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AHA update on STEMI EQUIVALENT
.......................
Many Occlusive MI (OMI) were missed by previous STEMI criteria on ECG so new AHA statement focused on below conditions to include in STEMI management so that these case must not be delayed Cath & treated as STEMI Protocols

1.Hyperacute T waves

2.De winter ECG

3.LBBB

4.Posterior wall MI

ูŠุนู†ูŠ ุฐู†ูŠ ูŠุนุงู…ู„ู† ู…ุนุงู…ู„ุฉ ุงู„ STEMI
โค4
ู…ุญุชุงุฌ ุงุฑุงุฆูƒู… ุฏูƒุงุชุฑู‡
ุดู†ูˆ ุงู„ุณุจุจ ุงู„ูŠ ูŠุฎู„ูŠูƒ ู…ูƒู…ู„ ูˆูŠ ูƒูˆุฑุณ ุงูˆ ุดุฑุญ ู…ุนูŠู† ุดู†ูˆ ุงู„ุดุบู„ุงุช ุงู„ูŠ ุชูุฑู‚ู„ูƒ ูˆุชุนุชุจุฑู‡ุง ู…ู‡ู…ุฉ ุณูˆุงุก ุจู„ู…ุญุงุถุฑ ุงู„ูŠ ูŠู†ุทูŠูƒ ุงู„ู…ุญุงุถุฑู‡
ุงูˆ ุจู„ู…ุญุชูˆู‰ ู†ูุณู‡ ูˆุงุฐุง ุชุฑูŠุฏ ุดุบู„ุฉ ุชุชุบูŠุฑ ุจู„ู…ุญุงุถุฑุงุช ู…ุงู„ุชู†ู‡ ุงูˆ ุจู„ุดุฑุญ ู…ุงู„ุชูŠ ูŠุงุฑูŠุช ุชูƒุชุจูˆู‡ุง
ู†ุนู…ู„ ู„ุฎุฏู…ุชูƒู… ู†ุฃุณู ู„ุฃุฒุนุงุฌูƒู…๐Ÿ˜…
โค8
ุทุจุนุง ู…ู† ุงุตุนุจ ุทุฑู‚ ุงู„ุดุฑุญ ู‡ูŠ ุงู„ุงูˆู†ู„ุงูŠู† ุงุจุฏุฏ ู…ูˆ ุณู‡ู„ุฉ ูˆุงู„ูŠ ุนู†ุฏู‡ ูุฑุตู‡ ูŠุดุฑุญ ุญุถูˆุฑูŠ ุงูุถู„ ุจู‡ูˆุงูŠู‡ ุŒ ุฎุตูˆุตุงู‹ ุงุฐุง ุงูˆูู„ุงูŠู† ู…ู† ุงุณุฌู„ ุงู„ููŠุฏูŠูˆ ูˆุงุฑูุนู‡ ูˆุงุฑุงุฌุนู‡ ุงุถู„ ุงูƒูˆู„ ุจูŠู†ูŠ ูˆุจูŠู† ู†ูุณูŠ ู„ูˆ ูƒุงูŠู„ ูƒุฐุง ุจุฏู„ ูƒุฐุง ุงูุถู„ ู…ู† ูƒุฐุง ู„ูˆ ุญุงุท ู‡ุงูŠ ุงู„ุตูˆุฑู‡ ุงูˆ ู‡ูŠุฌ ุดูŠ ูˆุงุจุฏ ู…ุง ุงุดูˆู ุฑุฏุฉ ูุนู„ ุทู„ุงุจ ูƒุฏุงู…ูŠ ูู‡ู„ ุดูŠ ูŠูˆุชุฑูƒ ูˆูŠุฎู„ูŠูƒ ุจุชุญุฏูŠ ุงู†ูˆ ุดู„ูˆู† ุชุฎุชุงุฑ ูƒู„ู…ุงุชูƒ ุจุนู†ุงูŠุฉ ูˆุชุณูˆูŠ ุดูŠ ุจุฎูŠุงู„ูƒ ุญุชู‰ ุชูƒูˆู„ู‡ ุŒ ู„ุฐู„ูƒ ุงู„ุญุถูˆุฑูŠ ุงุณู‡ู„ ุจ ูกู ู  ู…ุฑู‡ ุนู† ุงู„ุงู„ูƒุชุฑูˆู†ูŠ ุญุชู‰ ุงุฐุง ูˆุงุญุฏ ู…ุง ูู‡ู… ุชุนูŠุฏู„ู‡ ุงูˆ ุชุดูˆู ุงู„ู†ุชูŠุฌู‡ ุจุนูŠู†ูƒ ูู‡ ุงู„ุญู…ุฏุงู„ู„ู‡ ุงู„ู„ู‡ ุงู„ู…ุณุชุนุงู†
๐Ÿฅฐ15โค9๐Ÿ‘5
https://www.instagram.com/reel/Cre_SoDKBS-/?igshid=MzRlODBiNWFlZA==
ู‡ุฐุง ุงู„ูุฏูŠูˆ ุญู„ ู„ู…ุดูƒู„ุฉ ุฌุจูŠุฑู‡ ุชูˆุงุฌู‡ูƒ ุงุซู†ุงุก ู…ุง ุชุฏูˆุฑ ุนู„ู‰ P wave
ูˆุชุชูˆู‡ู… ุจูŠู†ู‡ุง ูˆุจูŠู† ุงู„ T wave
ุงุนุฑู ุงู„ูุฑู‚ ู‡ู†ุง
๐Ÿ”ฅ4โค1
ุงู‡ู… ุณู„ุงูŠุฏ ู…ู…ูƒู† ุชู‚ุฑุงู‡ ุจู‡ู„ูŠูˆู…

