Vascular/Cardiothoracic/Cardiology Flashcards
Screening aortic aneurysm
3-4.4cm 12 months
- 5-5.4cm 3 months
- 5cm+ 2 week ref
Aortic aneurysm diagnosis
US first, then CT angiogram guide surgery
ABPR critical ischaemia
<0.3
Critical limb ischaemia features
Rest pain >2w
Hanging legs of bed relieves
Gangrene
Diagnose acute limb threatening ischaemia
Doppler US then ABPI if positive
Acute limb threatening ischaemia treatment
IV heparin and vascular review
Thromolysis or surgery is definitive
Drugs for all patients PAD
Atorvastatin 80mg and clopidogrel
DVT diagnosis
Well score then proximal leg US, if negative then D dimer
DOAC if delay
Treatment DVT
1) DOAC
2) LMWH (dalteparin) followed by warfarin - renal impairment
Venous ulcer treatment
Compression bandaging
Aortic dissection diagnosis
CT angiography - false lumen
Transoesophageal ECHO if unstable
Aortic dissection treatment
A - surgery and control BP
B - control BP
Initial MI treatment
MONA:
- morphine
- oxygen
- nitrates
- aspirin
STEMI - when do PCI and fibrinolysis
PCI - within 2 hours or consider after 12h if ongoing ischaemia
Fibrinolysis - within 12h
Antiplatelet therapy before PCI
Aspirin and prasugrel, if already taking anticoagulant clopidogrel
Antiplatelet therapy fibrinolysis
Fondaparinux during then ticagrelor after procedure
Repeat ECG 60-90m and consider PCI
NSTEMI treatment
Fondaparinux if no PCI, unfractionated heparin if PCI
Depends on GRACE risk assessment
- <3% fondaparinux and dual antiplatelet therapy
- > 3% PCI, unfractionated heparin and dual antiplatelet therapy
NSTEMI dual antiplatelet therapy
GRACE:
- <3 - ticagrelor and aspirin
- > 3 - prasugrelor/ticagrelor and aspirin
Antiplatelet therapy in MI if bleeding risk
Clopidogrel instead of ticagrelor/prasugrelor
Bradyarrythmia most common after what MI
Inferior (II, III, avF)
Identify pericarditis after MI
Within 48h
Identify dressler syndrome after MI
2-6w after
Basically pericarditis
Dressler syndrome treatment
NSAID
Identify ventricuar aneurysm after MI
Persistent ST elevation and left ventricle failure
Identify free wall rupture after MI
1-2w after
Acute HF secondar to cardiac tamponade - raised JVP, pulses paradoxus (drop in BP when breath in)
Identiify ventrical septal defect after MI
1st week
Acute HF and pansystolic murmur
Identify acute mitral regurgitation after MI
Due to rupture papillary muscle
Acute hypotension, pulmonary oedema, early to mid systolic murmur
MI secondary prevention
All patients:
- dual antiplatelet therapy, stop second after 12m
- ACEI
- beta blocker
- statin
Stable angina diagnose
CT coronary angiography
Stable angina treatment
Aspirin
Atorvastatin
GTN
Long term relief
Stable angina long term relief
1) Beta blocker or CCB
2) Increase dose
3) Both
4) Consider long acting nitrate
CCB choice in stable angina
Monotherapy - rate limiting like verapamil or diltiazam
Dualtherapy - long acting like modified release nefedipine
Pericarditis diagnosis
ECG and ECHO
Pericarditis treatment
NSAID and colchine
Classification hypertension
1) Clinic 140/90 home 135/85
2) Clinic 160/100 home 150/95
3) Clinic 180/120
Hypertension treatment if <55 or T2 diabetes
1) ACEI or ARB
2) + CCB or thiazide like diuretic
3) + CCB and thiazide like diuretic
4) + spironolactone if K<4.5, otherwise a blocker or b blocker
Hypertension treatment if >55 or black
1) CCB
2) + ACEI or ARB or thiazide like diuretic
3) Follow same as <55
Most common valve infective endocarditis
Mitral valve
Cause infective endocarditis
Staph aureus
Cause infective endocarditis poor dental hygeine
Strep viridans
Cause infective endocarditis valve surgery last 2m
Staph epiderdimis
Cause infective endocarditis colorectal cancer
Strep bovis
Dukes major
Blood culture positive
Evidence on ECHO
Infective endocarditis treatment
1) Amoxicillin
2) Vancomycin and gentamin if allergic