Cardiovascular Flashcards
Risk factors for atrial fibrillation
Hypertension
Cardiomyopathy
Coronary heart disease
Valvular heart disease
Previous cardiac surgery
pericarditis
Lung diseases: PE, COPD, pneumonia
Hyperthyroidism
Alcohol
Classifications of atrial fibrillation
Lone
Paroxysmal= <7 days
Persistent= >7 days
Permanent= >7 days, not stopped by cardioversion or > 1 year without cardioversion indicated
Clinical features of AF
Asymptomatic
Palpitations
SOB
Chest pain
Syncope
Pre-syncope
Heart failure
Rate vs rhythm control for AF
Control rhythm
- If onset <48 hours
- In younger patients
- If there is heart failure
- If symptoms improve
If onset >48 hours
- Control rate
Rate control of acute AF without heart failure
First line
Beta blocker/ Ca2+ channel blocker
- Bisoprolol
- Diltiazem, verapamil
Second line
- Add digoxin
Rate control of acute AF with heart failure
First- Digoxin/ Amiodarone
Second line- Amiodarone
Rate control of permanent or paroxysmal AF
Beta blocker OR CCB
second line- add digoxin
Rhythm control of AF
- Acute
Normal heart
- Flecainide
- Sotalol
Abnormal heart
- Amiodarone
Rhythm control of AF
- Maintaining sinus rhythm
Normal heart
- Flecainide
- Sotalol
Abnormal heart
- Amiodarone
Non cardio-selective beta blockers
Propanolol
Carvedilol
Sotalol
Cardio-selective beta blockers
Atenolol
- 90% is renally cleared
- Contraindicated in renal disease
Bisoprolol
Esmolol
Metoprolol
Vasodilatory beta blockers
Labetalol
Carbedilol
Rate limiting CCB examples
Verapamil
Dilitiazem
Dihydropyridine CCB examples
L-type CCB
Almodipine
Nifedipine
Nimodipine
CHA(2)DS(2) VaSc
Score that estimates the risk of someone with AF, developing a stroke.
C- Congestive heart failure H- Hypertension A(2)- >75=2 D- Diabetes S(2)- Previous stroke, TIV or TE= 2
V= vascular disease
A- Age 65-74
Sc- female (sex)
Treat with warfarin if score >2.
HAS-BLED score
Calculates the risk of bleeding if on anticoagulation with AF.
H- Hypertension
A- Abnormal renal/liver function (1 point each)
S- Previous stroke
B- Bleeding history
L- Labile INR
E- Elderly
D- Drug/ Alcohol (1 point each)
> 3= significant risk of bleeding.
Lipid modification in stroke
Consider referral if
- Serum cholesterol> 7.5 + family history of CHD
- Serum cholesterol >9
Atorvastatin for primary intervention - >10% risk of developing CVD in 10 years - T1 DM - CKD
For secondary intervention
- Previous stroke or MI
Lifestyle treatment of heart failure
Exercise
Decrease alcohol consumption
Smoking cessation
Diuretics and heart failure
Beneficially in relieving symptoms
- Decreases cardiac preload
Examples
- Loop: furosemide, bemetanide
- K sparing: spironolactonne, amiloride
- Thiazides: bendroflumethiazide, metolazone
Other AF treatments
Radiofrequency/ Cryo-ablaton
Left atrial appendage occlusion
Pcsk9 inhibitors
Pcsk9 receptor binding degrades cholesterol receptors on the liver
- Inhibiting this means= more cholesterol receptors= less circulating cholesterol
Drug is indicated for complicated hypercholesterolaemia
Warfarin-Aspirin interaction
Aspirin can displace warfarin from plasma albumin
- Warfarin is highly bound to albumin
Displacement of 1-2% warfarin can double/triple its concentration
= Great risk of bleeding
Liver metabolism in elderly
Decreased liver volume and blood flow
= Decreased first pass metabolism= decreased enzyme activity
= Decreased clearance of drugs
Excretion of drugs in elderly
Decreases renal function
- GFR declines by 1% from 40
- Drugs renal excreted by >60%= affected by Renal function reduction
