the practise in treating CV patients Flashcards
what are 2 different clot strategies?
1- anti-thrombotic
2- thromboprophylaxis
3 types of anti- thrombotic?
1) thrombectomy (only in brain vessels)
2) thrombolysis (in brain and heart)
3) angioplasty + stent (heart especially)
2 types of thromboprophylaxis?
1) anti-clotting factor drugs (Warfarin, NOAC like riveroxiban)
2) anti-platelet drugs (Aspirin, Clopidogrel, Ticagrelor, Prasugrel)
when can ace inhibitors be used?
hypertension
heart failure
angina
when can B-blockers be used?
hypertension
heart failure
angina
when can calcium antagonists be used? (CCB)
hypertension
angina
when can diuretics be used?
hypertension
heart failure
overview of hypertension treatment?
ABCD
A= ACE inhibitor
B = beta blocker
C = CCB
D= diuretic esp thiazide diuretic
hypertension treatment, patient is <55yrs?
1) start ACE
2) add CCB
3) add diuretic
4) add spironolactone
5) then B or A blocker if necessary
hypertension treatment, if patent is >55yrs?
1) start CCB
2) add ACE
3) add diuretic
4) add spironolactone
5) then B or alpha blocker if necessary
what are the 4 pillars in the treatment of chronic Heart failure?
1) ACE or ARB or Sacubitril-Valsartan (never and ACE and SV)
2) Beta blocker
3) Aldosterone Receptor Blocker
4) SGLT2 inhibitor
what other drug should you give in chronic HF?
Furosemide or another diuretic if there is fluid retention
what are “devices” that are used to treat Chronic Heart Failure?
1) Cardiac Resynchronisation Therapy to long QRS patients = Biventricular Pacing
2) Implantable Cardiac Defibrillators to highly selected patients
3) heart transplant
what is biventricular pacing?
when the left and right ventricles contract a few secs apart making the CO even worse.
how will a Implantable Cardiac Defib work?
it senses the rhythm of the heart and if it is slightly off, then the patient will get a slight shock.
what is Sacubitril-Valsartan?
- used to replace ACE or ERB in severe heart failure
- Valsartan = ARB
- Sacubitril = inhibits Neprilysin
what does Sacubitril inhibiting Neprilysin do?
it degrades BNP and other vasoactive peptides
side effect of Sacubitril-Valsartan?
angioneurmtic oedema (like an ACE)
what drugs are given to prolong life for people chronic angina pectoris?
SAAB
- Aspirin
- Statin
- ACE inhibitor
- Beta blocker
angina pectoris?
chest pain due to oxygen supply to the heart being too low for its demand.
what drugs are given to relieve symptoms of angina pectoris?
- beta blocker
- CCB
- nitrates
- coronary angioplasty (putting a stent in)
- ivabridine or ranolazine
- coronary artery surgery
if there is
- cardiac pain
- negative troponin levels
then would is it most likely to be?
unstable angina
if there is
- cardiac pain
- positive troponin levels
- ST elevation on ECG
then would is it most likely to be?
STEMI
ST elevation elevation MI
if there is
- cardiac pain
- positive troponin levels
- no ST elevation on ECG
then would is it most likely to be?
NSTEMI
no ST elevation MI
treatment of STEMI?
Emergency =
- Aspirin
- angioplasty (if near hospital)
- thrombolysis (if far away)
- aspirin
- low MW heparin
- statins
- ACE
- B-blockers
(SAAB)
treatment of NSTEMI?
- aspirin
- angioplasty
statin
ACE
Beta blocker
(SAAB + non urgent angioplasty))
3 things to do for treatment of atrial fibrillation?
1) prevent emboli = warfarin/ riveroxaban/NOAC
2) control rate (crucial) = Beta blocker, digoxin
3) control rhythm = DC cardio version acutely, amiodarone if heart failure, stall, flecainide (only if heart function is normal), radioblation
most likely causes of stroke?
cerebral thrombosis
cerebral embolus
cerebral haemorrhage
treatment for stroke
side effects of ACE?
- dry cough
- renal dysfunction
- Angioneurotic oedema
- never give when pregnant
angiotensin blocker side effects?
renal dysfunction
never give in pregnancy
Beta Blocker side effects?
bradycardia
tired
asthma
CCB side effects?
ankle oedema for amlodipine
heart block for diltiazem & verapamil
diuretic side effects?
hypokalaemia
diabetes
gout
