Cardiology Flashcards
Recent Chest pain red flag Qs
Chest pain at rest
Chest pain now or within the last 72 hours
Heart Failure Ix
Bloods inc BNP
2WW Echo - HF + BNP >400
6ww Echo - HF + BNF >100
Heart Failure lifestyle advice
Smoking - stop
Alcohol - reduce
Salt - reduce
Cardiac rehab
Annual flu and pneumococcal vaccine
Heart failure HFrEF Mx
ACEi (or ARB)
B Blocker
Spironolactone (if NYHA III/ IV)
Aspirin - if vascular disease
DIuretics - symptom releief
Atrial fibrillation Ix
ECG
24 hr ECG monitoring
Bloods - FBC, TFT, UE
Echo - if suspected structural disease
Atrial fibrillation Mx
Rate control
- B Blocker (bisoprolol)
- CCB (diltiazem)
- Digoxin - sedentary lifestyle
HTN Mx (stage 1)
Stage 1: BP >140/90 or ABP > 135/85
- Treat if:
Adult <80 years with persistent stage 1 hypertension AND ≥1 of:
target organ damage
established cardiovascular disease
renal disease
estimated 10-year risk CVD ≥10%
Use clinical judgement if frailty or multimorbidity.
HTN Mx (stage 2)
BP >160/100 or ABP 150/95
- start treatment
HTN Mx (stage 3)
SBP >180 or DBP >110
- treat immediately.
- if papilloma/ retinal haemorrhage/ suspected phaeochromocytoma - need admission
HTN Mx
Step 1:
<55/ Diabetic/ CKD - ACEi/ ARB
>55/ Black - CCB
Step 2:
add CCB or ACEi
Step 3:
Thiazide like diuretic - eg Indapamide
Step 4:
K < 4.5 - Spironolactone
K > 4.5 - Alpha blocker/ Beta Blocker
Step 5:
Refer to Cardiology
Angina Ix
Rapid access clinic to confirm diagnosis
Angina Fx
Typical (3)
Constricting pain
Precipitated by exertion
Relieved by rest
If pain at rest = unstable angina = 999 admission
Angina Mx
Rapid access chest pain clinic
GTN spray - symptom relief
Risk factor Mx - Smoking, BP, diabetes, cholesterol, exercise
Secondary prevention - Aspirin 75mg od (unless already on Clopidogrel, then continue this). Atorvastatin 20mg OD. ACEi (if Diabetes, CKD etc)
1st - BBlock (bisoprolol/ atenolol) or CCB (diltiazem/ verapamil)
2nd - Ranolazine, Ivabradine, Nicorandil, long acting CCB
CHADSs VASc score (anticoag risk in AF)
Congestive heart failure
Hypertension
Age 65-74 (1)
Diabetes
Stroke/ TIA (2)
Vascular disease
Ages >75 (2)
Sex female
Female >2 = anticoag
Male >1 = coag
Orbit score (bleeding risk in AF)
Older age - >75 (1)
Reduced Hb - <130 Male or < 120 Female (2)
Bleeding Hx (2)
Insufficient Kidney function - eGFR <60 (1)
Treatment with antiplatelets (1)
Score:
0-2 = low
2-4 = med
>4 = high