wikidoc - Recent changes [en]

Chronic stable angina overview

2026-04-25T14:34:56Z

Treatment

← Older revision		Revision as of 14:34, 25 April 2026
(One intermediate revision by the same user not shown)
Line 108:		Line 108:

	==Treatment==		==Treatment==
	Treatment of chronic ~~stable angina~~ aims ~~at minimizing~~ symptoms, ~~reducing recurrent [[ischemia]]~~, ~~improving~~ the ~~quality~~ of ~~life and improving [[~~Chronic ~~stable angina prognosis\|prognosis]] by preventing [[MI]] and death~~. Treatment ~~options include [[Chronic stable angina secondary prevention\|~~lifestyle modification]], ~~[[Chronic stable angina medical~~ therapy~~\|pharmacotherapy]]~~ and ~~[[Chronic stable angina revascularization\|revascularization]] that help in slowing the disease progression~~, ~~preserving the endothelial function~~ and ~~preventing [[thrombosis]]~~.		Treatment of chronic coronary disease/chronic coronary syndromes aims to minimize symptoms and improve quality of life, and to reduce cardiovascular events through guideline-directed secondary prevention therapies.<ref name=":0">Virani, S. S., Newby, L. K., Arnold, S. V., Bittner, V., Brewer, L. C., Demeter, S. H., Dixon, D. L., Fearon, W. F., Hess, B., Johnson, H. M., Kazi, D. S., Kolte, D., Kumbhani, D. J., LoFaso, J., Mahtta, D., Mark, D. B., Minissian, M., Navar, A. M., Patel, A. R., … Peer Review Committee Members. (2023). 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA guideline for the management of Patients With Chronic Coronary Disease: A report of the American heart association/American college of cardiology joint committee on clinical practice guidelines. ''Circulation'', ''148''(9), e9–e119. <nowiki>https://doi.org/10.1161/CIR.0000000000001168</nowiki></ref><ref name=":1">Vrints, C., Andreotti, F., Koskinas, K. C., Rossello, X., Adamo, M., Ainslie, J., Banning, A. P., Budaj, A., Buechel, R. R., Chiariello, G. A., Chieffo, A., Christodorescu, R. M., Deaton, C., Doenst, T., Jones, H. W., Kunadian, V., Mehilli, J., Milojevic, M., Piek, J. J., … ESC Scientific Document Group. (2024). 2024 ESC Guidelines for the management of chronic coronary syndromes. ''European Heart Journal'', ''45''(36), 3415–3537. <nowiki>https://doi.org/10.1093/eurheartj/ehae177</nowiki></ref> Treatment includes lifestyle modification, event-preventing GDMT (antithrombotic therapy, intensive lipid lowering, BP/diabetes therapies, and selected cardiometabolic agents), antianginal drugs for symptom control, and revascularization when indicated.<ref name=":0" /><ref name=":1" />

	~~Patients~~ with ~~[[CAD\|single-vessel CAD]] may be started on initial [[Chronic stable angina medical therapy\|pharmacologic therapy]] and if non-responsive or symptomatic despite on therapy, [[Chronic stable angina~~ revascularization ~~percutaneous coronary intervention\|PCI]] may be a preferred alternative.~~		Initial management is GDMT, with revascularization considered for

	~~Patients with [[CAD\|double-vessel CAD]] and with [[EF\|normal LV function]] may be started on initial [[Chronic stable~~ angina medical therapy\|medical management]] and in non-responders, [[Chronic stable angina revascularization percutaneous coronary intervention\|PCI]] may be considered. However, the decision of [[Chronic stable angina revascularization percutaneous coronary intervention\|PCI]] versus [[Chronic stable angina revascularization coronary artery bypass grafting\|CABG]] depends on the coronary anatomy, ~~[[EF\|LV function]]~~ and ~~the need for complete revascularization.~~		(1) unacceptable angina/ischemia despite optimized medical therapy, and/or

	~~Patients~~ with ~~[[CAD\|triple~~-~~vessel CAD]] or [[~~left main~~]] [[CAD\|~~disease~~]] or reduced [[EF\|left ventricular~~ function]], ~~[[Chronic stable angina revascularization coronary artery bypass grafting\|CABG]] is the mainstay of management. However~~, ~~in cases~~ of ~~mild symptoms or preserved [[EF\|LVEF]] in patients with triple-vessel disease, initial [[Chronic stable angina medical therapy\|pharmacologic therapy]] or [[Chronic stable angina~~ revascularization ~~percutaneous coronary intervention\|PCI]] may be tried~~.		(2) selected patients with high-risk anatomy/physiology where revascularization may reduce spontaneous MI and cardiovascular death during long-term follow-up.

			The choice of PCI versus CABG should be individualized using a Heart Team approach based on coronary anatomy/complexity (including left main and multivessel disease), LV function, diabetes, bleeding/ischemic risk, and likelihood of complete revascularization.<ref name=":0" /><ref name=":1" />

