Vascular Flashcards
Tx/prevention of Post surgery DVT
Stop COCP 4 weeks pre op
Mobilize as early as possible
Immobilised patients should have heparin
At risk patients should have support hosiery or intermittent pneumatic pressure until 16 hours post op
Tx of known DVT
LMWH
Stop when INR 2-3
DOAC (1st line) or Warfarin if contraindicated
3 months if DVT is post op
6 months if no precipitating cause
Lifelong if there is known thrombophilia or recurrent DVT
Anticoagulation failure to prevent a PE may indicate an IVC filter, which would stop and thrombi making their way to the lungs
Tx of a PE
Major/minor treat as DVT
Massive A-E resus IV morphine + antiemetic LMWH SBP >90 = warfarin SBP <90 = vasopressors + thrombolysis (alteplase/streptokinase)
Lifestyle interventions for high blood pressure
Lifestyle intervention
Weight loss
Decrease alcohol, sodium, caffeine,
Stop smoking
when do you start pharmocological management for hypertension
Start in all of those with stage 2 (>140/90)
Start in those under 80 with stage 1 HTN (120-139/0-89) and one of the following:
>20% 10 year CV risk Other comorbidities Renal disease Known CV disease Organ disease `
Target Blood pressures in hypertension
Clinic:
<140/90
<150/90 if 80 or above
<130/80 if diabetic
<135/85 or 145/85 if Ambulatory
What is the pharmocological management of hypertension
1st line: ACEIs (<55, non black, high renin), CCBs (>55, black, low renin)
ACEis can be swapped for ARBs if adverse reaction
2nd line: ACEi + CCB
3rd line: +loopdiuretic
4th: spironlactone if K+ <4.5, or thiazide like diuretic, BB or alpha blocker (if CCB is dihydropiridine) if K+ >4.5
Tx of hyperlipidaemia
- lifestyle advice
- statins
- Ezetimibe
- Cholestyramine or PCSK9 inhibitor (alirocumab)
- fibrates - used for familial disease or with comorbin hypertriglycerideaemia
side effects of ace inhibitors
dry cough (10%)
hyperkalaemia
worsened renal function (up to 30% rise in creatinine allowed)
first dose hypotension
contraindications for ace inhibitors
renal artery stenosis
side effects of CCBs
Peripheral oedema
Postural hypotension
Reflex tachycardia
what qRISK score indicates atorvostatin prescription
> 10%
counselling points for statins
Nausea
Headache
Muscle pain
Always report muscle pain as rarely rhabdomyolysis occurs
Tx for unruptured unprotected AAA
<5.5cm
Treat with regular USS
Modify risk factors (HTN)
75% will progress to requiring surgery with no risk factor modification
> 5.5cm
Think about surgery
Risk of rupture in AAAs >6cm goes from 1% to 25%
Expansion >1cm in a year
Surgery
Symptomatic aneurysms
Surgery
Surgery = EVAR
major risk in EVAR surgery
kidney injury - contrast used is nephrotoxic and there is often ischaemia as the aorta is clamped