Cardio: treatments Flashcards
dilated cardiomyopathy
Standard systolic HF tx:
- mortality reduction with ACEI, BBs (metorpolol or carvedilol), ARBs, Spironolactone
- —>standard care= ACEI + BB + diuretic - symptom control with diuretics, digoxin (incrs cardiac contractility)
- can get AIC/D if ejection fraction <35-30%
HOCM–hypertrophic cardiomyopathy
- medical–1st and 2nd line
- surgical
- tx is focused on?
- what should pt avoid
**focus on early detection, medical management, surgical management, and/or ICD
MEDICAL TX:
- BB are first line
* alternatives: CCB
SURIGCAL
- myomectomy–refractory to medical tx
- alcohol septal ablation– alternative to surgical tx
AVOID
- dehydration
- extreme exertion
- exercise
- cautious use of digoxin (incrs contractility), nitrates and diuretics (these decrease LV volume)
Restrictive cardiomyopathy
-no specific tx
-tx underlying cause
EX: glucocorticoids for sarrcoidosis or chelation for hemacromatosis
-gentle diuretics for s/s, vasodilators
myocarditis
- supportive=mainstay
* standard systolic HF treatment (ACEI, diuretics, BB)
sympomatic or unstable sinus brady
first line= atropine
*no response–>epinephrine or pace
sicks sinus syndrome
stable: none
unstable: atropine 1st line—others: dopamine, epi, pacing
long term: pacemaker definite
A flutter
stable:
- vagal maneuvers
- rate control with: BBs (metoprolol, atenolol, esmolol) OR non-dihydropyridine CCBs (Diltiazem, Verapamil)
unstable:
* synchronized cardioversion
once in normal rhythm–>ablation is definitive management
AFIB
- stable
- unstable
- long term
STABLE
- rate control with BB (Met, aten, esmolol) or non-dihydropyridine CCB–diltia or verap
- digoxin can be used when BB or CCB are contraindicated (CHF or severe hypotension)
UNSTABLE
*electr cardioversion
LONG-TERM
1. rate control preferred over rhythm control for LT tx
2. cardioversion or pharm cardioversion
3. albation
4. ANTICOAGULATION: continued 4 weeks afrer cardioversion
-elective cardioversion– anticoag for at least 3 weeks b4 procedure
–>MOD to HIGH RISK OF EMBOLIZATION (score 2+)–> Warfarin
**non-vit K antagonists oral anticoagulants (NOACs) are pref over warfarin
EX: Dabigatran–binds and inhibits thrombin
or
Rivaroxaban–factor Xa inhib
pSVT
stable (regular, narrow complex)
- vagal mans
- AV node blockers–> ADENOSINE
- seocond line pharm tx=CCB or BBs or digoxin
unstable–cardiovert
MAT
difficult to tx
-CCB–verapamil
or
bb if LV function preserved
WPW
- stale
- unstable
- definitive
STABLE
- antiarrhytmics–>PROCAINAMIDE 1st line
- amiodarone
- AVOID AV BLOCKING AGNETS–adensoine, BB, CCB, digoxin–can lead to prefered conduction down bundle of kent— making tachy worse
UNSTABLE
*cardioversion
DEFINITIVE
*ablation
Aortic stenosis
- surgical
* valve replacement ONLY effective tx— TOC - tx before surgery
* since pt are depending on preload to maintian CO–>AVOID physical exertion and venodilators (eg nitrates) and negative inotropes (CCBs, BBs)
aortic regurg
MEDICAL
*afterload reduction–>ACEI, ARBs, Nifedipine, Hydralazine
Surgical–>definitive management
Mitral stenosis
*percutaneous valloon valvuloplasty—best tx for sympto in young pt
Medical–diuretics and sodium restriction for edema and voluem overload—rate control for AFIB with BBs, CCB or digoxin + anticoag– warfarin
mitral regurg
MEDICAL
-afterload reducers–ACEI, ARBs, hydralazine, nitrates diuretics
SURGICAL
-repair is preferrd over replacement–indicated if EF is <60% OR refrac to phrm tx