	===Pharmacotherapy===		===Pharmacotherapy===

Cardiomyopathy overview

2026-04-25T14:06:43Z

Primary Prevention

← Older revision		Revision as of 14:06, 25 April 2026
(11 intermediate revisions by the same user not shown)
Line 29:		Line 29:
	==Treatment==		==Treatment==
	===Medical Therapy===		===Medical Therapy===
	Treatment ~~depends~~ on the ~~type~~ of cardiomyopathy, ~~but may include medication~~, ~~implanted [[artificial pacemaker\|pacemakers]]~~, ~~[[Implantable cardioverter~~-~~defibrillator~~\|~~defribillators]]~~, ~~or [[ventricular assist device]]s (LVADs)~~, ~~or [[ablation]]~~. ~~The goal of treatment is often~~ symptom relief, and ~~some~~ patients ~~may eventually require a [[~~heart transplant]]. ~~Treatment~~ of ~~cardiomyopathy (~~and ~~other heart diseases) using alternative methods such as [[stem cell therapy]] is commercially available but is not supported by convincing evidence~~.		Treatment is phenotype-directed and includes guideline-directed medical therapy (GDMT) for heart failure syndromes and targeted therapy for specific cardiomyopathies such as hypertrophic cardiomyopathy (HCM). In HCM, management includes symptom-directed pharmacotherapy (beta-blocker or nondihydropyridine calcium-channel blocker, with disopyramide or a cardiac myosin inhibitor in selected adults with obstructive physiology), risk-based use of ICDs, and septal reduction therapy at experienced centers when symptoms persist despite medical therapy.<ref name="pmid38718139">{{cite journal \|vauthors=Ommen SR, Ho CY, Asif IM, Balaji S, Burke MA, Day SM, Dearani JA, Epps KC, Evanovich L, Ferrari VA, Joglar JA, Khan SS, Kim JJ, Kittleson MM, Krittanawong C, Martinez MW, Mital S, Naidu SS, Saberi S, Semsarian C, Times S, Waldman CB \|title=2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines \|journal=Circulation \|volume=149 \|issue=23 \|pages=e1239–e1311 \|date=June 2024 \|pmid=38718139 \|doi=10.1161/CIR.0000000000001250 \|url=}}</ref> <ref name="pmid35363499">{{cite journal \|vauthors=Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW \|title=2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines \|journal=Circulation \|volume=145 \|issue=18 \|pages=e895–e1032 \|date=May 2022 \|pmid=35363499 \|doi=10.1161/CIR.0000000000001063 \|url=}}</ref>For cardiomyopathy with HFrEF, foundational GDMT consists of an ARNI/ACE inhibitor/ARB, evidence-based beta-blocker, mineralocorticoid receptor antagonist, and SGLT2 inhibitor, with additional therapies and device-based treatment individualized by EF, QRS, symptoms, and comorbidities.<ref name="pmid35363499">{{cite journal \|vauthors=Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW \|title=2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines \|journal=Circulation \|volume=145 \|issue=18 \|pages=e895–e1032 \|date=May 2022 \|pmid=35363499 \|doi=10.1161/CIR.0000000000001063 \|url=}}</ref> Goals include symptom relief, prevention of sudden cardiac death (when relevant, e.g., HCM), and modification of heart-failure trajectory; patients with advanced heart failure despite GDMT should be referred to an advanced HF team for consideration of transplant and/or durable mechanical circulatory support.<ref name="pmid35363500">{{cite journal \|vauthors=Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW \|title=2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines \|journal=Circulation \|volume=145 \|issue=18 \|pages=e876–e894 \|date=May 2022 \|pmid=35363500 \|doi=10.1161/CIR.0000000000001062 \|url=}}</ref> In HCM with atrial fibrillation, oral anticoagulation is recommended irrespective of CHA₂DS₂-VASc, and rhythm and/or rate control should be individualized.<ref name="pmid38718139">{{cite journal \|vauthors=Ommen SR, Ho CY, Asif IM, Balaji S, Burke MA, Day SM, Dearani JA, Epps KC, Evanovich L, Ferrari VA, Joglar JA, Khan SS, Kim JJ, Kittleson MM, Krittanawong C, Martinez MW, Mital S, Naidu SS, Saberi S, Semsarian C, Times S, Waldman CB \|title=2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines \|journal=Circulation \|volume=149 \|issue=23 \|pages=e1239–e1311 \|date=June 2024 \|pmid=38718139 \|doi=10.1161/CIR.0000000000001250 \|url=}}</ref>

	===Surgery===		===Surgery===
	~~There~~ are ~~several types~~ of ~~surgery used~~ to ~~treat cardiomyopathy. They include~~ septal ablation, ~~[[septal myectomy]]~~, ~~surgically implanted devices to improve~~ the ~~function~~ of the ~~heart~~, ~~and [[heart transplant]]~~.		Procedural and surgical options are phenotype-specific and should be performed at experienced centers when indicated.<ref name="pmid38718139">{{cite journal \|vauthors=Ommen SR, Ho CY, Asif IM, Balaji S, Burke MA, Day SM, Dearani JA, Epps KC, Evanovich L, Ferrari VA, Joglar JA, Khan SS, Kim JJ, Kittleson MM, Krittanawong C, Martinez MW, Mital S, Naidu SS, Saberi S, Semsarian C, Times S, Waldman CB \|title=2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines \|journal=Circulation \|volume=149 \|issue=23 \|pages=e1239–e1311 \|date=June 2024 \|pmid=38718139 \|doi=10.1161/CIR.0000000000001250 \|url=}}</ref> For symptomatic obstructive HCM refractory to medical therapy, septal reduction therapy includes surgical septal myectomy or (in selected patients) alcohol septal ablation. Advanced heart failure may require durable mechanical circulatory support and/or heart transplantation after evaluation by an advanced HF team.<ref name="pmid38718139">{{cite journal \|vauthors=Ommen SR, Ho CY, Asif IM, Balaji S, Burke MA, Day SM, Dearani JA, Epps KC, Evanovich L, Ferrari VA, Joglar JA, Khan SS, Kim JJ, Kittleson MM, Krittanawong C, Martinez MW, Mital S, Naidu SS, Saberi S, Semsarian C, Times S, Waldman CB \|title=2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines \|journal=Circulation \|volume=149 \|issue=23 \|pages=e1239–e1311 \|date=June 2024 \|pmid=38718139 \|doi=10.1161/CIR.0000000000001250 \|url=}}</ref><ref name="pmid35363500">{{cite journal \|vauthors=Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW \|title=2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines \|journal=Circulation \|volume=145 \|issue=18 \|pages=e876–e894 \|date=May 2022 \|pmid=35363500 \|doi=10.1161/CIR.0000000000001062 \|url=}}</ref>

	===Primary Prevention===		===Primary Prevention===
	~~Methods of primary~~ prevention ~~for cardiomyopathy include; maintaining a healthy weight~~, ~~not smoking~~, ~~avoiding~~ alcohol and illicit drugs~~, reducing stress, and treating underlying conditions such as [[diabetes]]~~ and ~~[[high blood pressure]]~~.		Primary prevention focuses on ‘at risk’ (Stage A) and ‘pre-HF’ (Stage B) management: control hypertension, diabetes, obesity, and other cardiovascular risk factors; avoid cardiotoxins (including excess alcohol and illicit drugs); and treat structural heart disease early to prevent progression to symptomatic HF.

