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CP3 Management > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Early Management of ?ACS

A

MONCA

Morphine, 5mg IV up to 10mg
Oxygen - only if desaturated
Nitrates - GTN spray/buccal nitrates (c/o if hypotensive) 
Clopidogrel - or prasugrel/ticagrelor 
Aspirin - 300mg
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2
Q

what score should be used to assess a patient with ?ACS

A

GRACE score

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3
Q

what is the management of unstable angina and a STEMI

A

BROMAANCE

Beta-blocker - secondary prevention 
Reassurance
Oxygen - if <92% 
Morphine - 5mg up to 10mg 
Aspirin - 300mg, 75mg secondary prevention
Ace-Inhibitor - secondary prevention
Nitrates/GTN spray
Clopidigrel - 300mg then 75mg secondary prevention 
Fonduparinox 
Statins
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4
Q

Initial Management of a STEMI

A

MONA + PCI if within 90 mins ideally but may be up to 12 hours

if PCI not indicated thombolysis via alteplase/streptoskinase indicated if there are no other contraindications

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5
Q

Long term medications post ACS

A

Aspirin 75mg OD

Clopidogrel 75mg OD for at least a year

Beta Blocker Bisoprolol – dose titrated to get HR around 60bpm

Statin - 80mg atorvostatin O.N

Ace-inhibitor - 2.5mg ramipril B.D

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6
Q

Management of Stable angina

A
  1. GTN + BB
  2. GTN + BB + CCB or + Isorbide Nitrate if CIs are present
  3. GTN + BB + CCB + Nicorandil

Secondary prevention:
Statin
Low dose aspirin
ACE inhibitor of co-morbid diabetes

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7
Q

what is the advice for travel/work/driving post MI

A

May return to the office after 2 months
Drivers/pilots should not
Heavy manual labourers should seek lighter work

Travel - Avoid air travel for 2 months

Sex - Avoid intercourse for 1 month

Driving DVLA do not need to be notified
If successful treatment with PCI, driving can continue for 1 week
Otherwise driving can continue after 4 weeks

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8
Q

what is the advice for travel/work/driving in angina

A

DVLA do not need to be notified

Driving can continue unless it occurs at rest, whilst driving or on emotion

Recommence when adequete symptom control is achieved

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9
Q

what is the advice for travel/work/driving in AAA

A

Driving – notify DVLA if >6cm

Annual review to permit licensing

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10
Q

what are the rules for driving for HGV drivers with a new diagnosed cardiovascular condition

A

In general al CV diagnoses lead to revocation of licenses for 6 weeks

3 months after CABG

Relicensing can occur if exercise/other functional requirements are met

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11
Q

surgical management of angina

A 
PCI 
or
CABG 
Symptom control for patients unsuitable for PCI  
Must be on full medical therapy
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12
Q

what are the main incisions for cardiac surgery

A

Median sternotomy
Most common
Gives best view of heart

Anterolateral thoracotomy
Access to right of heart

Posterolateral thoracotomy
Access to distal arch and descending thoracic aorta

Bilateral transverse thoracotomy
Popular for double lung transplants, or heart and lung transplants

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13
Q

what is the main treatment for chronic coronary artery disease

A

CABG > PCI but both may be done

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14
Q

what are the options and their features for heart valve disorders

A

Prostetic valves are classified into man made or tissue valves

Man-made
Ball in cage or bileaflet valves
Durable but thrombogenic requiring anticoagulation with warfarin/NOAC
Gives an audible click that can be heard without a stethoscope if you stand close to the patient

Tissue valves
Homographs (humans) or Xenographs (pigs)
Anticoagulation not required but more prone to degenerative failure
Homographs are more resistant to degeneration so are preferred in younger patients to avoid long term anticoagulation
Valve infection is devastating, but fortunately rare, with the lowest risk being in homograft valves

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15
Q

Tx for constrictive pericarditis

A

excision of the whole pericardium

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16
Q

whats the management for acute pulmonary oedema

A

Sit upright

100% oxygen

IV diamorphine 1.25mg-5mg

IV furosemide 40mg-80mg

GTN spray 2 puffs sublingual (unless SBP <90)

Continue necessary investigations

SBP >100 = start IV nitrate infusion
Consider non invasive ventilation (CPAP) if not improving

