Cardio treatments Flashcards
what are the 3 steps in treatment of unstable angina + NSTEMI?
1) MONA C
2) could add fondaparinux (similar to LMWH)
3) Revascularisation
- PCI
- Thrombolysis if too late
- CABG (if >3 vessels affected)
what are the steps in treatment of STEMI?
1) diaMorphine + anti-emetic (metoclopramide)
2) oxygen
3) GTN
4) Aspirin (300mg chewed)
5) Clopidogrel/tricagrelor 300mg
6) PCI (angioplasty) within 90 mins
- Thrombolysis if PCI unavailable (streptokinase + aspirin)
7) emergency angioplasty if this fails
what are the contradindications for emergency angioplasty?
trauma haemorrhage ulcers recent surgery severe hypertension
what is PCI?
percutaneous coronary intervention
AKA angioplasty with stent
what are the 5 stages of treatment for stable angina?
1) GTN
2) secondary prevention: aspirin, ACE, statins
3) beta blockers/CCBs(amlodipine)
4) isosorbide mononitrate/ivabradine
5) CABG/PCI
how is heart failure investigated?
1) transthoracic ECHO
- systolic = low ejection fraction
- diastolic = LVH
2) ECG
3) CXR
4) FBC
what is the treatment for acute heart failure?
1) sit up
2) oxygen
3) IV furosemide
4) IV diamorphine
what is the treatment for chronic heart failure?
1) lifestyle advice
2) furosemide + bendroflumethiazide at start
3) ACE + Beta blockers
4) Spironolactone
5) Digoxin, ivabradine
6) other vasodilators - nitrates, hydralazine
7) ICD/CRT (if LBBB)
8) CABG (check eligibility via catheterisation)
9) cardiac transplant
what are the stages of treatment in SVT?
1) vagal manoeuvres: Valsalva movement/carotid massage (massage only in young and fit)
2) IV adenosine
3) IV verapamil
what are the steps in treatment of atrial fibrillation?
1) digoxin + CCB/Beta blocker
2) AAD class I (disopyramide) and III (amiodarone)
3) DC cardioversion if able to cardiovert (paroxysmal/persistent)
4) If permanent then AV node ablation or pacing in older patients
5) anticoagulate for stroke risk (esp in prosthetic valves)
what are the steps in treatment of atrial flutter?
1) amiodarone
2) DC cardioversion
3) RF ablation
4) anticoagulation
what are the steps in treatment of ventricular tachycardia?
1) Unstable = DC cardioversion
2) pulseless = defibrillation
3) stable = class 1 (disopyramide) + class III (amiodarone)
4) calcium chloride if hyperkalaemia
5) ICD (if life threatening)
what is the treatment for ventricular fibrillation?
1) defibrillation
2) IV magnesium chloride
3) ICD (first line long term)
what is ICD?
implantable cardiac defibrillator
what is torsades de pointes?
polymorphic ventricular tachycardia
what is the treatment fot torsades de pointes?
1) IV magnesium chloride
2) isoprenaline
3) pacemaker
what is the treatment for sinus bradycardia?
1) IV atropine
2) pacing (permanent if sick sinus syndrome)
how is 1st degree heart block treated?
stop block medications
how is2nd degree heart block treated?
mobitz type 1 = stop block medications
Mobitz type 2 = pacemaker + atropine
how is 3rd degree heart block treated?
pacemaker + atropine
what is the treatment for bundle branch block?
1) IV atropine
2) Pacemaker
what is the treatment for mitral regurgitation?
1) diuretics and ACE
2) surgical
- repair = prolapse
- replacement = degenerative
3) percutaneous
- clips in infancy
what is the treatment for mitral stenosis?
1) diuretics, beta blockers, digoxin (treat AF)
2) mitral valve replacement
3) balloon valvotomy
what is the treatment for aortic regurgitation?
1) diuretics and ACE
2) aortic valve replacement
what is the treatment for aortic stenosis?
1) aortic valve replacement
2) balloon valvotomy
3) TAVI
what is the treatment for empirical native valve infective endocarditis?
amoxicillin + gentamicin
what is the treatment for empirical prosthetic valve infective endocarditis?
vancomycin + gentamicin
what is the treatment for staph aureus infective endocarditis?
flucoxacillin
what is the treatment for MRSA endocarditis?
vancomycin + gentamicin + rifampicin PO
what is the treatment for strep viridans endocarditis?
penicillin + gentamicin
what is the treatment for strep epidermidis endocarditis?
vancomycin + gentamicin + rifampicin PO
what is the treatment for enterococcus/HACEK endocarditis?
amoxicillin/vancomycin + gentamicin
what is the treatment for intermittent claudication?
1) lifestyle advice
2) antiplatelets to increase walking distance
3) surgery in severe cases
- angioplasty +/- stent via femoral artery
- bypass grafts
- amputation
what are the steps in treatment of acute lower limb ischaemia (PE/DVT)?
1) heparin, warfarin if severe (MI/AF assoc)
2) angioplasty
3) graft thrombolysis
4) bypass grafting
5) surgery - embolectomy
when does an AAA require intervention?
> 5.5 cm
grown more than 1cm in past year
symptomatic
what is the treatment for AAA?
1) lifestyle advice
2) fitness testing
3) EVAR
4) open surgery
how is DVT treated?
1) anticoagulation
2) phlegmasia dolens - caval filters
3) compression (TED) stockings
how are varicose veins treated?
stockings
foam sclerotherapy
endovenous ablation
what is thrombophlebitis?
infection that causes a blood clot to form and occlude a vessel (usually in the legs)
what is the treatment for thrombophlebitis?
analgesics
elevation of limb
fondaparinux
what is the treatment for a stroke?
1) ABCDE, Oxygen
2) thrombolysis
3) hemicraniectomy
4) long term = address risk factors
what is the treatment for hypertrophic cardiomyopathy?
1) treat symptoms, prevent sudden death
2) low risk = amiodarone
3) medium risk = Beta blockers + verapamil
4) high risk = ICD
what is the treatment for dilated cardiomyopathy?
1) heart failure management
2) cardiac resynchronisation therapy
3) high risk = ICD
what is the treatment for arrythmogenic right ventricular cardiomyopathy?
non-life threatening = beta blockers
symptomatic = amiodarone, soltalol
what is the treatment for myocarditis?
1) treat underlying cause (eg remove drugs, treat infection)
2) bed rest, avoid athletics
3) ACE, beta blockers, spironolactone, digoxin
what is the treatment for pericarditis?
NSAIDs - ibuprofen
