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RACGP > cardiac > Flashcards

cardiac Flashcards

1
Q

hypertension management

A
  1. Start low-moderate dose, review BP in 3 months
  2. Commence 2nd medication at low-moderate dose
  3. review in 3 months
  4. In crease each medication to high dose one by one
  5. Add 3rd medication low dose
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2
Q

Hypertension- non-pharmacological Mx

A 
Weight loss
Increase physical activity
Decrease salt intake <6g/day
Decrease alcohol consumption
Smoking cessation
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3
Q

HTN- what to do when add ACEs

A
  1. check eGFR should not decline > 25%
  2. check K+ - avoid hyperkalaemia
  3. avoid postural hypotension
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4
Q

HTN- tripple Whammy

A

ACEIs + NSAIDs + Diuretic - AKI

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5
Q

CCBs- Side effect

A

peripheral oedema

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6
Q

Thiazide- S/E, c/I

A

vasodilator (not diuretic)
increase risk of DM if commenced in young pt
increase the risk of gout

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7
Q

Cardiac tamponade

A

Cardiac tamponade

Associated with SLE

Causes

- Viral infection
- SLE
- Uremia
- Other long list

C/F

- Elevated JVP
- Bilateral pitting leg oedema
- Hypotension
- muffled heart sound
- Pulsus paradoxus (decrease BP when inspiration by >10mmHg)
- Chest pressure
- Dyspnea
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8
Q

AAA - R/F and screening

A

R/F

- Age > 65
- Smoking
- Hypertension
- PVD
- COPD
- Marfan, ehlers-danlos

Screening: for pt who has 1st degree relative with AAA

- 2.5 - 3 cm → 10 years
- 3 - 3.9 cm → 3 years
- 4 - 4.9 cm → 1 year
- 5 - 5.5 cm → 6 months
- >5.5 →  referral to a surgeon
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9
Q

Pulmonary HTN - C/F, O/E

A

C/F
Exertional dyspnea
Recurrent Syncope

O/E
Increase P2
S3 gallop
Pitting leg oedema

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10
Q

HF- medication for increase survival

A

spironolactone
ACEI
B-Blockers (when EF<40%)
- carvedilol 3.125 mg BD (target 25mg BD
- metoprolol 25mg BD
- bisoprolol 1.25mg daily (target 5mg daily)

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11
Q

Coronary Artery Calcium scoring

A

Indication
Age 45 -75
CV risk assessment 10-15
CV risk assessment <10 with family history of premature CV event

Results
< 100 → normal
100 - 40 → aspirin and statin
> 400 → high risk → aspirin and statin → angiogram

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12
Q

high risk CV disease (without CV risk assessment)

A
  1. Age > 60 + DM
  2. DM + microalbuminuria (ACR women > 3.5, Men > 2.5)
  3. CKD
    • eGFR < 45
    • Macroalbuminuria (ACR women > 25, men > 35)
  4. Systolic BP > 180
  5. Cholesterol > 7.5
  6. Familial hypercholesterolemia
  7. ATSI > 74 years
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13
Q

target lipid profile

A
  • cholesterol < 4.0
  • TG <2.0
  • LDL <2
  • HDL > 1.0
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14
Q

causes of uncontrolled HTN

A
  1. poor compliance
  2. 2ndary underlying cause: eg CKD
  3. OSA
  4. alcohol intake
  5. smoking
  6. white coat hypertension
  7. excess salt intake
  8. illegal drugs
  9. machine technical error
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15
Q

hyperlipidaemia- nonpharmacological management

A
  1. reduce intake of saturated and trans fats
  2. replace saturated fat with mono-un-saturated fats
  3. increase intake of fibre
  4. introducing plant sterol-enriched milk, cheese product
  5. limit alcohol intake

to improve HDL

  1. wt loss
  2. increase physical activity
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16
Q

HF: symptoms and sings

A

Main symptoms

 - Exertional dyspnea
 - PND (paroxysmal nocturnal dyspnea)
 - Orthopnea
 - Fatigue

Main signs:

 - Elevated LJP
 - Hepatojugular reflux
 - S3
 - Displaced apex beat
 - Pitting leg oedema
17
Q

HF- Diagnosis

A

ECHO
BNP if cannot do ECHO
- BNP < 100 –> no HF
- BNP > 100 -> HF

18
Q

HF- non pharmacological management

A
  • cease smoking
    • decrease alcohol
    • wt reduction
    • exercise
19
Q

HF- medicaiton

A
  1. ACEIs / ARBs
  2. B-Blocker (when EF<40% and euvolaemia)
    • carvedilol 3.125 mg BD (target 25mg BD)
    • metoprolol 25mg BD
    • bisoprolol 1.25mg daily (target 5mg daily)
  3. Spironolactone (aldosterone antagonist)

diuretic in acute HF

20
Q

ACS-immediate management - What about O2?

A 
Call for help
IV cannula
ECG
Morphine
GTN
Aspirin 300mg 
O2 only if POE < 93%
21
Q

MI- list 5 important medication after discharge

A

`1. Aspirin

  1. Plavix
  2. statin
  3. b-blockers
  4. ACEIs
22
Q

AF- type

A
  1. paroxysmal AF < 7 days
  2. persistent AF > 7 days
  3. Permanent AF > 1 year
23
Q

AF- risk of VTE (which AF type is higher), what do you use to determine risk of VTE

A

all types carry same VTE risk

CHA2DS2-VASc

  1. congestive heart failure
  2. hypertension
  3. Age > 75 (2 points)
  4. Diabetes
  5. Stroke/TIA (2 points)
  6. vascular disease- peripheral
  7. Age 65-75
  8. Sex Category (female) 2 points

male score
0 –> no anticoagulant
1 –> consider anticoagulant
2 –> must have anticoagulant

female: just add on (as never score 0) i.e
1 –> no anticoagulant
2 –> consider anticoagulant
3 –> must have anticoagulant

RACGP (19 decks)

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