cardio treatment

Question 1

hypertension

Answer 1

1) if under 55, white, diabetic then ACEI or ARB
if 55+ or black then CCB
2) add on ARB (black people) + CCB (white)
3) add thiazide

Question 2

coronary heart disease

Answer 2

1) Manage underlying cause – anaemia, diabetes, HT
2) GTN
3) Secondary prevention: Aspirin, ACEI, Statin
4) B-blockers/CCB
5) B-blocker + amlodipine
6) If contraindicated then: Isosorbide mononitrate/Ivabradine/Nicorandil
7) Revascularisation procedures: PCI, CABG

Question 3

Unstable angina/NSTEMI (MONA+C)

Answer 3

1) morphine, oxygen, nitrate, aspirin and clopidogrel
2) could add fondaparinux
3) revascularisation = PCI or thrombolysis

Question 4

STEMI

Answer 4

1) MONA+C, PCI/ thrombolysis

Question 5

stable angina

Answer 5

GTN
2Y prevention: Aspirin, ACEI, statins
B-blockers/CCBs (amlodipine)

Question 6

heart failure

Answer 6

Investigation: Transthoracic ECHO, ECG, CXR, FBCs

Acute:
Sit up
Oxygen
IV Furosemide
IV Diamorphine

Chronic:
Lifestyle advice
Frusemide + bendroflumethiazide at start
ACEIs + B-blockers
Spiralactone
Digoxin, Ivabradine
Other vasodilators – nitrates, hydralazine
ICD/CRT (if LBBB)
CABG – (catheterisation to see eligibility)
Cardiac transplantation

Question 7

SVT

Answer 7

Vagal manoeuvres – Valsalva movement/Carotid massage
IV Adenosine
IV Verapamil

Question 8

AFib

Answer 8

1) Digoxin + CCBs/B-blockers
2) AAD Class I (Disopyramide) + III (Amiodarone)
3) DC Cardioversion if able to cardiovert (paroxysmal/persistent)
4) If permanent then AV node ablation or Pacing for older patients
5) Anticoagulate for stroke risk esp if prosthetic valves (CHA2DS2VASc score)

Question 9

atrial flutter

Answer 9

Amiodarone
DC Cardioversion
RF ablation
Anticoagulation

Question 10

VT

Answer 10

Unstable – DC Cardioversion
Pulseless - Defibrillation
Stable – Class I (Disopyramide) + III (Amiodarone)
Calcium chloride if hyperkalaemia

Question 11

VFib

Answer 11

Defibrillation
IV Magnesium Chloride
ICD

Question 12

torsades de pointes

Answer 12

IV Magnesium Chloride
Isoprenaline
Pacemaker

Question 13

sinus bradycardia

Answer 13

IV Atropine
Pacing

Question 14

1st degree heart block

Answer 14

Stop block medications

Question 15

2nd degree heart block

Answer 15

Mobitz I: Stop block medications
Mobitz II: Pacemaker (+Atropine)

Question 16

3rd degree/ full heart block

Answer 16

Pacemaker + Atropine

Question 17

mitral regurg

Answer 17

Diuretics and ACEI
Surgical

Question 18

mitral stenosis

Answer 18

Diuretics, B-blockers, Digoxin (treat AF)
Mitral Valve Replacement
Balloon valvotomy

Question 19

aortic regurg

Answer 19

Diuretics and ACEI
Aortic Valve Replacement

Question 20

aortic stenosis

Answer 20

Aortic Valve Replacement (AVR)
Balloon valvotomy

Question 21

infective endocarditis

Answer 21

Empirical Native Valve – Amoxicillin + Gentamicin
Empirical Prosthetic Valve – Vancomycin + Gentamicin
Staph. Aureus – Flucloxacillin

Question 22

intermittent claudication

Answer 22

Lifestyle advice (smoking + exercise)
Antiplatelets to increase walking distance

Question 23

lower limb ischaemia (PE/DVT)

Answer 23

Heparin, Warfarin if severe (MI/AF assoc.)
Angioplasty
Graft thrombolysis
Bypass grafting

Question 24

stroke

Answer 24

ABCDE, oxygen
Thrombolysis
Hemicraniectomy

Question 25

hypertrophic cardiomyopathy

Answer 25

Treat symptoms, prevent sudden cardiac death Low-risk: Amiodarone Med-risk: B-blockers + Verapamil High-risk: ICD

Question 26

myocarditis

Answer 26

Treat underlying cause (eg. remove drugs)/infection (eg. antibiotics) Bed rest, avoid athletics ACEI, B-blockers, Spironolactone, Digoxin

Question 27

pericarditis

Answer 27

NSAIDS - ibuprofen