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YR6 Images + Instruments > Acute Care- Cardio > Flashcards

Acute Care- Cardio Flashcards

(51 cards)

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1
Q

Mx of STEMI

A
  1. Aspirin 300mg
  2. PCI possible within 120 mins?

Y: Prasugrel, radial access, UFH with bailout glp IIb/IIIa inhibitor

N: Alteplase + Enoxaparin + DAPT (Aspirin + Ticagrelor) + repeat ECG

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2
Q

How should Mx of STEMI change if patient already on anticoagulants?

A

Swap Prasugrel for Clopidogrel

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3
Q

Mx of NSTEMI/ unstable angina

A
  1. Aspirin 300mg
    + Fondaparinux (no immediate PCI planned)
    OR
    + UFH (immediate angiography planned)
  2. GRACE score
    ,<3%: Ticagrelor or Clopidogrel
    >3%: Prasugrel + Angiography with UFH +/- PCI
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4
Q

Mx following ACS

A

DAPT
= Medically managed: Aspirin (lifelong) + Ticagrelor (12m)
= PCI: Aspirin (lifelong) + Ticagrelor/ Prasugrel (12m)
ACEi / ARB
BB or CCB
Statin

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5
Q

ACS Ix

A

ECG
Cardiac markers e.g. Troponin

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6
Q

3 non-modifiable RFs for ACS

A

Age
Male
FH

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7
Q

5 modifiable RFs for ACS

A

Smoking
DM
HTN
Hypercholesterolaemia
Obesity

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8
Q

Counselling patient with ACS

A

Chest pain because of a heart attack. Happened because a blood vessel to your heart has been blocked.
4w off driving

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9
Q

4 Sx of acute heart failure

A

SOB
Reduced exercise tolerance
Fatigue
Oedema

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10
Q

6 signs of acute heart failure

A

Cyanosis
Tachycardia
Raised JVP
Displaced apex beat
Bibasal crackles +/- wheeze
S3 heart sound

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11
Q

Ix for acute HF

A

Bloods: ?anaemia, electrolytes, infection
ECG: normal
CXR: pulmonary venous congestion, interstitial oedema, cardiomegaly
Echo
BNP

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12
Q

LVF on CXR

A

Alveolar oedema (bats wing shadowing)
Kerley B lines
Cardiomegaly
Upper lobe Diversion/ Dilated prominent upper lobe veins
Pleural Effusion

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13
Q

Mx of acute HF

A

IV Furosemide
+/- O2

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14
Q

Mx of respiratory failure in acute HF

A

CPAP

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15
Q

When should nitrates be used in acute HF? What is the major side effect/ contraindication to their use?

A

If concomitant myocardial ischaemia, severe HTN, AR or MR

Major SE/ CI: hypotension

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16
Q

Mx of acute HF with hypotension/ cardiogenic shock

A

Inotropes e.g. Dobutamine

Vasopressors e.g. Norepinephrine

Mechanical circulatory assistance: intra-aortic balloon counterpulsation or ventricular assist devices

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17
Q

In which circumstances should BB be stopped in acute HF?

A

HR < 50 beats per minute
2nd or 3rd degree AV block
Shock

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18
Q

What is the first line management for chronic heart failure?

A

ACEi + BB
Start one drug at a time

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19
Q

What is second line management of chronic heart failure? What needs to be monitored and why?

A

Aldosterone antagonist e.g. Spironolactone/ Eplerenone
Monitor K+ as ACEi + aldosterone antagonists can cause hyperkalaemia

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20
Q

What drug can be used second line in management of chronic heart failure with reduced ejection fraction?

A

SGLT-2 inhibitors: dapagliflozin, empagliflozin, canagliflozin

Reduce glucose reabsorption + increase urinary glucose excretion

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21
Q

What third line therapy can be initiated by a specialist for chronic HF?

Study These Flashcards
A

Hydralazine + Nitrate
Entresto: Sacubitril-valsartan
Digoxin
Ivabradine
Cardiac resynchronisation therapy

22
Q

Paroxysmal AF

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A

AF lasting >30s but <7 days (often <48h).
Self-terminating + recurrent.

23
Q

Persistent AF

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A

AF >7 days (spontaneous termination unlikely to occur after this time)
or <7 days but requiring cardioversion.

