cardio treatments Flashcards
aneurysm
Monitor unruptured aneurysms, consider elective surgical repair (endovascular or open) when >5.5cm (AAA) or rate of expansion >1cm/year. Followed up by regualr USS surveillance
ruptured - emergency surgical aneurysm repair - darcon or gore-tex graft, endovascular stent
angina
Lifestyle changes: smoking cessation, exercise, dietary advice, GTN spray for symptom relief
Stable:
1. β-blocker (atenolol/bisoprolol)
2. +/ rate limiting calcium channel blocker (diltiazem/verapamil)
3. Trial other drugs: isosorbide mononitrate/GTN patch, nicorandil, ivabradine
4. Ranolazine
5. Revascularisation can be considered if medical therapy is inadequate
Percutaneous coronary intervention with stent
Coronary artery bypass graft
Variant: calcium channel blocker and long acting nitrate
arterial dissection
initial management is BP control ▪ If the ascending aorta is involved – control the BP with IV labetolol then surgical management should be considered
▪ A descending aorta issue can be treated with medical management
● IV labetolol and bed rest
aortic regurgitation
treat underlying cause and if not then valve replacement
treat hypertension e.g. ACEi
if symptomatic with LV dilatation and decreasing function – valve replacement
asystole
NOT SHOCKABLE
iv adrenaline
iv should be given every 3-5 minutes
atrial flutter
Rhythm control: ablation/DCCV
Rate control: β-blocker/ CCB,
2nd line =digoxin
3rd line = amiodarone, anticoagulation drugs
atrial fibrillation
Rhythm control: ablation/DCCV
If cardioversion isn’t possible within the 24-48 hours of symptom onset, then you need to put the patient on anticoagulation (warfarin) for 6-8w and then bring back to cardiovert.
long term:
Rate control: β-blocker/ CCB,
2nd line =digoxin
3rd line = amiodarone, anticoagulation drugs
Paroxysmal: <48 hours, can spontaneously reverse, often recurrent
Persistent: >48 hours, needs DCCV
Permanent: no pharmacological or non-pharmacological methods
cardiac tamponade
treat the underlying cause
Urgent drainage of pericardial effusion (pericardiocentesis)
send fluid for culture, Zn stain, TB culture and cytology
dilated cardiomyopathy
Diuretics, β-blockers, ACEI, anticoagulation, ICD, LVADs, transplantation
coarctation of the aorta
surgery or balloon dilatation and stenting
heart failure
Lifestyle – exercise, fluid restriction, lower salt intake, stop smoking, stop alcohol
Symptom Relief - furosemide (loop diuretic) / digoxin
Treatment
ACEI/ARB + β-blocker (carvedilol)
+ Spironolactone (mineralocorticoid antagonist)
Hydralazine + isosorbide dinitrate can be used if intolerant of ACEI/ARB or in African Caribbean patients. Ivabradine can also be used.
annual flu vaccine and one-off pneumococcal vaccine
hypertension if < 55 and not afrocarribean or have type 2 diabetes
1st line - ACEi or ARB
2nd line - +CCB or thiazide diuretic
3rd line - +CCB or thiazide diuretic
4th line - blood potassium <= 4.5 mol/l then low dose spironolactone
if blood potassium > = 4.5mol/l then alpha blocker or beta blocker
hypertension if > 55 or afrocarribean
1st line - CCB
2nd line - +ACEi or ARB or thiazide diuretic
3rd line - +ACEi or ARB or thiazide diuretic
4th line - blood potassium <= 4.5 mol/l then low dose spironolactone
if blood potassium > = 4.5mol/l then alpha blocker or beta blocker
hypertrophic cardiomyopathy
treatment of symptoms and prevent sudden cardiac death
β-blockers/verapamil for symptoms, amiodarone for arrhythmias, anticoagulation, ICD
infective endocarditis
staph aureus - flucloxacillin
IVDU - flucloxacillin
viridans - Benzyl penicillin + gentamicin
enterococcus - amoxicillin + gentamicin
staph epidermis - vancomycin + gentamicin
native valves - amoxicillin + gentamicin
prosthetic valves - vancomycin + gentamicin + rifampicin
native valves sepsis - IV flucloxacillin
mitral regurgitation
Control any underlying/resultant conditions eg. AF
Surgery: repair if possible (eg. rupture/congenital problem) or replacement (eg. degenerative cause)
Diuretics improve symptoms particularly in functional mitral regurgitation
myocarditis
Supportive, treat underlying cause
athletic activities should be avoided for 6 months
pericarditis
NSAIDs or aspirin with gastric protection for 1-2 weeks, add colchicine for 3 months to reduce recurrence risk, steroids if due to autoimmune
if constrictive and chronic then complete removal of the pericardium
shock
ABCDE High flow oxygen Treat underlying cause if possible Volume replacement (except for cardiogenic shock) Inotropes for cardiogenic shock Vasopressors for septic shock Adrenaline for anaphylactic shock
stroke
Acute Management:
Thrombolysis (up to 4.5 hours from onset of symptoms)
Thrombectomy (up to 6.5 hours from onset of symptoms)
Prevention of another stroke:
If atheroembolic – aspirin, statins, diabetes management, hypertension management, lifestyle advice
If AF – anticoagulation drugs (warfarin, DOACs)
MI
STEMI - PCI within 120 minutes or thrombolytic therapy if not
NSTEMI - MONAA
calculate GRACE score
supraventricular tachycardia
Acute –valsalva/carotid massage, IV adenosine or IV verapamil, if compromised (systolic BP<90mmHg) use DCCV
Chronic – avoid stimulants, RFA, β-blockers
varicose veins
Risk Factor Modification, Graduated Compression Stockings (not those with low ABPI/arterial disease), Endovascular treatment, Surgery
wolf parkinson white syndrome
RFCA
