Cardiology Flashcards
What are some non- cardiac causes of AF
- Thyrotoxicosis (check tfts)
- Acute infection
- Pulmonary disease (check cxr)
- Alcohol excess (acute or chronic)
- The peri operative period
Which cardiology medication should be stopped in patients with AF & why?
Ivabradine- ineffective
How is acute onset AF (<48 hours) managed?
- HR controlled
- Offered cardioversion
- If haemodynamically unstable, DC cardioversion
- If haemodynamically stable, pharmacological- dc if this fails
What medications are used for pharmacological cardioversion in ACUTE AF?
amiodarone
vernaket
Flecainide
Terms for cardioversion if AF has been present >48 hours?
- Electrical cardioversion preferred
- Attempt after at least 3 weeks of anticoagulation/
- rule out left atrial thrombus & start parenteral anticoag
- after cardioversion, oral anticoag minimum 4 weeks
What is first line for long term rhythm control in AF?
B blockers
What are 2nd line for long term rhythm control in AF? What are the contraindications of each?
- Flecainide or propafenone (if no IHD, structural heart disease or heart failure),
- dronedarone (if no LVSD or heart failure present)
- amiodarone
What drug is first line for AF if patient has acute heart failure and why?
Digoxin
Because b blockers contraindicated in acute HF
RLCCBs contraindicated in HF
What medication can be used for pill in the pocket for paroxysmal AF?
- flecainide (300mg for patients >70kg, 200mg if <70kg)
- propafenone (600mg for patients >70kg, 450mg if <70kg).
MAX 1 dose in 24 hours
Which AF drug should be avoided in paroxysmal AF?
digoxin as it can flip them from sinus rhythm into af & worsen the af
What is the main risk of cardio version >48 hours?
There is a risk that a thrombus has formed and successful cardioversion could lead to a stroke.
Which cardiology drug can double digoxin levels?
amiodarone
Which medicines are contraindicated in HF & why?
NSAIDs (na retention)
RLCCBs
pioglitazone
dronedarone, flecanide,
What is first line treatment for HF- REF?
Bblocker + ACE inhibitor
ARB if ACE not tolerated
SPECIALIST- Hydralazine + Isosorbide if ACE/ARB not tolerated
How is chronic hyperkalaemia due to CKD/ ACE inhibitor use in HF managed?
Patriomer - 8.4g OD
Sodium zirconium cyclosilicate - 10g TDS then 5mg OD maintenance
After first line treatment for HF what are second and third line options?
2nd line- add MRA to BB + ACEi
(spironolactone/eplerenone)
3rd line- specialist
- ADD Ivabradine (if in sinus rhythm)
- replace ACE with sacubitril valsartan
- digoxin (if in sinus rhythm)
Medicines to hold in AKI
Contrast media (for scans) ACEi/ ARBs NSAIDs/ COX2i Diuretics metformin renally cleared opioids DMARDs (e.g methotrexate)
When must ACEi be stopped before entresto is started?
36 hour wash out period so in practice 2 days.
Reason: increased risk of angiodema with sucabitril & ACEi.
What does QRISK assess
10 year cardiovascular risk and how this compares to a healthy person of the same age.
Used for PRIMARY prevention only
What is the treatment for hypertension
Step 1 <55/ white: ACE (or ARB)
Step 1 >55/black : CCB (or thiazide like indapamide)
Step 2: Combo of ACE/ARB + CCB/thiazide
Step 3: ACE/ARB + CCB + thiazide
Step 4: spironolactone/ Ablocker/ Bblocker
What is recommended for primary prevention of CVD and when?
Atorvastatin 20mg OD is recommended if:
- QRISK2 score is >10%
- patient has type 1 diabetes
- > 85 years old if life expectancy is long
How is stable angina managed?
Treatment: GTN spray
1st line : Bblocker/ RLCCB
2nd line: combo Bblocker + normal CCB
3rd line: isosorbide, Ivabradine, nicorandil, ranolazine
Secondary prevention CVD:
- aspirin (+PPI if needed)
- atorvastatin 80mg OD regardless of lipids
What are the post MI secondary prevention medication
BADS
Bblocker
ACEi
Dual antiplatelets 12 months then stop one (+/- PPI)
Statin (atorva 80mg OD)
What is alteplase & when can it be given?
Thrombolyic agent for ischaemic strokes
Give within 4.5 hours of symptom onset
Why is anticoagulation held 2 weeks after a stroke?
Risk of haemorrhage transformation
Not for LMWH or TED stockings
But can use IPCs
When should statins be initiated after acute stroke and why?
After 48 hours due to the risk of haemorrhage transformation.
Use high intensity statin
Which antidepressant is recommended post stroke?
sertraline due to its better cardiovascular safety profile
How many ays frogmen for hip/knee ops?
Hip- 28 days
Knee 14 days
more days for hip as more further from the floor
What is defined as poor anticoagulant control on warfarin?
2x INR >5 or 1x INR >8 in six months
2x NR <1.5 in six months
time in therapeutic range (TTR) <65%
How should vitamin K be given and why?
IV only
Not s/c due to inconsistent correction of warfarin
Not IM due to the risk of haematoma formation
