Kounis Syndrome (Allergic Angina) - Pathophysiology #Kounis #Syndrome #Allergic #Angina #Pathophysiology #cardiology

Acute Coronary Syndrome (ACS) Definitions - Stable Angina, Unstable Angina, NSTEMI, STEMI 1 STABLE ANGINA - Angina pain develops when there is increased demand in the setting of a stable atherosclerotic plaque. The vessel is unable to dilate enough to allow adequate blood flow to meet the myocardial 2 UNSTABLE ANGINA - The plaque ruptures and a thrombus forms around the ruptured plaque, causing partial occlusion of the vessel. Angina pain occurs at rest or progresses rapidly over a short period of time. 3 NSTEMI - During an NSTEMI, the plaque rupture and thrombus formation causes partial occlusion to the vessel that results in injury and infarct to the subendocardial myocardium. 4 STEMI - A STEMI is characterized by complete occlusion the blood vessel lumen, resulting in transmural injury and infarct to the myocardium, which is reflected by ECG changes and a rise in troponins. #Diagnosis #Cardiology #ACS #Unstable #Angina #NSTEMI #Definitions ** GrepMed Recommended Text: The Only EKG Book You'll Ever Need - https://amzn.to/2Z0uM1Y

Vasospastic (Prinzmetal) Angina Definition / Epidemiology: • Rest angina attributed to coronary artery vasospasm. • Patients often younger than other ACS patients. • Strong association with smoking and cocaine use. • Associated with other vasospastic disorders (Raynaud, migraine, etc.) Pathophysiology: • Diffuse spasm of epicardial coronary artery. • Vascular smooth muscle hyper-reactivity of coronary arteries. • Imbalance of vagal and sympathetic tone may precipitate spasm. • Associations with endothelial dysfunction and microvascular injury. Presentation: • Recurrent anginal chest pain • Episodes can be associated with ST segment changes. • Normal exercise tolerance • Pain is not positional • Variable troponin elevation Diagnosis: • Transient ST segment changes on tele/ECG that resolves with resolution of sx. • Can perform provocative tests in cath lab Treatment: • Smoking cessation • CCBs (prevent vasoconstriction, promote vasodilation • Nitrates? By @NUIM_Chiefs #Vasospastic #Prinzmetal #Angina #cardiology #diagnosis #management

Kounis Syndrome Acute coronary syndrome (symptoms such as chest pain relating to reduced blood flow to the heart) caused by an allergic reaction or a strong immune reaction to a drug or other substance. Mast cell activation and release of inflammatory cytokines as well as other inflammatory agents from the reaction leads to spasm of the artery leading to the heart muscle or a plaque breaking free and blocking that artery. #Diagnosis #Kounis #Syndrome #Allergic #ACS #Anaphylaxis

Acute Coronary Syndrome - Management Algorithm • STEMI • NSTEMI (Troponin Positive) / Unstable Angina (UA, Troponin Negative) Management: • PCI • Fibrinolysis • Immediate Medical Therapy • Optimize Medical Therapy Matthew Ho, MD PhD @MatthewHoMD #Acute #Coronary #Syndrome #ACS #Management #Algorithm #cardiology

Allergic Rhinitis: Pathogenesis and clinical findings 1. Allergy Sensitization -> Antigen Exposure -> APC (macrophages, HLA class II) process antigen into peptides -> APC present peptides to Helper T cells -> Helper T cells release Interleukins (IL-4 and IL-3) -> IL-4 and IL-3 stimulate B-cell transformation to lgE producing Plasma Cells -> lgE Abs coat mast cells within nasal mucosa and basophils in the plasma 2. Primary Reaction Phase -> (initiated within 5 minutes of antigen exposure and maximum effect by 15 minutes) Antigen Exposure -> Antigen binds to lgE on mast cells and basophils -> Mast cells & basophils release mediators: preformed (histamine, serotonin, protease) & newly-generated (leukotrienes, prostaglandins, TNF-a) 3. Secondary Reaction Phase (occurs 4-6 hours after the primary reaction phase) Presence of mediators -> Recruitment of inflammatory cells (neutrophils, eosinophils, macrophages, lymphocytes), bone marrow proliferation of eosinophils -> Second phase of mediators released • Rhinorrhea • Sneezing and itching • Congestion and pressure • Tissue edema #Allergic #Rhinitis #Rhinorrhea #pathophysiology

ISCHEMIA Trial - Management Algorithm for patients with Stable Angina Stress Test -> ? +moderate or severe ischemia -> Coronary CTA (making clear to patient that you primarily seek to evaluate LMCA) -> ? +significant LMCA lesion -> Cardiac Catheterization with intent for revascularization (PCI vs CABG). Since this may be reaching some who are unfamiliar with the ISCHEMIA trial, I want to emphasize: this is for the outpatient with a stable symptom. This is not for acute coronary syndrome (ACS) evaluation or management. Based on results of ISCHEMIA trial 2019 - https://www.ischemiatrial.org/ By Dr. Francis Alenghat @ https://twitter.com/alenghat/ #ISCHEMIA #Stable #Angina #ChestPain #Diagnosis #Management #Algorithm #Cardiology #EBM #Trial

Pathophysiology in Obesity Hypoventilation Syndrome #Obesity #Hypoventilation #Syndrome #Pathophysiology

Pathophysiology of hepatorenal syndrome (HRS) doi: 10.1136/bmj.m2687 #hepatorenal #syndrome #HRS #Pathophysiology #nephrology

Wellens Syndrome on EKG Associated with a critical stenosis of the proximal LAD, suggestive of impending infarction - Present in pain-free state with history of recent angina - Abnormal T-wave in V2 & V3 - Isoelectric ST segment Type A: Biphasic Terminal T-wave Inversion Type B: Deep Symmetric T-wave Inversion FOAMfrat Team @FOAMfrat #Wellens #Syndrome #EKG #ecg #cardiology #electrocardiogram #diagnosis

Hepatorenal Syndrome - Pathophysiology - Dr. Eric Strong @DrEricStrong - Strong Medicine https://www.youtube.com/c/EricsMedicalLectures/ #HRS #Hepatorenal #Syndrome #Pathophysiology #nephrology