	==Preferences==		==Preferences==

Hypertension

2026-04-23T14:37:46Z

Modified the treatment section in line with the 2025 AHA/ACC guidelines for the management of hypertension

← Older revision		Revision as of 14:37, 23 April 2026
(One intermediate revision by the same user not shown)
Line 858:		Line 858:
	:*[[Renin-angiotensin-convertng enzyme inhibitors]] ([[ACEI]] or [[ARB]])		:*[[Renin-angiotensin-convertng enzyme inhibitors]] ([[ACEI]] or [[ARB]])
	:*[[Thiazide-like diuretic]]		:*[[Thiazide-like diuretic]]
	::*~~[[Betablocker]] is~~ first line ~~therapy in the presence of~~ [[~~angina~~]] ~~and [[~~heart failure]].		::*Beta-blockers are not first-line for hypertension unless specific comorbidities (e.g., [[coronary heart disease]], heart failure with reduced ejection fraction) are present.
	::*Second-line lowering [[BP]] agents are used in resistant [[hypertension]] or specific conditions.		::*Second-line lowering [[BP]] agents are used in resistant [[hypertension]] or specific conditions

			* For Stage 2 hypertension (BP ≥140/90 mm Hg), initiation of antihypertensive therapy with two first-line agents of different classes, ideally in a single-pill combination, is recommended to improve blood pressure control and medication adherence.

	*The mainstay of therapy for [[resistant hypertension]] is:		*The mainstay of therapy for [[resistant hypertension]] is:
Line 865:		Line 867:
	:*Improving medications adherence		:*Improving medications adherence
	:*Diagnosis and treatment of the causes of [[secondary hypertension]]		:*Diagnosis and treatment of the causes of [[secondary hypertension]]
	:*Adding [[spironolactone]] or [[hydralazine]] or [[ minoxidil]] to first line therapy ([[CCB]]s, [[inhibitors of RAS]], [[chlorthalidone]].		:*Adding [[spironolactone]] or [[hydralazine]] or [[ minoxidil]] to first line therapy ([[CCB]]s, [[inhibitors of RAS]], [[chlorthalidone]]).
			:*Renal Denervation may be reasonable as an adjunct in select patients

	{{familytree/start}}		{{familytree/start}}
Line 874:		Line 877:
	{{familytree \| B01 \| \| \| B02 \| \| \| \| \| B03 \| \| \| \|B04\| \|B01=Nomal [[BP]] ([[BP]]<120/80 mmHg)\|B02=Elevated [[BP]] ([[BP]]120-129/<80mmHg)\|B03=Stage1 [[hypertension]](BP 130-139/80-89mmHg\|B04=Stage 2 [[hypertension]] ([[BP]]≥ 140/90}}		{{familytree \| B01 \| \| \| B02 \| \| \| \| \| B03 \| \| \| \|B04\| \|B01=Nomal [[BP]] ([[BP]]<120/80 mmHg)\|B02=Elevated [[BP]] ([[BP]]120-129/<80mmHg)\|B03=Stage1 [[hypertension]](BP 130-139/80-89mmHg\|B04=Stage 2 [[hypertension]] ([[BP]]≥ 140/90}}
	{{familytree \| \|!\| \| \| \| \|!\| \| \| \| \| \| \|!\| \| \| \| \|!\| }}		{{familytree \| \|!\| \| \| \| \|!\| \| \| \| \| \| \|!\| \| \| \| \|!\| }}
	{{familytree \| C01 \| \| \| C02 \| \| \| \| \| C03 \| \| \| \|C04\| \|C01=Life style modifications\|C02=Nonpharmocological therapy (class1)\|C03= 10 ~~years~~ cardiovascular disease ([[CVD]]) ~~risk≥ 10~~%\|C04=Non pharmacological therapy and [[BP]]lowering medication}}		{{familytree \| C01 \| \| \| C02 \| \| \| \| \| C03 \| \| \| \|C04\| \|C01=Life style modifications\|C02=Nonpharmocological therapy (class1)\|C03= 10-year cardiovascular disease (CVD) risk ≥7.5% by PREVENT\|C04=Non pharmacological therapy and [[BP]]lowering medication}}
	{{familytree \| \|!\| \| \| \| \|!\| \| \| \| \|,\|-\|^\|-\|.\| \| \|!\| \| \| \| \| \| \| \| \|}}		{{familytree \| \|!\| \| \| \| \|!\| \| \| \| \|,\|-\|^\|-\|.\| \| \|!\| \| \| \| \| \| \| \| \|}}
	{{familytree \| \|D01\| \| \| D02 \| \| \| D03 \| \| D04 \|!\| \| \| \| \| \| \| D01=Reevaulation in 1 year (class 2a)\|D02=Reevaulation in 3-6 months (class 1)\|D03= NO, nonpharmocological therapy (class1)\|D04= Yes,non pharmacological therapy and [[BP]] lowering medication}}		{{familytree \| \|D01\| \| \| D02 \| \| \| D03 \| \| D04 \|!\| \| \| \| \| \| \| D01=Reevaulation in 1 year (class 2a)\|D02=Reevaulation in 3-6 months (class 1)\|D03= NO, nonpharmocological therapy (class1)\|D04= Yes,non pharmacological therapy and [[BP]] lowering medication}}
Line 1,217:		Line 1,220:

	*[[Surgery\|Surgical]] procedure may be performed for patients with [[secondary hypertension]] such as [[coarctation of aorta]], [[Primary aldosteronism\|primary aldosteronism.]]		*[[Surgery\|Surgical]] procedure may be performed for patients with [[secondary hypertension]] such as [[coarctation of aorta]], [[Primary aldosteronism\|primary aldosteronism.]]
			*Renal Denervation may be reasonable as an adjunct in select patients with resistant hypertension or drug intolerance, but requires evaluation by a multidisciplinary team.

