AF Health behaviour modification

Alcohol and Tobacco: ≤ 1 standard drink/day, consider complete abstinence of alcohol and tobaxxo OSA: CPAP for mod-devere OSA (AHI ≥ 15 hours) Weight: decrease weight, 10% to a BMI ≤ 27 Exercise: mod intensity ≥ 30 min per day, 3-5 days per week ( ≥ 200 min/week) DM: target A1c ≤ 7% BP: Target ≤ 130/80 at rest, prefer ACEi/ARB

AF Bleeding while on OAC

Mild bleed: delay VKA until INR >DOAC: idarucizumab or andexanet alfa, tranexamic acid

AF Special population

do NOT routinely use OAC for patient with Afib and advanced liver disease (Child Pugh C or associated with coagulopathy) Individualize treatment recommendation in patietns with active cancer Do NOT routinely anticoagulate patient with secondary AFib which has resolved OAC for most patients with AFib & hypertrophic cardiomyopathy

Cardiology Flashcards by Furqan Masud

ACLS
* key principles
* airway management
* circulation management
* ROSC
* poisoning as cause of cardiac arrest

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ACLS meds
* VF/ pulseless VT meds
* asystole/PEA meds
* bradycardia meds

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ACLS tachycardia meds

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ACLS
- shock energy for defibrillation
- advanced airway
- reversible causes

Basic life support (flow)
Adult cardiac arrest (flow)

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ACLS
- adult tachycardia HR >150 with pulse (flow)
- adult Brady cardia HR < 50 with pulse (flow)

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Atrial Fibrillation
- definition

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Atrial fibrillation
- epidemiology
- risk factors/ comorbid conditions/ etiology

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Atrial Fibrillation
- symptoms

asymptomatic
palpitations
weariness/ reduced exercise capacity/ fatigue
syncope/dizziness
heart failure
chest pain
dyspnea
stroke

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Atrial fibrillation
- history/physical
- complications

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Atrial fibrillation
- investigations
- screening

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Atrial fibrillation
- emergency room management of acute AF

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General approach to AF Management

GOAL: improve symptoms + prevention of cardiomyopathy/stroke
* Thromboembolic risk and OAC for patients at risk of CVA
* Management of Arrhythmia: Rate &/or rhythm control
* Assessment of risk factors with appropriate modification

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Health behaviour modification

Alcohol and Tobacco: ≤ 1 standard drink/day, consider complete abstinence of alcohol and tobaxxo
OSA: CPAP for mod-devere OSA (AHI ≥ 15 hours)
Weight: decrease weight, 10% to a BMI ≤ 27
Exercise: mod intensity ≥ 30 min per day, 3-5 days per week ( ≥ 200 min/week)
DM: target A1c ≤ 7%
BP: Target ≤ 130/80 at rest, prefer ACEi/ARB

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Maintenance Rate/Rhythm Control

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Anti-thrombotic therapy (paroxysmal or persistent) risk
Factors that increase bleeding risk

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Bleeding while on OAC

Mild bleed: delay VKA until INR <2 OR delay next DOAC dose
Significant bleed: Fluid, RBC + platelet transfusion, vit K (VKA) OR activated charcoal if DOAC ingested withing 4 hours
Life threatening bleed: VKA; PCC, tranexamic acid, Vit K IV, FFP
»DOAC: idarucizumab or andexanet alfa, tranexamic acid

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Anti-thrombotic therapy in Afib patients with ACS

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Special population

do NOT routinely use OAC for patient with Afib and advanced liver disease (Child Pugh C or associated with coagulopathy)
Individualize treatment recommendation in patietns with active cancer
Do NOT routinely anticoagulate patient with secondary AFib which has resolved
OAC for most patients with AFib & hypertrophic cardiomyopathy

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OAC Pharmacotherapy
Initiating DOAC after CVA
CVA on OAC (secondary prevention)

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INR
- what increases INR?
- Management of supratherapeutic INR

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Antithrombotic therapy interruption

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Dyslipidemia

Cardiovascular risk factors

Increase age
male
smoking
DM
Elevated cholesterol
Low HDL
HTN
Family hx of CVD (<60)
Inflammatory markers
Overweight/obese

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Dyslipidemia

CCS (IHD) Risk factors to screen earlier

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Dyslipidemia

Secondary causes of elevated LDL and TG

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# Dyslipidemia History/Physical: based on risk factors + secondary causes

* Hx: lifestyle, meds that increase LDL or TG, PMHx, fam hx * Px: Ht, Wt (BMI), WC, BP, Cardio, thyroid, large spleen/liver, xanthoma

# Dyslipidemia Familial hypercholesterolmeia (FH - 1 in 125 patients)

# Dyslipidemia Health behaviour modification/Herbal

# Dyslipidemia Pediatric per CCS 2022

# Dyslipidemia Guideline specifics

# Dyslipidemia Pharmacotherapy

# Dyslipidemia Population/Specific comorbidities

# Dyslipidemia Referral

* Drug intolerance * Poor response to pharmacotherapy * Highly elevated lipoproteins

# heart failure Definition of heart failure and etiology

* Epidemiology: average annual mortality rate of 10-35%

Stages + Classes (NYHA)

Etiology of heart failure

# Heart Failure Risk Factors

* Demographics: Older age, male, family hx of cardiomyopathy * Exposures: smoking, alcohol/substance use, chemotherapy/radiation * Medical hx: obesity, HTN, elevated lipids, IHD/CAD, DM, valvular disease, AFib