24
Q

Permanent AF

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A

AF that:
failed to terminate with cardioversion
OR
terminated but relapsed within 24h
OR
longstanding AF (>1y) in which cardioversion is CI or not been attempted

25
4 most common causes of AF?
Coronary artery disease HTN Valvular heart disease Thyrotoxicosis
26
3 lifestyle factors can cause AF
Caffeine intake Excessive alcohol intake Obesity
27
Describe an ECG in AF
Chaotic baseline Absent p waves Irregular intervals between QRS complexes
28
4 life-threatening features of tachycardias
Shock (Hypotension) Syncope Signs of myocardial ischaemia Signs of Heart failure
29
Once AF is identified on ECG, what investigations are performed?
Bloods Echo (TTE/ TOE)
30
What investigations can be performed to aid identification of underlying cause of AF?
FBC (Infection, Anaemia) U+Es (Electrolyte imbalance) TFTs (Thyrotoxicosis) Cardiac enzymes
31
When should rhythm control be tried first line in AF?
Haemodynamically unstable New onset AF <48h Heart failure (primarily caused by AF) Reversible cause.
32
Describe management of haemodynamically unstable patient with AF
DC cardioversion
33
If rhythm control is indicated in a haemodynamically stable patient, describe management?
<48h: Heparinise + cardioversion >48h: rate control + anti-coagulate for >,3w OR TOE to exclude a left atrial appendage thrombus then proceed
34
Describe ongoing management if AF is confirmed as being less than 48h and resolved with DC cardioversion
Further anticoagulation unnecessary
35
If onset of AF was more than 48 hours ago, why must a patient be anti-coagulated for at least 3 weeks prior to cardioversion?
High risk of cardioversion induced thromboembolism as clot likely to have formed in atria
36
What is used in pharmacological cardioversion?
Structural heart disease: Amiodarone NO structural heart disease: Flecainide
37
Describe electrical cardioversion
Synchronised to R wave to prevent delivery of a shock during the vulnerable period of cardiac repolarisation when VF can be induced.
38
Which drugs are used for rate control in AF?
B-blockers e.g. Atenolol, Metoprolol, Propranolol Rate limiting CCB e.g. Diltiazem Digoxin (2nd line)
39
Name a common contraindication to B-blockers in AF. What should be used first line?
Asthma Use CCB e.g. Diltiazem
40
In which patients with should nondihydropyridine CCBs be avoided?
Acute decompensated HF
41
What non-pharmacological method can be used for rate control in AF?
Catheter ablation (percutaneous, via groin) ablates faulty electrical pathways resulting in AF
42
Describe the use of anticoagulation with catheter ablation
Anticoagulate for 4w prior + during procedure Catheter ablation controls rhythm but doesn’t reduce stroke risk Continue anticoagulation as per CHADSVASc
43
4 complications of catheter ablation for AF
Cardiac tamponade Stroke Pulmonary vein stenosis Recurrence of AF
44
What tool is used to assess and manage stroke risk in AF?
CHA2DS2-Vasc Score
44
elements of CHA2DS2VASc?
Congestive HF 1 HTN (inc. treated HTN) 1 Age >= 75y (2), 65-74y (1) Diabetes 1 S2 Prior Stroke, TIA or thromboembolism 2 Vascular disease (inc. IHD + PAD) 1 Sex (F) 1
45
Describe the anticoagulation strategy based on CHA2DS2VASc score
0: No Tx 1: M: Consider anticoagulation F: No Tx (because score 1 only due to their gender) >,2: Offer anticoagulation
46
If CHA2DS2VASc score suggests no need for anticoagulation, what must be performed?
TTE to exclude valvular heart disease Vavular heart disease in combination with AF is an absolute indication for anticoagulation.
47
What scoring system is used to calculate risk of bleeding in patients with AF considering anticoagulants?
ORBIT Old (age >75) Red cells (anaemia) Bleeding hx Impairment (renal) Treatment (anti platelet Tx)
48
What class of drug is used first line for anticoagulation in AF? Give 4 examples
DOACs Apixaban Dabigatran Edoxaban Rivaroxaban
49
What drug is used for anticoagulation in AF when DOACs are contraindicated?
Warfarin
50
What should be used for long term stroke prevention in patients with AF once haemorrhage has been excluded?
Following TIA: DOAC (or warfarin) immediately Following acute stroke: DOAC (or warfarin) after 2w (anti-platelet in the interim)

YR6 Images + Instruments (21 decks)

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