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PACES Management > Cardio > Flashcards

Cardio Flashcards

1
Q

Management of acute STEMI

A 
A-E
Aspirin + Ticagrelor (hold ticagrelor until cath lab)
Oxygen if desaturating
Morphine IV and metoclopramide IV
Nitrate if still painful
Primary PCI <2h

if delay in primary PCI >2h, consider thrombolysis with alteplase (give ticagrelor after)
PCI will give heparin

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2
Q

Management of STEMI long-term

A

12m:
clopidogrel/ticagrelor

lifetime:
aspirin
statin
ACEi/ARB
Beta blockers
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3
Q

Medical management of acute NSTEMI

A

Aspirin 300mg
Assess for immediate PCI

Heparin OR fondaparinux (if no immediate cathlab)

GRACE score for if they get PCI (either immediately if unstable or within 72h if stable)

If GRACE >3% chance then PCI
If GRACE <3%, give ticagrelor/clopidogrel/prasugrel

Conisder
O2
Nitrate
Opioid
Anti-emetic
Beta blocker if Stable and no CI
DHP CCB
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4
Q

Contraindications to beta blockade in acute NSTEMI

A

Sign of HF/low CO
risk of cardiogenic shock
coronary vasospasm/cocaine

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5
Q

Management of NSTEMI long-term

A

12m:
clopidogrel/ticagrelor

lifetime:
aspirin
statin
ACEi/ARB
Beta blockers

Cardiac rehab

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6
Q

what defines LV dysfunction

A

EF <40%

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7
Q

Drugs given 1st line in chronic LVF

A

ramipril
bisoprolol
atorvastatin

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8
Q

drugs to consider if LVF not getting better

A 
eplerenone 
THEN
sacubutril/valsartan OR
dapagliflozin OR 
ivabradine
OR hydralazine + nitrate

consider digoxin if sinus
consider CRT

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9
Q

HF drug if intolerant of ACEi/ARB e.g. afro-caribbean

A

hydralazine + nitrate

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10
Q

Indications for CRT

A

HF with QRS >120

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11
Q

Indications for ICD

A

Risk of shockable rhythms
e.g. conduction disorder
structural disorders e.g. cardiomyopathy
HFrEF AND MI (40d post)

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12
Q

Number of leads of ICD

A

1

Right ventricle

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13
Q

Indications for Pacemaker

A 
SAN disease (sick sinus, bradycardia with wide QRS)
SLOW AF
3rd degree heart block or Mobitz 2
trifasicular block
tachycardia AND AV ablation
heart transplants
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14
Q

number of leads in pacemaker

A

2

RV and RA

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15
Q

ECG changes to paced rhythms

A

pacing spikes

look if after the spike there’s a p wave or QRS

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16
Q

Indications for CRT

A

Low EF + LBBB
QRS >130
cardiomyopathy
desynchrony

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17
Q

number of leads in CRT

A

3

RV, RA and LV (epicardial)

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18
Q

What drug to hold before and after angiogram?

A

metformin 48 pre and post

renal issues

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19
Q

when to revascularise NSTEMI?

A

painless: within 48h
painful: immediately

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20
Q

Acute LVF management

A 
Sit them up
furosemide for pul oedema
GTN if hypertensive
inotropes/vasopressors (dobutamine) if shock
oxygen if <90%

consider: opiate+emetic, NIV

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21
Q

Acute AF management <48h

A

if life threatening 3x DC

rate control: beta blocker, OR diltiazem OR digoxin

rhythm control: flecainide if young OR amiodarone if old

if HF, consider digoxin/amiodarone

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22
Q

Acute AF management >48h

A

if life threatening 3x DC

if not: heparin and then DOAC/warfarin for at least 3w and rate control before cardioversion as appropriate

If need to cardiovert now: TOE to exclude thrombus then DC cardioversion

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23
Q

Acute SVT management

A

vagal manoeuvres
adenosine 6mg IV
adenosine 12mg IV
adenosine 12mg IV

consider DC cardioversion

24
Q

Acute VF management or pVT

A

CPR 30:2
Shock
back to CPR

adrenaline every 3-5 minutes
amiodarone after 3 shocks

25
Q

Acute pulse VT management

A

amiodarone, lidocaine, procainamde, magnesium, cardioversion

26
Q

Torsades de Pointes management

A

congenital: high dose BB

drug induced: magnesium sulfate

27
Q

adenosine contraindication

A

asthma

use verapamil instead

28
Q

paroxysmal SVT management

A

conservative
ablation
rate control

29
Q

unstable aortic stenosis management

A

balloon valvuloplasty before TAVI

30
Q

Hypertension Management

A

1: ACEi or CCB (AC/>55y)
2: Both
3: Add thiazide-like diuretic
4: Beta blocker or alpha blocker or spiro

