Meeran: Clinical Cases Flashcards
What is the management ladder of T2 diabetes?
Diet and exercise Metformin Diarrhoea and tummy ache Metformin MR (with less SE) Sulphonylurea- Gliclazide Glitazones (Pioglitazone), Gliptins (like sitagliptin), SGLT-2 inhibitors (empagliflozin), GLP-1 agonists [esp in HF]
Which additional diabetes drugs reduces all cause cardiovascular mortality?
GLP-1 Agonists and SGLT-2 inhibitors
What is the function and side effects of GLP-1 agonists?
GLP-1 Agonists- increases insulin secretion and decreases glucagon (e.g. liraglutide)
SE- Adverse events
What is the function and side effects of DPP4 inhibitors?
increases incretin levels (e.g. sitagliptin)
SE- Pancreatitis and retinopathy
What is the function and side effects of SGLT-2 inhibitors?
Reduces renal glucose reabsorption (e.g. empagliflozin)
Reduces all cause cardiovascular mortality
SE- Genital skin infection risk
What are the five major criteria of Rheumatic Fever?
carditis (clinical and/or subclinical) Arthritis (polyarthritis) Sydenham Chorea Erythema marginatum Subcutaneous nodules
What drugs can you use to treat AF?
Warfarin- Amiodarone/ beta blockers/ digoxin
What drugs might you use for arterial problems vs venous problems?
Arterial problem- aspirin/ clopidogrel
Venous (or atrial) problem- Warfarin, apixaban
What scoring system do you use for stroke risk in AF?
CHADSVASC
What are the components of CHADSVASC?
Age Gender CHF history HTN histroy Stroke/ TIA/ Thromboembolism Hx Vascular disease Hx Diabetes Hx
Says whether antiplatelet (1pt) or anticoagulant (2
What are the important complications of AF?
Stroke
MI
What are the side effects if warfarin?
Higher bleeding risk
Do you control rate or rhythm?
EITHER
but rate control comes first (in older people)
How do you control rate and rhythm?
Digoxin blocks AVN so rate slows in ventricle. Better feeling for patients but atria still fibrillate. (Rate control)
Shocking causes defibrillation so the atrial fibres contract together again (rhythm control).
Amiodarone/ beta blockers- fibres are more likely to contract together. (Rhythm control).
Why does AF occur?
The SAN isn’t controlling the contraction, each fibre contracts independently (fibrillation of atria). No Atrial contraction. AVN stimulated randomly by independent fibres and fires randomly. Clot forms due to lack of atrial contraction (stasis).
What does ST elevation in all leads suggest?
Pericarditis
What is the treatment for viral pericarditis?
Ibuprofen (anti-inflammatory) or colchicine (not as good- SE)
Who gets bacterial pericarditis?
IVDU through injecting Staph Aureus
What would you advise for LBBB?
Lifestyle changes and risk factor control
What are broad complexes?
More than 3 small squares
Spreads to the other bundle after the first so slow depolarisation
William Marrow
How might you interpret ST segment in a LBBB?
If LBBB then ST segment is uninterpretable
What might you see on examination of complete heart block that is pathognomomic?
CAnnon Waves (high rising JVP)
What is the treatment of complete heart block?
Pacemaker
