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Cardiovascular > HTN, AF + Flutter > Flashcards

HTN, AF + Flutter Flashcards

1
Q

How to diagnose AF?

A

ECG - loss of p waves

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2
Q

When is TTE used?

A

(transthoracic echocardiography) For people with AF if: High risk of heart disease

Cardioversion is being considered

Baseline echo is needed for management plan

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3
Q

When is a TOE used?

A

Transoesophageal echocardiography

Used in people with AF when:

TTE demonstrates abnormality

TTE is difficult to perform

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4
Q

When should anticoagulants be considered in AF?

A

CHADS2-VASc

CHF

HTN

Age >65

DM

Stroke/ TIA/ VTE

Vascular disease

Age >75

Sex

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5
Q

Warfarin regime for AF

A

Slow loading regime - reaching therapeutic levels in 3-4 weeks 1-2mg initially Average daily maintenanec = 5mg INR to be measured daily until within therapeutic range (2-3), then twice weekly for 1-2 weeks, then every 12 weeks

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6
Q

Why are NOACs good, what monitoring is needed?

A

No need for regular INR tests Baseline clotting screen, renal + liver function before treatment Assess every 3 months Repeat tests once a year

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7
Q

Management of acute AF

A

Emergency electrical cardioversion if haemodynamically unstable

Rate or rhythm control if stable

Anticoagulate with heparin

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8
Q

How is HTN diagnosed?

A

Ambulatory BP monitoring or home BP monitoring

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9
Q

Classification of severity of HTN

A

Stage 1: 140/90 in clinic Stage 2: 160/100 in clinic Severe: 180/110 in clinic Accelerated: 180/110 + signs of papilloedema/ retinal haemorrhage

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10
Q

RF for HTN

A

Age Males Genetics Social deprivation Anxiety Smoking, poor lifestyle

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11
Q

What does HTN increase the risk of?

A

HF CHD Stroke CKD Peripheral artery disease Vascular dementia

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12
Q

How do you assess CV risk?

A

BP, total cholesterol + HDL Estimate 10 year risk using QRISK2

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13
Q

Management for HTN <55

A

1st line: ACEi or ARB 2nd line: ACEi or ARB + Ca channel blocker 3rd line: ACEi or ARB + Ca channel blocker + thiazide diuretic

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14
Q

Management for HTN >55 or black person

A

1st line: Ca channel blocker 2nd line: ACEi or ARB + Ca channel blocker 3rd line: ACEi or ARB + Ca channel blocker + thiazide diuretic

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15
Q

What is the CHA2DS-VASc score + what are the RF?

A

Score to assess risk of stroke in someone with AF

Congestive HF

HTN >75

DM Stroke/ TIA (2)

Vascular disease

Age >65

Sex (female)

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16
Q

What is the HAS-BLED score?

A

Score to assess 1 year risk of major bleeding in pts taking anticoagulants for AF

HTN

Abnormal renal + liver function

Stroke

Bleeding

Labile INR

Elderly

Drugs/ alcohol

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17
Q

What is the definition of AF?

A

Cardiac arrhythmia with absolutely irregular RR intervals

No distinct P waves on ECG

Rapid + chaotic atrial activity

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18
Q

What are the different classifications of AF?

A

Initial episode: >30s on ECG

Paroxysmal: recurrent >2 episodes that terminate within 7 days

Persistent: continous >7 days

Long standing persistent: continuous AF >12 months Permanent: decision made by pt and clinician

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19
Q

AF related symptoms

A

Palpitations SOB Fatigue Dizziness Syncope

20
Q

What is the link between AF + stroke?

A

AF increases stroke risk by 5% Associated with larger infarcts, increased disability + death

21
Q

When to offer anticoagulation in AF?

A

CHA2DS2VASC score >2 = offer warfarin or novel anticoagulant Score >1 = consider anticoagulation Score 0 = do not offer

22
Q

What needs to be given if AF >48 hours before cardioversion?

A

Minimum 3 weeks warfarin before + 4 weeks after

23
Q

What is catheter ablation?

A

Electrical isolation of pulmonary veins Prevents triggers of AF Blocks PV ectopics from entering left atrium Needs to have warfarin for 3 weeks before + 4 weeks after

24
Q

Caution with amiodarone

A

Thyroid risk = TFTs

Check LFTs due to hepatotoxicity

Pulmonary toxicity - CXR

Corneal whirls

Amiodarone has long half life

25
Q

Interactions of digoxin

A

Interactions with diuretics = causes hyperkalaemia (particularly furosemide)

26
Q

Mechanism of action, uses, SE + CI of indapamide

A

Thiazide like diuretic, alternative to CCB. Inhibit Na+/ Cl+ co-transporter in distal convuluted tubule. Useful to combine with ACEi + ARBs as these cause hyperkalaemia