SPB <100 = treat as cardiogenic shock
May require invasive ventilation

17
Q

Treatment of ARDS

A

ICU admission

Sit up

100% oxygen

CPAP used initially
Most progress to mechanical ventilation

IV nitrates titrated up until clinical improvement is seen
Or a drop in SBP

IV furosemide
40-80mg

Morphine
10-20mg + 10mg metclopramide

aminophylline if bronchospasm present

18
Q

Treatment algorithm for CCF

A
  1. Lifestyle advice + Ace-is + BBs, add diuretic if symptomatic with oedema
  2. Second line = spironolactone/ ATRA /hydralazine + nitrate second line
  3. digoxin 3rd line (unless there is bradycardia/heart block)
19
Q

what vaccinations are reccomended for CCF patient s

A

pneumococcal + seasonal flu

20
Q

how is aortic stenosis managed

A

Symptomatic = prompt valve replacement

Percutaneous valvuloplasty if unfit for surgery

asymptomatic = leave

21
Q

how do you manage an aortic regurgitation

A

Treat AF

Treat heart failure

Surgery if symptoms are deteriorating to prevent irreversible LV impairment (new york HF association 2 and above)

22
Q

how do you manage aortic regurgitation

A

Aim to replace valve before there is significant LV dysfunction so indicated If there are increasing symptoms, cardiomegaly or ECG deterioratio

23
Q

how do you manage mitral stenosis

A

Diuretics: reduce pre-load and pulmonary venous congestion

Surgical management if still activity-limiting
Balloon valvuloplasty if valve pliable/non-calcified
Open valvotomy otherwise

24
Q

Tx for bacterial endocarditis

A

if suspect consult a microbiologist early

Empirical therapy – IV for 4 weeks
Benzylpenicillin (or any beta lactam)
Gentamicin
+Fluclox if acute

Subsequent therapy dependent on sensitivies/organisms

25
Q

management of arrythmia

A

A-E treat reversible cause

Assess for adverse features  
Shock 
Syncope 
pulmonary oedema
chest pain
Risk of asystole  
Recent asystole 
Mobitz type 2  
Complete heart block 
If none of the above are present, continue to monitor

If any of these features are present, treat
Atropine 500mcg IV repeated up to 3mg
Cardiology may do transcutaneous pacing

26
Q

management of supraventricular tachycardias

A

A-E resus

DC cardioversion if there is abnormal features

if irregular rhythm treat as AF

Regular = attempt vagal manouvres first
Carotid sinus massage
Dunk head in water
Unsuccessful vagal manouvres = IV adenosine
6mg initially, then 12 if no effect, then another 12
Contraindicated in asthmatics, use IV verapamil instead
If adenosine unsuccessful, DC cardioversion

Secondary prevention is done using beta blockers

27
Q

Tx of ventricular tachycardias

A 
Immediate electrocardioversion if  
SBP <90 
Chest pain  
HR >150 
Pulmonary Oedema
Syncope

absence of these signs = amiodarone
300mg loading dose over 30 mins

28
Q

Tx of VFib

A

Treat as cardiac arrest (CPR and critical care team immediately)

29
Q

management of acute atrial fibrillation

A

if <48 hours - immediate cardioversion if haemodynamically unstable + heparin if possible

if >48 hours they should be anticoagulated for at least 3 weeks before DC cardioverted

If there is a high risk of cardioversion failure (e.g. Previous failure or AF recurrence) then it is recommend to have at least 4 weeks amiodarone or sotalol prior to electrical cardioversion

Following electrical cardioversion patients should be anticoagulated for at least 4 weeks.

30
Q

chronic management of atrial fibrillation

A

Rhythm control - flecainide or amiodarone (if Younger than 65 years, Symptomatic, First presentation, Lone AF or AF secondary to a corrected precipitant (e.g. Alcohol))

Cardiac ablation used as rate control for cases that dont respond to chemical antiarrhythmics

otherwise rate control - beta blockers/CCBs/Digoxin

use CHADSVASC and HASBLED for antocoagulation on either a DOAC or warfarin

31
Q

Tx of atrial flutter

A

AF

32
Q

Tx of eisenmengers

A

only curative treatment is a complete heart and lung replacement

33
Q

Tx of heart blocks

A

1st degree/2:1 nothing required

2:2 and 3rd = pacing

CP3 Management (11 decks)

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