CVS guidelines Flashcards
angina first Ix
CT angiogram
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
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
when do you measure what for statin monitoring
LFTs and baseline, 3m, 12m
What you aim to see after starting statin
40% reduction in non-HDL after 3m
When do you stop a statin
patient choice
CK 5x
LFTs 3x
CI of statin
macrolide use
How do you diagnose heart failure
do a NT-proBNP
if high –> specialist 2w
If raised –> specialist 6w
Treatment escalation for heart failure
1st = ACEi + BB 2nd = spironolactone 3rd = cardiac desynchronise or digoxin or ivabradine
furosemide if symptomatic
when can you give ivabradine
if HR >75 and LVEF <35%
when do you send someone in for same day assessment with hypertension
end organ damage (papilloedema, retinal haemorrhage)
stages of HTN
1 = 140/90 (135/85) 2 = 160/100 (150/95) 3 = 180/110
in who do you NOT treat HTN
anyone >80 years old
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
BP targets
normal = 140/90
over 80 = 150/90
diabets = 130/90
diabetes with end organ = 130/80
ambulatory are 5 lower
surgery indication for AS
symptoms
asymptomatic + pressure gradient >40 and LV dysfuntion
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
