Cardiology Flashcards by Jessica Radford

CHA2DS2-VASc

CCF - 1

HTN - 1

Age:
=>75 - 2
65-74 - 1

DM - 1

Stroke/TIA - 2

IHD/PAD - 1

Female - 1

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CHADS-VaSc 1 (male)

Consider anticoagulation with DOAC (Rivaroxaban)

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CHADS-VaSc 1 (female)

No anticoagulation

Need ECHO to exclude valvular heart disease

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CHADS-VaSc 2

Offer anticoagulation with DOAC

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Normal PR interval

120 - 200 ms

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Anteroseptal - ECG changes

V1 - V4

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Inferior - ECG changes

II, III, aVF

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Anterolateral - ECG

V4-V6, I, aVL

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Lateral - ECG changes

I, aVL +/- V5-V6

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Posterior - ECG changes

Tall R waves V1-V2

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Coronary artery affected: Anteroseptal changes

Left anterior descending

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Coronary artery affected: Inferior changes

Right coronary

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Coronary artery affected: Anterolateral changes

Left anterior descending,
or,
Left circumflex

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Coronary artery affected: Lateral changes

Left circumflex

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Coronary artery affected: Posterior changes

Usually left circumflex, also right coronary

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Definition of pulmonary arterial hypertension

Resting mean pulmonary artery pressure is >= 25 mmHg

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Normal QRS duration

< 120 ms

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INR > 8.0 with No bleeding

Oral Vitamin K 1-5 mg

Repeat dose vitamin K if INR still too high after 24hr

Restart warfarin when INR < 5

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Heart failure - 1st-line management for all patients

ACEi + beta-blocker

start one, then add other

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Heart failure - 2nd-line

Aldosterone antagonist 
(spironolactone/eplerenone)

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Heart failure - 3rd-line options

Ivabradine

Sacubitril-valsartan

Digoxin

Hydralazine with nitrate

Cardiac resynchroniziiton therpy

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Heart failure management – criteria for ivabridine

Sinus rhythm >75 bpm +

LVEF <35%

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Criteria for using sacubitril-valsartan (Entresto) for heart failure

LVEF <35%

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Heart failure management - indication for digoxin

Coexistant AF

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Heart failure management - indication for hydralazine with nitrate

Afro-Caribbean patient

Heart failure management - indication for cardiac resynchronization therapy

Widened QRS complex >130ms

- IHD - HTN - Aortic stenosis - Cardiomyopathy

Prolonged QTc in men

>440ms

Causes of LBBB

- IHD - HTN - Aortic stenosis - Cardiomyopathy

Hypertension - 4th line medical management (already taking A + C + D) - K < 4.5 mmol/l

Add low-dose spironolactone

Hypertension - 4th line medical management (already taking A + C + D) - K > 4.5 mmol/l

Add alpha-blocker (doxazosin) or beta-blocker (nebivolol, carvedilol)

Angina - all patients should be on | in absence of contraindications

Aspirin Statin Sublingual GTN prn

Angina - 1st line treatment

Beta-blocker + Calcium channel blocker

Medications which may exacerbate heart failure

Thiazolidinediones (pioglitazone) Verapamil NSAIDs Glucocorticoids Class I antiarrhythmics (fleicanide)

Severe hypertension requiring same-day specialist assessment/admission.

BP >=180/120 and any of: - Retinal haemorrhage /papilloedema - New confusion - Chest pain - Signs of heart failure - AKI

Most appropriate first-line anti-anginal for stable angina in a patient with heart failure.

Bisoprolol (beta-blocker)

If calcium channel blocker is used as monotherapy in stable angina - which one should be used?

Rate-limiting CCB (verapamil, diltiazem)

If calcium channel blocker is used in combo with beta-blocker in stable angina - which one should be used?

Long-acting dihydropyridine CCB (modified-release nifedipine).

Verapamil should never be prescribed with

Beta-blockers (risk of complete heart block)

Stage 1 HTN - clinic reading

>=140/90 mmHg

Stage 1 hypertension - criteria (ABPM/HBPM)

Average >= 135/85 mmHg

Stage 2 hypertension - criteria (clinic reading)

>=160/100 mmHg

Stage 2 hypertension - criteria (ABPM/HBPM)

Average >= 150/95 mmHg

Severe hypertension - criteria

Systolic BP >= 180 mmHg or Diastolic BP >= 120 mmHg

Clopidogrel effectiveness may be reduced by concurrent use of:

Omeprazole/esomeprazole | lansoprazole ok

At what eGFR should thiazide diuretics be avoided in CKD?

eGFR <30 ml/min (CKD stage 4)

Hypertension - 1st line management <55 years old and not AFC

ACEi/ARB

Hypertension - 1st line management any age, with T2DM, not AFC

ACEi/ARB

Hypertension - 1st line management >55 years old not T2DM

Calcium channel blocker (amlodipine)

Hypertension - 1st line management any age, AFC, not T2DM

Calcium channel blocker (amlodipine)

