``` 1 = A (diabetes, 55) 2 = A + C or A + D 3 = A + C + D 4 = spironolactone if 4.5 K+ 5 = specialist ```

CVS guidelines Flashcards by Amelia Gelson-Thomas

angina first Ix

CT angiogram

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Tx of angina escalation

A(ngina)BC
Everyone = GTN, aspirin, statin 80
1st = bb or ccb (verapamil [not in HF] or diltiazem)
2nd = max that dose
3rd = BB + CCB (use MR nifedipine)
4th = CABG or PCI or long acting nitrate

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Primary prevention diabetics: who?

If you’re under 40 and haven’t had it for 10 years and your 10 yr risk is >10% with no end organ damage, dw bout it

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when do you measure what for statin monitoring

LFTs and baseline, 3m, 12m

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What you aim to see after starting statin

40% reduction in non-HDL after 3m

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When do you stop a statin

patient choice
CK 5x
LFTs 3x

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CI of statin

macrolide use

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How do you diagnose heart failure

do a NT-proBNP
if high –> specialist 2w
If raised –> specialist 6w

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Treatment escalation for heart failure

1st = ACEi + BB
2nd = spironolactone 
3rd = cardiac desynchronise or digoxin or ivabradine

furosemide if symptomatic

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when can you give ivabradine

if HR >75 and LVEF <35%

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when do you send someone in for same day assessment with hypertension

end organ damage (papilloedema, retinal haemorrhage)

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stages of HTN

1 = 140/90 (135/85)
2 = 160/100 (150/95)
3 = 180/110

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in who do you NOT treat HTN

anyone >80 years old

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HTN escalation

1 = A (diabetes, <55) or C (black, >55)
2 = A + C or A + D
3 = A + C + D
4 = spironolactone if <4.5K, a or b if >4.5 K+
5 = specialist

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BP targets

normal = 140/90
over 80 = 150/90
diabets = 130/90
diabetes with end organ = 130/80

ambulatory are 5 lower

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surgery indication for AS

symptoms

asymptomatic + pressure gradient >40 and LV dysfuntion

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NSTEMI acute Tx

GTN, morphine, oxygen
300mg aspirin
300mg clopidogrel (prasugrel better)

LMWH (or unfrac heparin if PCI <24hrs or CKD)

Extra if GRACE high enough

— tirofiban (G2b3a)
— PCI within 96 hours

STEMI acute

GTN, morphine, oxygen
300mg aspirin
300mg clopidogrel (prasugrel better)

PCI within 2 hours

what if you cant get to cath lab within 2 hours

Do tPA

If ST-e not resolved in 90 mins, send for PCI

Reccured pain after PCI?

CABG

CI to thrombolysis (stroke timeline)

stroke within 3m

Ongoing Mx for ACS

BB + ACEi + statin

aspirin lifelong
clopidogrel/ticagrelor for 12m

After ACS

no sex for
no viagra for

no sex for 1m

No viagra for 6m

when do you cardiovert AF

Unstable = DC now
<48 hours = flecainide (no defect) or sotalol
>48 hours = anticoagulant for 3w then DC

rate vs rhythm control

>65 with ischaemic heart disease

rate control drugs | which if heart failure

BB or rate-limiting CCB (verapamil/diltiazem) | Use digoxin if HF

CHADSVASC

``` CHF = 1 HTN = 1 Age >75 = 2; >65 = 1 Diabetes = 1 Stroke/TIA = 2 PVD/CAD = 1 Female = 1 ``` anticoagulant if 1 or more (2 or more in woman)

INR target on warfarin - normal - recurrent - mechanical valves

normal is 2.5 recurrent is 3,5 mech valve depends on type but mitral is most

when do you start DOAC post-stroke if it was caused by AF

2 weeks later

svt treatment

``` unstable = DC shock otherwise = vagal, adenosine 6 12 12, shock ```

SVT prevention of future episodes

BB and ablation

VT treatment

``` unstable = shock pulseless = ATLS stable = loading dose amiodarone and then 24 hour infusion ```

Cardiac arrest

look listen feel start CPR 30:2 and put out call attach monitoring if PEA/asystole, adrenaline now and every 3-5 mins If shockable: - shock, CPR 2 mins repeat - after 3rd shock, adrenaline 1mg + amiodarone 300mg

Dukes criteria

For infective endocarditis (3M, 1M3m, 5m) Major = echo confirmation, 2culture of virdans, 3 cultures otherwise Minor = embolic stuff, immune stuff, fever, predisposing heart condition

IE Abx therapy native valve severe sepsis prosthetic valve

amoxicillin + gent Vanc + gent vanc + gent + rifamp

Surgery indications in IE

CCF persistent embolic events aortic abscess (daily ECGs)

Type A aortic dissection

surgery

type B aortic dissection

control BP and conservative | ?endovasc repair

Acute pulmonary oedema

``` Position upright Oxygen then CPAP then BiPAP Diuretic furosemide Morphine Antiemetic Nitrate (not if systolic <90) - start with GTN then can put infusion up ```

HASBLED criteria

``` hypertension abnormal renal or liver function history of stroke history of bleeding labile INR elderly >65 drugs predisposing to bleeding alcohol use ``` score of 3+ means high risk of bleeding on warfarin

Bug types for infective endocarditis - staph aureus - S epidermidis - strep mitis/sanguinis - strep bovis

- staph aureus = most common and IVDU - S epidermidis = first 2 months after prosthetic valve surgery - strep mitis/sanguinis = viridans type = dental stuff - strep bovis = CRC