	===Prevention===		===Prevention===
Line 1,222:		Line 1,226:
	*Effective measures for the [[primary prevention]] of hypertension include: <ref name="WheltonCarey2018">{{cite journal\|last1=Whelton\|first1=Paul K.\|last2=Carey\|first2=Robert M.\|last3=Aronow\|first3=Wilbert S.\|last4=Casey\|first4=Donald E.\|last5=Collins\|first5=Karen J.\|last6=Dennison Himmelfarb\|first6=Cheryl\|last7=DePalma\|first7=Sondra M.\|last8=Gidding\|first8=Samuel\|last9=Jamerson\|first9=Kenneth A.\|last10=Jones\|first10=Daniel W.\|last11=MacLaughlin\|first11=Eric J.\|last12=Muntner\|first12=Paul\|last13=Ovbiagele\|first13=Bruce\|last14=Smith\|first14=Sidney C.\|last15=Spencer\|first15=Crystal C.\|last16=Stafford\|first16=Randall S.\|last17=Taler\|first17=Sandra J.\|last18=Thomas\|first18=Randal J.\|last19=Williams\|first19=Kim A.\|last20=Williamson\|first20=Jeff D.\|last21=Wright\|first21=Jackson T.\|title=2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines\|journal=Hypertension\|volume=71\|issue=6\|year=2018\|issn=0194-911X\|doi=10.1161/HYP.0000000000000065}}</ref>		*Effective measures for the [[primary prevention]] of hypertension include: <ref name="WheltonCarey2018">{{cite journal\|last1=Whelton\|first1=Paul K.\|last2=Carey\|first2=Robert M.\|last3=Aronow\|first3=Wilbert S.\|last4=Casey\|first4=Donald E.\|last5=Collins\|first5=Karen J.\|last6=Dennison Himmelfarb\|first6=Cheryl\|last7=DePalma\|first7=Sondra M.\|last8=Gidding\|first8=Samuel\|last9=Jamerson\|first9=Kenneth A.\|last10=Jones\|first10=Daniel W.\|last11=MacLaughlin\|first11=Eric J.\|last12=Muntner\|first12=Paul\|last13=Ovbiagele\|first13=Bruce\|last14=Smith\|first14=Sidney C.\|last15=Spencer\|first15=Crystal C.\|last16=Stafford\|first16=Randall S.\|last17=Taler\|first17=Sandra J.\|last18=Thomas\|first18=Randal J.\|last19=Williams\|first19=Kim A.\|last20=Williamson\|first20=Jeff D.\|last21=Wright\|first21=Jackson T.\|title=2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines\|journal=Hypertension\|volume=71\|issue=6\|year=2018\|issn=0194-911X\|doi=10.1161/HYP.0000000000000065}}</ref>

	:*[[Weight loss]]: ~~Reduction 1 mmHg~~ in ~~[[blood pressure]] for every one kilogram [[~~weight reduction]]		:*Weight loss: Sustained ≥5% reduction in body weight or ≥3 kg/m² reduction in BMI. Expect ~1 mmHg SBP drop per 1 kg lost
	:*[[Healthy diet]]: A [[diet]] rich in [[fruits]], [[vegetables]], [[whole grains]], [[low-fat dairy products]], reduced content of saturated and [[total fat]]		:*[[Healthy diet]]: A [[diet]] rich in [[fruits]], [[vegetables]], [[whole grains]], [[low-fat dairy products]], reduced content of saturated and [[total fat]]
	:*[[Reduced]] intake of dietary [[sodium]]: ~~Less than 1000-15000~~ mg/day		:*Reduced intake of dietary sodium: Target <2300 mg/day, with ideal limit <1500 mg/day
	:*Enhanced intake of [[dietary~~]][[~~ potassium]]:3500–5000 mg/d by intaking rich diet with [[~~potassium~~]]		:*Enhanced intake of dietary potassium: 3500–5000 mg/d by ideally intaking rich diet with potassium, or moderate supplementation (<80 mmol/day)
			:*Use of salt substitutes: Replace regular table/cooking salt with potassium-based salt substitutes. Avoid in [[CKD]] or with potassium-sparing drugs
			:*Reduced alcohol intake: Abstinence is optimal for BP control. If consumed, reduce intake by >50% to ≤1 drink/day for women or ≤2 drinks/day for men
	:*[[Physical activity]]: [[Aerobic]] ( 90–150 min/week), dynamic resistance (90–150 min/week), [[Isometric exercise\|Isometric]] resistance (4 × 2 min handgrip, 1 min rest between exercises, 3 sessions per week)		:*[[Physical activity]]: [[Aerobic]] ( 90–150 min/week), dynamic resistance (90–150 min/week), [[Isometric exercise\|Isometric]] resistance (4 × 2 min handgrip, 1 min rest between exercises, 3 sessions per week)
	:*~~Reduced [[alcohol]] intake~~: ~~Men ≤2 drinks daily, Women ≤1 drink daily~~		:*Stress reduction: Transcendental meditation (2 × 20 min/day) or device-guided slow breathing (<10 breaths/min for 15 min/day) may be reasonable adjuncts to lifestyle modification

	*Once diagnosed and treated, patients with hypertension are followed-up every month for evaluation of medication adherence and response to treatment.		*Once diagnosed and treated, patients with hypertension are followed-up every month for evaluation of medication adherence and response to treatment.

			=== Treatment Goal ===
			For all adults with confirmed hypertension, the recommended target is <130/80 mm Hg. For high-risk patients (10-year CVD risk ≥7.5% by PREVENT), achieving SBP <120 mm Hg is encouraged to reduce major adverse events.

	==References==		==References==

Sandbox

2026-04-23T00:14:26Z

Medical Treatment of Patients With Thoracic Aortic Disease

← Older revision		Revision as of 00:14, 23 April 2026
Line 37:		Line 37:
	\|[[ACC AHA guidelines classification scheme#Classification of Recommendations\|Class I]]		\|[[ACC AHA guidelines classification scheme#Classification of Recommendations\|Class I]]
	\|-		\|-
	\|"'''1.''' Stringent control of ~~<nowiki>~~[[hypertension]]~~</nowiki>~~, <nowiki>[[lipid profile]]</nowiki> optimization, <nowiki>[[smoking cessation]]</nowiki>, and other <nowiki>[[atherosclerosis]]</nowiki> risk-reduction measures should be instituted for all patients with <nowiki>[[thoracic aortic aneurysm]]</nowiki> not requiring immediate surgical intervention, as well as for patients who are not considered surgical or stent graft candidates. ''([[ACC AHA guidelines classification scheme#Level of Evidence\|Level of Evidence: C]])''"		\|"'''1.''' Stringent control of [[hypertension]], <nowiki>[[lipid profile]]</nowiki> optimization, <nowiki>[[smoking cessation]]</nowiki>, and other <nowiki>[[atherosclerosis]]</nowiki> risk-reduction measures should be instituted for all patients with <nowiki>[[thoracic aortic aneurysm]]</nowiki> not requiring immediate surgical intervention, as well as for patients who are not considered surgical or stent graft candidates. ''([[ACC AHA guidelines classification scheme#Level of Evidence\|Level of Evidence: C]])''"
	\|}		\|}

