CVS conditions (FCM)) Flashcards
What is HF?
A condition where the heart is unable to pump blood around the body properly.
How do you diagnose HTN?
Ambulatory BP monitoring
When would you consider doing ABPM?
If the patient has 2 high blood pressure readings in clinic between 140/90-180/120
- Ensure that 2 measurements are taken per hour during the patients normal waking hours.
When would you refer a patient for same day specialist review if you are concerned about hypertension?
- If their BP is 180/120 or higher
- Theres signs of retinal haemorrhage or papilloedema
How would you manage a patient with a BP reading of 180/120 or higher with no signs of target organ damage?
Repeat the BP reading in 7/7
What are the clinical and ABPM readings to diagnose HTN?
Clinic:
140/90 or higher (Stage 1)
160/100 or higher (stage 2)
180/120 or higher (stage 3)
ABPM:
135/85 or higher (stage 1)
150/95 (stage 2)
What are the clinical and ABPM readings to diagnose HTN?
Clinic:
140/90 or higher (Stage 1)
160/100 or higher (stage 2)
180/120 or higher (stage 3)
ABPM:
135/85 or higher (stage 1)
150/95 (stage 2)
What blood pressure medication can cause Tall tented T waves (hyperkalaemia) on ECG?
Ramipril
First line treatment for a patient with heart failure with preserved ejection fraction (HFpEF)?
- First lifestyle
- Then medication (ACEi- Ramipril + Furosemide)
How would you manage atrial fibrillation if it occurred in the last 48 hours?
- If hemodynamically unstable:
- HR >150
- sob
- dizziness
-low BP
Admit to AMU for electrical cardioversion
Note: symptomatic people are likely to present to and initially managed in secondary care
What is aortic coarctation? what exam findings may you find? (3 things)
Narrowing of the aorta.
- Radial-femoral delay
- Systolic murmur
- Difference in BP between the upper and lower extremities
What is a characteristic ECG change in relation to Digoxin treatment?
Down-slopping of the ST segment (reverse ticks)
How would you differentiate an NSTEMI from unstable angina?
NSTEMI causes a rise in Troponin whereas unstable angina does not
When would a CABG be more suitable over PCI in a patient with stable angina? (3 things)
- > 65 yrs old
- Diabetics
- Complex 3 vessel disease
How do you diagnose HF? What levels would confirm the diagnosis? and what would you do next?
-Bnp
- 400–2000 ng/L (47–236 pmol/L)
- refer urgently for specialist assessment and for ECHO (within 6 weeks)
First line management for angina?
CCB or BB
IF, both are contraindicated use one of the following-
- Nicorandil
- Ivabradine
- Ranolazine
What drug should be given as secondary prevention in a patient with angina? and what is the alternative in those with diabetes?
Aspirin 75mg OD
In Diabetics:
ACEi
What does a pathological Q wave on ECG tell you?
That there was a previous MI
If a patient has HTN and diabetes, what medication would you start them on?
ACEi (ramipril)
Mid diastolic murmur?
Mitrial or tricuspid stenosis
What causes a diastolic murmur?
a narrowing (stenosis) of the mitral or tricuspid valves, or regurgitation of the aortic or pulmonary valves.
What causes a systolic murmur?
Mitrial valve prolapse
How does permanent Afib present?
sinus rhythm cannot be restored or maintained and AF is the accepted final rhythm
How does paroxysmal Afib present?
recurrent episodes (≥30 seconds in duration) that terminate spontaneously or with intervention within 7 days
How does persistent Afib present?
AF that fails to self-terminate within 7 days. If lasts >12 months known as ‘long-standing persistent AF’
How do you confirm Afib ?
12 lead ECG
What do you do if paroxysmal AF is suspected and AF is not detected on standard electrocardiography?
Ambulatory ECG
How would you manage a patient with A fib If the onset of atrial fibrillation (AF) was within the last 48 hours?
- Urgently admit to an acute medical unit for emergency electrical cardioversion
- Where an underlying cause for AF is identified, manage where possible, or refer as appropriate (using clinical judgement to determine urgency)
What are the 3 things you need to manage in A fib? (Give details on what drugs? )
- Rate control
- Beta-blockers
- Or Rate-limiting calcium channel blockers (CONTRAINDICATED IN HF!)
-Digoxin (if they do little/no exercise)
- Rhythm control
- Cardoversion
- Fleccanide or Amioderone drug (only if structural heart disease) - Prevention of thromboembolic events
- DOAC - apixaban etc.
When would you do Cardioversion in a patient who presents after 48hrs of onset of A fib?
After 3 weeks.
Because they need to be anti coagulated for at least 3/52 before it can be done
