Cardiovascular Flashcards
When should CVD risk be re-assessed (for differing risks)
Low risk = every 5 years
- or if risk factors worsen
- consider sooner if close to intermediate
- First nations every year
Intermediate = Every 2 years
High risk
- no formal reassessment
- manage as appropiate
Age for CVD risk assessment (3)
45-79
DM - 35-79
First nations - 30-79
Additional components on assessing CVD risk in diabetes (5)
HbA1c
Date from diagnosis
uACR + eGFR
BMI
Insulin within 6mo
When to re-classify CVD risk in CKD
HIGH risk if:
- anyone with sustained eGFR <45
- men with persistent uACR >25mg/mmol
- women with persistent uACR >35mg/mmol
Steps in CVD Risk Management (6/7)
SNAWAP
- Smoking cessation
- Nutrition
- Activity
- Weight
- Alcohol reduction
- Pharmacological -> BP lowering + Lipid Modification
When BP + cholesterol treatment required regardless of risk
SBP >160
DMP >100
TC >7.5 mmol/L
Calculated 45yo mans CVD risk 9% - multiple results showing eGFR 50, uACR 10 - ?any relevance
Mod CKD so could consider re-classifying to high risk.
- Sustained eGFR 45-59
- Persistent uACR 2.5-25mg/mmol (3.5-35 in women)
- lower eGFR or high ACR = severe = high risk
Pre-existing HTN in patient. Now pregnant.
How to pharma manage? (3)
Methyldopa
Labetalol
Clonidine
Lipid target for Very high risk
- CAD/Stroke/TIA/PAD
- Severe CKD (eGFR <30)
- FH + another risk factor
- DM with end organ damage
LDL - 50% reduction OR <1.4 (which is lower)
non-HDL - <2.2
Trigs - <1.7
Lipid targets for high CVD risk
LDL - 50% reduction or 1.8
seconadary causes of dyslipidaemia (7)
- CKD
- Nephrotic syndrome
- T2DM
- Hypothyroid
- Cholestasis
- Obesity
- Excessive ETOH
Acute chest pain - likely ACS
Mx steps
- Call for help/Organise transfer
- 300mg aspirin
- GTN
- IV Morphine
- 02 if Sats <93%
- Repeat ECG
- +- IV Access
Beta-blockers for heart failure with reduced LVEF (4)
Carvedilol
Bisoprolol
Nebivolol
Metoprolol succinate
Presents with pain in the thigh. US shows 15cm thrombosis in right superficial femoral vein.
Treatment?
Treat as DVT - superficial femoral vein is a deep vein
4 medications for HFrEF
ACE-i or ARB
B-Blocker
MRA (spiro)
SGLT2-inhibitor (empagliflozin)
Rx for symptomatic complete heart block
Atropine 0.5mg IV stat
+ rpt in 15mins
Presenting with new chest pain + new LBBB
Need to treat as ACS, assume MI until proven otherwise
SVT Mx in ED (2) + O/P paroxysmal Mx
Vagal maneouvre
Rapid bolus 6m IV Adenosine
OP - beta-block
Pt presents with acute onset palpitations and breathlessness. ECG shows VT, BP 120/60.
Rx?
VT:
Haemodynamically stable -> IV Amiodarone infusion
Unstable -> SHOCK
Digoxin toxicity
- weakness, confusion, visual changes
- wide spread ST depression, with down sloping fashion
ECG areas
- lateral
- inferior
- anterior
Pre-op patient, asking about anti-platelet agents
Withold for 7 days prior to non cardiac surgery
- resume with oral intake
CVD surgery needs discussion with cardio
85M pt on apixaban 5mg BD for AF. Stable weight 75kg, and recent mild worsening of renal failure - eGFR 45, Creat 110.
Would a dose change be needed
Apixaban for AF
- oral, 5mg BD
Reduce to 2.5mg BD for2+ risk factors for bleedings
- 80+ yo
- wt <60kg
- serum Creat >133
For this pt - leave dose unchanged
NB: above is NOT relevant in DVT/PE
KFP question, person with calf pain + swelling, atraumatic, no recent surgery. Suspect DVT.
Aspects of hx to clarify cause?
Need diverse DDx in questions
DVT/PE
- Recent air travel/immobility OR/
- 1st degree FHx of DVT OR/
- SOB/chest pain
MSK injury
- recent excessive exercise
- onset of pain during exercise
Cellulitis
- fever
KFP: 2 pharmacological managements steps for person with DVT
- Anti-coagulation
- Oral apixaban 10mg BD for 1wk, then decrease dose 5mg BD thereafter
- Oral rivaroxaban 15mg BD for 3wks, then 20mg OD thereafter - Anagesia
- oral paracetamol QID
- oral ibuprofen TDS
Duration of anti-coagulation therapy for DVT (4)
Pt with known HTN, on meds, presents with poorly controlled HTN.
Possible causes (8)
- non compliance with meds
- OSA
- Excessive ETOH or caffeine
- Medications AE (eg. pred)
- Primary aldosteronism
- Renal artery stenosis
- phaeochromocytoma
- High salt diet
Investigations for secondary HTN (6)
Renovascular
- UEC with eGFR
- Urinalysis
- uACR
Primary aldosteronism
- Aldosterone/renin ratio
Phaeochromocytoma
- plasma metanephrines
Cushings
- 1mg overnight dex supression test OR
- free cortisol in 24urine on 2 occasions
Hypertriglyceridaemia mx (3)
Trigs <4 - standard statin
4-10 - add fish oil
10+ = statin + fish oil + fenofibrate
Assessing stroke risk in patient with new AF?
CHA2DS2-VASc - 2+ males, 3+ females
C- CHF
H- HTN
A - Age >75 2points
D - DM
S - Stroke/TIA/VTE 2points
V - Vasc disease - IHD, PAD
A - Age 65-74
S - Sex female
Pharmacological options for Rx of stable angina (3)
- Beta-blocker: Atenolol OD
- Dihydropyridine Ca-Channel blockers: Amlodipine OD
- Long-acting nitrate: ISMN MR OD
Diagnostic criteria for metabolic syndrome (5)
3 of 5 = Metabolic Syndrome
1. Large waist circumference - population specific
2. Elevated trigs >1.7
3. Reduced HDL <1 for men, <1.3 for women
4. Elevated BP >130/85
5. Elevated fasting glucose >5.5
