Oral Antihypertensive Medications - Selection by Comorbidities
Comorbidities:
• Stable Angina, HFpEF, HFrEF, AFib, TAA/Marfan, Aortic Dissection
• CKD, DM, ESRD, PKD
• Pregnancy, Cluster Headache, Migraine, Opioid Withdrawal, PAD, Scleroderma, Essential Tremor
• Supine HTN, BPH, Cognitive Impairment, Portal HTN/varices, Osteoporosis, Gout, Rapid-Acting
Matthew Ho, MD PhD @MatthewHoMD
#Oral #Antihypertensive #Medications #Hypertension #HTN #Comorbidities #pharmacology #table #management
Lactic Acidosis - Differential Diagnosis Framework
Type A: Impaired O2 Delivery (DO2)
• Decreased O2 Delivery: Hypotension & Hypovolemia, Trauma & burns, Cardiogenic & Septic Shock, Severe Anemia, Cardiac Arrest, Severe Hypoxemia, Regional Ischemia, Compartment Syndrome
• Increased O2 Demand: Stress / Pain / Exercise, Fever, Hypothermia & Shivering, Seizures, Beta-Agonists, ↑ work of breathing, Localized soft-tissue infection, Mesenteric Ischemia, Microcirculatory dysfunction
Type B: Impaired O2 Utilization (VO2)
• Drugs/Toxins: - Propofol (PRIS), Valproic Acid, Biguanides (Metformin), Linezolid, Lactulose, HIV Antiretrovirals (esp. NRTIs), Acetaminophen, Ethanol, Methanol & Other toxic alcohols, Sodium Nitroprusside, Others (ie. Ricin, Strychnine, Niacin, Salicylates, Isoniazid)
• Impaired Clearance: Systemic liver Failure, Renal failure, Mitochondrial dysfunction, Inborn Errors of Metabolism
• Other: - Infections (ie. HIV, Malaria, Late Sepsis), Malignancy (Leukemia/Lymphoma), Diabetes Mellitus +/- DKA, Alcoholic lactic acidosis, Deficiencies (Thiamine & Biotin)
Type D: Bacterial Overgrowth
• Presents as AG acidosis with negative lactate. Difficult to diagnosis as it requires separate D-lactate testing
• Seen in Short Bowel Syndrome, where decreased carbohydrate digestion leads to presence of additional sugars in the colon.
• Bacteria ferment and convert these sugars into D-Lactate
Excerpted from original infographic by Nick Mark MD @nickmmark
#Lactic #Acidosis #Differential #Diagnosis #criticalcare #lactate
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
