Cardio Flashcards
when is atorvastatin given as primary prevention regardless of q risk
T1DM
CKD
QRISK for starting a statin
> 10%
what is ideal response to statin therapy
check lipids 3 months after starting
aim for 40% reduction in non HDL cholesterol
monitoring after starting a statin
check lipids and LFTs after 3 months
check LFTs after 12 months
how do statins affect LFTs
cause transient rise in AST/ALT in first few weeks of use
cholesterol lowering drugs besides statin
ezetimbe
PCSK9 inhibitors eg evolocumab
pneumonic for secondary prevention of cardiovasc disease
ABCD
ACEi
Beta blocker
Cholesterol
Dual antiplatelet
when is clopidogrel used for anticoagulation
PAD
after ischaemic stroke
aspirin daily dose
75mg
where are patients with angina referred to
rapid access chest pain clinic
when to avoid use of diltiazem and verapamil
HF with reduced ejection fraction
pharmacological mx of angina
- short term relief= GTN spray
- long term relief= beta blocker +- CCB (diltiazem or verapamil)
- secondary prevention (ABCD)
long acting nitrate example
isosorbide mononitrate
3 forms of ACS
unstable angina
NSTEMI
STEMI
RCA supplies
right atrium
right ventricle
inferior left ventricle
posterior septum
LCx supplies
left atrium
posterior aspect of left ventricle
LAD supplies
anterior left ventricle
anterior septum
how to use GTN
take when sx start
second dose after 5 mins if sx remain
third dose after 5 mins if sx remain
call an ambulance after 5 mins if sx remain
ECG changes in NSTEMI
ST depression
T wave inversion
LCA STEMI has changes in leads
I, avL, v3-6
LAD STEMI has changes in leads
V1-V4
LCx STEMI has changes in leads
I, avL, V5-V6
RCA STEMI has changes in leads
II, III, avF
anterolateral stemi artery involved
LCA
anterior stemi artery involved
LAD
inferior stemi artery involved
RCA
lateral stemi artery involved
LCx
anticoagulation for STEMI
300mg aspirin
PLUS
1. clopidogrel if high bleeding risk (on other anticoag)
2. prasugrel if normal bleeding risk
PLUS
fondaparinux (not needed if immediate PCI)
in NSTEMI how is decision made for PCI
GRACE score
> 3% angiography w PCI within 72 hrs
how do ACEi and aldosterone agonists affect potassium levels
cause hyperkalemia
DONT USE THEM TOGETHER
how long after MI does dresslers syndrome occur
2-3 weeks
ECG changes in pericarditis
PR depression
saddle shaped ST elevation
pericarditis mx
NSAIDs
Colchicine
maybe
steroids
percardiocentesis
cardiac output equation
stroke volume x heart rate
what system is affected in LV failure
pulmonary
what is the main outcome of LV failure
pulmonary oedema
in whom is LV failure common
older patients who are given fluid resus quickly
what type of resp failure does acute LV failure cause
type 1
what ejection fraction is normal
> 50%
what cardiothoracic ratio on CXR is cardiomegaly
> 0.5
COPD target o2 sats
88-92%
LVF mx
sit up
oxygen
diuretics
stop IV fluids
monitor fluids
assess underlying causes
inotrope example
dobutamine
HFpEF arises due to a dysfunction in
diastole
when asking about SOB in HF what should you remember to ask about
paroxysmal nocturnal dyspnoea
do you wake up at night out of breath
what classification system is used to grade severity of HF
NYHA
NYHA class 1
no limitation on activity
NYHA class 2
comfortable at rest
symptomatic with ordinary activity
NYHA class 3
comfortable at rest
symptomatic with any activity
NYHA class 4
symptomatic at rest
what BNP level warrants echo within 2 weeks
besides this within what time frame should echo be done for HF
> 2000- echo within 2 weeks
otherwise within 6 weeks
medical mx of HF
ABK
ACEi
Beta blocker
Kidneys- aldosterone agonist and loop diuretic
what is cardiac resynchronisation therapy
biventricular (triple chamber) pacemakers
objective is to synchronise contractions to optimise heart function
what structural heart change occurs in hypertension
left ventricular hypertrophy
LV has to contract against an increased systemic resistance
how is hypertension diagnosed
if BP in clinic is between 140/90-180/120 offer ABPM or home readings then diagnose
stage 1 hypertension clinic and ABPM/home reading
clinic: >140/90
ABPM/home: >135/85
stage 2 hypertension clinic and ABPM/home reading
clinic: >160/100
ABPM/home: >150/95
stage 3 hypertension BP
> 180/120
how to screen for end organ damage in hypertension
kidney= albumin:creatinine ratio, renal function
heart= echo for LVH, lipids
eyes= opthalmoscopy
is CCB is not tolerated in hypertension whats given
thiazide like diuretic
what is a common side effect of CCB
ankle oedema
4th step hypertension mx
if K+ >4.5= alpha blocker (doxazosin) or beta blocker
if K+ <4.5= spironolactone
how does spironolactone affect potassium levels
hyperkalemia
hypertension BP targets
<80= <140/90
>80= <150/90
alpha blocker example
doxazosin
