Best anti-hypertensive in patient of TIA/STROKE?
BETA BLOCKERS.. DIURETICS.. ACEI ..
UNLESS THERE. IS. COMORBID. CARDIAC. OR. OTHER. CONDITIONS.... THAT. NECESSITATES. ....LOWERING. OF. BLOOD. P.RESSURE...... ONE. SHOULD. ALLOW... .. AUTOREGULATION. OF. PATIENT'S BLOOD. PRESSURE. AT. HIGH. LEVELS. IN. . ACUTE. PHASE.... ...AS. IT. MAY. HELP. MAXIMIZE.... ... CEREBRAL. PERFUSION. PRESSURE...
Important is gradual reduction of bp Preferable is betablocker
Consider ARB Calcium channel blockers Are preferred
Nifidipine reduce 30 percent Cases of of tia or stroke
ARB and CCBs are choice for such patient.
THE. EMPIRICAL TREATMENT.. NEEDS ...ANTIPLATELETS AND ANTICOAGULANTS LIKE ASPIRIN. +. CLOPIDOGREL
Apparently ARB&CCBs
ARB and CALCIUM CHANNeL BLOCKER
Telmesartin H
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32yr/male, c/o occasional discomfort in the sternal regional ( chest tightness and breathing difficulty) . this episode lasts for half to one hour.c/o lightheadedness ( last for nearly an hour). c/o epigastric discomfort +.c/o sweating.C/o indigestion and belching (severe ) for past 1 month.No c/o vomting/nausea/ chest pain / headache.No c/o fever. His CBG , Blood pressure were normal at the time of incidence. he is known smoker but stopped for 3 months.His CBC ,ECG, THYROID PROFILE , CHEST X RAY WERE NORMAL.On examination CVS, RS WERE NORMAL. Bowel and bladder habits were normal.per abd-soft and BS +. the above complaints relieved by antacids and for PPI. eventhough he is on antacids he is still have the same problem . Now patient is on HP KIT BD for 10 days,Tab.nexito 10mg half HS for 5 days,tab. ativan 1mg hs for 10 days. tab. Revotril 0.5 mg half tablet twice a day for 10 days,tab.domstal BD for 20 days. he has been admitted in private hospital and treated there for 3 days and discharged with above medications .Again patient is having the similar complaint from today early morning. all his vitals were stable .kindly suggest me how to proceed further and what all are the medications to be added or any other investigation that we need to do for this patient. what suggestions can we give to the patient.I am posting all the investigations that done to the patient till date.kindly interpret the patient PFT. only rearrangement in LFT.
Dr. Gokul Raj2 Likes19 Answers - Login to View the image
NH/O Previous medical illness a 32 yrs female admitted with c/o diffculty in breathing,palpitation,cough,swelling on face O/E chest b/l crepts BP 210/120mm/hg P/R 160/min spo2 80at RA pls suggest treatment and diagnose@
Dr. Danish Pasha2 Likes27 Answers - Login to View the image
65yr old female patient came with c/o chest pain. BP-210/110.HR-90bpm.SPO2-98% in RA. S/E-WNL No other comorbidities.
Dr. Sheena John3 Likes14 Answers - Login to View the image
CASE Name: Mr. Ernesto Age/gender: 50/Male M-status: Married Date & Time: 4/29/20 & 8:00pm Chief complaint: Chest pain History of present illness: Patient is known to have hypertension since 10years. 2months PTC, patient experienced the chest pain, while climbing 1-2 steps of stair, which was relieved by rest, which sought consult, were ECG was done and result found normal, but his blood pressure was elevated. He was prescribed with Enalapril. 2days PTC, again patient experienced chest pain lasting for 45mins, which was squeezing in nature and feel like heaviness associated with difficulty of breathing and get fatigue easily. At rest, pain disappear. No medicine was taken no consult was done. 1hour PTC, patient started having severe chest pain, which was persistent and was 8/10 on scale of pain with excessive sweating, hence this prompted patient to consult at ER for further evaluation and management . Review of system: (-)Fever, (-) blurring of vision, (-) hearing problem (-) cough, (+)Shortness of breathing Past medical history: • Hypertenion for the past 10years • (-) Diabtes mellitus • (-) Asthma • (-)Tb • (-)MI • (-) Allergies • Past surgery : none Current medication: Enalapril Personal and social history: • Occupation: Retired, before use to work as seaman. • (+) Smoking: 10 cigarettes/day • (+) Alcohol drinking occasionally • (+) Caffeine beverages occasionally Family history: - Father died because of heart attack. Physical examination: - Conscious, coherent, oriented to time, place and person - BP 100/60 HR: 59/min RR: 26 cycles/min Temp 36.5 C; O2sat 98% at room air - Pink conjunctiva, anicteric sclera - No neck vein engorgement, no cervical lymphadenopathy, no neck mass or goiter - Symmetrical chest expansion, no retractions, vesicular breath sounds, no crackles - Adynamic precordium, regular rhythm, apex beat at the 6th left intercostal space anterior axillary line, no heaves, no thrills, no murmurs - Flabby abdomen, normoactive bowel sounds, soft, non-tender - No edema, no cyanosis on all extremities - Full and equal pulses - Neurologic examination: unremarkable Give the working diagnosis interprete the ECG and other labs and management in details.
Piyush B Solanki2 Likes6 Answers - Login to View the image
Kindly interpret the angiographic images in a patient of NSTEMI
Dr. Majaz Ahmad0 Like2 Answers
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