Cardiovascular Management Flashcards
ACS
- MONA
- Dual anti-platelet (aspirin, clopidogrel)
- Fondaparinux
- Secondary prevention: ACEi, B blockers, statins
- PCI (fibrinolysis within 12h if PCI not possible within 2h)
DVT/PE
DOACs or warfarin (need LMWH to cover until INR sufficient for warfarin or for a few days for dabigatran/edoxaban [but not apixiban/rivoroxaban])
Type B Aortic Dissection
- control HTN with β blockers/Ca channel blockers (e.g. amlodipine)
- avoid surgery as risk of retrograde dissection
- surgery indications: rupture, renal/visceral/limb ischaemia, refractory pain, uncontrolled HTN
HTN: <55 or with type II diabetes
- ACEi then add drugs
HTN: >55 or afro-Carribean descent
- Ca channel blockers then add drugs
Angina
- exacerbating factors: anaemia, fast AF, thyrotoxicosis
- RFs address: aspirin, statins, HTN control (ACEI), stop smoking, control diabetes
- PRN GTN
- anti-anginal first line = Ca channel blocker, β blocker
SVTs (narrow complex tachycardias)
- Vagal manoeuvres (Valsalva, carotid massage)
- adenosine
Ventricular Tachycardia
- amiodarone (K+ blocker = rhythm control)
- DC cardioversion
Chronic AF anti-coagulation
CHADVASC and HASBLED to manage the risks of bleeding/clotting
Acute AF anti-coagulation
- immediate anti-coagulation pre RFs for emboli detected: heparin (within 48h ideally)
- if not within 48h then make sure 3 weeks anticoagulation pre cardioversion
- severe –> DOAC/warfarin
First line heart failure
β blockers and Ca channel blockers (e.g. amlodipine)
AF rate vs rhythm control
- RATE: β blocker/rate limiting Ca channel blocker (verapamil, not amlodipine)
- digoxin second line
- asthma is contraindication for non-specific β blocker
- RHYTHM: flecinaide for cardioversion, or amiodarone if evidence of structural heart disease
- DC cardioversion if hypotensive and tachyarrythmia
Acute pulmonary oedema
loop diuretic
Ca channel blockers/beta blockers
- type B aortic dissection
- first line HF
- rate control AF: specifically verapamil
- angina
Second line rate control AF
= digoxin
Drugs causing long QT syndrome
METH CATS
- Methadone
- Erythromycin
- Terf…
- Haloperidol
- Chloroquinine/citalopram
- Amiodarone
- TCAs
- Sotalol
Pericarditis
- NSAIDs and aspirin
- colchicine to reduce risk of recurrence
- steroids if AI or not improving
Ruptured AAA
- blood, but maintain BP < 100mmHg to avoid rupturing a contained leak
- straight to theatre for surgery - graft
- prophylactic Abx
Drugs causing postural hypotension
- anti-HTN
- diuretics
- anti-psychotics
- TCAs
- EtOH
Sinus bradycardia
Atropine
