د/ ناصر الوايلي

10/08/2026

Absolute Contraindications of ACE inhibitors

❶ Pregnancy
❷ Previous angioneurotic oedema
❸ Hyperkalaemia (K > 5.5 mmol/L)
❹ Bilateral severe renal artery stenosis
❺ Severe renal artery stenosis in a single functioning kidney.

𝙎𝗼𝘂𝙧𝗰𝙚: ESC 2024 Guidelines for the Management of Arterial Hypertension.
𝙎𝙖𝙫𝙚 𝗶𝘁 ➠ 𝙎𝙝𝙖𝙧𝙚 ➠ 𝙡𝙞𝙠𝙚 & 𝙛𝙤𝙡𝙡𝙤𝙬 🔁

10/08/2026

Absolute Contraindications of ACE inhibitors

𝙎𝗼𝘂𝙧𝗰𝙚: ESC 2024 Guidelines for the Management of Arterial Hypertension.
𝙎𝙖𝙫𝙚 𝗶𝘁 ➠ 𝙎𝙝𝙖𝙧𝙚 ➠ 𝙡𝙞𝙠𝙚 & 𝙛𝙤𝙡𝙡𝙤𝙬 🔁

10/08/2026

Absolute Contraindications of ARBs

❶ Pregnancy
❷ Hyperkalaemia (K > 5.5 mmol/L)
❸ Bilateral severe renal artery stenosis
❹ Severe renal artery stenosis in a single functioning kidney.

𝙎𝗼𝘂𝙧𝗰𝙚: ESC 2024 Guidelines for the Management of Arterial Hypertension.
𝙎𝙖𝙫𝙚 𝗶𝘁 ➠ 𝙎𝙝𝙖𝙧𝙚 ➠ 𝙡𝙞𝙠𝙚 & 𝙛𝙤𝙡𝙡𝙤𝙬 🔁

09/08/2026

09/08/2026

Indications of Intervention in Asymptomatic Severe Aortic Stenosis
√ EF < 50%
√ 1 of 4 :
❶ EF < 55%
❷ Very severe AS : (Vmax > 5 m/s or MG ≥ 60 mmHg)
❸ Severe calcification of AV in Cardiac CT & Vmax progression ≥ 0.3 m/s/y
❹ Increased BNP/NT-proBNP > 3 times normal range.
√ Sustained fall in BP > 20 mmHg during exercise Test.
√ As alternative to close active surveilance.

𝙎𝗼𝘂𝙧𝗰𝙚: ESC 2025 Guideline

07/08/2026

Indications of Fibrinolytic in STEMI Patients

CLASS I: STEMI with Symptom onset < 12 hrs. & anticipated delay to PPCI
> 2 hrs from FMC, fibrinolytic therapy should be administered in
patients without contraindication to reduce MACE.

CLASS III: Fibrinolytic not recommended in NSTEMI patient (except in posterior
STEMI) due to risk of hemorrhagic stroke & major noncerebral bleeding.

Source : ACC/AHA 2025 Guideline
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07/08/2026

2026 HFpEF Treatment

❶ Dapagliflozin or Empagliflozin (First-Line)
❷ Finerenone
❸ Semaglutide or Tirzepatide for HFpEF & obesity (BMI ≥30 kg/m²)
❹ Add ARNI for
✒ Males with EF