Cardio Revision Session Flashcards
Treatment of STEMI
get them to PCI- if in 120mins away (and warn cadio)
Give Aspirin 300mg and Ticagrelor/clopidogrel (local choice (p2y12 inhib)
O2 only if desats
Morphine and Metoclopramide
Get heparin on board- esp for PCI n other
B-block can be given, but not urgent/F1 job
if PCI delay consider thrombolysis (not as good)
How long after an MI can you drive? What extra medical things can you do?
wait 1 week if MI
Wait 4w if complications of MI occured- in case of arrythmias
smoking cessation, MI clinic, cardiac rehab etc
Long term post MI reduced eject fraction management to improve LV function
LV dysf:
Bisprolol
Ramipril
Eprenolone (Spiro)
and Now- add Dapagliflozin (SGLT2 inhib)
can up the doses as much as possible
then can switch to better/other-Sacubatril/Valsartan (enresto)
for MI Aspirin and ticagrelor
Statin
What are the criteria and logic behind cardiac resynch therapy? And what other device?
Only with pt with lowered LV AND LBBB
helps with symptoms and longevity
can also use ICD to improve longevity
NSTEMI mx
Same start
Aspiring + p2y12
Morphine and metoclopramide
LVMH/Fondaparinux
GTN if BP is good
O2 is sats are low
Bblock/CCB if allowed
ECHO for LV-main prognostic
and stop LMVH 48h before angiograms
Stable Angina Management
Anti anginal-
B-block, CCB (Amodipine), Ivabrandine (Nitrate that reduce HR)
What improves the prognosis/mortality of stable angina
statin!
and anti-platelet (sx)
PCI has been shown to have no use
Ix for stable/unstable angina
ANything that tells you its ischemia
Stress Echo/treadmill ECg- not ideal but will tell
CT angio is the gold standard–amazing negative predictive value- very good at ruling it out
dont do invasive angiogram -useless
AF management and prognosis benefit
Verpramil, amiodarone, digoxin and other DONT IMPROVE PROGNOSIS-only sx
DOACs (FXa inhbib)/Warfarin (vit K inhib) do improve prog-depending of chad-vasc and orbit score
Mx strats-
asymptomatic- no point in rate control
rythm control only for big sx-like big hypo/SOB-B-fleicanide/propanefrone/Amiodarone
Rate-b-block, rate limit CCB
Digoxin, amiodarone
dont love amiodarone cause of SE (lung fibrosis, thyroid, eyes)
Care-fleicanide can cause tachyarrytmias
but also prodecure
unstable- DC cardioversion
AF ablation,
if cant be anticoaged- LA occlusion device (like a filter for clots)
AF causes and presentation
IHD is 1st
Valvular disease- especially mitrial (anything that makes atrium bigger)
PE
Sepsis
Diastolic HF
Hyperthyroidism
electrolyte
present with palpitation and sob
can be paroxysmal or permanent
the longer in AF the least cahnces of going back to sinus
SVT management acute and long term
vagal -> adenosine
DC cardio if BP drop unwel
Long term- if 1 episode, with a cause (like infection) -conservative Mx
if repeated–ablation to consider
VT management
Shock, -IV amiodarone
IV mag in torsade de pointes
can put ICD 12w post stemi
CVS exams start and hands
Intro
topless at 45 degrees-
Inspect–pale, SOB, tripod, oedema, cigarette
hands-check hands
cigarette stain,, arachnodactyly, colour
CRT, check temperature
osler, janeway, splinter heamorhage
Clubbing, quinkes sign
Duypuytrens
xanthelasma
and pulse-regularand characteristic
Radial radial delay and collapsing pulse
go up arm- offer BP difference
CVS exams head, neck and inspect
head-
eyes- xanthoma, corneate arcus, conjunctival pallor
Mouth-dentition, arched palate
Hypoxia
neck-
JVP and hepatojugular reflex (press 10s)in SEM corner- should be 3cm above sternum not more
listen carotid, feel carotid (BELL)
inpect- scars front and back, visible apex and heave, cachexic,
CVS heart/precodrium exam
Feel for thrills and heaves and apex (5th intercostal, midclavicular
listen to 4 areas-feel pulse on carotid while doing
inspire expire (Right /Left)
Listen in axilla for mitrial regurg and ask to lean on that side (USE BELL)
Lean forward during Aortic-for aortic regurg
then go into listening to lungs as back, percuss bases, sacral oedema
finish in legs
and DRESS up
