Cardiovascular: explanation and treatment Flashcards
Sinus tachycardia: treatment?
Address underlying cause
Beta blocker
SVT
- Explanation?
- Treatment?
- Explain the heart and pacemaker. The AV node goes into overdrive, making the heart beat faster.
- Initial treatment: lower heart rate through blowing into a syringe, massaging carotids.
- IV adenosine: resets the pacemaker, converting SVT to a normal rhythm. Feel crappy (chest pain, SOB, dizzy, headache, nausea) but short lived and should improve heart rhythm. Small risk of other heart arrhythmias, so will put on defib pads.
- Long term treatment: beta blocker/CCB, ablation.
Atrial fibrillation
- Normal anatomy and physiology
- Definition
- Causes
- Pathophys
- Symptoms
Normal anatomy and physiology
- Heart is a ball of muscle, 2 atria and 2 ventricles. Has an electrical system that causes it to contract
Definition
- Atrial fibrillation is a condition where the atria quiver, due to altered electrical activity in the heart
Causes
- Underlying heart problems + surgery; metabolic syndrome
- Resp conditions like COPD or OSA
- Hyperthyroidism
- AOD
Pathophys/symptoms
- Hard and fast: palpitations
- Ventricles don’t always contract: chest pain, SOB, fainting, fatigue.
- Blood clots
Atrial fibrillation
- Treatment
If unstable: electrical cardioversion
Rate control
- Slow down the heart rate; often reverts to normal heart rhythm
- 1st line is beta blocker/CCB’s (diltiazem/verapamil)
- 2nd line is digoxin
- 3rd line is amiodarone
- AV node ablation + ventricular pacemaker
Rhythm control
- Electrical or pharmacological (flecainide, amiodarone)
- Only if onset is <48 hours; if more, need to anticoagulate for atleast 3 weeks or check there is no atrial thrombus with TEE
Anticoagulation
- CHADSVASC score for stroke risk; HAS-BLED for bleeding
- DOACs > warfarin (except for moderate/severe mitral valve stenosis)
Ventricular tachycardia
- Explanation?
- Explain heart and pacemaker.
- New pacemaker develops in the ventricles –> beats very fast –> associated symptoms
Ventricular tachycardia
- Initial management?
HAEMODYNAMICALLY STABLE
Pharmacological cardioversion
UNSTABLE
Pulse present
- Monomorphic: electrical cardioversion
- Polymorphic or unsure: defibrillation
Pulseless: CPR + defibrillation
Ventricular tachycardia
- Long term management
Pharmacological: beta blockers +- antiarrhythmics
Implantable cardioverter defibrillator, or ablation
Ventricular fibrillation
- Treatment
- Resuscitation: CPR, defibrillation, + antiarrhythmics
- Afterwards: antiarrhythmics, + beta blockers
- Find and treat underlying causes
- Implantable cardioverter-defibrillator: if cause is irreversible and high risk of recurrence.
AV blocks
- Explanation?
- Treatments?
Draw heart and AV node
Explain the function of atria and ventricles; and the electrical signal
1st degree: signal goes slowly.
2nd degree type I: signal goes slower then stops.
2nd degree type II: signal randomly doesn’t get passed through
3rd degree: signal doesn’t go through at all. Atria and ventricles contract autonomously
Treatment
- Only for 2nd degree type II, and 3rd degree
- IV, admit, monitor, pacemaker
Bundle branch blocks
- How to explain?
- Treatment?
- Draw heart + electrical system
- Explain function of atria and ventricles
- One of the pathways doesn’t work, relies on the electricity from the other pathway
- Pathway gets damaged due to scarring (previous AMI)
- No treatment if on its own
Classification of coronary ischemic syndromes?
Coronary ischemic syndromes
- ECG and troponin for STEMI, NSTEMI, unstable angina, stable angina?
STEMI: ST elevation >1mm (exceptions in V2/V3) in atleast 2 continguous leads; elevated troponin
NSTEMI: no ST elevation (may be ST depression, T wave inversion); elevated troponin
Unstable angina: troponin not elevated
Stable angina: troponin not elevated
Acute coronary syndrome treatment?
- Acute
- Chronic
IV
Aspirin, clopidogrel, ticagrelor
Morphine
GTN (if it’s NOT an inferior AMI)
Cath lab: balloon angioplasty +- stent (or CABG if many arteries or hard to access)
Long term
- GTN as needed
- Dual antiplatelet therapy: aspirin + ticagrelor
- ACE inhibitor
- Beta blocker
- Statin
- Cardiac rehabilitation: SNAPV
Stable angina treatment?
- Acute
- Chronic
Acute
- GTN as needed
Chronic
- Balloon angioplasty +- stent, or CABG
- Antiplatelet monotherapy: aspirin (or ticagrelor if contraindicated)
- ACE inhibitor
- Beta blocker
- Statin
Heart failure
- What is it?
- Symptoms
Heart is a muscular pump; it pumps blood around your body, thereby supplying your body with the nutrients it needs to carry out its functions/
Heart failure is when the muscle doesn’t pump as well as it once did.
Because not enough nutrients are getting to the body, you can fell tired, faint, and have chest pain
Blood can back up into your lungs : causing SOB and pink frothy sputum.
Blood can back up into your body, causing leg swelling, abdo pain.
Heart failure
- Treatment?
Medications to reduce load on your heart.
- ACE/ARB/ARNI
- Beta blocker
- Mineralocorticoid receptor antagonist
- SGLT2 antagonist
Advanced
- Left ventricular assist device
- Heart transplant
