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AFP > Cardiology > Flashcards

Cardiology Flashcards

1
Q

If a patient presents with bradycardia, what should you look for?

A

Adverse Features

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2
Q

What are the four adverse features

A

HF
Myocardial ischaemia
Shock
Syncope

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3
Q

If a patient has bradycardia with adverse features what should you do

A

IV atropine 500mcg

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4
Q

What dose of atropine is given

A

IV 500mcg

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5
Q

If a patient with bradycardia has a satisfactory response to 500mcg IV atropine what is done

A

Assess if they are at-risk of asystole

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6
Q

What 4 factors make a patient at-risk of asystole

A
  • Recent asystole
  • Ventricular pause >3s
  • Mobitz II AV block
  • Complete HB, Broad QRS
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7
Q

If a patient is not at risk of asystole what is done

A

Observe

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8
Q

If a patient is at-risk of asystole what is done

A

Repeat IV atropine 500mcg IV

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9
Q

what is the maximum dose of atropine that can be given

A

Up to 3mg

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10
Q

what happens if there is not a satisfactory response to atropine

A

Repeat up to 3mg IV

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11
Q

what is an alternative approach to repeating atropine

A

Transcutaenous Pacing

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12
Q

what other drugs can be given as an alternative to atropine

A

Adrenaline

Isoprenaline

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13
Q

what is the mnemonic to remember STEMI management

A

MONARTH

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14
Q

what is given in a STEMI

A 
Morphine, Metclopramide 
Oxygen 
GTN 
Aspirin 
Reperfusion 
Ticagrelor 
Heparin
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15
Q

what dose of morphine is given

A

5mg IV morphine (4-hourly)

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16
Q

what should be given with IV morphine

A

IV Metclopramide

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17
Q

what dose of metclopramide is given

A

10mg

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18
Q

what dose of GTN is given

A

500mcg sublingual

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19
Q

how often can GTN spray be repeated

A

every 5-minutes

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20
Q

what is the maximum dose of GTN spray that can be given

A

3 doses

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21
Q

what loading dose of aspirin is given

A

300mg PO

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22
Q

what is the long-term dose of aspirin

A

75mg OD

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23
Q

what is the loading dose of ticagrelor

A

180mg PO

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24
Q

what dose of fondaparinux is given

A

2.5mg SC

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25
Q

when should fondaparinux be stopped

A

Continue for 8-days. Stop 24h before CABG surgery if intended

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26
Q

when is PCI attempted

A
  • STEMI on ECG

- Can reach reperfusion centre in 120min

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27
Q

if PCI is not available what is performed

A

Fibrinolysis

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28
Q

what is used for fibrinolysis

A

Tenectaplase

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29
Q

what time frame should tenectplase be implemented

A

WITHIN 6-HOURS OF SYMPTOMS

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30
Q

how is tenectplase given

A

30-60mg over 10s

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31
Q

what should be ordered after tenectplase

A

ECG

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32
Q

what are you looking for on post-tenectplase ECG

A

50% resolution in ST elevation

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33
Q

if there is not 50% reduction in ST elevation, what is done

A

Rescue PCI

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34
Q

how is a patient with NSTEMI initially managed

A

Initial drug-management

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35
Q

what is included in the initial drug-treatment of NSTEMI

A 
IV morphine, IV metoclopramide 
Sublingual GTN 
Aspirin (300mg) 
Ticagrelor (180mg) 
Fondaparinux (2.5mg)
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36
Q

what dose of morphine is given

A

5mg IV

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37
Q

what dose of sublingual GTN is given

A

500mcg

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38
Q

what dose of aspirin is given

A

300mg

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39
Q

what dose of ticagrelor is given

A

180mg

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40
Q

when is fondaparinux not given

A

Do not give unless angiography in next 24h is planned

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41
Q

after initial management of NSTEMI what is performed

A

Calculate GRACE score

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42
Q

what dose the GRACE score calculate

A

Risk of in-hospital mortality and 6-month mortality

43
Q

what is required to calculate GRACE score

A 
Age 
HR 
BP 
Cardiac enzymes 
Creatinine 
Cardiac arrest on admission 
Killip class 
ST segmenet elevation
44
Q

