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PACES Management > Cardio > Flashcards

Cardio Flashcards

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1
Q

Management of acute STEMI

A 
A-E
Aspirin + Ticagrelor (hold ticagrelor until cath lab)
Oxygen if desaturating
Morphine IV and metoclopramide IV
Nitrate if still painful
Primary PCI <2h

if delay in primary PCI >2h, consider thrombolysis with alteplase (give ticagrelor after)
PCI will give heparin

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2
Q

Management of STEMI long-term

A

12m:
clopidogrel/ticagrelor

lifetime:
aspirin
statin
ACEi/ARB
Beta blockers
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3
Q

Medical management of acute NSTEMI

A

Aspirin 300mg
Assess for immediate PCI

Heparin OR fondaparinux (if no immediate cathlab)

GRACE score for if they get PCI (either immediately if unstable or within 72h if stable)

If GRACE >3% chance then PCI
If GRACE <3%, give ticagrelor/clopidogrel/prasugrel

Conisder
O2
Nitrate
Opioid
Anti-emetic
Beta blocker if Stable and no CI
DHP CCB
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4
Q

Contraindications to beta blockade in acute NSTEMI

A

Sign of HF/low CO
risk of cardiogenic shock
coronary vasospasm/cocaine

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5
Q

Management of NSTEMI long-term

A

12m:
clopidogrel/ticagrelor

lifetime:
aspirin
statin
ACEi/ARB
Beta blockers

Cardiac rehab

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6
Q

what defines LV dysfunction

A

EF <40%

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7
Q

Drugs given 1st line in chronic LVF

A

ramipril
bisoprolol
atorvastatin

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8
Q

drugs to consider if LVF not getting better

A 
eplerenone 
THEN
sacubutril/valsartan OR
dapagliflozin OR 
ivabradine
OR hydralazine + nitrate

consider digoxin if sinus
consider CRT

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9
Q

HF drug if intolerant of ACEi/ARB e.g. afro-caribbean

A

hydralazine + nitrate

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10
Q

Indications for CRT

A

HF with QRS >120

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11
Q

Indications for ICD

A

Risk of shockable rhythms
e.g. conduction disorder
structural disorders e.g. cardiomyopathy
HFrEF AND MI (40d post)

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12
Q

Number of leads of ICD

A

1

Right ventricle

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13
Q

Indications for Pacemaker

A 
SAN disease (sick sinus, bradycardia with wide QRS)
SLOW AF
3rd degree heart block or Mobitz 2
trifasicular block
tachycardia AND AV ablation
heart transplants
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14
Q

number of leads in pacemaker

A

2

RV and RA

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15
Q

ECG changes to paced rhythms

A

pacing spikes

look if after the spike there’s a p wave or QRS

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16
Q

Indications for CRT

A

Low EF + LBBB
QRS >130
cardiomyopathy
desynchrony

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17
Q

number of leads in CRT

A

3

RV, RA and LV (epicardial)

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18
Q

What drug to hold before and after angiogram?

A

metformin 48 pre and post

renal issues

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19
Q

when to revascularise NSTEMI?

A

painless: within 48h
painful: immediately

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20
Q

Acute LVF management

A 
Sit them up
furosemide for pul oedema
GTN if hypertensive
inotropes/vasopressors (dobutamine) if shock
oxygen if <90%

consider: opiate+emetic, NIV

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21
Q

Acute AF management <48h

A

if life threatening 3x DC

rate control: beta blocker, OR diltiazem OR digoxin

rhythm control: flecainide if young OR amiodarone if old

if HF, consider digoxin/amiodarone

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22
Q

Acute AF management >48h

A

if life threatening 3x DC

if not: heparin and then DOAC/warfarin for at least 3w and rate control before cardioversion as appropriate