Sandbox

2026-04-22T17:31:17Z

Thoracic Aortic Aneurysm Medical Therapy ===== Overview ===Medical therapy for patients with a thoracic aortic aneurysm includes aggressive blood pressure control targeting a goal of 130/80 mmHg for all patients, heart rate reduction with beta-

Show changes

Heart failure resident survival guide

2026-04-21T11:24:22Z

Treatment of Heart Failure in Stage C and D

Show changes

Hypertension in adolescents

2026-04-20T07:12:34Z

Show changes

Congestive heart failure Management of Acute heart failure

2026-04-18T10:39:34Z

Transitional care plan: components (Class 1 recommendation):[2]

← Older revision		Revision as of 10:39, 18 April 2026
(One intermediate revision by the same user not shown)
Line 249:		Line 249:

	\|MedCond =Congestive heart failure\|Mannitol}}		\|MedCond =Congestive heart failure\|Mannitol}}

			=== '''Transitional care plan:''' ===

			* '''Structure of early post-discharge follow-up''':
			* It has two distinct events:<ref name=":3" />
			*# '''Follow-up phone call within 2-3 days of discharge'''
			*# '''Clinic visit within 7-14 days of hospital discharge'''
			* The first post-discharge appointment provides the opportunity to reassess clinical status, provide additional patient education, review medications and adjust doses, and address issues that might lead to readmission or worsening HF.

			==== '''Transitional care plan components''' (Class 1 recommendation):<ref name=":0" /> ====

			* Addressing any precipitating causes of worsening HF identified in the hospital

			* Adjusting diuretics based on volume status (including weight) and electrolytes
			* Coordination of safety laboratory checks (e.g., electrolytes after initiation or intensification of GDMT)
			* '''Plans for GDMT optimization''', including:
			** Plans for resuming medications held in the hospital
			** Plans for initiating new medications
			** '''Plans for titration of GDMT to goal doses as tolerated'''
			* Reinforcing HF education and assessing compliance with medical therapy and lifestyle modifications
			* Addressing high-risk characteristics (comorbid conditions, limitations in psychosocial support, impaired health literacy)
			* Referral to cardiac rehabilitation where appropriate
			* Referral to palliative care specialists in selected patients

	==References==		==References==

User:Nehal Eid

2026-04-18T10:30:11Z

← Older revision		Revision as of 10:30, 18 April 2026
(One intermediate revision by the same user not shown)
Line 2:		Line 2:

	'''Wikidoc contributions:'''		'''Wikidoc contributions:'''

			[[Intravenous drug use (recreational)]]

	[[Juvenile idiopathic arthritis]]		[[Juvenile idiopathic arthritis]]

	[[~~Sudden cardiac death~~]]		[[Hypertension and Blood Pressure Control in Diabetics]]

	[[~~Cosibelimab-ipdl~~]]		[[Lipid Management in Diabetics]]

	[[~~Olezarsen~~]]		[[Coronary heart disease in Diabetics]]

	[[~~Intravenous drug use (recreational)~~]]		[[Congestive heart failure Management of Acute heart failure]]

	[[~~Hypertension and Blood Pressure Control in Diabetics~~]]		[[Sudden cardiac death]]

	[[~~Lipid Management in Diabetics~~]]		[[Cosibelimab-ipdl]]

	[[~~Coronary heart disease in Diabetics~~]]		[[Olezarsen]]

Congestive heart failure Management of Acute heart failure

2026-04-18T10:26:50Z

Hospitalization

Show changes

Rheumatoid arthritis overview

2026-04-16T12:40:15Z

Medical Therapy

@@ Line 77: / Line 77: @@
 ==Medical Therapy==
 The mainstay of treatment of [[rheumatoid arthritis]] is pharmacotherapy. Early diagnosis of [[rheumatoid arthritis]] is helpful in treatment. Choice of treatment depends on various factors such as stage of [[disease]], comorbid conditions, stage of therapy and presence of severe prognostic signs. There are two types of therapies- non-pharmacological therapy and pharmacological therapy. There are different drug regimen depending upon the stage of the disease. In active stage, combined therapy include disease-modifying antirheumatic drugs ([[DMARDs]]) are used along with the [[anti-inflammatory drugs]]. Therapy for resistant disease and flares is the addition of oral [[glucocorticoids]]. In case of the flare, add another [[DMARDs]] with [[methotrexate]] or replace with another [[DMARDs]].
 ==Surgical Therapy==

Coronary heart disease overview

2026-04-16T12:00:59Z

Secondary Prevention

← Older revision		Revision as of 12:00, 16 April 2026
(3 intermediate revisions by the same user not shown)
Line 1:		Line 1:
	__NOTOC__		__NOTOC__
	{{Coronary heart disease}} {{CMG}}		{{Coronary heart disease}} {{CMG}} {{AE}} {{MSD}}

