Cardio treatments Flashcards by Joanne McEwan

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)

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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

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what are the contradindications for emergency angioplasty?

trauma
haemorrhage
ulcers
recent surgery
severe hypertension

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what is PCI?

percutaneous coronary intervention

AKA angioplasty with stent

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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

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how is heart failure investigated?

1) transthoracic ECHO
- systolic = low ejection fraction
- diastolic = LVH
2) ECG
3) CXR
4) FBC

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what is the treatment for acute heart failure?

1) sit up
2) oxygen
3) IV furosemide
4) IV diamorphine

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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

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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

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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)

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what are the steps in treatment of atrial flutter?

1) amiodarone
2) DC cardioversion
3) RF ablation
4) anticoagulation

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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)

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what is the treatment for ventricular fibrillation?

1) defibrillation
2) IV magnesium chloride
3) ICD (first line long term)

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what is ICD?

implantable cardiac defibrillator

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what is torsades de pointes?

polymorphic ventricular tachycardia

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what is the treatment fot torsades de pointes?

1) IV magnesium chloride
2) isoprenaline
3) pacemaker

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what is the treatment for sinus bradycardia?

1) IV atropine

2) pacing (permanent if sick sinus syndrome)

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how is 1st degree heart block treated?

stop block medications

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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