Cardio Flashcards
angina investigation
1st line - coronary angiography
also - ECG, exercise ECG, BP, bloods (FBC, U+E, glucose, lipid, TFT, LFT, troponins)
what 2 drugs should people with angina be put on unless contraindicated
aspirin and statin
angina 1st line symptom prophylaxis
Beta blocker or CCB
angina rapid symptom control
GTN
if no response to beta blocker or CCB in angina what do you do
switch to the other or use combination
- if using beta blocker use nifedipine as CCB
what drugs can be added to CCB + BB in angina treatment if not responding
long acting nitrate - isosorbide mononitrate
ivabradine
nicorandil
ranolazine
definitive treatment angina
CABG/PCI
what advice should be given regarding use of GTN
o When symptoms develop, stop activity and take GTN spray.
o If no symptom relief, take another spray after 5 minutes.
o If still no symptom relief 5 minutes after this, call 999.
o 8 hours per day nitrate free to avoid tolerance
acute management of suspected ACS
MONA + T morphine oxygen nitrates aspirin ticagrelor
when can PCI be given
if patient presents within 12 hours of symptom onset and PCI could be given in 120 mins from ECG diagnosis
what should be given prior to PCI
further dual antiplatelet therapy
Aspirin + prasugrel (60mg)
if PCI unavailable what can be done
thrombolysis
what drug is used in thrombolysis
alteplase
what drug is given to patients during PCI
heparin
what do you do if ECG 90 mins after thrombolysis fails to show resolution of ST elevation
PCI
Post ACS treatment
statin lifelong ACEI BB dual antiplatelet - aspirin 75mg lifelong - ticagrelor
GTN spray PRN
lifestyle advice
BP/glycaemic control
how long should dual antiplatelet treatment be given post ACS
aspirin lifelong
ticagrelor 3 months or 4 weeks if no PCI
drug for s/s of HF after ACS
spironolactone / eplerenone
acute treatment of NSTEMI
same as STEMI
treatment of NSTEMI if ischaemic ECG changes or elevated cardiac markers
immediate treatment with fondaparinaux or LMWH
treatment of NSTEMI following confirmation
BB
unstable angina treatment upon confirmation
BB and LMWH (same as nstemi)
unstable tachycardia treatment
1 - DC cardioversion up to 3 times (if applicable)
2 - amiodarone 300mg IV over 10-20 mins
1st line treatment stable SVT
1 - vagal manoeuvres
2nd line treatment stable SVT
IV adenosine
- if asthma IV verapamil
what is used instead of adenosine in 2nd line treatment stable SVT
IV verapamil
treatment stable VT
amiodarone loading dose followed by 24 hour infusion
or lidocaine
what drug should NOT be used in VT
verapamil
treatment irregular broad complex tachycardia
AF with BBB - treat same as unstable narrow/SVT
treatment polymorphic VT
IV mag sulf
treatment sinus tachycardia
beta blocker
definitive treatment of WPW
radioablation of extra pathway
acute AF treatment - heamodynamically unstable
emergency cardioversion (rhythm control) DCCV
rate control 1st line in AF
BB or CCB (diltiazem)
2nd line rate control in AF
digoxin e.g. if HF
what should always be given before rhythm control
antiplatelet
1st line rhythm control in AF if evidence of structural heart disease
amiodarone 900mg over 24 hours
1st line rhythm control in AF if no evidence of structural heart disease
flecainide
when is rhythm control indicated in AF
symptoms for < 48 hours or be anticoagulated
if AF > 48 hours how long must someone be taking heparin before cardioversion
3 weeks
treatment chronic AF
BB or CCB
3rd line treatment chronic AF if BB or CCB not worked
digoxin
when would rhythm control be used in chronic AF
Symptomatic. CCF present. Younger patient. Presenting for the first time with lone AF. Reversible cause
what is the drug used in rhythm control in chronic AF
sotalol or amiodarone for 4 weeks
anticoagulation in AF stroke risk score assessment
CHADVASC
what drug is used as anticoagulation in chronic AF
noac - edoxaban, apixaban, rivaroxaban, dabigatran
treatment atrial flutter
beta blocker
RFA
treatment unstable VT
DCCV
sustained VT
amiodarone central line
treatment V fib
DCCV
what drugs can cause TdP
macrolides - clarithromycin etc
tx LQTS
low risk - lifestyle modifications and beta blockers
high risk- lifestyle + ICD +/- BB
unstable bradycardia
atropine 500mcg IV repeat up to 3mg at 2-3 min intervals
tx mobitz type 1
nothing unless associated with haemodynamic instability / collapse
- if so atropine, TC pacing
tx mobitz type 2
ventricular pacemaker
tx 3rd degree heart block
ventricular pacing
when is HTN treated
stage 2 and above or stage one if Diabetes. Renal disease. End organ damage. Established cardiovascular disease. 10-year cardiovascular risk > 10%.
