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YR6 Images + Instruments > Acute Care- Cardio > Flashcards

Acute Care- Cardio Flashcards

1
Q

Mx of STEMI

A
  1. Aspirin 300mg
  2. PCI possible within 120 mins?

Y: Prasugrel, radial access, UFH with bailout glp IIb/IIIa inhibitor

N: Alteplase + Enoxaparin + DAPT (Aspirin + Ticagrelor) + repeat ECG

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2
Q

How should Mx of STEMI change if patient already on anticoagulants?

A

Swap Prasugrel for Clopidogrel

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3
Q

Mx of NSTEMI/ unstable angina

A
  1. Aspirin 300mg
    + Fondaparinux (no immediate PCI planned)
    OR
    + UFH (immediate angiography planned)
  2. GRACE score
    ,<3%: Ticagrelor or Clopidogrel
    >3%: Prasugrel + Angiography with UFH +/- PCI
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4
Q

Mx following ACS

A

DAPT
= Medically managed: Aspirin (lifelong) + Ticagrelor (12m)
= PCI: Aspirin (lifelong) + Ticagrelor/ Prasugrel (12m)
ACEi / ARB
BB or CCB
Statin

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5
Q

ACS Ix

A

ECG
Cardiac markers e.g. Troponin

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6
Q

3 non-modifiable RFs for ACS

A

Age
Male
FH

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7
Q

5 modifiable RFs for ACS

A

Smoking
DM
HTN
Hypercholesterolaemia
Obesity

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8
Q

Counselling patient with ACS

A

Chest pain because of a heart attack. Happened because a blood vessel to your heart has been blocked.
4w off driving

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9
Q

4 Sx of acute heart failure

A

SOB
Reduced exercise tolerance
Fatigue
Oedema

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10
Q

6 signs of acute heart failure

A

Cyanosis
Tachycardia
Raised JVP
Displaced apex beat
Bibasal crackles +/- wheeze
S3 heart sound

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11
Q

Ix for acute HF

A

Bloods: ?anaemia, electrolytes, infection
ECG: normal
CXR: pulmonary venous congestion, interstitial oedema, cardiomegaly
Echo
BNP

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12
Q

LVF on CXR

A

Alveolar oedema (bats wing shadowing)
Kerley B lines
Cardiomegaly
Upper lobe Diversion/ Dilated prominent upper lobe veins
Pleural Effusion

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13
Q

Mx of acute HF

A

IV Furosemide
+/- O2

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14
Q

Mx of respiratory failure in acute HF

A

CPAP

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15
Q

When should nitrates be used in acute HF? What is the major side effect/ contraindication to their use?

A

If concomitant myocardial ischaemia, severe HTN, AR or MR

Major SE/ CI: hypotension

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16
Q

Mx of acute HF with hypotension/ cardiogenic shock

A

Inotropes e.g. Dobutamine

Vasopressors e.g. Norepinephrine

Mechanical circulatory assistance: intra-aortic balloon counterpulsation or ventricular assist devices

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17
Q

In which circumstances should BB be stopped in acute HF?

A

HR < 50 beats per minute
2nd or 3rd degree AV block
Shock

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18
Q

What is the first line management for chronic heart failure?

A

ACEi + BB
Start one drug at a time

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19
Q

What is second line management of chronic heart failure? What needs to be monitored and why?

A

Aldosterone antagonist e.g. Spironolactone/ Eplerenone
Monitor K+ as ACEi + aldosterone antagonists can cause hyperkalaemia

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20
Q

What drug can be used second line in management of chronic heart failure with reduced ejection fraction?

A

SGLT-2 inhibitors: dapagliflozin, empagliflozin, canagliflozin

Reduce glucose reabsorption + increase urinary glucose excretion

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21
Q

What third line therapy can be initiated by a specialist for chronic HF?

A

Hydralazine + Nitrate
Entresto: Sacubitril-valsartan
Digoxin
Ivabradine
Cardiac resynchronisation therapy

22
Q

Paroxysmal AF

A

AF lasting >30s but <7 days (often <48h).
Self-terminating + recurrent.

23
Q

Persistent AF

A

AF >7 days (spontaneous termination unlikely to occur after this time)
or <7 days but requiring cardioversion.

24
Q

Permanent AF

A

AF that:
failed to terminate with cardioversion
OR
terminated but relapsed within 24h
OR
longstanding AF (>1y) in which cardioversion is CI or not been attempted

25
Q

4 most common causes of AF?

