Cardiology Flashcards
What are the types of AF as defined by duration?
Paroxysmal (comes and goes - usually less than 48hrs)
Persistent (more than a week or needs cardioversion)
Long standing persistent (more than a year)
Permanent (all the time)
How is the need for anticoagulation determined in AF? How is it interpreted?
C - congestive heart failure (1) H - hypertension (1) - includes on current tx A - age over 65 (1) D - diabetes mellitus (1) - includes on current tx S - previous stroke, TIA or VTE (2) V - vascular disease (1) A - age over 75 (1) S - sex female (1)
0 - low risk, 1 - mod risk, >1 high risk
Don’t offer anticoagulation just off female gender, take into account bleeding risk,
What score is used to assess bleeding risk for anticoagulation?
H - hypertension A - abnormal liver or renal function or alcohol (1,1,1) S - stroke B - bleeding history L - labile INR E - elderly over 65 D - drugs (antiplatelet / NSAID)
What INRs should prompt the reassessment of warfarin in AF?
After first 6 weeks
2 higher than 5 or 1 higher than 8 in last 6 months
2 less than 1.5 in last 6 months
What factors should prompt for AF rhythm control over rate control?
Known reversible cause CHF due to the AF New onset AF Able to ablate (flutter) Ineffective rate control Younger, active or symptomatic
What factors suggest rate control over rhythm control in AF?
Permanent/not responding to rhythm control
Recurrent over 65
What drugs can be used to control AF rate?
What should be considered in prescribing?
What can be used if drugs not effective?
Beta blockers
Calcium channel blockers
Digoxin (in elderly no ambulant patients only - not effective in young as high catacholamines overwhelm vagus)
Ablation of the AV with pacemaker insertion.
What general means can be used to achieve AF rhythm control?
DC cardioversion
Amiodarone
Fleccanide
What defines unstable AF and how should it be treated?
AF with MI, shock, angina or pulmonary oedema
UFH cover, DC cardiovert, 4 weeks of LMWH and anticoagulant
If CHADSVASc is >0 lifelong anticoagulant
Consider amiodarone to maintain NSR for 1 year
How should a case of AF that presents within 48 hours of onset be managed if rhythm control is desired?
UFH cover
Cardioversion
If CHADSVASc high then lifelong anticoagulants
Consider amiodarone for 1 year to maintain NSR
How should a stable case of AF be managed for rhythm control if it presents after 48 hours?
3 weeks of anticoagulation
DC cardioversion
LMWH and anticoagulation for 4 weeks
If CHADSVASc high then lifelong oral anticoagulation
Consider amiodarone before and up to a year after to maintain NSR
How should a stable but urgent case of AF that presents after 48 hours be managed if rhythm control desired?
Transosophageal ultrasound to check for clots
If absent - UFH, cardiovert, 4 weeks LMWH/anticoag
If present anticoagulate then check again after 3 weeks then proceed as for stable presentation out of 48 hours
What can be used for chronic rhythm control in AF?
Beta blocker
Flecanide
Amiodarone
Pill in pocket stratergy to be taken if symptomatic (if very low risk)
What are causes of atrial fibrillation?
Hypertension Heart failure MI/ischemia Mitral stenosis/regurgitation Rheumatic heart disease Alcohol Thyrotoxicosis Valve surgery CABG Idiopathic
What are the diagnostic criteria for infective endocarditis?
Duke criteria
2 major, 1 major and 3 minor, 5 minor
Major - typical or persistent positive blood culture. - positive echo or confirmed regurgitation
Minor - predisposing factor. - fever. - vascular signs. - positive blood culture not meeting major. - positive echo not meeting major
What are risk factors for infective endocarditis?
Dermatitis IV injection / IVDU Valve disease Valve replacement Patent VSD or ductus arteriosus
Signs and symptoms of infective endocarditis
Fever/malaise Night sweats Weight loss Splenomegaly Clubbing Splinter haemorrhages New or changed murmur Oslars nodes / janeway lesions Roth spots Abcesses
What are oslars nodes, janeway lesions and roth spots?
Oslars - vasculitis caused painful infarcts on fingers/toes
Janeways - embolic caused painless palmer or planter abcesses
Roth - vasculitis caused retinal haemorrhages with a pale centre
Common causes of native valve infective endocarditis?
Streptococcus viridans - mouth
Staphylococcus aureus - skin
Enterococcus faecalis
Common causes of prosthetic valve infective endocarditis within one year of surgery?