# Heart Failure Precipitating Factors

# Heart Failure Prevention

* Exercise - evidence of an inverse dose-response relationship between physical activity and development of heart failure * Prevention/ treating cardiovascular risk factors (tx dyslipidemia/ hypertension/ DM/ smoking cessation) * Evidence for ACEi/ARB, BB, SGLT2i (in DM)

# Heart Failure Screening (American)

* NP screen at risk patient to identify those that require echo (BNP >50 pg/ml or NT-proBNP > 125 pg/ml prompts referral + echo)

# Heart Failure History (Signs and Symptoms) and physical

Symptoms of HF for diagnosis = 2 major or 1 major + 2 minor

* Major: orthopnea, elevated JVP, + AJR, rales, S3, cardiomegaly, acute pulmonary edema * Minor: SOBOE, PND, edema, HR >120, hepatomegaly, pleural effusion | AJR = abdominojugular reflex

# Heart Failure * Differential diagnosis * PRIDE Score * H2FPEF Score

HFmEF + HFpEF suggestive findings

# Heart Failure * Investigations - initial * Subsequent investigations if +ve findings?

# Heart Failure Investigations - Routine/Specific

# Heart Failure Multimorbidity

Assess for frailty, cognitive impairment, dementia and depression, all of which may affect treatment, adherence, follow-up and prognosis

# Heart Failure Patient Education - Self Care

# Heart Failure Non-pharmacotherapy for HF management

# Heart Failure Managing Comorbidity

# Heart Failure Pharmacotherapy

# Heart Failure Complementary and Alternative Medicines

* Co-Q10, D-Ribose, L-Carnitine, Omega-3 fatty acids * If deficient - Replace thiamine and vitmain D

# Heart Failure Management HFrEF

# Heart Failure Management HFmEF

* Moderate recommendation SGLT2, weak ARNi, ACEi, ARB, MRA, BB

# Heart Failure Management HFpEF

# Heart Failure Management of HFrecEF (aka HFimpEF) ## Footnote Heart Failure recovered ejection fraction, heart failure improved ejection fraction

* Do not discontinue goal directed medical therapy (from HFrEF) * ECG & NT-Pro BNP q6-12 months, Echo q1-3yr

# Heart Failure Management of abnormal Cr + electrolytes

# Heart Failure Management of pre-HF

* If LVEF ≤ 40%: tx with ACEi + BB, if ≤ 30% consider ICD

# Heart Failure Management based on pehnotype

# Heart Failure Follow-up frequency and what to monitor

# Heart Failure Management Acute Heart Failure

# Heart Failure Advanced HF/ Care Planning/ Palliative Care

* Advance HF: marked symptoms with minimal exertion and end-organ hypo-perfusion despite maximal medical therapy * HF has an unpredictable course - can be complex + emotional * Palliative therapies can start at the time of diagnosis * Care planning discussions need to be ongoing + repeated * (Avoid NSAIDs/codeine/TCAs)

# Heart Failure When to refer

* Initial HF diagnosis, after hospitalization * HF with ischemia, HTN, valvular dz, syncope, renal dz, other co-morbidities, unknown etiology, treatment intolerance, poor compliance

Hypertension epidemiology

* 2% of children * 7% of pregnant women * 25% of adults * 90% lifetime risk

# HTN Normal BP (preferred method ABPM> HBPM> AOBP > non-AOBP)

# HTN Types of blood pressure based on location of readings

# HTN CVD risk factors (increases risk)

# HTN Complications/ Target organ damage

# HTN Differential/ Induced hypertension

# HTN Screening with office BP - USPSTF (not EBM suggested) ## Footnote USPSTF: United States Preventive Services Task Force

* Adults ≥ 40 or with risk factors - annual AOBP * Adults 18-39 q 3-5 years AOBP

# HTN History

# HTN Physical exam

# HTN Initial investigations Maintenance Investigations

# HTN Specific investigations for secondary causes

# HTN Monitoring

# HTN Flow chart

# HTN Health behaviour change (lifestyle modification)

# HTN General approach to pharmacotherapy

# HTN Target blood pressure (caution in DBP ≤ in pts with CAD)

# HTN Common medications and considerations

# HTN Condition/Disease specific medication choices - assess for pregnancy as some medications are contraindicated

# HTN Hypertensive emergency * Definition * Signs, symptoms and management (4 conditions)

# HTN Reactive hypertension

# IHD Classification of acute coronary syndrome

# IHD * Epidemiology * Risk factors

# IHD Signs + Symptoms Physical exam

# IHD Complications

# IHD Differential for chest pain

# IHD Classifications CCS Stage with hallmark injury

# IHD Pre-test (%) likelihood of CAD - Diamond-Forrester risk model

# IHD Investigation for stable chest pain work-up

# IHD Clinical decision tools for chest pain (NSTE-ACS)

# IHD Lifestyle modifications

# IHD Long term medications

# IHD Acute Management of ACS chest pain

# IHD Investigations for acute chest pain

# IHD Acute medications Discharge medications

# IHD NSTE-ACS (Unstable angina/NSTEMI) Management

# IHD Cardiac Rehabilitation

* Recommended if recent MI, PCI, CABG, stable angina, heart transplant, or spontaneous coronary artery dissection event

# IHD * STEMI Management * Long term management and follow-up

# IHD Chronic stable angina (Management)

# IHD IHD Flowchart

# Pericarditis Definition

Inflammation of the pericardium

# Pericarditis Causes

# Pericarditis Signs and symptoms

# Pericarditis Differential

# Pericarditis Investigations

# Pericarditis Management