Cardiology Flashcards
ACS medical management
- Aspirin 300mg (75mg OD thereafter)
- Ticagrelor 180mg (90mg BD thereafter)
- Fondaparinux 2.5mg s/c OD (5 days)
- GTN spray PRN
- Morphine 2.5-5mg IV/IM 2-4 hourly
- Metaclopramide 10mg PO/IV/IM PRN max TDS
- Atorvastatin 80mg ON
- Bisoprolol - titrated to HR
- Ramipril (when clinical evidence of HF, start at least 48hr after MI) 2.5 mg BD for 3 days, then 5 mg BD.
Causes of left axis deviation
- LVH
- LBBB
- LAFB
- Inferior MI
- Ventricular ectopy
- Paced rhythm
- Wolff-Parkinson White (R-sided accessory)
Causes of right axis deviation
- RVH
- LPFB
- Lateral MI
- Acute lung disease (eg PE)
- Chronic lung disease (eg COPD)
- WPW (L-sided accessory)
- Ventricular ectopy
- Hyperkalaemia
- Sodium-channel blocker toxicity
- Normal in kids or tall/thin adults (horizontal heart)
Contra-indications to b-blockers
Asthma Hypotension Bradycardia Cardiogenic shock 2nd-degree/3rd-degree AV block Severe peripheral arterial disease (Verapamil)
MOA of b-blockers
Negative inotrope + negative chronotrope: reduced HR, reduces BP, reduces angina
ECG findings in acute MI
Hyperacute T waves:
Often the first sign of an MI
Persist for a few minutes
ST elevation:
T wave inversion:
Occurs within 24 hours
Lasts days/months
Pathological Q waves:
Develop after hours/days
Persist
CHADSVASC score
C - congestive heart failure - 1
H - hypertension (/on antihypertensives) - 1
A2 - age >= 75 - 2
- age 65 - 75 - 1
D - diabetes - 1
S2 - prior stroke/TIA - 2
V - vascular disease (IHD/PVD) - 1
S - sex: female - 1
0 - no treatment
1 - consider anticoagulation in males
2+ - offer anticoagulation
VTE prophylaxis (medical patient)
LMWH:
Dalteparin 5000units s/c OD
Enoxaparin 40mg s/c OD
VTE prophylaxis (medical patient + renal disease)
If eGFR<
UFH:
The 3 features of typical angina:
- Constricting discomfort in the front of the chest or neck, shoulders, jaw or arms.
- Precipitated by physical exertion
- Relieved by rest or GTN in about 5 minutes
All 3 features = Typical angina
2 features = Atypical angina
1 or 0 features = Non-anginal chest pain
Management of hypertension if <55 years and not Afro-Caribbean?
Management of HTN <55y and not Afro-Caribbean:
- ACE inhibitor (Ramipril 1.25mg OD)
- A + Calcium-channel blocker (Amlodipine)
- A + C + Diuretic-thiazide-type (Indapamide)
- A + C + D +
K =< 4.5 - Spironolactone
K > 4.5 - Increase thiazide dose
Diuretic not tolerated - A-blocker or B-blocker
Ramipril dosing HTN
Ramipril dosing post-MI (secondary prevention)
Ramipril dosing symptomatic heart failure
Ramipril dosing (primary prevention)
Ramipril dosing HTN:
Initially 1.25 - 2.5 mg OD
Increased if necessary up to 10 mg OD
Dose increased at intervals of 2-4 weeks
Ramipril dosing post-MI (secondary prevention):
IF clinical evidence of heart failure, start at least 48 horus post-infarction:
2.5 mg BD for 3 days, then 5 mg BD
Ramipril dosing symptomatic heart failure:
Initially 1.25 mg OD
Increased if tolerated up to 10 mg daily, preferably taken in 2 divided doses
Increase dose gradually at intervals of 1-2 weeks
Ramipril dosing primary prevention: Prevention of cardiovascular events in patients with atherosclerotic CVD or DM and >=1 other risk factor for CVD Initially 2.5 mg OD 1-2 weeks 5 mg OD 2-3 weeks 10 mg OD
Amlodipine dosing HTN
Amlodipine dosing HTN:
Initially 5 mg OD
Maximum 10 mg OD
Indapamide dosing HTN
Indapamide dosing HTN:
2.5 mg OM immediate release
Or, 1.25 mg OM modified-release
Spironolactone dosing HTN
Monitoring requirements
Spironolactone dosing HTN:
25 mg OD
Monitor electrolytes - discontinue if hyperkalaemia occurs