If need to cardiovert now: TOE to exclude thrombus then DC cardioversion

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23
Q

Acute SVT management

Study These Flashcards
A

vagal manoeuvres
adenosine 6mg IV
adenosine 12mg IV
adenosine 12mg IV

consider DC cardioversion

24
Q

Acute VF management or pVT

Study These Flashcards
A

CPR 30:2
Shock
back to CPR

adrenaline every 3-5 minutes
amiodarone after 3 shocks

25
Acute pulse VT management
amiodarone, lidocaine, procainamde, magnesium, cardioversion
26
Torsades de Pointes management
congenital: high dose BB | drug induced: magnesium sulfate
27
adenosine contraindication
asthma | use verapamil instead
28
paroxysmal SVT management
conservative ablation rate control
29
unstable aortic stenosis management
balloon valvuloplasty before TAVI
30
Hypertension Management
1: ACEi or CCB (AC/>55y) 2: Both 3: Add thiazide-like diuretic 4: Beta blocker or alpha blocker or spiro
31
management for pericarditis
high dose NSAIDs +/- colchicine for pain relief and reduce inflammation PPI Exercise restriction Treat cause: uraemia, hypothyroid, infection, TB
32
two forms of post-MI pericarditis
early 2-5d | late (dressler) up to 11w
33
HOCM management
exercise restriction aggressively treat atrial arrhythmia beta blocker/verapamil +/-disopyramide consider ICD consider heart debulking or transplant
34
drugs contraindicated in HOCM
digoxin, nitrates, inotropes
35
dilated CM management
``` Strenuous exercise restriction ACEi Beta blockers Spiro Pacemaker/ICD/CRT Left Ventricular Assist Device (LVAD) ``` Consider Batista procedure or transplant
36
Management of restrictive CM
``` Beta blocker ACEi Digoxin Diuretics Treat underlying cause transplant ```
37
Ages to decide between surgical or transcatheter valve replacement for symptomatic AS
age <65 surgical age 65-80 surgical OR transcatheter 80+ transcatheter
38
Chronic AF management
Rate control: beta blocker, verapamil, digoxin or amiodarone Anticoagulate based on CHADSVASC >=2: DOAC, dabigatran, rivaroxaban, apixaban, and edoxaban consider DC cardioversion or ablation
39
Infective Endocarditis management
oxygen >94% ?fluid resus Blood cultures before empirical antibiotic therapy native valve: amox +/- gent prosthetic: vanc + rifampicin + gent
40
Duke's criteria for infective endocarditis
2 major OR 1 major and 3 minor or 5 minor major: bacteraemia 2 cultures 12h apart or echo minor: fever, echo, vascular, immunological involvement, 1 culture, risk factors for IE
41
Rheumatic fever management
bed rest NSAIDs aspirin Pen V if CCF/cardiomegaly/3rd degree HB: steroids Syndenhams chorea: haloperidol or diazepam long-term Abx +/- surgical repair/replacement
42
What scoring system counters CHADSVASC
ORBIT | can also use HASBLED
43
Second degree Heart block type 2 management
urgent cardio referral pacing ablation
44
LBBB treatment
compare to old to see if dynamic new LBBB treat at STEMI in unsure if STEMI use SGARBOSSA criteria
45
Contraindication to nitrate
Aortic stenosis/hypotension
46
Management of aortic dissection
Type A: urgent surgery Type B: conservative: labetalol, 2nd nicardipine 3rd hydralazine
47
Warfarin reversal
``` Major bleeding: PCC Any bleeding (inc major): IV Vitamin K ``` No Bleeding: >8 give oral Vit K 5-8 withhold warfarin and reduce maintenance
48
management of stable angina
conservative: smoking, weight loss, exercise, diet aspirin + statin GTN symptomatically Beta blocker or CCB (rate limiting) combine BB and CCB (non-rate limiting) Any of RINN: ranolazine, ivabradine, nicorandil, long acting nitrate (isosorbide)
49
``` ACS ECG changes and territories anteroseptal anterolateral lateral Inferior Posterior ```
``` anteroseptal: V1-4, LAD Anterolateral: V4-6 + aVL, LAD/Cx Lateral: I + aVL + V5-6, left Cx Inferior: II + III + aVF, Right Posterior: tall R waves in V1/2, LCx or Right ```
50
4 H and 4Ts
Hypoxia Hypovolaemia Hypothermia Hypo/hyperkalaemia, hypoglycaemia, hyperacidaemia Thrombosis Tamponade Tension Toxin
51
Post MI heart block management
Inferior: Atropine Anterior: temporary TC pacing
52
Post MI rupture management
Early: inotropes/vasopressors Surgery: balloon pump inside aorta Late: Pericardiocentesis + thoracotomy
53
what cardiac marker to use if ?reinfarct MI
CK-MB instead of troponin
54
bradycardia management
atropine 500mcg IV | consider TC pacing, adrenaline
55
NHYA classification
1) no limitation 2) comfy at rest, slight limitation 3) comfy at rest, marked limitation on minor activity 4) dyspnoea at rest
56
ECG of dissection
Any of 1) normal 2) STEMI in inferior leads 3) pericarditis changes

PACES Management (11 decks)

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