Coagulase -ve staphylococci
What fungi can be associated with infective endocarditis?
Candidia,
What examinations are required in suspected infective endocarditis?
Blood cultures x3 from different sites FBC for anaemia / neutrophilia Urinanalysis for microscopic haematauria Cxr for cardiomegally Echo for vegitiations or regurgitations
Example of blind therapy for native valve infective endocarditis
Amoxicillin and gentamicin
Example of blind antibiotic therapy for prosthetic valve infective endocarditis?
Vancomycin, gentamicin and rifampicin
Signs of heart failure on CXR?
Diffuse consolidation (bat wings - perihilar consolidation) Reticular interstitial consolidation Increased heart size Kerley b lines Bilateral pleural effusion
Why do you get batwing (perihilar) consolidation in heart failure? When else do you get it?
Better lymphatic drainage peripherally
Non cardiogenic odema
Causes of heart failure?
Three commonest and 4 others
IHD Dilated cardiomyopathy Hypertension Non-dilated cardiomyopathy Valvular heart disease Congenital heart disease Arrhythmia Alcohol and drugs
What are the two mechanisms of heart failure? What is happening?
Systolic - decreased contraction strength of the heart reducing cardiac output
Diastolic - failure of the heart to appropriately relax during diastole
What type of heart failure would be most vulnerable to a sudden tachycardia? Why?
Diastolic - reduced filling time.
What is frank starlings law? What is frank starlings curve? How does it appear normally? Why?
That the higher the end diastolic volume, the greater the ventricle is stretched and the stronger the force of contraction.
The curve is a plot of ventricular performance against filling pressure. It rises initially due to starlings law then falls as the fibrous pericardium will no longer stretch and further filling compresses the arteries
How is starlings law effected in a systolic heart failure?
Decreased cardiac output causes increased end systolic volume, increased venous pressure and thus increased end diastolic volume. This would normally cause increased cardiac output back to normal however, in heart failure the starling curve is depressed thus cardiac output must be maintained by other means (e.g. Increasing pulse) .
What compensatory factors designed to maintain blood pressure actually end up worsening heart failure?
Increased afterload due to systemic vasoconstriction
Myocardial damage due to high sympathetic tone
Increased wall stretch due to high preload due to high venous return and salt/water retention
What physiological process that occurs during heart failure actually aids the heart long term?
ANP and BNP release in response to stress causing sodium and water loss with vasodilation
What is the classification method of heart failure?
Nyha classification for heart failure
1 - no limitation, normal exercise does not cause symptoms
2 - mild limitation, comfortable at rest but normal activity causes symptoms
3 - marked limitation, comfortable at rest but mild activity causes marked symptoms
4 - symptoms at rest
Symptoms of heart failure
Exertional dysponea
PND
Orthopneoa
Fatigue
Abdominal signs of heart failure?
Ascites
Hepatomegaly
Why does heart failure cause pulmonary oedema?
Pulmonary venous hypertension results in increased plural fluid production
Systemic venous hypertension results in decreased lymphatic drainage so decreased pleural fluid reabsorption
Primary care tests in heart failure prior to referral?
BNP
CXR
ECG
Secondary care tests for heart failure?
Echocardiography
Cardiac MRI
In mild heart failure is cardiac output reduced? What about ejection fraction?
CO normal due to increased preload and tachycardia
EJ decreased
Common causes of right heart failure?
Secondary to left
Cor-pulmonale
Pulmonary hypertension
Right sided valve disease or right sided ischemia
Non-medical management of heart failure?
Low level exercise Low salt intake Stop alcohol Stop smoking Prophylactic vaccination
Drug classes used in heart failure
Diuretics Ace inhibitors Beta blockers Aldosterone antagonist Inotropic agents Nitrates
Surgical management of heart failure?
Biventricular pacemaker
Transplantation
Left ventricular assist device
If furosemide not working what options are there (confined to diuretics)?
Up titrate dose
Switch to bumetanide
Add a thiazide
What drug classes are prognosis altering in heart failure?
Ace inhibitors
Arbs
Beta blockers
Spironolactone
What drugs purely cause symptom relief in heart failure with no change to prognosis?
Diuretics
Inotrophs
Nitrates
How are beta blockers thought to work to improve heart failure prognosis?
