Cardiology Flashcards
In any ST elevation
cardio referral + advice
ACS is pain not relieved by …
GTN 3 x @ 5 min intervals
ACE early managent
O2 if <94% Morphine 5-10mg + metaclopramide GTN/IV nitrites (Systolic >90mmHg) Aspirin 300mg chewed immediate PCI referral if ST elevation
NO st elevation
GRACE score
continue ECG
clopidogrel 300
fonduparinax (unless angiography w/i 24 hours)
STEMI gold standard
PCI door to balloon 90 mins
post PCI `
clopidogrel abciximab (GP IIb/IIIa inhibitor) --> ONLY GIVEN ONCE
When do you thrombolyse?
in STEMI if PCI C/I
NSTEMI high risk
GRACE >3% in 6 months/raised trops/persistant pain/st depression/diabetes
semi-elective PCI in 48 hours
NSTEMI low risk
GRACE<3%/ unresolvable unstable angina
give clopidogrel if risk = 1.5-3%
Long term ACS
bed rest
daily U&Es and cardiac enzymes 2-3 days
Fonduparinax ( discuss w/ cardio if PCI w/i 24hours)
Aspirin 75mg for life
Clopidogrel 75mg for a year
Bisoprolol for life
Atorvostatin 80mg
Ramipril 2.5mg b.d. (statin + ACE-i after 24-48 hours)
oral nitrates if angina
lifestyle advice
discharge 5-7 days
Stable Angina
lifestyle advice GTN + CCB/BBlocker Nicorandil if refractory if symptomatic on 2 anti-anginals, PCI/CABG referral
Secondary prevention
Statin
low dose aspirin
ACE-i if cormorbid disease
POST ACS life advice
work: office after 2 months pilots/drivers = never heavy labourers = new job Travel : avoid planes for 2 months Sex: avoid for 1 month Driving: don't need to tell DVLA post PCI can drive after a week, otherwise 4 weeks
Angina DVLA
dont need to tell
can continue unless unstable/whilst driving/emotion
recommence when symptoms controlled
AAA DVLA
tell DVLA if >6cm
stop driving if >6.5cm
HGV drivers
always tell DVLA
stop for 6 weeks
stop for 3 months post CABG
re-licensed if requirements met
constrictive pericarditis
surgery to remove pericardium
myxoma
whack it out
pulmonary oedema
A-->E sit upright, O2 IV access, ECG 1.25-5mg slow diamorphine 40-80mg furosemide GTN 2 puffs if >90systolic
if still bad, CPAP + furosemide
ARDS
ICU 100% O2, sit patient up NIV (CPAP) IV nitrates IV furosemide Morphine + metoclopramide Aminophylline if bronchospasm
LV dysfunction
lifestyle advice
- ACE-i + BBlocker
- diuretic if oedema
- Spirinolactone/ATRA/hydralazine + nitrate
- digoxin
Heart failure lifestyle advice
education, obesity, salt , smoking bed rest after exacerbation exercise (not strenuous) vaccines: influenza, pneumococcal Sex: dont use viagra/sildenafil
do not use ACE-i with..
NSAIDS (renal impairment)
Always check what in heart failure?
renal function
