Cardio! Flashcards
What is Rivaroxaban?
-anticoagulant
-factor Xa inhibitor
-used to treat DVT and PE
-binds directly to factor Xa, blocking the amplification of the coagulation cascade, preventing the formation of thrombus
A PR interval > 200ms (five small squares) is …
first degree heart block
What ECG variants are considered normal in an athlete?
-sinus bradycardia
-junctional rhythm
-first degree heart block
-Mobitz type 1 (Wenckebach phenomenon)
What are the 3 classifications of acute coronary syndrome?
-STEMI
-NSTEMI
-unstable angina
Management guidance groups the patients into two groups: STEMI and NSTEMI/unstable angina
Describe the common management of all patients with acute coronary syndrome
Initial drug therapy:
-aspirin 300mg
-oxygen if <94%
-morphine for severe pain
-nitrates
-next step in management is to determine whether they meet the ECG criteria for STEMI
Once a STEMI has been confirmed the first step is to immediately assess eligibility for coronary reperfusion therapy. There are two types of coronary reperfusion therapy:
-percutaneous coronary intervention
-fibrinolysis
Describe management of STEMI
-STEMI identified
-aspirin 300mg
-PCI possible within 120 mins:
if yes-> give prasugrel (anti-platelet), radial access preferred, give unfractionated heparin + bailout glycoprotein IIb/IIIa inhibitor
-if PCI not possible within 120 mins -> fibrinolysis-> give an antithrombin at the same time and following procedure give ticagrelor
Describe the management for NSTEMI/unstable angina
-NSTEMI/unstable angina identified
-aspirin 300mg
-Fondaparinux if no immediate PCI planned
-estimate 6 month mortality (e.g. GRACE):
Low risk->conservative management- ticagrelor (anti-platelet)
Intermediate/high risk-> PCI- offer immediately if clinically instable (e.g. hypotensive), otherwise offer within 72 hours- give prasugrel or ticagrelor, give unfractionated heparin
What is the risk assessment tool used in acute coronary events?
The Global Registry of Acute Coronary Events (GRACE)
It takes into account:
-age, HR, BP, cardiac (Killip class) and renal function (serum creatinine), cardiac arrest on presentation, ECG findings, troponin levels
What is the first line treatment for hypertension in diabetes?
ACE inhibitors/ or A2RBs e.g. ramipril / or irbesartan
It also also important when assessing a patient with newly diagnosed hypertension to ensure they do not have any end-organ damage:
fundoscopy: to check for hypertensive retinopathy
urine dipstick: to check for renal disease, either as a cause or consequence of hypertension
ECG: to check for left ventricular hypertrophy or ischaemic heart disease
Name common drugs used to treat hypertension
-ACEi
-CCB
-thiazide type diuretic
-angiotensin II receptor blocker (A2RB)
What is the most common cause of secondary hypertension?
Primary hyperaldosteronism, including Conn’s syndrome
What is acute coronary syndrome?
Acute coronary syndrome is usually the result of a thrombus from an atherosclerotic plaque blocking a coronary artery.
When a thrombus forms in a fast-flowing artery, it is formed mainly of platelets.
This is why antiplatelet medications such as aspirin, clopidogrel and ticagrelor are the mainstay of treatment.
What is the root of the aorta and what are the branches from here?
The aortic root is where the aorta and the heart connect.
The right and left coronary arteries branch from the root of the aorta.