31
Q

management for pericarditis

A

high dose NSAIDs +/- colchicine for pain relief and reduce inflammation
PPI
Exercise restriction

Treat cause: uraemia, hypothyroid, infection, TB

32
Q

two forms of post-MI pericarditis

A

early 2-5d

late (dressler) up to 11w

33
Q

HOCM management

A

exercise restriction
aggressively treat atrial arrhythmia
beta blocker/verapamil +/-disopyramide

consider ICD
consider heart debulking or transplant

34
Q

drugs contraindicated in HOCM

A

digoxin, nitrates, inotropes

35
Q

dilated CM management

A 
Strenuous exercise restriction
ACEi
Beta blockers
Spiro
Pacemaker/ICD/CRT
Left Ventricular Assist Device (LVAD)

Consider Batista procedure or transplant

36
Q

Management of restrictive CM

A 
Beta blocker
ACEi
Digoxin
Diuretics
Treat underlying cause
transplant
37
Q

Ages to decide between surgical or transcatheter valve replacement for symptomatic AS

A

age <65 surgical
age 65-80 surgical OR transcatheter
80+ transcatheter

38
Q

Chronic AF management

A

Rate control: beta blocker, verapamil, digoxin or amiodarone
Anticoagulate based on CHADSVASC >=2: DOAC, dabigatran, rivaroxaban, apixaban, and edoxaban

consider DC cardioversion or ablation

39
Q

Infective Endocarditis management

A

oxygen >94%
?fluid resus
Blood cultures before empirical antibiotic therapy

native valve: amox +/- gent
prosthetic: vanc + rifampicin + gent

40
Q

Duke’s criteria for infective endocarditis

A

2 major OR 1 major and 3 minor or 5 minor

major: bacteraemia 2 cultures 12h apart or echo
minor: fever, echo, vascular, immunological involvement, 1 culture, risk factors for IE

41
Q

Rheumatic fever management

A

bed rest
NSAIDs aspirin
Pen V

if CCF/cardiomegaly/3rd degree HB: steroids

Syndenhams chorea: haloperidol or diazepam

long-term Abx +/- surgical repair/replacement

42
Q

What scoring system counters CHADSVASC

A

ORBIT

can also use HASBLED

43
Q

Second degree Heart block type 2 management

A

urgent cardio referral
pacing
ablation

44
Q

LBBB treatment

A

compare to old to see if dynamic

new LBBB treat at STEMI
in unsure if STEMI use SGARBOSSA criteria

45
Q

Contraindication to nitrate

A

Aortic stenosis/hypotension

46
Q

Management of aortic dissection

A

Type A: urgent surgery

Type B: conservative: labetalol, 2nd nicardipine 3rd hydralazine

47
Q

Warfarin reversal

A 
Major bleeding: PCC
Any bleeding (inc major): IV Vitamin K

No Bleeding:
>8 give oral Vit K
5-8 withhold warfarin and reduce maintenance

48
Q

management of stable angina

A

conservative: smoking, weight loss, exercise, diet
aspirin + statin

GTN symptomatically
Beta blocker or CCB (rate limiting)

combine BB and CCB (non-rate limiting)

Any of RINN: ranolazine, ivabradine, nicorandil, long acting nitrate (isosorbide)

49
Q 
ACS ECG changes and territories
anteroseptal
anterolateral
lateral
Inferior
Posterior
A 
anteroseptal: V1-4, LAD
Anterolateral: V4-6 + aVL, LAD/Cx
Lateral: I + aVL + V5-6, left Cx
Inferior: II + III + aVF, Right
Posterior: tall R waves in V1/2, LCx or Right
50
Q

4 H and 4Ts

A

Hypoxia
Hypovolaemia
Hypothermia
Hypo/hyperkalaemia, hypoglycaemia, hyperacidaemia

Thrombosis
Tamponade
Tension
Toxin

51
Q

Post MI heart block management

A

Inferior: Atropine
Anterior: temporary TC pacing

52
Q

Post MI rupture management

A

Early:
inotropes/vasopressors
Surgery: balloon pump inside aorta

Late:
Pericardiocentesis + thoracotomy

53
Q

what cardiac marker to use if ?reinfarct MI

A

CK-MB instead of troponin

54
Q

bradycardia management

A

atropine 500mcg IV

consider TC pacing, adrenaline

55
Q

NHYA classification

A

1) no limitation
2) comfy at rest, slight limitation
3) comfy at rest, marked limitation on minor activity
4) dyspnoea at rest

56
Q

ECG of dissection

A

Any of

1) normal
2) STEMI in inferior leads
3) pericarditis changes

PACES Management (11 decks)

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