Metoprolol tartrate vs succinate dosing mnemonic

Metoprolol tartrate is short acting. 

Metoprolol succinate is long acting. 

Mnemonic succinate single dose, tartrate two doses.

-IkaN (Nakeya Dewaswala Bhopalwala) 

EKG quiz #1

What does this EKG show? 

Answer will be posted soon.

-IkaN

Treatment of myocardial infarction associated pericarditis

Hi everyone! There are two types of myocardial infarction associated with pericarditis. Let

s learn more about the management!

Early infarct-associated pericarditis: Occurs 1 to 3 days after transmural myocardial infarction (because of the interaction of the healing necrotic epicardium with the overlying pericardium). 

Late post-myocardial infarction pericarditis (Dressler’s syndrome): Occurs weeks to months after myocardial infarction. 

Initial therapy includes high-dose aspirin (650 to 1,000 mg every 6 to 8 hours).

Proton pump inhibitor (PPI)  - improves the gastric tolerability of the aspirin. 

Acetominophen can be added for pain management.

Dosing of aspirin:

Initial: 650 mg to 1 g every 8 hours until resolution of symptoms for at least 24 hours and normalization of inflammatory biomarkers (eg, C-reactive protein). A treatment period of one to two weeks before tapering is usually sufficient. 

Taper: Decrease each dose by 250 to 500 mg every 1 to 2 weeks. Ensure patient remains asymptomatic and inflammatory biomarkers are normal. 

There is no published experience on the use of colchicine in peri-infarction pericarditis. Colchicine may reduce the need for pericardiocentesis or other pericardial interventions and is usually given at a dose of 0.6 mg twice daily for a month, or longer if the patient has a recurrence of symptoms.

Why are NSAIDs such as ibuprofen avoided in the peri-infarct period?

Interferes with the antiplatelet aggregation effects of aspirin. 

Interferes with myocardial healing.

PS: Acetominophen does not affect the coagulation system and can be used.

References:

Post-cardiac injury syndrome: aetiology, diagnosis, and treatment https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-15/Post-cardiac-injury-syndrome-aetiology-diagnosis-and-treatment

Pericardial Disease https://www.ahajournals.org/doi/10.1161/circulationaha.105.561514

-IkaN (Nakeya Dewaswala)

Read EKGs with me #1

Answer below:

Normal P wave ECG notes and mnemonic

Here is the video:

 

Mnemonic:

Notes:
Sinus P waves
Axis: 0 and +75 degrees
Upright: Leads I, II, V5, V6
Inverted: aVR
Duration: <120ms or 3 small squares
Amplitude:
Limb leads: < 2.5 mm (0.25mV)
Precordial leads: < 1.5 mm (0.15mV)

-IkaN

Determining pacemaker type from EKG (RV pacing vs biventricular pacing)

 Hello, cardiowesomites!

Today we are going to learn how to determine pacemaker type from EKG (RV pacing vs biventricular pacing)

Notes:

Normal cardiac pressures mnemonic (Normal Swan-Ganz pressures)

LV aneurysm: Difference between true LV aneurysm and LV pseudoaneurysm

LV aneurysms are most commonly caused by myocardial infarction. What's the difference between true aneurysm and pseudoaneurysm?

Types of pulmonary hypertension mnemonic

Here are my notes and a video on types of pulmonary hypertension - WHO classification! It comes with a mnemonic :)

RV pressure and volume overload notes

Cardiac valves anatomy and mnemonics

Check out the YouTube video here!

-IkaN 

ECG axis mnemonic (short version)

Video here:

 

Notes below:

Cardiovascular drugs that can cause digoxin toxicity

A number of cardiovascular drugs predispose patients to digoxin toxicity, including verapamil, quinidine, and amiodarone. The dosage of digoxin must be reduced if given concomitantly with these drugs. The presumed mechanism underlying this interaction involves the ability of these drugs to inhibit the P-glycoprotein transporter.

Mnemonic: These drugs cause you to go whack! VAQ - Verapamil, Amiodarone, Quinidine

Other drugs to keep in mind are Diltiazem, Spironolactone, Flecainide.

Mnemonic by Huzefa Bhopalwala

References:

Waldorff S, Hansen PB, Egeblad H, Berning J, Buch J, Kjaergård H, Steiness E. Interactions between digoxin and potassium-sparing diuretics. Clin Pharmacol Ther. 1983 Apr;33(4):418-23. doi: 10.1038/clpt.1983.56. PMID: 6831820.

Andrejak M, Hary L, Andrejak MT, Lesbre JP. Diltiazem increases steady state digoxin serum levels in patients with cardiac disease. J Clin Pharmacol. 1987 Dec;27(12):967-70. doi: 10.1002/j.1552-4604.1987.tb05598.x. PMID: 3437068.

