Management Flashcards
When a patient has a confirmed STEMI what are the two different treatment options that you have?
Either a PCI or thrombolytic treatment
When you have confirmed a STEMI why do you need to act fast?
Because “time is muscle” and the quicker you unblock the vessel the less muscle you will lose
What is the time frame for thrombolytics to be used in?
6-12 hours, but ideally within 90 minutes
Apart from MIs when else can you use thrombolytics?
For certain types of strokes and pulmonary embulous
How does a PCI work?
It maintains coronary artery potency by inflating a stent in the vessel, which allows for blood flow to be restored
Why is a PCI preferred to using thrombolytics?
When you carry out a PCI you have a decreased risk of bleeding and reinfarction
What do we use to remember the secondary medications used to manage cardiovascular disease?
The 6 A’s
What are the 6 A’s?
~Aspirin, 75 mg once a day
~Another anti-platelet for 12 months
~Atrovastatin 80 mg once a day
~ACE inhibitor such as ramipril
~Atenolol or another Beta blocker, at the highest dose tolerable until max dose
~Aldosterone antagonist eg epleronone, for patients with clinical heart failure
When prescribing secondary medication for CVD what are the aims of the therapy?
~Decrease oxygen demand
~Increase oxygen supply
What is the acronym that you follow when you know that your patient is having a NSTEMI?
BATMAN
B-Beta blockers (unless contradicted)
A-Aspirin, 300mg loading dosse
T- Ticagrelor, 180mg loading dose OR 300mg clopidogrel loading dose
M- Morphine
A- Anticoagulants, low molecular weight heparin at treatment dose
N- Nitrates, GTN spray, to relieve coronary artery spasms
What is the additional step to the BATMAN treatment for patients?
Give the patients oxygen if their sats are below 95%
What is the acronym that you would use if your patient is a confirmed STEMI?
MONAC
M-Morphine
O-Oxygen
N-Nitrates
A-Aspirin
C-Cyclizine or metaclopramide (antisickness)
What can we prescribe to reduce the chances of pericarditis reoccurring?
Colchicine
If a patient with pericarditis is not improving after NSAIDs what can we prescribe them?
Corticosteroids
How do we treat myocarditis usually?
The same as conventional heart failure
How can we treat patients with dangerous atheroma?
We can stent them, via an angioplasty
What should be the first line drugs to treat the symptoms of heart failure?
Loop diuretics
What are the main 3 drug classes that we use to treat heart failure?
Diuretics, ACE inhibitors and beta blockers
Before starting and patient on diuretics and before increasing their dose what should you check?
Their serum electrolyte levels and renal function
What can we use Digoxin to treat?
Heart Failure
When prescribing Digoxin why is it important that we monitor the plasma levels of the drug?
Because it has a small therapeutic window and so it can become toxin in the body very quickly
What criteria does the patient have to meet to be prescribe Entresto?
~LVEF less than 35%
~ NYHA classification of between 2 and 4
~ Already on a stable does of an ACE inhibitor or ARBs
When a patient presents with acute heart failure what are the 4 things you should immediately do?
~ Give IV nitrates
~ Give IV diuretics
~ Give oxygen
~ Monitor and restrict the fluid intake
When a patient presents with heart failure symptoms what are the further investigations that you should be carrying out?
12 lead ECG, Blood (FBC, U and Es, LFTs and BNP), ECHO and a chest X-ray
