Cardiovascular facts Flashcards
What is AF
Atrial fibrillation is where the heart beats abnormally fast
Management of AF involves either rate control or rhythm control
What is the first line treatment for AF?
Rate control is first line unless rhythm control would be a better fit for the patient
If ablation would treat it better then this is 1st line for the patient
What needs to be done when AF is first diagnosed ?
Assess of stroke and bleeding risk
Use CHA2DSVASC scoring system for stroke
ORBIT scoring for bleeding risk
Treatment choice for rate control in AF?
Beta blocker or rate-limiting CCB (Diltiazem or Verapamil)
If monotherapy does not control the persons symptoms, consider combination therapy of 2 of: Beta blocker, diltiazem and digoxin
When is digoxin appropriate for AF
If monotherapy does not control symptoms
Digoxin and a beta blocker is recommended if there is no ventricular function
Only recommended for patients at rest and who have non-paroxysmal AF
What are the risk factors for stroke?
- Prior ischaemic strokes
- HTN
- Diabetes
-HF - > 65 years
- Female
How are antiarrhythmic drugs classified ?
Vaughan William Classification
Class 1 = Lidocaine Flecainide
Class 2 = Beta blockers
Class 3 = Amiodarone, sotalol
Class 4= Non dihydropyridine CCB (Verapamil)
What are the side effects of Amiodarone?
- Corneal microdeposits
- Thyroid dysfunction
- Hepatotoxicity
- Pulmonary toxicity
- Grey skin discolouration
What are interactions of amiodarone that need to be considered?
- Increased risk of digoxin toxicity
- Increased risk of bradycardia
- Causes hypokalemia
- Prolong QT interval
What is Digoxin?
Cardiac glycoside
Indicated for AF and HF
Given as a once daily dose
Side effects of digoxin?
- Skin reactions
- Vision disorders
- Nausea
- Diarrhoea
- Vomiting
Symptoms of digoxin overdose? How do you treat it
- Yellow vision
- Blurred vision
- Confusion
Life-threatening = antidote DIGIFAB
When are digoxin levels taken?
Plasma digoxin is done 6 hours after a dose
digoXin, siX
Which patients are at high risk for VT
> Reduced mobility
Obesity
Pregnant and postpartum
60years +
History of venous thromboembolism
What is the treatment of VT?
Low molecular weight heparin is initially given
Warfarin is started at the same time as LMWH
Heparin is continued for at least 5 days or until INR is >2 for at least 24 hours
What is given for an ischaemic stroke?
Alteplase within 4.5 hours of symptoms if an intracranial haemorrhage is excluded
Within 24 hours of symptoms onset if intracranial hemorrhage has been excluded then should start ASPIRIN or alternative antiplatelet
What is the long term management of stroke?
1st line = Clopidogrel
Dipyridamole MR or aspirin if clopidogrel is contraindicated or intolerant
High intensity statin
BP target <130/80
Lifestyle changes- diet, exercise, alcohol and smoking
How long does it take Warfarin to work?
Vitamin K antagonist
48-72 hours to work
Name some common interactions of warfarin
Altered anticoagulant effect with PENICILLINS
Increased anticoagulant effect with CRANBERRY JUICE, METRONIDAZOLE and TETRACYCLINES
Important not to make drastic changes in your diet
When is clopidogrel given for 12 months
Clopidogrel is given for up to 12 months with aspirin in NSTEMI, most benefit seen in the first 3 months
Given for 4 weeks with aspirin in STEMI
What is a key counselling point for MR Dipyramidole
Should be dispensed in the original container and discarded 6 weeks after opening
What are the 3 heparins and what are their side effects
Tinzaparin
Enoxaparin
Dalteparin
All given parenterally
> Heparin-induced thrombocytopenia: skin allergy
Hyperkaleamia
Why are LMWH preferred over heparins?
LMWH is preferred because of their longer duration of action
Can be given as a ONCE DAILY dose SC
Hypertension brackets