Co reduces then returns to normal
Pvr decreases long term possibly due to beta 1 blockade of renin release
Other than social factors and directly treating the heart failure, what else should be considered in a heart failure patient?
Treating cause
- revasculisation, antiarrhythmics, antihypertensives
What management option can be considered in inpatient treatment of severe heart failure?
Fluid restriction
What aldosterone antagonist is used in heart failure? Main side effect?
Spironolactone - gynacomastia
Beta blocker for heart failure?
Bisoprolol
Carvediolol
At what point would you consider aspirin for primary prevention of cvd?
Qrisk2 >20
Bp
At what point should statins be considered for cvd primary prevention? Which? How much?
Qrisk2 >10
Atovastatin
20mg
Stage 1 hypertension thresholds
Clinic > 140/90
Home > 135/85
Stage 2 hypertension thresholds
Clinic 160/100
Home 150/95
Severe hypertension threshold
> 180/110
Treatment threshold for hypertension?
All stage 2
Stage 1 under 80 with - dm, ckd, cvd, qrisk2 >20%, organ damage
Under what age should secondary causes of htn be actively sort?
40
Secondary causes of htn?
Renal artery stenosis Fibromuscular dysplasia Phaeochromocytoma Cushings Conns OSA
Presentation of renal artery stenosis?
Refractory HTN
Deteriorating renal function worsened by ACEi
Treatment options for renal artery stenosis?
Angioplasty with stenting if:
- bilateral
- unilateral with only one kidney
- effecting renal function
How does a phaeochromocytoma present?
Refractory htn Sweating Palpitations Headache Anxiety
How is phaeochromocytoma tested for?
24 hour urine catacholamines
How is phaeochromocytoma diagnosed and treated? Waht needs to be considered prior to treatment?
Ct/mri/pet post +ve urine
Surgical removal
Load with sodium and fluids prior to surgery to prevent bp crash
How does cushings syndrome present in a htn capacity?
Refractory htn
Hypokalaemia
Central obesity, moon face, dorsocervical fat pad, purple striae, bruising, thin skin, dm, polyuria, polydipsia, hirtuism, baldness
How does conns syndrome present?
What metabolic abnormalities stem from the electrolyte imbalance?
Hypertension
Hypokalaemia
Glucose intolerance and metabolic alkalosis
How does conns cause hypokalaemia?
Aldosterone triggers
- uptake of k into cells by na/k atpase
- increased ENaC, ROMK and NaKATPase in principal cells of DT and CD
How is conns diagnosed?
Serum aldosterone levels
24 hr urinary aldosterone
What can cause conns?
Adrenal adenoma
Idiopathic adrenal hyperplasia
How is conns syndrome managed?
Spironolactone
Adrenalectomy (effective if adenoma cause not hyperplasia)
Cause of hypertrophic cardiomyopathy?
Genetic - dominant inheritance or spontanious
Symptoms of hypertrophic cardiomyopathy?
Sudden death Palpitations Angina Dysponea Syncope
Change in apex beat in hypertrophic cardiomyopathy?
Double tap
NOT. Displaced!
What conditions can cause displacement of apex beat?
Left ventricular dilation - dilated cardiomyopathy - aortic stenosis - severe hypertension Mediasteinal shift
Signs of hypertrophic cardiomyopathy?
Double tap apex beat
Murmur like aortic stenosis
Heart failure symptoms
Systolic thrill left sternal edge
ECG changes in hypertrophic cardiomyopathy?
LVH AF VT WPW PVCs
Complications of hypertrophic cardiomyopathy
LVOT obstruction - syncope, angina
Disordered myocytes - arrhythmia, PVCs
Treatment of hypertrophic cardiomyopathy
Exercise limitation Beta blockers Amiodarone Dual chamber pacing ICD Septal myomectomy for LVOT obstruction
Causes of dilated cardiomyopathy?
Unknown but related to alcohol, htn, viruses and genetics
Presentation of dilated cardiomyopathy
Fatigue Dysponea LVF AF VT
Signs of dilated cardiomyopathy
Displaced apex beat
Mitral regurgiation
CHF
ECG in dilated cardiomyopathy
Poor r wave progression
Treatment of dilated cardiomyopathy
Rest Digoxin ACEi Biventricular pacing Anticoagulation ICD transplantation
Causes of pericarditis?
Viral Bacterial Idiopathic MI Uraemia Autoimmune Drug induced Radiotherapy Tumour
Signs of uncomplicated pericarditis?