CI in oedema + HF

SE: Impotence, hyponatraemia, hypokalaemia (causing cardiac arrhythmias) Can increase plasma glucose

27
Q

Mechanism of action, uses, SE + CI of beta blockers

A

Used for CVD, HF, AF, SVT, HTN

Beta 1 blockers - reduce force of contraction + speed of conduction in the heart

Prolong refractory period at AV node

SE: fatigue, cold extremities, headache, GI S+S, impotence

CI in asthma

28
Q

Mechanism of action, uses, SE + CI of ARBs

A

Used in HTN, HF, CVD, diabetic nephropathy + CKD

Block action of angiotensin 2 on AT1 receptor

Reduces peripheral vascular resistance, lowering BP. Less likely to cause angioedema so good in Africans

SE: hypotension, hyperkalaemia, renal failure

CI: pregnancy, renal artery stenosis, AKI

29
Q

Mechanism of action, uses, SE + CI of ACEi

A

HTN, HF, CVD, diabetic nephropathy + CKD

Block action of ACE to prevent conversion of angiotensin 1 to 2

SE: hypotension, dry cough, hyperkalaemia, angioedema

CI: pregnancy, AKI, renal artery stenosis

NSAIDs increase risk of renal failure

Take first dose before bed

30
Q

Mechanism of action, uses, SE + CI of CCB

A

HTN (amlodipine), SVT (diltiazem + verapamil)

Vasodilation of arterial smooth muscle

SE amlodipine: ankle swelling, flushing, headache, palpitations

SE verapamil: constopation, bradycardia, heart block, HF

Diltiazem - any of these SE

Diltiazem + verapamil CI in HF

Amlodipine CI in severe aortic stenosis

31
Q

Stage 1 + 2 HTN + management

A
  • Stage 1 = 140/90 = lifestyle + diet (unless comorbidity), review in 2-4 weeks
  • Stage 2 = 160/100 AND 150/95 ABPM = begin medical management
32
Q

Describe management of AF

A

Rate control first

  • Beta blocker 1st line
  • Diltiazem 2nd line
  • Digoxin if sedentary
  • Combine

Except (when not to use rate control):

  • whose atrial fibrillation has a reversible cause
  • who have heart failure thought to be primarily caused by atrial fibrillation
  • with new-onset atrial fibrillation
  • with atrial flutter whose condition is considered suitable for an ablation strategy to restore sinus rhythm

Rhythm control

  • If over 48hrs, electrical
  • Use amiodarone 4 weeks before + 12 months after electrical
  • Drug treatment: BB or amiodarone if HF
  • Dronedarone after successful cardioversion 2nd line
33
Q

What is the pill in the pocket?

A

BB or flecanide

34
Q

How do you treat HTN with CKD?

A

High BP in CKD – ACEi (regardless of age or race)

35
Q

What is the target BP for DM?

A

<140/80 or 130/80 if there are any complications of DM present

36
Q

Causes of AF

A

PIRATES

Pulmonary causes

Ischaemia/ infarct

Rheumatic disease

Alcohol + anaemia

Thyrotoxicosis/ toxins

Electrolytes + endocarditis

Sepsis

37
Q

Management of atrial flutter

A

DC cardioversion >48hrs perform TOE

Cardiovert with LMWH cover

Rate control with digoxin, verapamil or BB

38
Q

Management of AF

A

Rate control 1st line

BB 1st, CCB 2nd (not in HF)

Rhythm control if symptoms persist - cardioversion or medical anti-arrhythmics (amiodarone) - only if symptoms <48hrs or if they are anticoagulated for 3 weeks prior

Catheter ablation if AF persistent despite rate + rhythm control

39
Q

What is atrial flutter?

A

Rhythm with rapid regular atrial depolarisations at 300 bpm + venticular rate of 150 bpm

40
Q

What is atrial flutter associated with?

A

Mitral valvular disease, post-cardiac surgery, pericardial disease, pulmonary disease

41
Q

Management of atrial flutter

A

Same as AF (rate control + anticoagulation)

DC cardioversion or amiodarone

Ablation for long term therapy

42
Q

What is a hypertensive emergency?

A

Onset or progression of end-organ damage due to cerebrovascular, cardiovascular or renalvascular system

43
Q

What is accelerated HTN?

A

Defined by retinal damage (hemorrhages, exudates + arteriolar narrowing)

44
Q

What is malignant HTN?

A

Accelarated HTN + papilloedema

Usually when diastolic is >140

45
Q

Why is adenosine not helpful in AF/ flutter?

A

Adenosine doesn’t affect atria

46
Q

What is multifocal atrial tachycardia?

A

P waves change every beat

Due to random pacemakers setting off beats

Occurs when heart is under strain

Cardiovascular (15 decks)

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