Lewis GP, Holtzman JL. Interaction of flecainide with digoxin and propranolol. Am J Cardiol. 1984 Feb 27;53(5):52B-57B. doi: 10.1016/0002-9149(84)90502-2. PMID: 6695818.

Koren, G., MacLeod, S. CHARACTERISTICS OF DIGOXIN INTERACTION WITH QUINIDINE, VERAPAMIL AND AMIODARONE: IN VIVO AND IN VITRO STUDIES. Pediatr Res 18, 154 (1984). https://doi.org/10.1203/00006450-198404001-00367

SYNTAX score mnemonic

In the SYNTAX (Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) trial, patients with 3-vessel and left main coronary artery disease (LMCAD) treated with coronary artery bypass graft surgery (CABG) compared with percutaneous coronary intervention (PCI) with first-generation drug-eluting stents (DES) had lower 5-year rates of death, myocardial infarction (MI), stroke, or unplanned revascularization.

Abdominal aortic aneurysm notes

Here are my notes for the ABIM. Old post https://www.medicowesome.com/2016/11/step-2-ck-abdominal-aortic-aneurysm.html

-IkaN 

A cardiologist and infectious disease specialist discuss their favorite statin

Cardiologist: What's your favorite statin? Atorvastatin? Rosuvastatin? 

Infectious disease specialist: Cilastatin! 

I onced misspelled it as cilastin and this joke was inspired. Idea credits to Randy Bornmann! 

Fact of the day - Athlete's heart

Hi!

Athlete's heart - physiologic eccenteric hypertrophy (cardiac remodeling) - changes include resting bradycardia, higher cardiac output with exercise, dilatation of LV cavity size with hypertrophy of myocytes compared to normal heart.

vs pathologic hypertrophy in case of systolic heart failure, aortic/mitral regurgitation, dilated cardiomyopathy(DCM) (volume overload conditions).

LV systolic ejection fraction is normal - low-normal in athletes.

(vs HCM- high, DCM- low)

HCM is a common cause of death in athletes, especially those with family history.

That's all

- Jaskunwar Singh

METABOLIC SYNDROME - MNEMONIC

BE AWARE of THE HIGH SUGARS

(3 or more of the following : diagnosis of Metabolic syndrome)

Blood Pressure >/=130/85mmHg

Abdominal obesity ( waist circumference) > 40 inches in males; >35 inches in females

Triglycerides >/=150 mg/dl

HDL cholesterol < 40mg/dl in males; < 50mg/dl in females

Fasting blood Sugars >/=100mg/dl

Hope this helps:)

- Padma Sri Katikaneni

Management of asymptomatic carotid atherosclerotic disease and carotid artery stenosis mnemonic

Super short post!

A) Asymptomatic

≥80% stenosis: Carotid endarterectomy

≤79% stenosis: Medical management

Mnemonic AGES: Asymptomatic Greater than Eighty Surgery

B) Symptomatic

≥70% stenosis: Carotid endarterectomy

Mnemonic SSS: Symptomatic Seventy Surgery

50%-69% stenosis

Male: Carotid endarterectomy

Female: Medical management

Mnemonic MMM: Males Manage More than fifty with surgery

<50% stenosis: Medical management

That's all!

-IkaN

Direct oral anticoagulants (DOACs) dosing for stroke prevention in atrial fibrillation mnemonic

Hi everyone!

Here are some DOAC dosing mnemonics for atrial fibrillation! 

RivarOxaban: Once daily

Apixaban: Twice daily 

Dabigatran: Twice daily

EdOxaban: Once daily

Mnemonic: Drugs with O have Once-daily dosing. 

Rivaroxaban: 20 mg once daily with the evening meal (creatinine clearance [CrCl] >50 mL/minute); or 15 mg once daily with the evening meal (CrCl ≤50 mL/minute).

Mnemonic: R without the straight line | looks like 2 to me for 20 mg!

Apixaban: 5 mg twice daily (CrCl >50 mL/minute); or 2.5 mg twice daily for those with any two of the following: age ≥80 years, body weight ≤60 kg, or serum creatinine ≥1.5 mg/dL.

Mnemonic: Apixa has 5 letters for 5 mg!

Dabigatran: 110 mg BID or 150 mg BID (CrCl >30 mL/minute).

European labeling suggests dose reduction in patients older than 75 years (eg, 150 mg orally once per day or 110 mg orally twice per day).

Edoxaban: 30 mg (weight ≤60 kg) or 60 mg (weight >60 kg) orally once daily.

That's all!

Remember that the dosing varies for VTE treatment and prophylaxis so do not apply these mnemonics for VTE.

-IkaN