Learning Cardiology

  SGLT2 Inhibitors First developed for glycemic control for patients with diabetes, have become one of the four pillars of guideline-directed medical therapy for patients with HF  In 2015, the EMPA-REG OUTCOME study evaluated the impact of empagliflozin on major adverse cardiac events in patients with diabetes and unexpectedly showed a 35% relative risk reduction in hospitalization for HF.   How Do SGLT2 Inhibitors Work?  SGLT2 inhibitors block the reabsorption of sodium in the proximal tubules of the kidney.  Significant natriuresis as well as osmotic diuresis due to glucosuria.  Have also been shown to attenuate adverse cardiac remodeling and fibrosis in animal models. Available drugs Empagliflozin: SGLT 2 inhibitor, Dose 10 mg and 25 mg Dapagliflozin: SGLT2 inhibitor, Dose 5 mg and 10 mg Sotagliflozin: SGLT 1 and 2 inhibitor, Dose 200 mg and 400 mg Sotagliflozin is slightly different than dapagliflozin and empagliflozin in that it is a combined SGLT1/2 inhibitor.  SGLT2 inhibition l

 

Points to remember about pulmonary artery hypertension 1. Pulmonary arterial hypertension (PAH) - mean pulmonary arterial pressure > 20 mm Hg and a pulmonary vascular resistance > 3 WU, with a normal capillary wedge pressure of < 15 mm Hg 2. Increased pulmonary resistance results in right ventricular overload and right heart failure 3. Mortality of at least 50% in 7 years 4. Pregnancy in women with PAH is associated with high maternal and neonatal mortality rates 5. The only therapy with a direct survival benefit is intravenous epoprostenol, a prostanoid vasodilator 6. A positive acute vasodilator response is defined by a decrease in mean PAP ≥ 10 mm Hg to reach a mean PAP < 40 mm Hg with an improved or stable cardiac output. In these patients, high-dose calcium channel blockers significantly lower PAP and vascular resistance. 7. Most common cause of death- right sided heart failure 8. Agents within the same class (including PDE-5 inhibitors and guanylate cyclase stimulat

  a wave and v wave roughly correspond to P wave and QRS complex in electrocardiogram respectively.  a wave falls on S1 and v falls on S2. Hence, in sinus rhythm a wave is preceded by v wave .  In 1st degree heart block, a wave (P) will occur much before S1 (onset of ventricular systole) and denotes a prolonged PR interval. And, with further prolongation, a wave may merge with previous  v wave .   In 2nd degree type 1 AV block, there will gradual prolongation of a-v interval in JVP ending with a wave which is not followed by v wave .  In 2:1 AV block, there will be two a waves for each v wave . Alternate a wave will coincide with ventricular systole resulting in regular cannon a waves .  In complete heart block, a-v interval is variable with a more than v waves along with irregular cannon a waves . Irregular cannon a waves will be seen whenever a wave coincides with ventricular systole because of AV dissociation in CHB.  Irregular cannon a waves may also be seen during

Q. Which of the following formula is not used for estimation of LDL? A. Friedwald B. Sampson C. Martin/Hopkins D. Bazett Correct answer: D. Bazett Bazett's formula is used for estimation of corrected QT interval on ECG. Whereas, other three formulas Friedwald, Sampson and Martin/Hopkins are used for low density cholesterol (LDL) estimation in blood.