Pericardial friction rub (hammonds sign)
Cardiac enzymes in pericarditis?
Normal unless progresses to myocarditis
Treatment of uncomplicated pericarditis?
Treat cause
Aspirin
If no response, corticosteroids
Signs of pericardial effusion?
Muffled heart sounds Non-palpable apex beat Dull percussion note to lower left lung Raised JVP Kussmauls sign Pulsus paradoxus
What is kussmauls sign in pericardial effusion? Why?
Increased JVP on inspiration
Normally jvp falls with inspiration as decreased pressure aids return to heart. If impaired filling of heart then blood returns, but is pooled into the veins increasing jvp.
Signs that a pericardial effusion has progressed to tamponade?
Haemodynamic compromise
What is pulsus paradoxus?
Sbp drops on inspiration
Inspiration lowers pressure so increases venous return, dilates right ventricle, compressing left ventricle resulting in decreased blood ejected from the left!
What is becks triad of cardiac tamponade?
Low bp, increased jvp, muffled heart sounds.
Treatment of cardiac tamponade?
Pericardiocentesis
How should repeated pericardial tamponades be treated?
Fenestrations cut into pericardium to allow drainage
Causes of cardiac tamponade?
Any of pericarditis
Aortic dissection
Warfarin therapy
Trauma (inc biopsy or puncture during cardiac catheterisation)
What is a cardiomyopathy?
An idiopathic myocardial disease
How may myocarditis present?
Asymptomatic
Pain, fatigue, dysponea, palpitations, CHF
What would cardiac enzymes show in a myocarditis patient?
Elevation
Advice in patients with myocarditis
Bed rest
Avoid athletic activities for 6months at least
Classification method of heart failure?
NYHA
1 - normal exercise does not produce symptoms
2 - mild limitation - normal exercise produces symptoms
3 - marked limitation - gentle exercise produces severe symptoms
4 - symptoms at rest
Causes of raised JVP
Fluid overload - RVF (CHF, cor pulmonale), iatrogenic
Mechanical obstruction of SVC - cancers
What does the JVP reflect?
Right atrial pressure
Auscultation procedure of the chest in a CVS exam? What murmur are you listening for? What breathing should be performed to increase?
Apex beat - mitral (expiration)
Left axilla - mitral regurgitation (expiration)
Apex rolled left - mitral stenosis (expiration)
4th ICS LSE - tricuspid (inspiration)
2nd ICS LSE - pulmonary (inspiration)
2nd ICS RSE - aortic (expiration)
Neck - aortic stenosis (expiration)
4th ICS LSE leaning forward - aortic regurgitation (expiration)
Base of lungs posteriorly! Bibasal crackles
Why would you auscultate the chest of a patient with chest pains?
Extra heart sounds - heart failure Mitral regurgitation - papillary muscle rupture post MI VSD - post MI Pericardial friction rub - pericarditis Aortic stenosis - angina
What is the first heart sound?
Closure of the AV valves
What is the second heart sound?
Closure of the semilunar valves
Why may the second heart sound split?
Inspiration - venous return to RV increases so pulmonary closes after aortic
RBBB - delayed RV contraction
ASD - increases RV volume
LBBB - delayed LV contraction
What is a third heart sound? Causes?
Sound of rapid ventricular filling in early diastole.
Normal 40 LVF
What is a fourth heart sound? Cause?
End diastolic sound due to atria contracting against an incompliant ventricle
E.g. LVH,
Which heart sound should be auscultated with the bell?
Mitral stenosis (leaning left at apex)
How are heart murmurs graded?
1 - only heard in optimum conditions by expert
2 - heard in optimum conditions by anyone
3 - heard but no thrill
4 - heard with thrill
5 - heard with partial contact
6 - heard without stethoscope
What is the murmur of mitral stenosis?
Mid diastolic murmur best heard with bell rolled to left at apex
Opening snap
What is the murmur of mitral regurgitation?
Pansystolic murmur best heard at the axilla
What is the murmur of aortic stenosis? How can cause be narrowed down by listening?
Ejection systolic murmur best heard at the neck Ejection click (not calcified as leaflets too stiff)
What is the usual murmur of aortic regurgitation?
Early diastolic murmur best heard left sternal edge when leaning forwards
Causes of ejection systolic murmurs?
Aortic stenosis
LVOT obstruction
Causes of pansystolic murmur?
Mitral regurgitation
Tricuspid regurgitation
VSD
Causes of early diastolic murmurs?
