Cardio Flashcards
Management of acute STEMI
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
Management of STEMI long-term
12m:
clopidogrel/ticagrelor
lifetime: aspirin statin ACEi/ARB Beta blockers
Medical management of acute NSTEMI
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
Contraindications to beta blockade in acute NSTEMI
Sign of HF/low CO
risk of cardiogenic shock
coronary vasospasm/cocaine
Management of NSTEMI long-term
12m:
clopidogrel/ticagrelor
lifetime: aspirin statin ACEi/ARB Beta blockers
Cardiac rehab
what defines LV dysfunction
EF <40%
Drugs given 1st line in chronic LVF
ramipril
bisoprolol
atorvastatin
drugs to consider if LVF not getting better
eplerenone THEN sacubutril/valsartan OR dapagliflozin OR ivabradine OR hydralazine + nitrate
consider digoxin if sinus
consider CRT
HF drug if intolerant of ACEi/ARB e.g. afro-caribbean
hydralazine + nitrate
Indications for CRT
HF with QRS >120
Indications for ICD
Risk of shockable rhythms
e.g. conduction disorder
structural disorders e.g. cardiomyopathy
HFrEF AND MI (40d post)
Number of leads of ICD
1
Right ventricle
Indications for Pacemaker
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
number of leads in pacemaker
2
RV and RA
ECG changes to paced rhythms
pacing spikes
look if after the spike there’s a p wave or QRS
Indications for CRT
Low EF + LBBB
QRS >130
cardiomyopathy
desynchrony
number of leads in CRT
3
RV, RA and LV (epicardial)
What drug to hold before and after angiogram?
metformin 48 pre and post
renal issues
when to revascularise NSTEMI?
painless: within 48h
painful: immediately
Acute LVF management
Sit them up furosemide for pul oedema GTN if hypertensive inotropes/vasopressors (dobutamine) if shock oxygen if <90%
consider: opiate+emetic, NIV
Acute AF management <48h
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
Acute AF management >48h
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
Acute SVT management
vagal manoeuvres
adenosine 6mg IV
adenosine 12mg IV
adenosine 12mg IV
consider DC cardioversion
Acute VF management or pVT
CPR 30:2
Shock
back to CPR
adrenaline every 3-5 minutes
amiodarone after 3 shocks
Acute pulse VT management
amiodarone, lidocaine, procainamde, magnesium, cardioversion
Torsades de Pointes management
congenital: high dose BB
drug induced: magnesium sulfate
adenosine contraindication
asthma
use verapamil instead
paroxysmal SVT management
conservative
ablation
rate control
unstable aortic stenosis management
balloon valvuloplasty before TAVI
Hypertension Management
1: ACEi or CCB (AC/>55y)
2: Both
3: Add thiazide-like diuretic
4: Beta blocker or alpha blocker or spiro
management for pericarditis
high dose NSAIDs +/- colchicine for pain relief and reduce inflammation
PPI
Exercise restriction
Treat cause: uraemia, hypothyroid, infection, TB
two forms of post-MI pericarditis
early 2-5d
late (dressler) up to 11w
HOCM management
exercise restriction
aggressively treat atrial arrhythmia
beta blocker/verapamil +/-disopyramide
consider ICD
consider heart debulking or transplant
drugs contraindicated in HOCM
digoxin, nitrates, inotropes
dilated CM management
Strenuous exercise restriction ACEi Beta blockers Spiro Pacemaker/ICD/CRT Left Ventricular Assist Device (LVAD)
Consider Batista procedure or transplant
Management of restrictive CM
Beta blocker ACEi Digoxin Diuretics Treat underlying cause transplant
Ages to decide between surgical or transcatheter valve replacement for symptomatic AS
age <65 surgical
age 65-80 surgical OR transcatheter
80+ transcatheter
Chronic AF management
Rate control: beta blocker, verapamil, digoxin or amiodarone
Anticoagulate based on CHADSVASC >=2: DOAC, dabigatran, rivaroxaban, apixaban, and edoxaban
consider DC cardioversion or ablation
Infective Endocarditis management
oxygen >94%
?fluid resus
Blood cultures before empirical antibiotic therapy
native valve: amox +/- gent
prosthetic: vanc + rifampicin + gent
Duke’s criteria for infective endocarditis
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
Rheumatic fever management
bed rest
NSAIDs aspirin
Pen V
if CCF/cardiomegaly/3rd degree HB: steroids
Syndenhams chorea: haloperidol or diazepam
long-term Abx +/- surgical repair/replacement
What scoring system counters CHADSVASC
ORBIT
can also use HASBLED
Second degree Heart block type 2 management
urgent cardio referral
pacing
ablation
LBBB treatment
compare to old to see if dynamic
new LBBB treat at STEMI
in unsure if STEMI use SGARBOSSA criteria
Contraindication to nitrate
Aortic stenosis/hypotension
Management of aortic dissection
Type A: urgent surgery
Type B: conservative: labetalol, 2nd nicardipine 3rd hydralazine
Warfarin reversal
Major bleeding: PCC Any bleeding (inc major): IV Vitamin K
No Bleeding:
>8 give oral Vit K
5-8 withhold warfarin and reduce maintenance
management of stable angina
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)
ACS ECG changes and territories anteroseptal anterolateral lateral Inferior Posterior
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
4 H and 4Ts
Hypoxia
Hypovolaemia
Hypothermia
Hypo/hyperkalaemia, hypoglycaemia, hyperacidaemia
Thrombosis
Tamponade
Tension
Toxin
Post MI heart block management
Inferior: Atropine
Anterior: temporary TC pacing
Post MI rupture management
Early:
inotropes/vasopressors
Surgery: balloon pump inside aorta
Late:
Pericardiocentesis + thoracotomy
what cardiac marker to use if ?reinfarct MI
CK-MB instead of troponin
bradycardia management
atropine 500mcg IV
consider TC pacing, adrenaline
NHYA classification
1) no limitation
2) comfy at rest, slight limitation
3) comfy at rest, marked limitation on minor activity
4) dyspnoea at rest
ECG of dissection
Any of
1) normal
2) STEMI in inferior leads
3) pericarditis changes
