Cardiology Flashcards
stage 1 hypertension
140/90 clinical (135/85 HBPM)
Stage 2 Hypertension
160/100 (150/95 HBPM)
first line antihypertensive for patient who is diabetic or <55
ACEi or ARB
First line antihypertensive for patient who is not diabetic or >55
CCB
Management option when patient’s hypertension is not managed on singular ARB ACEi or CCB
Add a thiazide diuretic e.g. Indapamide (or the other i.e. if on CCB add ACEi or ARB, and vice versa)
Management options if patient’s hypertension is not managed with ARB/ACEi & CCB & Thiazide diuretic
- if K+ less than or equal to 4.5, add Spironolactone
- If K+ is greater than 4.5, add an Alpha or Beta Blocker
Beta-Blocker side effects
- dry mouth
- changes in taste
- drug-induced Lichen planus
- bradycardia/hypotension
ACE-inhibitor side effects
- dry cough
- loss of taste
- dry mouth
- ulceration
- angiodema
ARB side effects
- dry mouth
- angioedema
- sinusitis
- taste loss
- hyperkalaemia
Loop diuretic side effects
- ototoxicity
- hypocalcaemia
- hypokalaemia
- hypomagnesaemia
- hyponatraemia
- gout
Thiazide diuretic side effects
- dehydration
- postural hypotension
- hyponatraemia
- hypokalaemia
- hypercalcaemia
- impaired glucose tolerance
- impotence
important caution when prescribing potassium and ace inhibitor together
can precipitate hyperkalaemia
initial medical treatment of ACS
MONA
- Morphine
- Oxygen if Hypoxaemic
- Nitrates
- Antiplatelets - DUAL therapy- Aspirin + clopidogrel/ticegralor/prasugrel
Anticoagulant used in ACS when patient is going for immediate/early angio
Unfractionated Heparin or Bivalirudin
Anticoagulant used when angio is not planned
Fondaparinux or enoxaparin
Reperfusion in a patient with STEMI presenting within 12hrs onset
- PCI within 120 mins
- If PCI not available within 120 minutes, consider thrombolysis (alteplase) + transfer to PCI centre
Reperfusion in a patient with STEMI presenting after 12hrs onset
- consider PCI if continuing myocardial ischaemia or cardiogenic shock
- Calculate grace score:
(1) if Low Risk (predicted 6m mortality <3%): conservative management (nitrates, statins, beta blockers + antithrombotic treatment (aspirin/clopidogrel/ticegralor) + LMWH if patient is in hospital
(2) If High risk (predicted 6m mortality >3%): if stable, offer angiography + revascularisation within 72hrs. If unstable, immediate angiography +/- PCI
Secondary prevention of ACS
Block An ACS:
- Beta Blockers
- ACE-inhibitors
- Aspirin (lifelong)
- Clopidogrel/Ticegralor for 1 year following ACS
- Statin high dose e.g. Atorvastatin 80mg
ECG findings for STEMI:
(1) Acute
(2) within days
(3) long term
(1) Peaked T waves (<5 waves) followed by ST elevation (<20 mins) which resolves in hours-days
(2) Within days: Q waves followed by T wave inversion
(3) Long term: Q waves, ST elevation
other causes of ST elevation apart from STEMI (8)
- Pericarditis - widespread saddle-shaped
- Myocarditis
- Left Ventricular Hypertrophy
- Aortic dissection
- LBBB/RBBB
- PE
- Brugada syndrome
- Hyperkalaemia
ECG findings- hypokalaemia (5)
- U waves (especially in V4-V6)
- small or absent T waves (occasionally inversion)
- PR prolongation
- ST depression
- Long QT interval
ECG findings- Hyperkalaemia (5)
- tall tented T waves
- small P waves
- Wide QRS
- Asystole
- Ventricular Fibrillation
ECG findings- Hypocalcaemia
- Long QT interval
- Short QRS complex
ECG findings- Hypercalcaemia
- Short QT interval
- Long QRS complex