ุดู†ูˆ ุงู„ูุฑู‚ ู…ุง ุจูŠู† ุงู„
myocardial injurie
and myocardial infarction??
โค12
Smith ECG Blog Posts organized into an amazingly educational collection, with examples of each type of subtle OMI and of mimics.

Also on the banner at the top for easy access any time
https://hqmeded-ecg.blogspot.com/p/omi-pocket-guide.html?m=1

ุณุงู…ุนูŠู† ุจู‡ู„ู…ูˆุถูˆุน ู‚ุจู„ุŸ ูƒู„ ุชูุงุตูŠู„ู‡ ุงู†ุดุงุก ุงู„ู„ู‡ ุฌุงูŠู‡ ุจูƒูˆุฑุณ ุงู„ cardiology
โค5
Creative Doctors ๐Ÿ–ค
ุงู‡ู… ุณู„ุงูŠุฏ ู…ู…ูƒู† ุชู‚ุฑุงู‡ ุจู‡ู„ูŠูˆู… ุดู†ูˆ ุงู„ูุฑู‚ ู…ุง ุจูŠู† ุงู„ myocardial injurie and myocardial infarction??
ุงู„ุจูˆุณุช ุดูˆูŠู‡ ุทูˆูŠู„ ุจุณ ู…ู‡ู… ูˆุชู‚ุงุจู„ู‡ ูƒู„ุดุด ู‡ูˆุงูŠู‡ ุจุญูŠุงุชูƒ ุงู„ุนู…ู„ูŠู‡ ูˆุชุนุจู†ูŠ๐Ÿ˜…

ุงูƒูˆ ู…ุตุทู„ุญูŠู† ุถุฑูˆุฑูŠ ู†ู…ูŠุฒ ุจูŠู†ู‡ู† ูˆู†ุนุฑู ุงู„ูุฑู‚

What's a difference between Myocardial injury

VS myocardial infarction

ุดู†ูˆ ุงู„ูุฑู‚ุŸุŸุŸ
ุญุณุจ ESC guideline 2018

Detection of an elevated cTn value above the 99th percentile upper reference limit (URL) is defined as myocardial injury. The injury is considered acute if there is a rise and/or fall of cTn values.

