Cardiology Flashcards
Medications post MI
DAPT
ACEi
B block
statin
Spironolactone (Aldosterone antagonist) - if signs of heart failure within 3-14 days
Furosemide side effects
hypoNA, hypoK, hypoMg, hypoCAL
ototoxicity
AKI
hyperglycaemia (less common than with thiazides)
gout
DVLA HTN rules
> 180/100 = lorry/ vans (group 2) need to inform DVLA and can not drive
DVLA CVD rules
Angioplasty (elective)
CABG
ACS
Angina
Pacemaker
Catheter ablation for arrythmia
ICD
AAA >6cm
Heart transplant
Angio - 1 week
CABG - 4 weeks
ACS - 4 weeks (if successful PCI then 1 week)
Angina - stop if symptoms at wheel
Pacemaker - 1 week
Catheter ablation - 2 days
ICD - 6 months. If Group 2 unable to drive
AAA >6cm - Notify DVLA, still drive. >6.5cm no driving
heart transplant - 6 weeks
Angina Ix
1st - CT Coronary angiogram
2nd - Non invasive imaging eg stress echocardiography
3rd - Invasive imaging - eg myocardial perfusion scan
When to start anticoagulation in
stroke
TIA
stroke - after 14 days
TIA - start immediately
both after excluding haemorrhage on CTH
AF Mx Rate control
1st - B block
2nd - CCB (amlodipine, nifedipine, diltiazem)
3rd - Digoxin
Angina Mx
Aspirin + Statin
GTN spray PRN
1st - B Block or CCB (verapamil)
2nd BB + CCB (amlodipine)
3rd - a long-acting nitrate (ISMN), ivabradine, nicorandil
Prosthetic heart valves antithrombotic therapy
bioprosthetic
mechanical
Prosthetic heart valves - antithrombotic therapy:
bioprosthetic: aspirin
mechanical: warfarin + aspirin
Mechanical valves - target INR:
aortic:
mitral:
aortic: 3.0
mitral: 3.5
Chronic heart failure Mx
1st - ACEi + B block
2nd - Spironolactone/ Dapagliflozin (SGLT 2i)
3rd - Cardiologist
Annual influenza
one off pneumococcal
Hypertension management
If <80yo AND Stage 1 HTN AND no Diabetes/ QRISK >10%/ organ damage = lifestyle modification before medication
1st - ACEi/ ARB (<55yo or diabetic) OR CCB (>55yo/ Black)
2nd - A + C / A+ D / C + D (if Black ARB > ACEi)
3rd - A + C + D (eg Indapamide)
4th - K <4.5 - Spiro
- K >4.5 B Block/ Alpha block
5th - specialist
Primary prevention statin
QRISK >10%, T1DM >10 years, CKD eGFR <60
Atorvastatin 20mg OD
If non HDL as not fallen by >40% then increase dose
When to refer a patient with chest pain
<12 hours + abnormal ECG = immediate admission
12-72 hours = same day hospital assessment
> 72 hours = perform full assessment, ecg, troponin then reassess
Stable angina Ix
1st - CT Angiography
2nd - Non invasive Ix eg Myocardial perfusion scintigraphy/ SPECT/ stress echo/ MR perfusion
3rd - invasive coronary angiography
Long term antiplatelet Mx
ACS (medical manage)
PCI
Stroke/ TIA
ACS - Aspirin (lifelong) + Ticagrelor (12 month)
PCI - Aspirin (lifelong) + Prasurgrel (12 month)
Stroke - Clopidogrel (life long)
Warfarin: management of high INR
Major bleeding
- Stop warfarin
- IV vit K 5mg
- Prothrombin complex concentrate (or FFP)
INR > 8.0 + Minor bleeding
- Stop warfarin
- IV Vit K 1-3mg
- Repeat dose of vitamin K if INR still too high after 24 hours, Restart warfarin when INR < 5.0
INR 5.0-8.0 + Minor bleeding
- Stop warfarin
- IV Vit K 1-3mg
Restart when INR < 5.0
INR > 8.0 + No bleeding
- Stop warfarin
- PO Vit K 1-5mg
- Repeat dose of vitamin K if INR still too high after 24 hours, Restart when INR < 5.0
INR 5.0-8.0 + No bleeding
- Withhold 1 or 2 doses of warfarin
- Reduce subsequent maintenance dose
Amiodarone SE
thyroid dysfunction: both hypothyroidism and hyper-thyroidism
corneal deposits
pulmonary fibrosis/pneumonitis
liver fibrosis/hepatitis
peripheral neuropathy, myopathy
photosensitivity
‘slate-grey’ appearance
thrombophlebitis and injection site reactions
bradycardia
lengths QT interval
Amiodarone Monitoring
TFT, LFT, U&E, CXR prior to treatment
TFT, LFT every 6 months
Blood pressure stage hypertension criteria
Stage 1 hypertension
Clinic BP >= 140/90 mmHg
HBPM average BP >= 135/85 mmHg
Stage 2 hypertension
Clinic BP >= 160/100 mmHg
HBPM average BP >= 150/95 mmHg
Severe hypertension
Clinic systolic BP >= 180 mmHg, or clinic diastolic BP >= 120 mmHg
Blood pressure target age dependent
Age < 80 years
Clinical 140/90 mmHg HBPM 135/85 mmHg
Age > 80 years
Clinical 150/90 mmHg HBPM 145/85 mmHg
NYHA Heart failure class criteria
NYHA Class I
no symptoms
no limitation: ordinary physical exercise does not cause undue fatigue, dyspnoea or palpitations
NYHA Class II
mild symptoms
slight limitation of physical activity: comfortable at rest but ordinary activity results in fatigue, palpitations or dyspnoea
NYHA Class III
moderate symptoms
marked limitation of physical activity: comfortable at rest but less than ordinary activity results in symptoms
NYHA Class IV
severe symptoms
unable to carry out any physical activity without discomfort: symptoms of heart failure are present even at rest with increased discomfort with any physical activity
Hypertension targets
<80
>80
CKD
CKD + albuminuria
T1DM
<80yo - 140/90
> 80yo - 150/90
CKD - 140/90
CKD with albuminuria (ACR >70) - 130/80
T1DM - 135/85 (unless metabolic syndrome or albuminuria then 130/80)
Ankle Brachial Pressure Index (ABPI) Mx
<0.5 = severe arterial disease.
Compression treatment is contraindicated.
Refer the person urgently for specialist vascular assessment.
0.5 - 0.8 = peripheral arterial disease
Compression should generally be avoided. However, reduced compression can be used under specialist advice and with strict supervision.
Refer the person for specialist vascular assessment.
0.8 -1.3 = no significant arterial disease.
Compression may be safely applied in most people.
Familial hypercholesterolaemia most important blood test
low density lipoprotein - c