	==Overview==		==Overview==
Line 34:		Line 34:
	==Treatment==		==Treatment==
	===Medical Therapy===		===Medical Therapy===
	Goals for treating coronary artery disease include lowering [[blood pressure]], ~~maintaining [[~~HbA1c~~]] levels to less than~~ 7%, and lowering [[LDL]] cholesterol. Long-term treatment will generally depend on the symptoms and severity of disease, and include [[aspirin]], [[ACE inhibitors]], and other ani-coagulant and anti-platelet regimens. The mainstay of treatment for [[chronic stable angina\|stable angina]] which occurs with exertion, includes [[nitroglycerin]]. When unstable angina causes symptoms at rest, or in the setting of an acute [[myocardial infarction]], the immediate therapy is [[morphine]], [[oxygen]], [[nitrate]] and [[aspirin]]. [[Angioplasty]] may also be required in cases of [[acute coronary syndrome]].		Goals for treating coronary artery disease include lowering [[blood pressure]], managing diabetes with cardiovascular-risk-reducing agents such as SGLT2 inhibitors and GLP-1 receptor agonists, independent of HbA1c target<ref name="pmid39289001">{{cite journal \|vauthors=Galli M, Gragnano F, Vrints C, Andreotti F \|title=2024 ESC guidelines on chronic coronary syndromes: what is new in pharmacotherapy? \|journal=Eur Heart J Cardiovasc Pharmacother \|volume=10 \|issue=7 \|pages=572–574 \|date=November 2024 \|pmid=39289001 \|doi=10.1093/ehjcvp/pvae069 \|url=}}</ref>, and lowering [[LDL]] cholesterol. Long-term treatment will generally depend on the symptoms and severity of disease, and include [[aspirin]], [[ACE inhibitors]], and other ani-coagulant and anti-platelet regimens.Low-dose colchicine (0.5 mg daily) should also be considered as an adjunctive anti-inflammatory therapy for long-term management. <ref name="pmid37558377">{{cite journal \|vauthors=Nelson K, Fuster V, Ridker PM \|title=Low-Dose Colchicine for Secondary Prevention of Coronary Artery Disease: JACC Review Topic of the Week \|journal=J Am Coll Cardiol \|volume=82 \|issue=7 \|pages=648–660 \|date=August 2023 \|pmid=37558377 \|doi=10.1016/j.jacc.2023.05.055 \|url=}}</ref> The mainstay of treatment for [[chronic stable angina\|stable angina]] which occurs with exertion, includes [[nitroglycerin]]. When unstable angina causes symptoms at rest, or in the setting of an acute [[myocardial infarction]], the immediate therapy is [[morphine]], supplemental oxygen (only if SpO₂ <90%), nitrate, and aspirin. [[Angioplasty]] may also be required in cases of [[acute coronary syndrome]].Beta-blockers should be used selectively: they are indicated when LVEF is <50%, or in the presence of angina, arrhythmias, or hypertension, but are no longer routinely recommended for all patients with chronic coronary disease.

	===Primary Prevention===		===Primary Prevention===
	The [[LDL]] target in primary prevention depends upon the patient's [[risk factors]]. If the ~~patient has CHD or its equivalent~~, ~~then the LDL goal is under 100 mg~~/dl. ~~If the patient has 2~~ risk ~~factors~~, the LDL ~~goal is 130 mg~~/dl. ~~If the patient has~~ < ~~2 risk factors~~, ~~the LDL goal~~ is < ~~160 mg~~/dl. Attempts should be made to reduce [[triglyceride]] levels and to increase [[HDL]] levels. The underlying causes for existing [[dyslipidemia]]s should be identified and appropriately managed. Drugs that cause dyslipidemias should be avoided. Patients should be evaluated reguarly for the presence of risk factors for coronary heart disease, and those with increased risk should be counseled on the beneficial effects of daily [[aspirin]] therapy. Patients should also regularly be counseled about modifying risk factors such as [[obesity]], [[hypertension]], [[smoking]], and the benefits of an [[exercise]] plan.		The [[LDL]] target in primary prevention depends upon the patient's [[risk factors]]. LDL targets in primary prevention should be guided by estimated 10-year ASCVD risk using the PREVENT™ equations<ref name="urlACC, AHA Release New Clinical Guideline For Managing Dyslipidemia - American College of Cardiology">{{cite web \|url=https://www.acc.org/latest-in-cardiology/journal-scans/2026/03/13/15/20/acc-aha-release-new-clinical-guideline-for-managing-dyslipidemia \|title=ACC, AHA Release New Clinical Guideline For Managing Dyslipidemia - American College of Cardiology \|format= \|work= \|accessdate=}}</ref>. Statin therapy is recommended for those with intermediate risk (5–<10%) and reasonable for those with borderline risk (3–<5%) after shared decision-making, with the goal of achieving at least a 50% LDL-C reduction from baseline<ref name="urlACC, AHA Release New Clinical Guideline For Managing Dyslipidemia - American College of Cardiology">{{cite web \|url=https://www.acc.org/latest-in-cardiology/journal-scans/2026/03/13/15/20/acc-aha-release-new-clinical-guideline-for-managing-dyslipidemia \|title=ACC, AHA Release New Clinical Guideline For Managing Dyslipidemia - American College of Cardiology \|format= \|work= \|accessdate=}}</ref>.Non-statin therapies — including ezetimibe, bempedoic acid, and PCSK9 inhibitors should be considered when statin therapy alone is insufficient.<ref name="urlACC, AHA Release New Clinical Guideline For Managing Dyslipidemia - American College of Cardiology">{{cite web \|url=https://www.acc.org/latest-in-cardiology/journal-scans/2026/03/13/15/20/acc-aha-release-new-clinical-guideline-for-managing-dyslipidemia \|title=ACC, AHA Release New Clinical Guideline For Managing Dyslipidemia - American College of Cardiology \|format= \|work= \|accessdate=}}</ref> Attempts should be made to reduce [[triglyceride]] levels and to increase [[HDL]] levels.Coronary artery calcium (CAC) scoring and Lp(a) measurement should be considered to further refine cardiovascular risk and guide treatment intensity.<ref name="urlACC, AHA Release New Clinical Guideline For Managing Dyslipidemia - American College of Cardiology">{{cite web \|url=https://www.acc.org/latest-in-cardiology/journal-scans/2026/03/13/15/20/acc-aha-release-new-clinical-guideline-for-managing-dyslipidemia \|title=ACC, AHA Release New Clinical Guideline For Managing Dyslipidemia - American College of Cardiology \|format= \|work= \|accessdate=}}</ref> The underlying causes for existing [[dyslipidemia]]s should be identified and appropriately managed. Drugs that cause dyslipidemias should be avoided. Patients should be evaluated reguarly for the presence of risk factors for coronary heart disease, and those with increased risk should be counseled on the beneficial effects of daily [[aspirin]] therapy. Patients should also regularly be counseled about modifying risk factors such as [[obesity]], [[hypertension]], [[smoking]], and the benefits of an [[exercise]] plan.

