Acute Care- Cardio Flashcards
Mx of STEMI
- Aspirin 300mg
- PCI possible within 120 mins?
Y: Prasugrel, radial access, UFH with bailout glp IIb/IIIa inhibitor
N: Alteplase + Enoxaparin + DAPT (Aspirin + Ticagrelor) + repeat ECG
How should Mx of STEMI change if patient already on anticoagulants?
Swap Prasugrel for Clopidogrel
Mx of NSTEMI/ unstable angina
- Aspirin 300mg
+ Fondaparinux (no immediate PCI planned)
OR
+ UFH (immediate angiography planned) - GRACE score
,<3%: Ticagrelor or Clopidogrel
>3%: Prasugrel + Angiography with UFH +/- PCI
Mx following ACS
DAPT
= Medically managed: Aspirin (lifelong) + Ticagrelor (12m)
= PCI: Aspirin (lifelong) + Ticagrelor/ Prasugrel (12m)
ACEi / ARB
BB or CCB
Statin
ACS Ix
ECG
Cardiac markers e.g. Troponin
3 non-modifiable RFs for ACS
Age
Male
FH
5 modifiable RFs for ACS
Smoking
DM
HTN
Hypercholesterolaemia
Obesity
Counselling patient with ACS
Chest pain because of a heart attack. Happened because a blood vessel to your heart has been blocked.
4w off driving
4 Sx of acute heart failure
SOB
Reduced exercise tolerance
Fatigue
Oedema
6 signs of acute heart failure
Cyanosis
Tachycardia
Raised JVP
Displaced apex beat
Bibasal crackles +/- wheeze
S3 heart sound
Ix for acute HF
Bloods: ?anaemia, electrolytes, infection
ECG: normal
CXR: pulmonary venous congestion, interstitial oedema, cardiomegaly
Echo
BNP
LVF on CXR
Alveolar oedema (bats wing shadowing)
Kerley B lines
Cardiomegaly
Upper lobe Diversion/ Dilated prominent upper lobe veins
Pleural Effusion
Mx of acute HF
IV Furosemide
+/- O2
Mx of respiratory failure in acute HF
CPAP
When should nitrates be used in acute HF? What is the major side effect/ contraindication to their use?
If concomitant myocardial ischaemia, severe HTN, AR or MR
Major SE/ CI: hypotension
Mx of acute HF with hypotension/ cardiogenic shock
Inotropes e.g. Dobutamine
Vasopressors e.g. Norepinephrine
Mechanical circulatory assistance: intra-aortic balloon counterpulsation or ventricular assist devices
In which circumstances should BB be stopped in acute HF?
HR < 50 beats per minute
2nd or 3rd degree AV block
Shock
What is the first line management for chronic heart failure?
ACEi + BB
Start one drug at a time
What is second line management of chronic heart failure? What needs to be monitored and why?
Aldosterone antagonist e.g. Spironolactone/ Eplerenone
Monitor K+ as ACEi + aldosterone antagonists can cause hyperkalaemia
What drug can be used second line in management of chronic heart failure with reduced ejection fraction?
SGLT-2 inhibitors: dapagliflozin, empagliflozin, canagliflozin
Reduce glucose reabsorption + increase urinary glucose excretion