Myocardial infarction ncludes detection of a rise and/or fall of cTn with at least one value above the 99th percentile and with at least one of the following:

1-Symptoms of acute myocardial ischemia;
2-New ischemic electrocardiographic (ECG) changes;
3-Development of pathological Q waves;
4-Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality in a pattern consistent with an ischemic etiology;
5-Identification of a coronary thrombus by angiography including intracoronary imaging or by autopsy.

ูŠุนู†ูŠ ุดู„ูˆู† ุŸ ุงู†ุทูŠูƒ ู…ุซุงู„ ูˆุงู†ุช ุญุชูู‡ู…

ุงุฌุงูƒ ุจูŠุดู†ุช ูฃูฅ ุณู†ู‡ ูˆุนู†ุฏู‡ CKD and regular dialysis ูˆุงูŠุถุงู‹ ู‡ูˆ hypertensive ูˆุงุณุชุดุงุฑูˆูƒ ุนู„ูŠู‡
ูˆูƒุงู„ูˆู„ูƒ ูŠุงุจู‡ ู‡ุฐุง ุนู†ุฏู‡ troponin positive
ุงู„ ECG ุนู†ุฏู‡ ู†ูˆุฑู…ุงู„ ุจุณ ุนู†ุฏู‡ LVH and nonspecific T wave changes ูˆู‡ูˆ ูƒุงู† asymptomaticู…ู† ูƒู„ุดูŠ ูˆุงูŠุถุงู‹ Echo ู†ูˆุฑู…ุงู„

ู‡ุณู‡ ู‡ุฐุง ุดู†ูˆ ุชุนุชุจุฑู‡ ู‡ู†ุงุŸุŸ
ุงุนุชุจุฑู‡ myocardial injures
ุดุฑุงุญ ุชุณูˆูŠู„ู‡ุŸ

the best approach is :
1-serial ECG
2-second set troponin
3-ECHO

ุณูˆูŠุช ุงู„ูุญูˆุตุงุช ูˆุฑุฌุนุชู„ูƒ :
1 -NO dynamic ECG change
2-No significant chang in troponin
2-hypertensive heart in ECHO

Final diagnosis:
chronic myocardial injury secondery to uremic toxin and hypertension

Management:
Bp control,proper management of renal condition

#yassin_Ayad
ู‡ุฐุง ุงู„ู‡ุงุดุชุงูƒ ุญุฎู„ูŠ ู…ู†ุง ูˆู‡ูŠุฌ ุญุชู‰ ุชูˆุตู„ูˆู† ู„ู„ุจูˆุณุชุงุชโค๏ธ
๐Ÿ‘13
Atypical presentations of MI
especially in elderly

1- recurrent or persistence hiccups
2-vomting
3- profuse sweating
4_ severe headache ( cardiac cephalgia)

this is autonomic symptoms
โค31
Avoid excluding a diagnosis of STEMI based on a single ECG as findings can change over time and with symptom fluctuation.

ูŠุนู†ูŠ ู…ู† ุชุดูˆูู‡ STEMI ูŠุนู†ูŠ STEMI ู„ุง ุชุชุงุฎุฑ ูˆู„ุง ุซุงู†ูŠุฉ
โค9
Algorithm ุนุธูŠู…
โค1
ู†ุบุดุดูƒู… ุดูˆูŠู‡ ู…ู† ู…ุญุงุถุฑุงุชู†ุง ุจู„ cardiology ุงู„ู‚ุงุฏู…ุฉ๐Ÿ˜
ุญูˆู„ุชู‡ ูˆุงุฎุชุตุฑุช ู…ู†ู‡
๐Ÿ”ฅ12โค2
The term aortic stenosis is often used interchangeably with aortic valve stenosis. However, stenosis of the aortic outflow tract can occasionally be caused by nonvalvular etiologies, which are discussed separately (e.g., supravalvular aortic stenosis in Williams-Beuren syndrome).
โค1
ู…ุฑุงุช ุงูƒูˆ sign ุชุดูˆูู‡ุง ุจู„ู…ุณุชุดูู‰ ุชุญุชุงุฑ ุจุชูุณูŠุฑู‡ุง ุจุณ ู…ู† ุชุณุชู…ุฑ ุชู‚ุฑู‡ ุชุตุงุฏูู‡ุง ูุฏ ูŠูˆู… ุจ textbook

