Congestive Heart Failure - Causes, Pathophysiology and Differential Diagnosis • Dilated Cardiomyopathy • Hypertrophic Cardiomyopathy • Restrictive Cardiomyopathy HFrEF Causes: • Cardiovascular • Toxic • Infectious • Other HFpEF Causes: • Afterload • Valvular • Infiltrative • Genetic • Other Dr. Jorge Cortés @Jcortesizaguirr #Congestive #HeartFailure #Causes #Pathophysiology #Differential #Diagnosis #cardiology #HFrEF #HFpEF #CHF

Elevated Liver Enzymes - Differential Diagnosis Algorithm Severe ALT > 15x ULN • Viral • Drugs/Toxins • Ischemia • Autoimmune • Wilson's • Pregnancy - AFLP, HELLP Moderate ALT 5-15x ULN • Viral • Drugs • Wilson's • Hemochromatosis • NAFLD • Others Mild ALT < 5x ULN • NAFLD • Alcohol • Viral • Hemochromatosis • Drugs • AIH • A1AT deficiency • Wilson's • Others • Cholestatic disease US — Normal Bile Ducts • PSC • Alcoholic hepatitis • Drugs • TPN • Sepsis • Infiltrative • Cirrhosis (any) • Congenital US - Dilated Bile Ducts • Common Bile Duct Stone • Biliary stricture • Worms/flukes • Cholangiocarcinoma • Pancreatic cancer • Others #LFTs #Hepatology #LiverEnzymes #Differential #Diagnosis #Algorithm #Causes

COPD Management Algorithm - GOLD 2019 guidelines Categorize into COPD GOLD A-D -> Initiate first-line therapy -> Follow-up based on further DYSPNEA or EXACERBATIONS COPD GOLD 2019 guidelines were published in November and a few changes were included. When managing the pharmacotherapy of COPD, the first step is to categorize patients into GOLD Group A-D based on their dyspnea level and history of exacerbations. Which group they are in will tell you what to initiate as a first-line agent. See one of my previous posts about how to categorize and what to initiate (this is unchanged from GOLD 2018). What did change is the follow-up step. Instead of simply stepping up therapy from single to dual to triple, GOLD 2019 recommendations take into account whether the patient is having worsening dyspnea or exacerbations on current regimens. If dyspnea is present, recommendation is to step to dual bronchodilators or change devices (there are only 3 dual bronchodilator combo inhalers available in the US). If patient has exacerbations, you can consider initiating triple therapy which includes ICS if patients have high levels of eosinophils. ICS use should only be used in patients who have high eosinophils. Unnecessary ICS use actually increases risk of pneumonia and patients with COPD naturally have a higher risk of pneumonia, so careful consideration of inhalers is needed. Jarred Prudencio, PharmD - https://www.instagram.com/ambcarerx #COPD #GOLD #GOLD2019 #Guidelines #Management #Pulmonary #Algorithm #pharmacology

Stages in the development of HF and recommended therapy by stage. ACEI indicates angiotensin-converting enzyme inhibitor; AF, atrial fibrillation; ARB, angiotensin-receptor blocker; CAD, coronary artery disease; CRT, cardiac resynchronization therapy; DM, diabetes mellitus; EF, ejection fraction; GDMT, guideline-directed medical therapy; HF, heart failure; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; HRQOL, health-related quality of life; HTN, hypertension; ICD, implantable cardioverter-defibrillator; LV, left ventricular; LVH, left ventricular hypertrophy; MCS, mechanical circulatory support; and MI, myocardial infarction. #CHF #Congestive #HeartFailure #Staging #Stages #ACCAHA #Algorithm #Management #Cardiology