	===Secondary Prevention===		===Secondary Prevention===
	Patients who should be treated with secondary prevention are those with established atherosclerosis including peripheral artery		Patients who should be treated with secondary prevention are those with established atherosclerosis including peripheral artery disease; carotid artery disease; atherosclerotic aortic disease; diabetes and those with a 10-year ASCVD risk >20% by contemporary risk calculators (e.g., PREVENT™ equations or SCORE2).<ref name="url2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines \| Circulation">{{cite web \|url=https://www.ahajournals.org/doi/10.1161/CIR.0000000000001423 \|title=2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines \| Circulation \|format= \|work= \|accessdate=}}</ref> There are 13 aspects of secondary prevention: Smoking cessation; blood pressure control; lipid-lowering; increasing physical activity; weight loss; diabetes control; antiplatelet agents/anticoagulants; RAS blockers; beta-blockers; depression management; cardiac rehabilitation, influenza vaccine and low-dose colchicine (0.5 mg/day) for anti-inflammatory residual risk reduction.<ref>SEC Working Group for the 2024 ESC guidelines for the management of chronic coronary syndromes and SEC Guidelines Committee. (2025). Comments on the ESC 2024 guidelines for the management of chronic coronary syndromes. ''Revista Espanola de Cardiologia (English Ed.)'', ''78''(3), 170–175. <nowiki>https://doi.org/10.1016/j.rec.2024.10.007</nowiki></ref> Please note that secondary prevention guidelines, especially, those involving medication, may differ between [[Unstable Angina\|UA/NSTEMI]]; [[STEMI]]; and [[Chronic Stable Angina]].
	disease; carotid artery disease; atherosclerotic aortic disease; diabetes and those with a ~~Framingham Risk Score of~~ > 20%.
	There are 12 aspects of secondary prevention: Smoking cessation; blood pressure control; lipid-lowering; increasing physical activity; weight loss; diabetes control; antiplatelet agents/anticoagulants; RAS blockers; beta-blockers; depression management; cardiac rehabilitation ~~and~~ influenza vaccine. Please note that secondary prevention guidelines, especially, those involving medication, may differ between [[Unstable Angina\|UA/NSTEMI]]; [[STEMI]]; and [[Chronic Stable Angina]].

	==References==		==References==

Sandbox

2026-04-16T00:52:30Z

← Older revision		Revision as of 00:52, 16 April 2026
Line 1:		Line 1:
			== ACS Treatment ==
			Primary Prevention:

	~~{{familytree/start}}~~		'''Equivalent intensity for CHD-risk equivalents (LoE: A):''' Patients with established CHD should be targeted for secondary prevention. Crucially, patients with a '''CHD risk equivalent''' — defined as atherosclerosis in other vascular beds, diabetes mellitus, chronic kidney disease, or a Framingham-calculated 10-year risk exceeding 20% — should receive '''the same intensity of risk factor intervention''' as those with overt, clinically apparent CHD.
	~~{{familytree \| \| \| \| \| \| \| \| \| \| \| \| A01 \| \| \| \| \| \|A01=Adult ALL }}~~
	~~{{familytree \| \|,\|-\|-\|-\|v\|-\|-\|-\|-\|-\|-\|+\|-\|-\|-\|-\|-\|-\|-\|-\|-\|.\| \| }}~~
	~~{{familytree \| \|!\| \| \| \|!\| \| \| \| \| \| \|!\| \| \| \| \| \| \| \| \| \|!\| \| \| }}~~
	~~{{familytree \| D01 \| \| D02 \| \| \| \| \| D03 \| \| \| \| \| \| \| \| D05 \| \| \| \|D01=Burkitt Leukemia\|D02=PH-Positive B-ALL\|D03=PH-negative B-ALL\|D05=T-ALL}}~~
	~~{{familytree \| \|!\| \| \| \|!\| \| \| \|,\|-\|-\|^\|-\|-\|.\| \| \| \|,\|-\|-\|^\|-\|-\|.\| \| \| }}~~
	~~{{familytree \| \|!\| \| \| \|!\| \| \| \|!\| \| \| \| \| \|!\| \| \| \|!\| \| \| \| \| \|!\| \| \| }}~~
	{{familytree \| E01 \| \| E02 \| \| E03 \| \| \| \| E04 \| \| E05 \| \| \| \| E06 \| \| \|E01=R-hyper CVAD<br> DA-R-EPOCH\|E02=Chemotherapt+TKI <br> Blinatumomab+TKI\|E03=Younger adults\|E04=Older Adults\|E05=ETP\|E06=Non ETP}}
	~~{{familytree \| \|!\| \| \| \|!\| \| \| \|!\| \| \| \| \| \|!\| \| \| \|!\| \| \| \| \| \|!\| \| \|}}~~
	{{familytree \| \|!\| \| \| \|!\| \| \| F01 \| \| \| \| F02 \| \| F03 \| \| \| \| F04 \| \|F01=Chemotherapy+<br>blinatumomab\|F02=Chemotherapy+<br>blinatumumab+InO <br>Chemotherapy-free blinatumomab + InO\|F03=Chemotherapy+pegAsp+<br>nelarabine+venetoclax\|F04=Chemotherapy+pegAsp+<br>nelarabine}}
	~~{{familytree \| \|!\| \| \| \|!\| \| \| \|!\| \| \| \| \| \|!\| \| \| \|!\| \| \| \| \| \|!\| \| \| }}~~
	~~{{familytree \| \|!\| \| \| \|!\| \| \| \|!\| \| \| \| \| \|!\| \| \| \|!\| \| \| \| \| \|!\| \| \| }}~~
	~~{{familytree \| \|!\| \| \| \|!\| \| \| \|!\| \| \| \| \| \|!\| \| \| \|!\| \| \| \| \| \|!\| \| \| }}~~
	~~{{familytree \| \|`\|-\|-\|-\|^\|-\|-\|-\|^\|-\|-\|v\|-\|-\|^\|-\|-\|-\|^\|-\|-\|-\|-\|-\|~~'~~\| \| \| }}~~
	~~{{familytree \| \| \| \| \| \| \| \| \| \| \| \| G01 \| \| \| \| \| \| \| \| \| \| \| \| \| \|G01=<div style="float: left; text~~-~~align~~: ~~left; height~~: ~~3em; width: 20em;">~~ '''~~Measurable residual disease monitoring~~'''~~<br> </div>}} }}~~
	~~{{familytree \| \| \| \| \| \| \| \| \| \| \| \| \|!\| \| \| \| \| \| \| \| \| \| \| \| \| \| }}~~
	~~{{familytree \| \| \| \| \| \| \| \| \| \| \| \| H01 \| \| \| \| \| \| \| \| \| \| \| \| \| \| \|H01=<div style="float: left; text~~-~~align: left;">~~'''~~Alloegenic hematopoietic stem cell transplant~~''' ~~<br>•Ph-like ALL~~ with ~~CRLF2 and JAK vairants<br>•High-risk cytogenetics in B-ALL<br>•High-risk Ph-positive B-ALL: IZKF1 genotype<br>•T-ALL: ETP-ALL<br>•Persistent measurable residual disease by NGS<br> </div>}}~~
	~~{{familytree/end}}~~

