20 cards Flashcards
(23 cards)
Which type of anti-anginal med can tolerance be developed to
Standard release isorbide mononitrate
Acute management of SVT
- Vagal manouvers: valsalva, carotid sinus massage
- IV adenosine: 6mg -> 12mg -> 18mg . Use verapamil if asthmatic
- Electrical cardioversion
Signs of R sided HF
increased JVP, ankle edema, hepatosplenomegaly
Management of aortic dissection
Depends on type
Type A- acending- surgical, control BP within 100-120 while awaiting intervention
Type B - descending - conservative, bed rest, IV labetalol
Mangement of acute onset of AF >48 hours/ uncertain time
Rate control with bisoprolol
How does radiation induced cardiomyopathy present
years after treatemtn, dilated cardiomyopathy with signs of CHF
When does paradoxical embolism occur
R to L shunt that causes the venous embolus to bypass pulmonary circulation and enter the systemic circulation -> arterial occlusion events
What ix is done to identify a patent foramen ovale
Bubble echocardiogram
Who needs lipid modifying therapy
Moderate risk patient whose absolute CVD risk is 10- 15% if they have not reached their target after 6 months of lifestyle mods OR FH of premature CVD OR ATSI
High risk patient whose absolute CVD risk is >15% OR DM and >60yo OR DM with microalbuminuria OR pt with CKD/HTN OR pt with familial hypercholesterolemia OR serum total cholesterol >7.5
What parameters to check before starting statins
LFTS, renal fx
What is the main target of lipid modifying therapy
LDL
When is low intensity statin therapy indicated
Primary prevention of ASCVD
When is high intensity statin therapy indicated
Secondary prevention or primary prevention in very high risk
When to take atorvastatin
ANytime
When to take simvastatin
after evening meal
Adverse effects of statin therapy
Myositis or myopathy –> muscle pain and weakness +/- increased CK
Increased AST and ALT
Rhabdomyolysis –> myalgia + myoglobinuria + 10 times elevated CK
What med can statins interact with to cause rhabdomyolysis
Erythromyocin/ clarithromyocin
Investigation of muscle symptoms in person on statins
https://ccmsfiles-tg-org-au.eu1.proxy.openathens.net/s6/images/CVG8-Statin-assoc-muscle-symptoms-v3.png
Contraindications to statins
Pregnancy
Severe liver diseases
Chronic hepatitis
Heavy ETOH consumption
Ezetimibe
Cholesterol absorption inhibitor
Reduces LDL by 15-20%
sfx: GI disturbance, myositis and increased ALT
Fish oil/ omega 3 fatty acid
Doesn’t reduce LDL, decreases TG levels
Not associated with decreased CVS mortality and morbidity
SFX: increased risk of bleeding in patients on anticoags and antiplatelets
Fenofibrates
Indications: hypertriglyceridemia in patients with pancreatitis PMH
SFX: Myositis- check CK regularly
PCSCK9 inhibitors
Monoclonal antibodies that block breakdown of LDL receptors
Very expensive
Given as a SC injection every 2-4 weeks
