Cardiovascular Treatments Flashcards
Hypertension:
For those > 55 years (low renin) or African-Caribbean or women of child bearing age, first line treatment is:
- Calcium channel blocker
- Then thiazide diuretic
- Then ACE inhibitor (for the elderly only). African-caribbean and women of child bearing age should be given ARB
For the young (high renin), first line treatment is:
- ACE inhibitor (e.g Ramapril)
- Then thiazide diuretic
- Then calcium channel blocker
- Then for both give a beta blocker
- ACE inhibitors only show their full effectiveness in those with high renin. Side effects include renal artery stenosis, renal impairment and renal failure so monitor U+E. A cough is an adverse drug reaction, something ARB does not give.
- Side effect of thiazide: Gout and impotence
Pregnancy:
- Many medications are teratogenic
-
Atherosclerosis:
- Aspirin (anti-platelet - inhibitor of thromboxane)
- Statins (e.g simvastatin. These drugs increase the expression of LDL receptors by hepatocytes which decreases the amount of LDL cholesterol in the blood.)
- BP control, smoking cessation, weight loss, diet control
Stable Angina:
Address those risk factors
First line (relief of symptom):
- Sublingual GTN (for symptom relief vasodilator)
- Beta blockers (block beta adrenoreceptors, therefore blocking the sympathetic nervous system. This decreases HR, contractility and systolic wall tension.)
- Calcium channel blockers (prevent calcium influx into myocytes. Can be rate limiting or vasodilating)
Second line:
- Ivabradine (blocks pacemaker funny current, slows HR, barely lowers BP)
- Long acting nitrates
- Nicorandil
- Ranolazine
All patients to be put on:
- Aspirin 75 mg (anti-platelet)
- Statins (These drugs increased the expression of LDL receptors by hepatocytes which decreases the amount of LDL cholesterol in the blood)
- ACE inhibitors (prevent conversion of angiotensin I to angiotensin II. Angiotensin II makes the blood vessels narrower however this is prevented through the use of ACEI. Use if evidence of LVH!!)
STEMI/NSTEMI/Unstable Angina (ACSI
Immediate treatment:
- Morphine
- Oxygen
- Nitroglycerine (GTN)
- Aspirin
Pharmacological:
- All ACS patients to be given Aspirin 75 mg + Clopidogrel (both anti-platelets)
- Beta blockers (reduced myocardial oxygen demand)
- Statins
- ACE inhibitors (always if LVH)
- Analgesia
- Anticoagulate (fondaparinux - reduced the risk of blood clots)
Management:
- Percutaneous coronary intervention (coronary angiography and revascularisation)
- Coronary artery bypass graft
Thrombolysis (dissolve any clots)
Make the usual lifestyle changes
Mitral Stenosis:
- Diuretics (and restriction of sodium intake)
- Anticoagulate with Warfarin for those with AFib, restore the ventricular rate
Interventional treatment:
- Mitral valve replacement
- Surgical valvotomy (procedure done to enlarge narrowed heart valves)
Mitral Regurgitation:
- Mitral valve apparatus repair
- Mitral valve replacement
Aortic Stenosis:
- Medical treatment is limited to those who develop heart failure
- Surgical replacement or repair of the aortic valve
Aortic Regurgitation:
- Vasodilator therapy has shown to delay the timing for surgical intervention
- Surgical replacement or repair of the aortic valve
Heart Failure:
- Diuretic (loop type, plus thiazide type diuretic)
- ACE inhibitor
- ARB
- Beta blocker
- Spironolactone (for oedema, inhibits aldosterone)
- Digoxin (slows the pulse in fast AF)
- Warfarin
Atrial fibrillation:
Rate control:
- Beta blocker - first line (bisoprolol)
- Calcium channel blocker + warfarin
- Digoxin (slows the pulse in fast AF)
Rhythm control:
- Amiodarone - Class III anti arrhythmic drug
- Catheter ablation
- Anticoagulation
- Cardioversion
Acute Limb Ischaemia
- Open Embolectomy
- Vascular bypass (surgery)
- Thrombolysis (if not available for surgery)
- IV heparin (anticoagulate, after the surgery)
If the limb is not salvagable:
- Amputation (if limb is not viable)
- Palliate (if not fit or unwilling for amputation)
Chronic Limb Ischaemia
Best medical therapy:
- Anti- platelet therapy
- Statin therapy
Risk factor control: Hypertension control Diabetes control Lipid control Smoking cessation
Exercise: 150% improvement in walking time
Surgery: Open repair Endovascular repair Revascularisation Bypass
Abdominal Aortic Aneurysm
- If the aneurysm is > 5.5cm (large AAA) then SURGERY
This includes: - Open Repair (open surgery - use a general anaesthetic)
- Endovascular Repair (placement of extendable stent graft into the aorta without actually opening the aorta - use a local anaesthetic)
Thoracic Aneurysm
Open and endovascular repair
Infective Endocarditis:
Antibiotics to be started as soon as all blood cultures are taken
- For native valves, IV Gentamicin and IV Ampxycillan (4 weeks)
- For native valves + sepsis, give IV Gentamicin + IV Vancomycin
- For prosthetic valves, give Gentamicin + Vancomycin + Rifampicin (6 weeks)
- Surgery for: Fungal endocarditis, heart failure, valvular obstruction, persistent bacteraemia, repeated emboli or myocardial abscess
- Prophylaxis to be limited to HIGH RISK patients