User:Hasnain Ali

2026-04-14T19:59:22Z

Recently Edited Topics

← Older revision		Revision as of 19:59, 14 April 2026
(2 intermediate revisions by the same user not shown)
Line 32:		Line 32:
	*'''Dr. Ruth. K. M. Pfau Civil hospital Karachi, Pakistan (July/2021 - Jan/2022)'''<br>'''Position:''' Intern/House officer<br>'''Supervisor Attending:''' Multiple		*'''Dr. Ruth. K. M. Pfau Civil hospital Karachi, Pakistan (July/2021 - Jan/2022)'''<br>'''Position:''' Intern/House officer<br>'''Supervisor Attending:''' Multiple

	==~~Resently~~ Edited Topics==		==Recently Edited Topics==
			* [[Transient global amnesia\|Transient Global Amnesia]]

← Older revision		Revision as of 00:52, 16 April 2026
Line 1:		Line 1:
			== ACS Treatment ==
			Primary Prevention:

	~~{{familytree/start}}~~		'''Equivalent intensity for CHD-risk equivalents (LoE: A):''' Patients with established CHD should be targeted for secondary prevention. Crucially, patients with a '''CHD risk equivalent''' — defined as atherosclerosis in other vascular beds, diabetes mellitus, chronic kidney disease, or a Framingham-calculated 10-year risk exceeding 20% — should receive '''the same intensity of risk factor intervention''' as those with overt, clinically apparent CHD.
	~~{{familytree \| \| \| \| \| \| \| \| \| \| \| \| A01 \| \| \| \| \| \|A01=Adult ALL }}~~
	~~{{familytree \| \|,\|-\|-\|-\|v\|-\|-\|-\|-\|-\|-\|+\|-\|-\|-\|-\|-\|-\|-\|-\|-\|.\| \| }}~~
	~~{{familytree \| \|!\| \| \| \|!\| \| \| \| \| \| \|!\| \| \| \| \| \| \| \| \| \|!\| \| \| }}~~
	~~{{familytree \| D01 \| \| D02 \| \| \| \| \| D03 \| \| \| \| \| \| \| \| D05 \| \| \| \|D01=Burkitt Leukemia\|D02=PH-Positive B-ALL\|D03=PH-negative B-ALL\|D05=T-ALL}}~~
	~~{{familytree \| \|!\| \| \| \|!\| \| \| \|,\|-\|-\|^\|-\|-\|.\| \| \| \|,\|-\|-\|^\|-\|-\|.\| \| \| }}~~
	~~{{familytree \| \|!\| \| \| \|!\| \| \| \|!\| \| \| \| \| \|!\| \| \| \|!\| \| \| \| \| \|!\| \| \| }}~~
	{{familytree \| E01 \| \| E02 \| \| E03 \| \| \| \| E04 \| \| E05 \| \| \| \| E06 \| \| \|E01=R-hyper CVAD<br> DA-R-EPOCH\|E02=Chemotherapt+TKI <br> Blinatumomab+TKI\|E03=Younger adults\|E04=Older Adults\|E05=ETP\|E06=Non ETP}}
	~~{{familytree \| \|!\| \| \| \|!\| \| \| \|!\| \| \| \| \| \|!\| \| \| \|!\| \| \| \| \| \|!\| \| \|}}~~
	{{familytree \| \|!\| \| \| \|!\| \| \| F01 \| \| \| \| F02 \| \| F03 \| \| \| \| F04 \| \|F01=Chemotherapy+<br>blinatumomab\|F02=Chemotherapy+<br>blinatumumab+InO <br>Chemotherapy-free blinatumomab + InO\|F03=Chemotherapy+pegAsp+<br>nelarabine+venetoclax\|F04=Chemotherapy+pegAsp+<br>nelarabine}}
	~~{{familytree \| \|!\| \| \| \|!\| \| \| \|!\| \| \| \| \| \|!\| \| \| \|!\| \| \| \| \| \|!\| \| \| }}~~
	~~{{familytree \| \|!\| \| \| \|!\| \| \| \|!\| \| \| \| \| \|!\| \| \| \|!\| \| \| \| \| \|!\| \| \| }}~~
	~~{{familytree \| \|!\| \| \| \|!\| \| \| \|!\| \| \| \| \| \|!\| \| \| \|!\| \| \| \| \| \|!\| \| \| }}~~
	~~{{familytree \| \|`\|-\|-\|-\|^\|-\|-\|-\|^\|-\|-\|v\|-\|-\|^\|-\|-\|-\|^\|-\|-\|-\|-\|-\|~~'~~\| \| \| }}~~
	~~{{familytree \| \| \| \| \| \| \| \| \| \| \| \| G01 \| \| \| \| \| \| \| \| \| \| \| \| \| \|G01=<div style="float: left; text~~-~~align~~: ~~left; height~~: ~~3em; width: 20em;">~~ '''~~Measurable residual disease monitoring~~'''~~<br> </div>}} }}~~
	~~{{familytree \| \| \| \| \| \| \| \| \| \| \| \| \|!\| \| \| \| \| \| \| \| \| \| \| \| \| \| }}~~
	~~{{familytree \| \| \| \| \| \| \| \| \| \| \| \| H01 \| \| \| \| \| \| \| \| \| \| \| \| \| \| \|H01=<div style="float: left; text~~-~~align: left;">~~'''~~Alloegenic hematopoietic stem cell transplant~~''' ~~<br>•Ph-like ALL~~ with ~~CRLF2 and JAK vairants<br>•High-risk cytogenetics in B-ALL<br>•High-risk Ph-positive B-ALL: IZKF1 genotype<br>•T-ALL: ETP-ALL<br>•Persistent measurable residual disease by NGS<br> </div>}}~~
	~~{{familytree/end}}~~