Aortic regurgitation
Pulmonary regurgitation
Causes of mid diastolic murmurs
Mitral stenosis
Causes of continuous murmurs?
Patent ductus arteriosus
Nature of pericarditis pain
Sharp
Worse on inspiration and swallowing
Eased by leaning forward from sitting
How can thoracic aortic dissection be classified?
Type a - involving arch and aortic valve proximal to left subclavian
Type b - involving the descending thoracic aorta distal to the left subclavian artery.
How can dissecting aortic aneurysm be diagnosed?
CT or transoesophageal echo
What management should thoracic dissecting aortic aneurysms recieve?
Type a - antihypertensives if HTN, arch replacement surgery
Type b - medical management unless complications develop
Which type of dissecting aortic aneurysm is more common?
Type a
Complications of type a dissecting aortic aneurysms?
Coronary artery occlusion
Aortic incompetence
Cardiac tamponade
What sort of replacement heart valves are there? Lifespans? Risks?
Manufactured - lifelong, risk of clots
Tissue - 10-20 years, no risk of clots
Causes of aortic stenosis?
Senile calcification
Rheumatic heart disease
Congenital
Symptoms of aortic stenosis?
Exertional dysponea
Angina
Syncope
Heart failure
Signs of aortic stenosis?
Ejection systolic murmur loudest on expiration radiating to neck
Slow rising pulse
Heaving apex beat
Heart failure
Tests that might show signs of aortic stenosis?
CXR - calcification
Echo - decreased flow
ECG - blocks as calcification spreads, LVH
Causes of aortic regurgitation
Infective endocarditis Aortic dissection Chest trauma Rheumatic fever Connective tissue diseases SLE RA
Symptoms of aortic regurgitation
Dysponea
Palpitations
Syncope
Angina
Signs of aortic regurgitation
Early diastolic murmur loudest on expiration radiating to sternum
Collapsing pulse with wide pulse pressure
Carotid pulsation
Head nodding with heartbeat
Test findings for aortic regurgitation?
Ecg - lvh
Cxr - lvh, pulmonary oedema
Echo - regurgitaiton
Causes of mitral stenosis?
Rheumatic heart disease
Congenital
Carcinoid syndrome
Prosthetic valve
Symptoms of mitral stenosis?
Dysponea Fatigue Palpitations Chest pains Haemoptysis Right heart failure Systemic emboli
Signs of mitral stenosis
Mid diastolic murmur loudest at apex on expiration and leaning left
Malar flush
Af
Low volume pusle
Test findings for mitral stenosis?
Ecg - p mitrale, rvh, rad, af
Cxr - left atrial enlargement
Echo - low flow
Causes of mitral regurgitation
Lv dilatation Calcification Rheumatic fever Infective endocarditis Prolapse Ruptured chordae tendinae or papillary muscle Congenital
Symptoms of mitral reguritation
Dysponea
Fatigue
Palpitaitons
Signs of mitral regurgitation
Pansystolic murmur loudest at apex radiating to axilla
Displaced hyperdynamic apex
Rv heave
Af
Tests showing signs of mitral reguritation
Ecg - af, pmitrale, lvh
Cxr - lv enlargement, calcification
Echo - regurg
How can you perform a cardiac stress test in different ways?
Treadmill
Beta agonist like dobutamine
Vasodilator like adenosine
What are positive results in a cardiac stress test?
Chest pains Sob Presyncope St depression (significant) Us wall motion changes Decreased radioisotope distribution on nuclear imaging
When does troponin begin to rise post insult? Peak? Decline?
3-4 hours, peak at 18-36 hours, decline in 10-14 days
When does ckmb begin to rise post insult? Peak? Decline?
3-8 hours, peak at 24 hours, decline at 48-72 hours
Causes of raised troponin?
AMI Heart surgery PE with right ventricular strain Pericarditis and myocarditis Aortic dissection Heart failure Cardioversion Trauma Sepsis End stage renal disease Rhabdomyolysis
What is rheumatic fever?
An inflammatory disease following urti with beta haemolytic streptococcus (pyogenes) caused by antibody cross reactivity
What is required for a diagnosis of rheumatic fever?
Throat culture showing strep pyogenes (rare as infection usually passed)
Blood antigen
Antibody titre
Scarlet fever
Signs and Symptoms of rheumatic fever?
