Cardio Flashcards
what criteria must be fulfilled for PCI to be given for STEMI
must have presented within 12 hours and must be able to do PCI within 120 minutes of the time that thrombolysis could be given
what drugs are given if STEMI
-aspirin 300mg immediately
-2nd anti platelet (prasugrel if low bleed risk, clopidogrel if high bleed risk)
-if having PCI need UFH and glycoprotein bailout inhibitor
an ECG is done 60-90 minutes after fibrinolysis, if changes have not resolved –> what happens next?
PCI?
what does GRACE score estimate
6 month mortality after ACS
if GRACE score is >3% after nSTEMI, what happens next?
PCI within 72 hours
(+ aspirin which should have already been given + prasugrel/clopidogrel) + UFH
what dual anti platelet is used if GRACE score determines low risk after nSTEMI and therefore no PCI planned?
ticagrelor
when would someone with an nSTEMI have PCI immediately
if they are unstable
generally what dual anti platelet is used after ACS
aspirin +
prasugrel if low bleed risk
clopidogrel is higher bleed risk
what is given to a patient with nSTEMI if they are not going for PCI immediately
aspirin 300mg (always for ACS)
+ fondaparinux !
give 4 causes of polymorphic VTACH (tornadoes de pointes)
things which cause long QT –> hypothermia, hypocalcaemia, subarachnoid and macrolides
Complications of torsades de pointes
v fib
Tx of torsades de pointes
IV mag sulphate
adverse signs of adult tachycardia
MI, syncope, shock, HF
MX of VTACH with / without adverse signs
with –> immediate synchronised cardioversion
without –> amiodarone loading dose 300mg IV followed by a 24 hour infusion
stepwise Mx of SVT
1) vagal manoeuvres
2) adenosine (6-12-18mg) and need to monitor ECG continuously
3) verapamil or beta blocker
4) if all above ineffective –> synchronised DC shock
causes of de novo acute heart failure
MI, valve dysfunction, arrhythmias
causes of acute heart failure (on background of chronic)
MI, uncontrolled HTN, non compliance with meds, infection
questions to ask about acute heart failure
1) was there any chest pain (thinking was MI the cause)
2) palpitations? (was arrhythmia the cause)
3) fever? (is infection the cause)
4) are they taking their medications as prescribed
Ix for acute heart failure
bloods - FBC, troponin, infection, BNP!
CXR
ECG
Echo
MX of acute heart failure
1) IV loop diuretics (need higher dose if CKD or if already on diuretics) + catheterise to monitor fluid balance
2) oxygen (only if hypoxic)
3) vasodilators (not as routine but nitrates may be helpful if the heart failure is caused by ischaemia)
4) if there is hypotension (shows cardiogenic shock and this is a poor prognostic factor) –> considered dobutamine or vasopressors like noradrenaline
5) if resp failure –> CPAP
6) continue normal medications
-only stop B blockers if HR <50 of in 2nd or 3rd degree heart block
RF of aortic dissection
main RF =. hypertension
others = marfans, male, bicuspid aortic valve
main presenting features of aortic dissection
tearing chest pain and pulse deficit
-may also have other features if spinal arteries affected (paraplegia) or if renal arteries affecting (pain) or mesenteric pain
O/E of aortic dissection
variations in the BP across arms
IX of aortic dissection
ECG, CXR, high troponin, high D dimers
Gold standard = CT angiogram
-can also do TTE/TOE/MRA
