes are administered under electrocardiographic monitoring and for a limited period of time due to their detrimental effects including myocardial ischaemia and arrhythmogenesis.In patients pre- treated with beta blockers, levosimendan or milrinone are the preferable inotropes, but in patients with systolic blood pressure below 85 mmHg, both agents should be avoided or used in combination with other inotropes or a vasopressor due to their hypotensive effects. #cardionotes

Warfarin acts as a vitamin K antagonist (VKA) by inhibiting vitamin K epoxide reductase, thereby impairing the regeneration of active vitamin K and preventing γ-carboxylation of clotting factors II, VII, IX, and X, as well as proteins C and S. #cardionotes

DOAC use in hepatic impairment Child-Pugh class A: All DOACs appear to be safe. Child-Pugh class B: Apixaban, dabigatran, and edoxaban can be used, and rivaroxaban should be avoided. Child-Pugh class C: There is insufficient evidence to support the use of DOACs. #cardionotes

All beta- blockers used for treatment of HF are lipophilic, with extensive liver metabolism. Lipid solubility allows these compounds to reside longer and at higher concentrations in cell membranes. #cardionotes

الاسبرين يقي من تكرار ال VTE لكن بفاعلية اقل بكتير من ال DOACs Low-dose aspirin monotherapy provides modest benefit for secondary prevention of recurrent VTE after completion of anticoagulation, reducing recurrence risk by approximately 30% to 40%; however, it is substantially less effective than extended anticoagulation with DOACs. #cardionotes

For most patients with acute VTE planned to receive a DOAC, apixaban should be considered as the treatment of choice Source: 2026 ACC Scientific Statement; Direct Oral Anticoagulants in Primary and Secondary Prevention of Thrombotic Events. #cardionotes

حالتين من ال Pulmonary embolism ممكن يتعالجوا في البيت (دون حجز بالمستشفى) Subclinical PE Symptomatic PE with a low clinical severity score. #cardionotes

مريض ال VTE اللي هياخذ NOAC بيستخدم هيبارين (UFH or LMWH) لمدة ٥ ايام على الاقل لو هياخد Dabigatran or edoxaban اما لو هياخذ واحد من ال Rivaroxaban or apixaban فمش محتاج يبدا بهيبارين بياخذ جرعة عالية في الاول ثم يكمل على الجرعة المعتادة كما بالصورة والجرعات وال strategies دي بتعتمد على ال Trials design اللي اختبرت هذه الادوية في هذه الحالات في الايام الاولى من تكون الجلطة والعلاج بيكون فيه Higher risk of recurrence #cardionotes

ال Diltiazem لا يستخدم اثناء الحمل او الرضاعة اما ال verapamil ممكن تستخدم #cardionotes