Cardio Flashcards
Critères chirurgicaux insuffisance mitrale
Class I indications for surgery (repair when possible vs. replacement)
for PRIMARY MR:
* Severe, symptomatic 1o MR irrespective of LVEF
* Severe, asymptomatic 1o MR + LV systolic dysfunction (LVEF ≤ 60%,
LVESD ≥ 40mm)
no class I indication for surgery/intervention for 2o MR
Anticoagulation en sténose mitrale
Anticoagulation (VKA) indicated if à prior embolic event
OR LA thrombus OR AF.
OAC with VKA if i) rheumatic MS and AF; ii) rheumatic MS and prior embolic event; iii)
rheumatic MS and LA thrombus (N.B. ii and iii do not require AFIB)
Critères sténose mitrale sévère
– MV area ≤1.5 cm2 (very severe = ≤1 cm2)
– Pulmonary artery systolic pressure >50mmHg
– Diastolic pressure half time (PHT) >150 ms
Indications coumadin
– VKA (i.e. warfarin) should be used instead of DOAC for valvular AF (CCS 2016, 2018 and 2020
definition):
* Mechanical heart valves
* Rheumatic mitral stenosis
* Moderate-severe non-rheumatic mitral stenosis
– Warfarin should also be considered (class IIa) in patients with new onset AF ≤ 3 months post-valve
replacement (surgical or percutaneous)
Indications chirurgicales sténose mitrale
2 types of interventions – percutaneous vs. surgical
Percutaneous mitral balloon commissurotomy (PMBC) indicated if (Class I):
* Severe, symptomatic MS + favourable valve anatomy + can be performed at
a “Comprehensive Valve Centre”
– CONTRAINDICATED if: i) LA thrombus (need preop TEE) ii) >moderate MR
MV surgery (commissurotomy +/- repair OR replacement) indicated if (Class I):
* Severe, symptomatic MS + acceptable surgical risk + contraindicated/failed
PMBC
* Severe MS and other cardiac surgery planned
Résultats étude COMPASS
COMPASS trial results:
– Low dose ASA + rivaroxaban 2.5 mg BID
– “Another option for secondary prevention in patients with chronic stable CAD” (buried in
CCS antiplatelet 2018 text)
– Reasonable alternative to ASA alone in patients with CAD + AF at low risk of stroke
(CHADS65 = 0) (CCS 2020 AF guidelines)
PCI vs pontage
- Conflicting stroke data
- Less repeat revascularization with
CABG - ↑ Survival with CABG in highly
select scenarios
Recette double antiplaquettaire en SCA
Antiplatelet: ASA + 2nd agent (P2Y12 inhibitor: ticagrelor, clopidogrel, prasugrel)
– Loading doses à ASA (160 mg CHEWED), Ticagrelor (180 mg), Prasugrel (60mg) Clopidogrel
(300-600 mg)
* Ticagrelor C/I if previous intracranial hemorrhage, prasugrel C/I if ANY prior TIA/Stroke
* If thrombolysis à ASA + Clopidogrel (NO TICAGRELOR OR PRASUGREL)
Rx associées à une péricardite
procainamide,
hydralazine, INH, minoxidil, dilantin
Quel médicament éviter avec la cocaine
beta-bloqueurs
Fitness to drive avec SCA
STEMI/NSTEMI
with LVEF >40%
private car : 2 weeks post d/c
commercial driver :1 months post
d/c
STEMI/NSTEMI
with LVEF ≦ 40%
Private car : 1 month post d/c
commercial driver : 3 months post
d/c
STEMI/NSTEMI
with no PCI
performed
private car : 1 month post d/c
commercial driver : 3 months post
d/c
UA (ACS without
MI)
private car : 48h w/ PCI
7 d w/o PCI
commercial driver : 7 d w/ PCI
1 month w/o
PCI
P2Y12 à choisir si haut risque de saignement
clopidogrel over ticagrelor
Choix antiarythmiques selon FeVG, maladie coronarienne ou insuffisance cardiaque
FEVG < 40 % = amio
FEVG > 40% = amio ou sotalol
mx coronarienne = amio, dronedarone ou sotalol