Cope's sign is reflex sinu bradycardia ( or any degree of bradycardia even CHB) in patient with biliary colic . it's completely reversible and pain control is the mainstay of treatment .
โค11๐Ÿ”ฅ2
ุตูˆูŠุญุจ ู…ู† ูŠู…ูˆุช ุงู„ู…ู†ุฌู„ ูŠุฏุงุนูŠ

ุฃุญุงู‡ ุดูˆุณุนูƒ ุฌุฑุญูƒ ู…ุง ูŠุณุฏู‡ ุงู„ุซุงุฑ
ูŠุตูˆูŠุญุจ ูˆุญฺฏ ุงู„ุฏู… ูˆุฏู…ูƒ ุญุงุฑ
ู…ู† ุจุนุฏูƒ ู…ู†ุงุฌู„ ุบูŠุถ ูŠุญุตุฏู† ู†ุงุฑ
ุดูŠู„ ุจูŠุงุฑุบ ุงู„ุฏู… ููˆฺฏ ูŠู„ุณุงุนูŠ
ุตูˆูŠุญุจ ู…ู† ูŠู…ูˆุช ุงู„ู…ู†ุฌู„ ูŠุฏุงุนูŠ

ู„ุง ุชูุฑุญ ุจุฏู…ู†ู‡ ู„ุง ูŠู„ฺฏุทุงุนูŠ
ุตูˆูŠุญุจ ู…ู† ูŠู…ูˆุช ุงู„ู…ู†ุฌู„ ูŠุฏุงุนูŠ

ุงู„ุดู‡ูŠุฏ ุงู„ุญูŠ ุฑุงุญ ูŠุจู‚ู‰ ุซุฃุฑูƒ ูˆุซุฃุฑ ุฒู…ู„ุงุฆูƒ ููŠ ู‚ู„ูˆุจู†ุง .
โค19
ุชูˆู‚ู ุงู„ู†ุดุฑ ุงู„ู‰ ุฅุดุนุงุฑ ุงุฎุฑ
ุญุฏุงุฏ ุฃู„ูŠู…๐Ÿ’”
โค19
โค30๐Ÿ”ฅ2
ู‡ุงูŠ ุงู„ู…ุนู„ูˆู…ุฉ ู‚ุฏูŠู…ุฉ ู…ู† 2016 ูŠุนู†ูŠ ู‚ุจู„ ู„ุง ุงุฏุฎู„ ุทุจ
ูˆุชุดูˆู ู‡ุฐุง ุงู„ mnemonic ู„ุญุฏ ู‡ุณู‡ ู…ูˆุฌูˆุฏ ุจู…ุญุงุถุฑุงุช ุงู„ูƒู„ูŠุงุช ุŒ ูู…ุง ุนุฑู ุดูˆูƒุช ูŠุตุญูˆู† ูˆูŠุนุฏู„ูˆู‡ู† ๐Ÿ˜‚ ุงู„ุญู„ูˆุฉ ูŠุฑูŠุฏู‡ุง ู…ู†ูƒ ุจุงู„ุงู…ุชุญุงู† ูˆูŠู†ู‚ุตูƒ ุฏุฑุฌู‡

While morphine has traditionally been part of AHF management (and the LMNOP mnemonic), recent evidence shows that morphine use is associated with worsening symptoms and an increased need for intensive care.
โค8