Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Emergencies > Heart > Flashcards

Heart Flashcards

1
Q

management of ACS

A
  • morphine 5-10 mg iv
    • consider antiemetic metoclopramide 10 mg iv or cyclizine 50 mg iv
  • oxygen - only if patients have a SpO2 < 95%
  • Nitrates - only use for HTN or LVF
  • Dual anti-platelet: Aspirin - 300 mg po/iv
    • prasugrel 60mg po/ticagrelor 180mg po/clopidogrel 300 mg po
  • Restore perfusion - PCI or thrmobolysis..
  • anticoagulation for PCI - injectable (pref bivalirudin, otherwise enoxaparin and Gp IIb/IIIa blocker
  • beta-blockers (bisoprolol 2.5 mg od) - CIs: heart failure, asthma, bradycardia, cardiogenic shock
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is the evidence for restricting oxygen to patients with SpO2 < 95%?

A

DETO2X-AMI, a SWEDEHEART study

NEJM 2017

no statistical significance between 6 L/min supplimental O2 or ambient air inhalation in composite clinical end points, biochemically and at 1-year follow up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is the evidence for ticagrelor versus clopidogrel?

A

PLATO study, sponsored by AstraZenica.
Pub: Sept 2009, NEJM​
also NICE guidance from 2011

ticagrelor has a shorter onset of action and more robust anti-platelet effect than clopidogrel

follow up was at 1 year

vascular composite end-points (stroke and MI) were greater with clopidogrel than ticagrelor

ticagrelor > clopidogrel for all-cause mortality

ticagrelor has a greater bleeding risk than clopidogrel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

management algorithm for restoring perfusion in STEMI?

A

confirm STEMI on ECG

  • PCI available within 120 mins, presenting within 12 hours of symptom onset
    • primary PCI, needs anticoagulation - bivalirudin IM
  • PCI not available within 120 mins
    • thrombolysis (tenecteplase iv bolus)
    • transfer to specialist care centre for residual PCI or angiography +/- stenting
  • presenting to medical services >12 hours from symptom onset?
    • fondaparinux
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are the ECG diagnostic criteria for STEMI?

A
  • ST segment elevation:
    • >1 mm in 2 consecutive limb leads
    • >2mm in 2 consecutive chest leads
  • new onset LBBB
  • posterior changes: deep ST segment depression and tall R waves in V1-V3
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what clinical calculator would be suitable to assess 6-month mortality risk in patients with ACS?

A

GRACE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are the indications for admission in NSTEMI ACS?

A

rise in troponin

dynamic ST or T-wave changes

secondary criteria: LVEF <40%, prev CABG, prev PCI, early angina post-MI, diabetes, CKD

intermediate- or high-risk GRACE score

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

which ACS patients are you happy to discharge?

A
  • no recurrence of chest pain
  • no changes on ECG
  • normal range cardiac enzymes (1st test)
    • check with biochem when the patient should have their second Troponin taken, can they come back for it? do they just have to wait until the result?
  • no signs of heart failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is the anticoagulation method for NSTEMI?

A

fondaparinux (direct factor Xa inhibitor) 2.5 mg OD

if not, then LMWH (enoxaparin 1 mg/kg/12hrs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

beta-blocker SHOULD NOT be used with another cardiac drug… ?

A

verapamil - precipitates asystole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

beta-blockers CI?

A

asthma/COPD

heart failure

heart block/brady

cardiogenic shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is the role of nitrates in management of ACS?

A

only for pain relief - recurrent following MI

or chronic pain management with stable angina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

on discharge following ACS, what other medicines should be offered?

A

ACE-I to prevent cardiac remodelling and control BP

statins

dual anti-platelet

beta-blockers (if CI, use cardioselective CCB diltiazem or verapamil)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are the causes of ARDS?

A

trauma

burns

sepsis/malaria

pancreatitis

post-op

aspirin overdose

glue sniffing / drug abuse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are the causes of pulmonary oedema?

A

LVF, valvular disease, malignant hypertension, arrythmia

ARDS

fluid overload

neurogenic (head injury)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

investigations for pulmonary oedema

A

CXR ECG ABG

bloods - U&E, toponin, BNP

further tests - echocardiogram

17
Q

managing pulmonary oedema

1st line

A
  • diamorphine 1.25-5 mg iv slowly
    • ​care in liver failure
  • furosemide 40-80 mg iv slowly
    • dose adjustment in renal failur
  • GTN 2 sprays SL, or 2 x 0.3 mg SL tablets
    • avoid if SBP <90 mmHg
  • convert to ISDN 2-10 mg/hr infusion if SBP >100 mmHg
18
Q

added therapies for pulmonary oedema not getting better with 1st line?

A

CPAP

further furosemide

further nitrate infusion

19
Q

first steps for cardiogenic shock…

A

call for help! - difficult to treat and has a high mortality

oxygen, sats aiming 94-98%

diamorphine 1.25-5 mg

investigate U&E, arrythmias and acid-base disturbance
(bloods, ABG, ECG)

20
Q

what is the difference between a ventricular ectopic and a run of VT?

A

>3 together at a rate of >100 bpm is a VT

21
Q

how many small squares for a QRS complex to be called ‘broad’?

A

3 small squares (120 ms)

22
Q
A

ventricular fibrilation

23
Q
A

ventricular tachycardia

24
Q
A

torsade de pointes

25
Q

ventricular tachycardia management

A

1st pulse?? if no, follow arrest protocol
then… oxygen, aim sats > 90%, iv access secured. secure cardiac monitoring, get 12-lead ECG and get defib ready/attach pads

2 - signs of haemodynamic instability (SPB <90, chest pain, clamy, altered GCS/AMTS)

  • if no…
    • correct metabolic disturbances (K+, Mg++, Ca++)
    • CENTRAL LINE amiodarone 300 mg iv loading slowly over 20 mins
    • followed by 900 mg infusion over 24 hours
  • if yes…
    • call for expert help, prepare sedation for DC cardioversion
26
Q

is ventricular fibrillation shockable or non-shockable?

A

shock!

use DC cardioversion

no synchronisation needed, there is no R wave present

27
Q

define narrow complex tachycardia

A

ECG shows heart rate >100 bpm, with QRS <120 ms across or less than 3 small squares

28
Q

when do you use vagal manoeuvres in managing arrythmia?

A

only narrow complex tachycardia, with a regular rhythm..

i.e. SVTs only.

increases AV block and may reveal an underlying atrial rhythm

29
Q

managing narrow complex tachycardia?

A

haemodynamically stable or not?

yes - vagal manoeuvres. adenosine 6 mg iv, large vein, 0.9% saline flush. must be monitoring with a rhythm strip while infusing.
12 mg after 2 mins. further 12 mg after another 2 mins. 3 doses max.
consult BNF for heart transplant or if on dipyramidole

no - DC cardioversion

30
Q

what medicines interact with adenosine?

A

theophylline blocks

dipyramidole potentiates

31
Q

what are the alternatives to adenosine in the management of SVT?

(3 drugs, 1 procedure)

A

verapamil, atenolol, amiodarone, DC cardioversion

32
Q

what should a junior doctor do for bradycardia?

A

12-lead ECG, manual blood pressure, assess for signs of haemodynamic instability

cardiac monitor

oxygen, aim sats >90%

if risk of asystole - atropine 300 mg iv STAT, repeat doses every 3 mins until safe

if patient could need pacing, call cardiology and anaesthetist

Emergencies (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions