PassMed Flashcards
Rhythm control if structural heart disease
Amiodarone
Rhythm control if no structural heart disease
Flecanide
What is the ECG criteria for STEMI in men under 40
2.5 mm (i.e ≥ 2.5 small squares) ST elevation in leads V2-3 in men < 40 years,
What is the ECG criteria for STEMI in men over 40
≥ 2.0 mm ST elevation in leads V2-3 in men > 40 years
What is the ECG criteria for STEMI in women
1.5 mm ST elevation in V2-3 in women
What are some other criteria for STEMI
1 mm ST elevation in other leads
new LBBB
High INR + bleeding acutely - how do you manage this
Stop warfarin
Give intravenous vitamin K 5mg
Prothrombin complex concentrate - if not available then FFP*
What to do if someone’s INR is over 5 or 8
Any major bleed - give 5mg IV vit K + prothrombin complex concentrate
Any minor bleed - give 3mg IV vit K
If INR over 8 but no bleed - 5mg PO vit K
If INR over 5, no bleed - stop 2 doses, then reduce dose
Bumetanide - SE and MOA
Loop diuretic causing electrolyte imbalances
Stable angina management
BB or rate limiting CCB such as verapamil
I.e. if using CCB alone - verapamil or diltiazem
If using BB with CCB -> use long acting CCB such as amlodipine or modified release nifedipine
If ccb or bb doesn’t control symptoms, use both
If one of these isn’t tolerated, add: ivabradine or nicorandil
third drug only added if waiting for PCI
What is a key thing to consider when prescribing nitrates
NICE advises that patients who take standard-release isosorbide mononitrate should use an asymmetric dosing interval to maintain a daily nitrate-free time of 10-14 hours to minimise the development of nitrate tolerance
this effect is not seen in patients who take once-daily modified-release isosorbide mononitrate
so either:
standard release morning and evening
or modified release isosorbide mononitrate
tamponade ecg
electrical alternans
