#BRASH_SYNDROME
Bradycardia
Renal failure
AV node blocker: beta-blocker, verapamil, or diltiazem
Shock
*Hyperkalemia
This syndrome is due to a vicious cycle in the setting of medications, hyperkalemia, and renal failure Renal failure causes hyperkalemia and may cause the accumulation of some AV node blockers (e.g. atenolol, nadolol). Hyperkalemia synergizes with AV node blockers to cause bradycardia and hypoperfusion. Hypoperfusion, in turn, causes worsening of the renal failure.

Medical conditions associated with Bradycardia:
🫀Cardiomyopathies
🫀Cardiac Inflammatory Dz (Myocarditis, Sarcoid, Toxo)
🫀Infiltrative (Amyloid, Lymphoma)
🫀Ischemia
🫀Lupus/RA/Scleroderma
🫀Physical Conditioning
🫀Coughing/Peeing
🫀HypoK/HyperK
🫀Acidosis
@PoojaJagadishMD

After ablation for atrial fibrillation,among patients at high risk for stroke
it's recommended to opt for:

1- anticoagulation or
2- LAA exclusion ( closure).

Kearns Sayre Syndrome:

» Mitochondrial disease with maternal inheritance
» Ataxia +Ophthalmoplegia+SNHL+RP
» Cardiac: Cardiomyopathy +Conduction defects
» Also might have Diabetes and Hypoparathyroidism

Some cardiac conduction defects ....

With muscle weakness and hypertonia >>> myotonic dystrophy .

With facial palsy and history of skin rash >>> Lyme disease .

With history of eye swelling + South America >>> Chagas disease .

With Hypercalcemia and lung infiltrations >>> Sarcoidosis .

With RBBB and left axis deviation and SOB >>> Ostium primum ASD.

With history of abnormal ventriculoarterial connection >>> congenitally corrected TGA .

#mrcp1_said......Saeed Fawzy

#PLEASE_REMEMBER
#Neuropsychiatric_symptoms plus:
symptoms in young indicates Wilson's if associated hepatic disorder (jaundice, hepatomegaly, ascites) present.
#Neuropsychiatric symptoms in young indicates Acute intermittent porphyria if it is associated with acute abdominal pain & acute motor neuropathy.
#Neuropsychiatric symptoms in young indicates variant Creutzfeldt–Jakob disease if associated with sensory symptoms in the limbs, ataxia, dementia.(MRI of brain- high signal change in palvinar area)
Add more please
#REGARDS.

#Stemi_equavalents
1_wellen syndrome:
WELLENS SYNDROME:
Wellen's syndrome is a pattern of deeply inverted or biphasic T waves in V2-3,which is highly specific for a critical, proximal left anterior descending (LAD) artery stenosis. The syndrome is also referred to as LAD coronary T-wave syndrome.
Patients may be pain free by the time the ECG is taken and have normally or minimally elevated cardiac enzymes, however, they are at extremely high risk for extensive anterior wall MI within the next few days to weeks.
Due to the critical LAD stenosis, these patients usually require invasive therapy, do poorly with medical management and may suffer MI or cardiac arrest if inappropriately stress tested.
#DIAGNOSTIC_CRITEAREA:
Rhinehart et al (2002) describe the following diagnostic criteria for Wellens’ syndrome:
•Deeply-inverted or biphasic T waves in V2-3 (may extend to V1-6).
•Isoelectric or minimally-elevated ST segment (< 1mm).
•No precordial Q waves.
•Preserved precordial R wave progression.
•Recent history of angina.
•ECG pattern present in pain-free state.
•Normal or slightly elevated serum cardiac markers.
There are two patterns of T-wave abnormality in Wellens’ syndrome:
Type A = Biphasic, with initial positivity & terminal negativity (25% of cases).
Type B = Deeply and symmetrically inverted (75% of cases).
#RISK_FACTORES FOR WELLENS SYNDROME:
smooking
hypertension
DM
hyperchlostrolaemia
hyperlipidaemia
family history
occupitional stress

#Stemi_equavalents:
Are those pts who dont presents with classical changes of stemi but have acutely occluded coronory A
they are often associated with poorer outcome&worse prognoses
*they benefit from timely intervention.
The common stemi equavalents are:
1-dewinter complex
2-wellen syndrome
3-st elevation in avr
4- LBBB with sagrobossa critirea
5-isolated posterior mi
6- T waves upright in V1

#PLEASE_REMEMBER
The most common cause of aortic stenosis in <70 years aged pts.is cong.bicusbide A. valve
In >70 years aged pts.is degenerative calcification disaes

D/D OF HYPERPIGMENTATION :
Primary Addison's
Nelson's syndrome
Cushing's disease
Post- acne
Post- herpetic
Ptyriasis Vesticular
Acanthosis nigricans
Sun exposure
*Drug induced
#REGARDS