Cardiology Flashcards
Bloods when starting ACEi
Check U+E before + at 2 weeks
- Allowed a 30% increased in creatinine
- Allowed K up to 5.5
Significant renal impairment after starting ACEi
Bilateral renal artery stenosis
Which hypertensive drug if <55 or T2DM?
ACEi or ARB
Which hypertensive drug if >55 + no T2DM or Afro Carib + no T2DM
CCB
2nd line hypertensive
ARB/ACEi + CCB or ARB/ACEi + thiazide diuretic
3rd line hypertensive
ARB/ACEi + CCB + thiazide like diuretic
4th line hypertensive
If K < 4.5 - add spironolactone
If K > 4.5 - add BB or AB
If BP not controlled with 4 steps then specialist review
1st degree heart block
Consistent prolongation of the PR interval
2nd degree heart block - Mobitz type I (Wenkebach)
Progressive prolongation of the PR interval until eventually the QRS complex is dropped
2nd degree heart block - type II
Consistent PR interval with intermittently dropped QRS complexes. Typically repeats after every 3rd or 4th p wave (3:1 or 4:1)
3rd degree heart block
No electrical communication between atria and ventricles due to failure of conduction
P waves + QRS have no association with each other
Stoke adams attack
Collapse without warning
Pallor followed by flushing on recovery
Bradycardic
Usually lasts 10-30s - some seizure like activity occurs if attack is prolonged
Rapid recovery but maybe some slight confusion
What heart block is typically seen on ECG during a stokes adams attack?
3rd degree
QRS complex for a supra ventricular tachyarrythmia
Regular - narrow
QRS complex for a ventricular tachyarrythmia
Wide e.g. VT, VF, torsades de pointe
Exception = WPW - supra ventricular but has wide QRS due to ventricular preexcitation
Treatment for bradycardia
Atropine
WPW ECG
Short PR interval
Wide QRS with delta wave
Torsades de pointes
Form of VT with a long QT syndrome
Usually drug induced but also caused by hypoK
Can progrèss to VF/death
Tx = IVI Mg usually effective
- Don’t give anti arrhytmics - they worsen it
Treatment for PSVT
1st = vagal manoeuvres 2nd = IV adenosine (CI in severe asthma)
Long term = ablation
2nd line = medical tx
- AVNRT = BB, verapamil, diltiazem
- AVRT = fleicanide (digoxin + verapamil CI in WPW)
Treatment for sustained VT with HD stable
Amiodarone
Doses of IV adenosine
6mg then 12mg then 12mg
Which drug can you not prescribe with beta blockers?
Verapamil
- Risk of complete heart block
Stable angina management
All get statin + aspirin S/L GTN to abort Use either a BB or CCB - If CCB alone - use verapamil or diltiazam - If with BB - then use amlodipine If still sx then use dual BB + CCB
Valvular heart disease + AF = absolute need to… ?
Anticoagulate
If CHA2DS2VASc score suggests no need to anticoagulant - need to do an echo to check for any valvular heart disease
HASBLED score
HTN - 1
Abnormal renal function (Cr > 200 or dialysis)
OR
Abnormal liver function (cirrhosis, BR 2x normal, ALT/AST/ALP 3x normal) - 1 for both so worth 2
Stroke - 1
Bleeding, hx of bleeding, tendency to bleed - 1
Labile INRs - 1
Elderly >65 - 1
Drugs predisposing to bleeding (APs or NSAIDs)
OR
Alcohol use (>8 drinks/week) - 1 for each so worth 2
Score >3 indicates high bleeding risk