tx HTN in diabetes
ACEI 1st line
tx HTN in young patients with diabetes if ACEI not tolerated or may become pregnant or have clear sign of sympathetic drive i.e. sweating, palpitations
BB
tx pathway HTN < 55 or T2DM
1) ACEI
2) ACEI + CCB or ACEI + thiazide
3) ACEI + CCB + thiazide
4) spironolactone (if K<4.5) or alpha or beta blocker if K >4.5
tx pathway HTN non diabetics > 55 or afrocarribean
1) CCB
2) ACEI + CCB or ACEI + thiazide
3) ACEI + CCB + thiazide
4) spironolactone (if K<4.5) or alpha or beta blocker if K >4.5
hypertensive crisis
no end organ damage - oral treatment
end organ damage but no LVF - labetolol
end organ damage with LVF - furosemide and hydralazine
ix HF
raised BNP - 1st line
non-pharmacological tx HF
weight loss
fluid restrict
salt restrict
exercise
1st line tx heart failure
ACEI + BB
2nd line tx HF
spironolactone
risk of spironolactone + ACEI
hyperkalaemia - monitor
3rd line HF
digoxin
ivabradine
hydralazine
sacubitril-valsartan
acute tx HF
sit up high flow O2 furosemide IV diamorphine IV nitrates IV CPAP
some others find dinner not crucial
when should diamorphine not be used in HF
COPD
ix endocarditis
blood cultures from 3 separate sites time and person
1st line imaging TTE
imaging in endocarditis if prosthetic valve, vegetations or non-diagnostic image on TTE
TOE
native valve endocarditis tx
amoxicillin and gent
severe native valve endocarditis tx or penicillin allergy or MRSA
vanc and gent
staph aureus endocarditis tx
flucloxicillin
strep viridans endocarditis tx
benzylpenicillin
prosthetic valve staph endocarditis tx
fluclox + rifampicin + gent
prosthetic valve staph endocarditis treatment penicillin allergy
vanc + rifampicin + gent
enterococcus endocarditis tx
amox/vanc + gent
prosthetic valve blind endocarditis tx
vanc + gent + rifampicin
symptom control HOCM
Bblockers / verapamil
tx arrhythmic right ventricular cardiomyopathy
rhythm control - bb / amiodarone
ICD
pericarditis tx
NSAID and colchicine
pericardial effusion tx
pericardiocentesis
cardiac tamponade tx
pericardiocentesis
diagnostic ix aortic dissection
CT angio CAP
tx aortic dissection
analgesia and bed rest
type A - open or endovascular repair and maintain BP between 100-120
type B - beta blockers
AAA screening
all men > 65 - single ultrasound
ruptured AAA investigation
US
ruptured AAA treatment
open or endovascular repair
- infrarenal EVAR
- suprarenal TVAR
AAA < 5.5cm
monitor
how often do you scan AAA 3-4.4cm
yearly
how often do you scan AAA 4.5-5.4cm
3 monthly
first line investigation peripheral arterial disease
duplex US
tx peripheral arterial disease
clopidogrel and statin
lifestyle - exercise beyond pain
surgical - stent, endartarectomy, BPG
acute limb-threatening ischaemia investigation
hand held doppler examination + ABPI
acute limb-threatening ischaemia treatment
IV opioid and IV unfractionated heparin
superficial thrombophlebitis tx
LMWH for 30 days or fondaparinaux for 45
oral NSAID 2nd line
DVT treatment 1st line
NOAC e.g. rivaroxaban
DVT 2nd line treatment
LMWH + warfarin or LMWH + dabigatran/edoxaban
how long should anticoagulation continue in unprovoked DVT
6 months
how long should anticoagulation continue in provoked DVT
3 months
PE treatment 1st line
rivaroxaban
PE treatment 2nd line
LMWH + dabigatran or edoxaban
or LMWH + warfarin
when would LMWH + warfarin be used in PE/DVT treatmetn
renal failure and APLS
HTN treatment in patients with CKD and ACR > 30 regardless of age
ACEI / ARB