A

Coronary artery disease
HTN
Valvular heart disease
Thyrotoxicosis

26
Q

3 lifestyle factors can cause AF

A

Caffeine intake
Excessive alcohol intake
Obesity

27
Q

Describe an ECG in AF

A

Chaotic baseline
Absent p waves
Irregular intervals between QRS complexes

28
Q

4 life-threatening features of tachycardias

A

Shock (Hypotension)
Syncope
Signs of myocardial ischaemia
Signs of Heart failure

29
Q

Once AF is identified on ECG, what investigations are performed?

A

Bloods
Echo (TTE/ TOE)

30
Q

What investigations can be performed to aid identification of underlying cause of AF?

A

FBC (Infection, Anaemia)
U+Es (Electrolyte imbalance)
TFTs (Thyrotoxicosis)
Cardiac enzymes

31
Q

When should rhythm control be tried first line in AF?

A

Haemodynamically unstable
New onset AF <48h
Heart failure (primarily caused by AF)
Reversible cause.

32
Q

Describe management of haemodynamically unstable patient with AF

A

DC cardioversion

33
Q

If rhythm control is indicated in a haemodynamically stable patient, describe management?

A

<48h: Heparinise + cardioversion
>48h: rate control + anti-coagulate for >,3w OR TOE to exclude a left atrial appendage thrombus then proceed

34
Q

Describe ongoing management if AF is confirmed as being less than 48h and resolved with DC cardioversion

A

Further anticoagulation unnecessary

35
Q

If onset of AF was more than 48 hours ago, why must a patient be anti-coagulated for at least 3 weeks prior to cardioversion?

A

High risk of cardioversion induced thromboembolism as clot likely to have formed in atria

36
Q

What is used in pharmacological cardioversion?

A

Structural heart disease: Amiodarone
NO structural heart disease: Flecainide

37
Q

Describe electrical cardioversion

A

Synchronised to R wave to prevent delivery of a shock during the vulnerable period of cardiac repolarisation when VF can be induced.

38
Q

Which drugs are used for rate control in AF?

A

B-blockers e.g. Atenolol, Metoprolol, Propranolol
Rate limiting CCB e.g. Diltiazem
Digoxin (2nd line)

39
Q

Name a common contraindication to B-blockers in AF. What should be used first line?

A

Asthma
Use CCB e.g. Diltiazem

40
Q

In which patients with should nondihydropyridine CCBs be avoided?

A

Acute decompensated HF

41
Q

What non-pharmacological method can be used for rate control in AF?

A

Catheter ablation
(percutaneous, via groin)
ablates faulty electrical pathways resulting in AF

42
Q

Describe the use of anticoagulation with catheter ablation

A

Anticoagulate for 4w prior + during procedure
Catheter ablation controls rhythm but doesn’t reduce stroke risk
Continue anticoagulation as per CHADSVASc

43
Q

4 complications of catheter ablation for AF

A

Cardiac tamponade
Stroke
Pulmonary vein stenosis
Recurrence of AF

44
Q

What tool is used to assess and manage stroke risk in AF?

A

CHA2DS2-Vasc Score

44
Q

elements of CHA2DS2VASc?

A

Congestive HF 1
HTN (inc. treated HTN) 1
Age >= 75y (2), 65-74y (1)
Diabetes 1
S2 Prior Stroke, TIA or thromboembolism 2
Vascular disease (inc. IHD + PAD) 1
Sex (F) 1

45
Q

Describe the anticoagulation strategy based on CHA2DS2VASc score

A

0: No Tx
1: M: Consider anticoagulation
F: No Tx (because score 1 only due to their gender)
>,2: Offer anticoagulation

46
Q

If CHA2DS2VASc score suggests no need for anticoagulation, what must be performed?

A

TTE
to exclude valvular heart disease
Vavular heart disease in combination with AF is an absolute indication for anticoagulation.

47
Q

What scoring system is used to calculate risk of bleeding in patients with AF considering anticoagulants?

A

ORBIT
Old (age >75)
Red cells (anaemia)
Bleeding hx
Impairment (renal)
Treatment (anti platelet Tx)

48
Q

What class of drug is used first line for anticoagulation in AF? Give 4 examples

A

DOACs
Apixaban
Dabigatran
Edoxaban
Rivaroxaban

49
Q

What drug is used for anticoagulation in AF when DOACs are contraindicated?

A

Warfarin

50
Q

What should be used for long term stroke prevention in patients with AF once haemorrhage has been excluded?

A

Following TIA: DOAC (or warfarin) immediately
Following acute stroke: DOAC (or warfarin) after 2w (anti-platelet in the interim)

YR6 Images + Instruments (21 decks)

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