ALL Treatment Flashcards
Stable/unstable angina pectoris
Reduce risk factors;
- Smoking cessation
- Reduce fat intake
- Control DM
First line;
- Beta blockers
- CCBs
- Ivabridine
- GTN spray
Second line;
- Statins
- ACEi/ARB
- Aspirin
Surgery;
- If high risk of ACS event
- Coronary angioplasty (balloon or stent)
- CABG
NSTEMI
Morphine
Oxygen
Nitrates
Aspirin
Dual anti-platelet therapy for following year;
e.g. aspirin and clodipogrel/ticagrelor
Secondar prevention;
- Beta blockers
- CCBs
- Statins
- ACEi/ARB
Consider PCI or CABG.
STEMI
Thrombolysis/fibrinolysis <90mins
PCI >90mins
Secondary prevention;
- ACEi
- Statins
- Anti-coagulants e.g. aspirin, clopidogrel
- Smoking cessation, reduce fat intake, etc.
Heart failure
First line;
- Diuretics
- Digoxin
- ACEi/ARB
- ANP-promoting drugs
Second line (symptomatic);
- Beta blockers
- Spironolactone
- Sacubitril/valsartan
Third line (stop progression);
- Ivabridine
- Warfarin
Infective endocarditis
IV antibiotics for 2 weeks, oral for 2-4 weeks.
NVIE;
- Ampicillin
- Flucloxacillin
- Gentamicin
PVIE;
- Vancomycin
- Gentamycin
- Flucloxacillin
Surgery if;
- Large vegetations (or systemic emboli)
- Persistent pyrexia
- Severe regurgitation
Mitral stenosis
- Loop diuretics
- AF? Anti-coagulants
- Echo MV orifice <1.5cm2? Valve replacement
- Valvotomy to widen MV
Mitral regurgitation
Acute;
- Aim to reduce preload and afterload
- Sodium nitroprusside
- Dobutamine
Chronic;
- Valve repair, replacement if severe
Aortic stenosis
- HF treatment - loop diuretics, etc.
- AV replacement if severe
Aortic regurgitation
- Vasodilators
- AV repair, replacement if LV dilation
Stroke
Thrombolysis as soon as possible
Thrombectomy (clot retrieval) - surgery
Done with thrombolysis
Consider hemicraniectomy if middle cerebral artery stroke complicated by cerebral oedema in over 60 yo patient (within 48 hours of onset)
TIA
75mg Clopidogrel
OR
75mg Aspirin + 200mg dipyridamole
Statins
ACEI/ARBS (hypertensive treatment)
Vitamin K antagonists to reduce risk of bleeding
Carotid endarterectomy (prophylactic) If 50-69% stenosis or >70% stenosis
Hypertension
Investigate possible end-organ damage, advice on lifestyle.
ACEi e.g. ramipril Beta blocker e.g. bisoprolol CCB e.g. amlodipine Diuretic (thiazide-like) e.g. indapimide ARB
Step 1: use A if <55 and non-black, use C if >55 / black
Step 2: use A + C if non-black, use ARB instead of A if black
Step 3: A + C + D
Step 4: A + C + D + D
Use higher dose D if serum K+ >4.5moll
Use K+ sparing D (spironolactone) if serum K+ <4.5moll
Atrial flutter
- Treat the reversible underlying condition e.g. hypertension
- Rate/rhythm control with beta blockers or cardioversion
- Radiofrequency ablation of the re-entrant rhythm
Supraventricular tachycardia (and Wolff-Parkinson-White syndrome)
Short-term;
- Continuous ECG monitoring
- Valsalva manoeuvre
- Carotid sinus massage: massage the carotid on one side gently with two fingers
- Adenosine: an alternative is verapamil (CCB)
- DC cardioversion if above treatment fails
Long-term; - Beta blockers - Calcium channel blockers - Amiodarone (prolongs refractorines, interacts with digoxin) Radiofrequency ablation
Torsades de Pointes
Short-term;
- Correct cause of prolonged QT
- Give magnesium infusion
- Defibrillate if VT occurs
Long-term;
- Beta blockers (not sotalol)
- Pacemaker or implantable defibrillator
