CARDIO Flashcards
ALS shockable vs non shockable rhythms
: shockable’ rhythms: ventricular fibrillation/pulseless ventricular tachycardia (VF/pulseless VT)
‘non-shockable’ rhythms: asystole/pulseless-electrical activity (asystole/PEA)
if the cardiac arrested is witnessed in a monitored patient (e.g. in a coronary care unit) then the 2015 guidelines recommend
up to three quick successive (stacked) shocks’,
ALS when to give adrenaline in non shockable rhythms
ASAp
ALS: when to give amiodarone in SHOCKABLE rhythms
after 3 shocks
ALS: when to give adrenaline in SHOCKABLE rhythm s?
once compressions restarted after 3rd shock
repeat every 3-5 minutes
what are the 4 Hs and 4 TS
Hypoxia
Hypovolaemia
Hyperkalaemia, hypokalaemia, hypoglycaemia, hypocalcaemia, acidaemia and other metabolic disorders
Hypothermia
Hypoxia
Hypovolaemia
Hyperkalaemia, hypokalaemia, hypoglycaemia, hypocalcaemia, acidaemia and other metabolic disorders
Hypothermia
Thrombosis (coronary or pulmonary)
Tension pneumothorax
Tamponade – cardiac
Toxins
Angina pectoris: drug management
1.beta-blocker or a calcium channel blocker
calcium channel blocker is used as monotherapy a rate-limiting one such as verapamil or diltiazem
if used in combination with a beta-blocker then use a longer-acting dihydropyridine calcium channel blocker
features of aortic regurgitation
early diastolic murmur: intensity of the murmur is increased by thehandgrip manoeuvre
collapsing pulse
wide pulse pressure
Quincke’s sign (nailbed pulsation)
De Musset’s sign (head bobbing)
mid-diastolic Austin-Flint murmur i
What is chadvasc
CCongestive heart failure1
HHypertension (or treated hypertension)1
A2Age >= 75 years2Age 65-74 years1
DDiabetes1
S2Prior Stroke, TIA or thromboembolism2
VVascular disease (including ischaemic heart disease and peripheral arterial disease)1
SSex (female) 1
0 no treatment
1 treatment for men
>2 anticoagulate
Management of AF <48hrs
Heparinised
Cardioversion - electrical (pharmacological if structural heart disease)
Further anticoagulation is unnecessary thereafter unless factors of ischaemic stroke
Tachycardia with adverse signs mx
synchronised DC shocks up to 3
Treatment following this is given according to whether the QRS complex is narrow or broad and whether the rhythm is regular or irregular.
Broad complex tachycardia no adverse signs
Regular
assume ventricular tachycardia (unless previously confirmed SVT with bundle branch block)
loading dose ofamiodaronefollowed by 24 hour infusion
Irregular
seek expert help. Possibilities include:
atrial fibrillation with bundle branch block- the most likely cause in a stable patient
atrial fibrillation with ventricular pre-excitation
torsade de pointes
Narrow complex tachycardia no adverse signs mx
Regular
vagal manoeuvres followed by IV adenosine
if the above is unsuccessful consider a diagnosis of atrial flutter and control rate (e.g. beta-blockers)
Irregular
probable atrial fibrillation
if onset < 48 hr consider electrical or chemical cardioversion
rate control: beta-blockers are usually first-line unless there is a contraindication
DVLA rules
1 week - angioplasty , pacemaker
4 weeks- ACS, CABG, ICD
Secondary prevention of stable cardiovascular disease with an indication for an anticoagulant
anticoagulant monotherapy is given without the addition of antiplatelets
Poorly controlled hypertension, already taking an ACE inhibitor, calcium channel blocker and a thiazide diuretic next step
potassium < 4.5 mmol/l add low-dose spironolactone
if potassium > 4.5 mmol/l add an alpha- or beta-blocker
GRACE score
age
heart rate, blood pressure
cardiac (Killip class) and renal function (serum creatinine)
cardiac arrest on presentation
ECG findings
troponin levels
Which patients with NSTEMI/unstable angina should have coronary angiography (with follow-on PCI if necessary)?
immediate: patient who are clinically unstable (e.g. hypotensive)
within 72 hours: patients with a GRACE score > 3%i.e. those at intermediate, high or highest risk
Ecg changes in pericarditis
changes in pericarditis are oftenglobal/widespread, as opposed to the ‘territories’ seen in ischaemic events
‘saddle-shaped’ ST elevation
PR depression: most specific ECG marker for pericarditis
Peri-arrest rhythms: bradycardia and haemodynamic compromose mx
Atropine (500mcg IV) is the first line treatment in this situation.
If there is an unsatisfactory response the following interventions may be used:
atropine, up to a maximum of 3mg
transcutaneous pacing
isoprenaline/adrenaline infusion titrated to response
Specialist help should be sought for consideration of transvenous pacing if there is no response to the above measures.
Atrialnfibrrikation managing stroke risk
CHA₂DS₂-VASc tool should be used
>1 and male or >2 and female
DOAC
Wayfaring if rneak function poor
Antiplatelet Secondary prevention for ACS
Aspirin (lifelong) & ticagrelor (12 months) fir ACS and post PCI
When is clopidogrel used as secondary prevention
TIA
Ischemic stroke
Peripheral arterial disease
Stain contra - indications
macrol ides .e. erythromycin
pregnancy
Indications for statins
Established CVS disease and 10 year risk> 10%
T1DM >40 yr or have nephropathy
Statins doses
atorvastatin 20mg for primary prevention
atorvastatin 80mg for secondary prevention
How do statins work
inhibit HMG-CoA reductase, the rate-limiting enzyme in hepatic cholesterol synthesis
following the administration of 2 doses of intramuscular adrenaline, if symptoms of anaphylaxis are not improving
Adrenaline infusion should be started.
Patients with MI secondary to cocaine use should be given
IV benzodiazepines as part of acute (ACS) treatment
NICE guidelines advise starting anticoagulation ? ? weeks after the event (in the absence of haemorrhage) unless it is a very large cerebral infarct. It advises that ‘anticoagulation treatment should not be used routinely for the treatment of acute stroke’. This is due to the risk of haemorrhagic transformation.
2 weeks
Which cakciumnchannel blockers are used in angina
if a calcium channel blocker is used as monotherapy a rate-limiting one such as verapamil or diltiazem should be used
if used in combination with a beta-blocker then use a longer-acting dihydropyridine calcium channel blocker (e.g. amlodipine, modified-release nifedipine)
Organophosphate insecticide poisoning
mnemonic = SLUD)
Salivation
Lacrimation
Urination
Defecation/diarrhoea
cardiovascular: hypotension, bradycardia
also: small pupils, muscle fasciculation
Management
atropine
acute limb ischaemia mx
ABC approach
analgesia: IV opioids are often used
intravenous unfractionated heparin is usually given to prevent thrombus propagation, particularly if the patient is not suitable for immediate surgery
vascular review
Definitive management:
intra-arterial thrombolysis
surgical embolectomy
angioplasty
bypass surgery
amputation: for patients with irreversible ischaemia
