Cardiology Flashcards
Medications for HFrEF
BB+ARNI>ACE/ARB/+MRA+SGLT2+Ivabradine (SR and HR>70) + vericiguat (HF hospital in 12 mo)
HFpEF medications/treatment
Manage HTN Loop Diuretics to reduce congestion Candesartan (CHARM trial) MRA (TOPCAT) SGTL2 (Emporer-Preserved) For those with DM: metformin. NO Saxagliptin. NO thiazolinediones Exercise/smoking/education/EtOH Iron def: IV iron target Ferritin >100
Valve Disease:
What does A, B, C, D classification mean?
A: at risk
B: progressive
C: severe, asymptomatic
D: severe, symptomatic
Valve
Aortic stenosis: these group of medications should not be used in AS patients
Afterload reducers, vasodilators: eg ACEi. Can use after TAVI
Valve
AS: what are the numbers on echo fro severe AS?
AVA <1 cm2
Gradient >40 mmHg
Vmax> 4 m/s
(Very severe AS: Vmax >5; Gradient >50mmHg
Aortic stenosis indication for Intervention?
Severe AS+
Symptomatic OR LVEF <50%
OR Severe AS, asymptomatic, having CVSx
OR Symptomatic with low flow/low gradient+EF<50%
OR symptomatic low flow, low gradient, EF >50% if AS is presumed cause of symptoms
Indications for intervention for AR
Severe symptomatic AR
Severe asymptomatic but EF <55%
Severe, asymptomatic AR undergoing other CVSx
Mitral Stenosis - when can you do Percutaneous mitral balloon commisurotomy (PMBC)
severe symptomatic AS + favourable valve anatomy + can be performed at experienced centre
Contraindicated: if moderate Mitral regurgitation
Indications for intervention in Primary Mitral regurgitation
Severe, symptomatic MR
Severe MR, asymptomatic, with LVEF <60%/LVESD >40mm
Indications for Intervention in Secondary MR
GDMT for HFrEF including CRT/cath before considering for Percutaneous Mitral valve repair
Symptomatic HFrEF and severe MR
INR targets for AVR and MVR (no DOACS to be used for any mechanical or bioprosthetic valve replacements)
AVR:
- current generation INR 2.5
- Old AVR (ball in cage) 3.0
MVR: INR 3
ASA: dont need to add to mech valves unless other indication
- lifelong ASA in biosprosthetic valves
New onset AF within 3 mo of bioprosthetic valve: need to use VKA
Management of thoracic aortic dissection
IV preferred Control HR first <60 (to reduce shear) Then BP target SBP <120 DO NOT CONTROL BP BEFORE HR due to risk of compensatory increased HR! BB>CCB>Nitroprusside>ACEi
Type A: Surgery
Type B: med mgmt
DO NOT USE BB IN COCAINE INDUCED DISSECTION - because dont want pure alpha activation!
What is first line medication for cocaine induced aortic dissection
Generally IV BB (labetalol) is first line, but BB contraindicated in cocaine use due to risk of pure alpha unopposed alpha activation by cocaine
Etiology of pericarditis Ddx
V: MI
I: Infection- TB, Fungal, coxsackie, flu, parvo, adenovirus
T: toxins: Hydralazine, Procainamide, Digoxin, INH, dilantin
A: autoimmune: RA, SLE
M: metabolic: Hypothyroid, uremis, dialysis
I: iatrogenic: post radiation or CV Sx
N: neoplasm: breast, mesothelioma, lung, leukemia, lymphoma
Indications to admit pericarditis?
Fever, trop rise, pericardial effusion >20mm, tamponde, unstable
On Oral anticoags, immunocompromised, no improvement after 7d of treatment,
Treatment of pericarditis
First occurrence: NSAIDs (or ASA +/- PPI) 1-2 wks+ Colchicine 6 mo
first recurrence: NSAIDS 2weeks + Colchicine x6 mo
2nd recurrence: Glucocroticoids 2-4 wks + Colchicine
3rd recurrence Flucocorticoids+ Colchicine+ ASA
4th recurrence: other therapies like pericardiectomy, IVIG, anakinra
Pregnancy: NO COLCHICINE at all
<20 wks = ASA/NSAIDS ok
>20 wks: DO NOT USE HIGH DOSE ASA/NSAIDS
Breastfeeding: NO ASA
pulses paradoxus
drop in BP >10mmHg on inspiration
Kussmaul sign
JVP goes up with inspiration! This is because there is cardiac tamponade or constrictive pericarditis leading to increased pressure around the heart on inspiration, and blood gets pushed back up into the JVP
Name and complete the triad associated with Aspirin/NSAIDs sensitivity + Nasal polyps AND ______
Samster’s triad
1) ASA/NSAID sensitivity: exacerbates respiratory disease
2) Asthma
3) Nasal polyps
AF etiology
P: PE, COPD, OSA I: infarct, infection, idiopathic R: rheumatic mitral valve disease A: anemia T: toxins: Cocaine, EtOH, caffeine, thyrotoxicosis E: electrolytes, endocarditis, Ethanol S: stress, stimulants, post -op stress
When are VKA preferred for AF? associated conditions
mod-severe mitral stenosis
Rheumatic mitral valve stenosis
mechanical heart valves
New onset AF within 3 months of valve replacement
What is the only medication that has mortality benefit in AF?
OAC
OAC in CKD for AF? What are the cutoffs
eGFR >15: OAC okay
eGFR <15 or on HD: no OAC
Factors that increase risk of bleeding when considering OAC/DAPT for CAD and AFIB
Age >65, frail, wt <60 kg, HTN, prior stroke/ICH, excess EtOH, Hb <110, CKD, liver disease