absence d’insuffisance cardiaque et de maladie coronarienne = amio, dronedarone, flecainide, propafenone, sotalol
arrêt BB si ajout sotalol (2 BB)
screening maladie artérielle périphérique
adults age>50 with risk factors
(smoking, diabetes), even if asymptomatic
– No role for routine testing in asymptomatic
individuals without risk factors
– No role in also routinely screening for coronary
artery disease/carotid artery disease unless
they have symptoms of these conditions
ABI or TBI test of choice to
confirm diagnosis of PAD in patients with
symptoms
Fitness to drive après pacemaker
Impaired LOC or
high grade AV block
1 week post implant
Lead upgrade/revision (also
applies for ICD private driving)
1 week post implant if
history of impaired LOC/high
grade AV block
Otherwise OK to drive
Fitness to drive syncope
Single/recurrent
vasovagal syncope
OK to drive
Reversible cause
(orthostatic,
dehydration) or
avoidable trigger
(micturition)
private 1 week commercial 1 month
Single unexplained
syncope
private 1 week commercial 12 months
Recurrent
unexplained
syncope
private 3 months commercial 12 months
fréquence surveillance AAA et indication chx
- Screen all men >65-80 for AAA once with U/S [Canadian Task Force on Preventive Services 2017]
- In those with asymptomatic AAA, smoking cessation is the only medical therapy proven to reduce risk of
rupture
– Recommendations for BP management (<140/90 CCS / <130/80 AHA), statin use (if atherosclerotic disease is reasonable, if no
atherosclerosis can consider) and low dose aspirin if atherosclerotic disease present, are similar to thoracic aortic aneurysm
– Avoid fluoroquinolones in patients with known aortopathy due to increased risk of rupture [FDA, 2018] - Surveillance recommendations (ultrasound first line, CT if ultrasound not adequate):
– 3.0 to 3.9 cm: imaging every 3 years
– 4.0 to 4.9 cm men, 4.0 to 4.4 cm women: imaging every 12 months
– >5.0 cm men, >4.5 cm women: imaging every 6 months - Threshold for surgery (needs to balance risk of aneurysm rupture and risk of repair):
– Men: 5.5 cm or more or <5.5 cm if symptoms attributable to AAA (class I)
– Women: 5.0 cm or more or <5.0 cm if symptoms attributable to AAA (class I)
– If rate of growth is greater than 0.5 cm in 6 months, AAA repair is reasonable class IIb)
Indication evolocumab (Repatha)
LDL > 2,2 ou apo-B > 0,8
ou non-HDL > 2,9
ajout après statine et ezetrol pour MCAS ou AAA (prévention secondaire) ou LDL > 5
Indication icosapent éthyl (Vascepa)
Fasting TG ≥1.5-5.6 AND
– ASCVD on maximally tolerated statin (with LDL >1 )
OR
– DM on max tolerated statin with ≥1 CV risk factor
* Men ≥ 55y and Women ≥65y
* Smoker currently or within 3 mos
* HTN
* HDL <1.04 men or <1.3 women
* hsCRP >3
* eGFR 30-60 ml/min
* Retinopathy
* Albuminuria
* ABI <0.9
Signes clinique d’une insuffisance aortique
B3
pouls bisfériens
apex large et latéralisé
pression différentielle augmentée
souffle systolique éjectionnel
souffle d’austin flint
signe de Musset
signe de Muller
signe de Quincke
pouls de corrigan / water-hammer
signe de traube
signe de Durozier
signe de Hill
2 signes cliniques hautement suggestif d’une insuffisance aortique
pouls bisférien
souffle diastolique
Définition syndrome de POTS
augmentaiton FC > 30 soutenue (ou >=120) en passant de la position couchée à debout sans baisse de TA 20/10
B2 dédoublé et fixe, penser à
CIA
antithrombotique apres TAVI
ASA + plavix
ou coumadin (2,5) x 3-6 mois puis