Carditis - tachycadia, mit/aor regurg, ccf, cardiomegally, conduction defect Arthritis Erythema marginatum Subcutaneous nodules Fever Raised crp
Main complication of rheumatic fever? Prevalence?
Rheumatic heart disease
60% of those with rheumatic fever and carditis
Presentation of rheumatic heart disease?
Aortic and mitral regurgitation progressing to chronic stenosis
Treatment for rheumatic fever?
Rest
Penicillin
Aspirin if carditis
Immobilise arthritic joints
What treatments are required long term post rheumatic fever? Durations?
Prophylactic penicillin
If valve disease lifelong
If carditis 10 years
Otherwise 5 years
Diagnostic criteria for infective endocarditis?
How many points needed?
Dukes criteria
2 major
1 major 3 minor
5 minor
Major dukes criteria for ie
Positive blood culture - typical from 2 sites or atypical from 3
Evidence of endocardial involvement - vegetation, regurgitation
Minor dukes criteria for ie?
Predisposition Fever >38 Vascular signs Positive blood culture not meeting major Postive echo not meeting major
Predisposing factors for infective endocarditis
Ivdu Dental work Prosthetic valve Valve disease Structural heart disease Previous endocarditis
Vascular signs of infective endocarditis. What are they?
Roth spots - retinal haemorrhage - white centred haemorrhage
Oslars nodes - immune complex - painful, red, raised, fingers/toes
Janeway lesions - septic emboli - nonpainful, palms/soles
Splinter haemorrhages - blood clot under nail - vertical red line
2 causative organisms of infective endocarditis?
Strep viridans
Staph aureus
Signs and symptoms of ie not covered in dukes criteria?
Night sweats Weight loss Anaemia (normochromic normocytic) Clubbing Long PR on ECG Glomerulonephritis with haematuria Abscesses from emboli
Key symptoms of angina
Constricting pain to front of chest with classic radiation
Precipitated by physical exertion
Relieved by rest or GTN
How can angina be classified diagnostically into typical, atypical and non-anginal
Typical - 3?key symptoms
Atypical - 2
Non anginal - 0-1
How should a diagnosis of angina be reached?
Looking at symptoms (typical vs atypical), age and risk factors (low or high) on a table derived by nice. Gives a percentage risk of coronary artery disease.
If a patient with angina symptoms has a less than
Look for other causes - aortic stenosis, HCM
If a patient has angina type symptoms and a risk of cad of >90% what should be done?
Make the angina diagnosis and treat
If a patient with angina type symptoms has a risk of cad between 10 and 90% what tests are available in order from those for patients most likely to have angina to the least
Coronary angiography
Functional imaging
CT calcium scoring
What is CT calcium scoring?
Looks for amount of calcification in the coronary arteries
Management of angina?
Council re provoking factors
Short acting nitrate for symptom relief
Secondary prevention - aspirin, statin, ACEi
Reduce episodes - beta blocker, long acting nitrate
Surgery - cabg, pci
What is cardiac functional imaging?
Moving MRI of the heart
What classes as cvd for the purpose of determining if a patient should recieve 80mg atorvostatin?
Mi Angina Stroke Tia Peripheral arterial disease
How can risk be stratified in unstable angina and NSTEMI
Using the GRACE score
What component make up the grace risk score for ua and nstemi
Age Pulse Sbp Creatinine Heart failure Cardiac arrest St segment changes Raised troponin
What immediate treatments should be offered to ua and nstemi patients? What risks stratifications for each?
- Aspirin - all
- Prasugrel - all except lowest risk ua
- Gp iib/iiia inhibitors - =/>intermediate risk going for angiography in 96 hours
- Fondaparinux - all except renal failure or angiography in 24 hrs
- UFH - all who cant have fondaparinux
- Angiography - =/> intermediate risk within 96 hours
Long term medications to add to acute treatments of ua and nstemi
Cardiac rehab
Acei, beta blocker, statin
Lifestyle modification advice (smoking, diet, drinking, exercise)
Consideration for stent or cabg
Rules for driving post MI?
Cars - at least one month off and until dr says safe. No need to tell dvla
Trucks - tell dvla. Stop for at least 6 weeks and until dr says safe
Non MI causes of raised troponin
Myocarditis Heart failure Renal failure PE Septic shock Electrical cardioversion
Causes of raised BNP
Heart failure Myocarditis Renal failure Elderly + female Digoxin Hyperaldosteronism / cushings