Hypertension - 2nd line management - already taking ACEi/ARB

Add: CCB (amlodipine) or TLD (indapamide)

Hypertension - 2nd line management - already taking CCB

Add: ACEi or ARB (ARB if AFC) or TLD (indapamide)

Hypertension - 3rd line management, already taking ACEi + TLD

Add CCB

Hypertension - 3rd line management, already taking ACEi + CCB

Thiazide-like diuretic (Indapamide)

Myocardial infarction secondary prevention - all patients should be offered

- Dual antiplatelet therapy - ACEi - Beta-blocker - Statin

Myocardial infarction secondary prevention - with signs of heart failure + reduced LVEF

Aldosterone antagonist (eplerenone)

Timing of initiation aldosterone antagonist post-MI

Within 3-14 days of MI | After ACEi initiated

Dual antiplatelet therapy following medically-managed ACS

Aspirin life-long + Ticagrelor for 12 months

Dual antiplatelet therapy following PCI

Aspirin life-long + Ticagrelor or prasugrel for 12 months

Anti-thrombotic therapy for bio-prosthetic heart valve

Aspirin

Anti-thrombotic therapy for mechanical prosthetic heart valve

Warfarin + aspirin

DVLA advice post ACS (successful angioplasty)

1 week off driving

DVLA advice post ACS | not successfully treated by angioplasty

4 weeks of driving

DVLA advice post elective angioplasty

1 week off driving

DVLA advice post CABG

4 weeks off driving

DVLA advice post pacemaker insertion

1 week off driving

1st-line agents for long-term rate-control in AF

standard beta-blocker or rate-limiting calcium channel blocker (diltiazem)

Indication to use digoxin as rate-limiting agent in AF

Sedentary Beta-blocker/CCB not appropriate Co-existent heart failure

Caution/CI for ACEi

``` Pregnancy/breastfeeding Renovascular disease Aortic stenosis Hereditory angioedema Potassium >= 5.0 ```

Amiodarone - baseline tests prior to starting

TFT, LFT, U&E, CXR

Amiodarone - monitoring

TFT, LFT 6-monthly

Drugs which cause QT prolongation

``` Amiodarone Sotalol TCAs SSRIs (especially citalopram) Chloroquine Erythromycin Haloperidol Ondansetron ```

Target clinic BP if patient <80y

140/90 mmHg

Target clinic BP if patient >=80y

150/90 mmHg

Target ABPM/HBPM if patient <80y

135/85 mmHg

Target ABPM/HBPM if patient >=80y

145/85 mmHg

Target clinic BP: Type 1 diabetes without albuminuria/metabolic syndrome

135/85 mmHg

Target clinic BP: Type 1 diabetes with albuminuria or metabolic syndrome

130/80 mmHg

Target BP in CKD with Diabetes

<130/80 mmHg

Target BP in CKD (not diabetic, ACR <70)

<140/90 mmHg

Target BP in CKD (not diabetic, but ACR >70)

<130/80 mmHg

Target clinic BP in T2DM (no CKD)

Same as gen pop: Under 80y <140/90 Over 80y <150/90

Target INR for aortic mechanical valve

3.0

Target INR for mitral mechanical valve

3.5

Statin for primary prevention

atorvastatin 20mg

Statin for secondary prevention

atorvastatin 80mg

Blood test monitoring for statins

LFTs at baseline, 3 months + 12 months

Who should receive a statin for primary prevention

- 10-year CV risk >=10% - T1DM diagnosed >10y / aged >40 / nephropathy - CKD - Familial hypercholesterolaemia

Investigation for suspected IHD (non-acute) - 1st line

CT coronary angiography

Investigation for suspected IHD (non-acute) - 2nd line

Non-invasive functional imaging | MR perfusion scan, stress echo

Investigation for suspected IHD (non-acute) - 3rd line

Invasive coronary angiography

DVLA post ICD insertion for HOCM (no history of arrhythmia)

4 weeks off driving

Amlodipine maximum dose

10mg per day

A side effect of which cardiac medication is ulceration?

Nicorandil (vasodilator used in angina)

Statins in pregnancy

Contraindicated in pregnancy and pre-conception (congenital anomaly)

Offer statin (without risk assessment) to T1DM if:

>40y Diagnosed >10y ago Nephropathy CVD risk factors

Offer statin (without risk assessment) to

Certain T1DM pt CKD FH

*Consider* offering statin (without risk assessment) to

>=85y | All T1DM

<85y QRISK >10% + no T2DM

Lifestyle modification first (if appropriate) | Offer statin

<85y QRISK >10% + T2DM

Offer statin

Statin for primary prevention - followup

Repeat TC, HDL, non-HDL in 3m | Looking for 40% reduction in non-HDL

If suspect chronic heart failure

NT-pro-BNP ECG Tests for other causes/aggravators

Suspected CHF and NT-pro-BNP >2000

2 week referral for ECHO + cardiologist

Suspected CHF and NT-pro-BNP 400-2000

6-week referral for ECHO + cardiologist