what GRACE score indicates a high-risk of mortality

A

More than 1.5

45
Q

what is given if a high GRACE score

A

Clopidogrel 300mg

46
Q

what is given if GRACE score is more than 3

A

Clopidogrel 300mg

Glycoprotein Inhibitors

47
Q

name two glycoprotein inhibitors

A

Tirofiban

Eptifbatide

48
Q

what is the criteria for giving glycoprotein inhibitors

A
  • GRACE score more than 3

- Due to have PCI

49
Q

if GRACE score less than 1.5 what is done

A

Clopidogrel 300mg - if PCI in next 24 hours

50
Q

how is a NSTEMI with GRACE score less than 1.5 managed

A

Outpatient

  • Stress test
  • Elective angiography and PCI
51
Q

how should patients with tachyarrythmias be approached

52
Q

what is first looked for in patients with tachyarrythmias

A

Adverse Features

53
Q

what are the 4 adverse features of tachyarrhythmias

A

HF
Myocardial Ischaemia
Shock
Syncope

54
Q

if a patient has any adverse features what should be done

A

DC Cardioversion

55
Q

how many attempts of DC cardioversion should be conducted

56
Q

what is given after third attempt of DC cardioversion if not responding

A

300mg IV amiodarone over 10-20min

57
Q

what dose of amiodarone is given

A

300mg IV, 10-20min

58
Q

if not responding to 300mg IV amiodarone what is given

A

900mg IV amiodarone over 24h

59
Q

if patient is stable with tachycarrythmia was is assessed

A

Narrow or Broad QRS

60
Q

what defines a narrow QRS complex

A

Less than 0. 12s

61
Q

if a broad QRS what then needs to be looked at

A

Regular or irregular

62
Q

what does a regular broad-QRS tachyarrythmia likely indicate

63
Q

how is VT managed

A

IV amiodarone over 20-60 minutes

64
Q

what dose of amiodarone is given for VT

A

300mg over 20-60 minutes

65
Q

what is an alternative regular broad-complex tachycardia to VT

A

SVT with BBB

66
Q

how is SVT with bundle branch block managed

A

As a narrow-complex tachycardia

67
Q

what is an irregular broad-complex tachyarrythmia

A

AF with BBB

Pre-excited AF

68
Q

what defines a narrow complex tachycardia

A

<0.12s QRS

69
Q

what is an irregular narrow-complex tachycardia

70
Q

how is AF managed

A

B-blocker or diltiazem

71
Q

if a patient has an irregular narrow-complex tachycardia AND HF - what is used?

A

Digoxin or amiodarone

72
Q

what is a narrow-complex regular tachyarrythmia

73
Q

how is a narrow-complex tachyarrythmia initially managed

A

Vagal manouveres

74
Q

name 2 vagal manouveres

A

Vasaval maneurvre

Carotid sinus massage

75
Q

if vagal manouveres fail what is given

A

6mg IV adenosine

76
Q

what dose of adenosine is given

77
Q

if no effect after 6mg iV adenosine, what is given

A

12mg IV adenosine

78
Q

if no effect after 12mg IV adenosine, what is given

A

12mg IV adenosine

79
Q

if sinus rythm is achieved after adenosine what does it likely indicate

A

re-entry SVT

80
Q

if sinus rythm does not return after adenosine what may it indicate

A

Atrial Flutter

81
Q

what is a CI to adenosine

82
Q

what is a mneumonic to remember the causes of cardiac arrest

83
Q

what are the 4Hs that can cause cardiac arrest

A
  • Hypoxia
  • Hypothermia
  • Hypoglycaemia, Hypocalcaemia, Hyperkalaemia
  • Hypovolaemia
84
Q

what are the 4Ts that can cause cardiac arrest

A
  • Thrombosis
  • Tension pneumothorax
  • Toxins
  • Tamponade - cardiac
85
Q

how are rhythms associated with cardiac arrest divided

A
  1. Shockable

2. Non-Shockable

86
Q

what are the two non-shockable rhythms

A

PEA

Asystole

87
Q

what are the two shockable rhythms

A

pulseless VT

VF

88
Q

if a patient is unresponsive and not-breathing what should be done first

A

Call resuscitation team

89
Q

what is done after resuscitation team are called

A

Start chest compressions

90
Q

what is the ratio of chest compressions

91
Q

what should be done whilst CPR is ongoing

A

Attach self-adhesive defibrillator pads

92
Q

where are the defibrillation pads attached

A
  1. Below right clavicle

2. V6 Mid-Axillary Line

93
Q

what should be done once defibrillation pads attached

A

Stop CPR (5 seconds) to assess the rhythm

94
Q

what is done if rhythm is shockable

95
Q

how long is CPR continued for before the next shock

96
Q

how many shocks are performed before adrenaline is given

97
Q

what dose of adrenaline is given

A

1mg IV (1:10,000)

98
Q

what is given in addition to adrenaline

A

Amiodarone 300mg IV

99
Q

how often is IV adrenaline given

A

every 3-5 minutes

100
Q

when is further amiodarone considered and what dose

A

After the 5th shock (150mg)

101
Q

if a patient has witnessed (on cardiac monitoring) episode of VT or VF what is done

A

3 successive shocks then start CPR for 2-minutes

102
Q

what is PEA

A

electrical activity that would normally be associated with a palpable pulse. There is electrical activity but not enough to maintain SBP above 80mmHg

103
Q

how are non-shockable rhythms managed

A
  • CPR 30:2
  • 1mg adrenaline IV as soon as access achieved
  • Continue CPR 30:2
  • Give adrenaline every 3-5 minutes

AFP (5 decks)

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