Cardio Flashcards by Emma Hill

angina investigation

1st line - coronary angiography

also - ECG, exercise ECG, BP, bloods (FBC, U+E, glucose, lipid, TFT, LFT, troponins)

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what 2 drugs should people with angina be put on unless contraindicated

aspirin and statin

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angina 1st line symptom prophylaxis

Beta blocker or CCB

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angina rapid symptom control

GTN

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if no response to beta blocker or CCB in angina what do you do

switch to the other or use combination

- if using beta blocker use nifedipine as CCB

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what drugs can be added to CCB + BB in angina treatment if not responding

long acting nitrate - isosorbide mononitrate
ivabradine
nicorandil
ranolazine

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definitive treatment angina

CABG/PCI

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what advice should be given regarding use of GTN

o When symptoms develop, stop activity and take GTN spray.
o If no symptom relief, take another spray after 5 minutes.
o If still no symptom relief 5 minutes after this, call 999.
o 8 hours per day nitrate free to avoid tolerance

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acute management of suspected ACS

MONA + T
morphine
oxygen
nitrates
aspirin
ticagrelor

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when can PCI be given

if patient presents within 12 hours of symptom onset and PCI could be given in 120 mins from ECG diagnosis

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what should be given prior to PCI

further dual antiplatelet therapy

Aspirin + prasugrel (60mg)

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if PCI unavailable what can be done

thrombolysis

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what drug is used in thrombolysis

alteplase

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what drug is given to patients during PCI

heparin

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what do you do if ECG 90 mins after thrombolysis fails to show resolution of ST elevation

PCI

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Post ACS treatment

statin lifelong 
ACEI 
BB
dual antiplatelet
- aspirin 75mg lifelong
- ticagrelor

GTN spray PRN
lifestyle advice
BP/glycaemic control

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how long should dual antiplatelet treatment be given post ACS

aspirin lifelong

ticagrelor 3 months or 4 weeks if no PCI

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drug for s/s of HF after ACS

spironolactone / eplerenone

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acute treatment of NSTEMI

same as STEMI

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treatment of NSTEMI if ischaemic ECG changes or elevated cardiac markers

immediate treatment with fondaparinaux or LMWH

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treatment of NSTEMI following confirmation

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unstable angina treatment upon confirmation

BB and LMWH (same as nstemi)

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unstable tachycardia treatment

1 - DC cardioversion up to 3 times (if applicable)

2 - amiodarone 300mg IV over 10-20 mins

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1st line treatment stable SVT

1 - vagal manoeuvres

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2nd line treatment stable SVT

IV adenosine | - if asthma IV verapamil

what is used instead of adenosine in 2nd line treatment stable SVT

IV verapamil

treatment stable VT

amiodarone loading dose followed by 24 hour infusion | or lidocaine

what drug should NOT be used in VT

verapamil

treatment irregular broad complex tachycardia

AF with BBB - treat same as unstable narrow/SVT

treatment polymorphic VT

IV mag sulf

treatment sinus tachycardia

beta blocker

definitive treatment of WPW

radioablation of extra pathway

acute AF treatment - heamodynamically unstable

emergency cardioversion (rhythm control) DCCV

rate control 1st line in AF

BB or CCB (diltiazem)

2nd line rate control in AF

digoxin e.g. if HF

what should always be given before rhythm control

antiplatelet

1st line rhythm control in AF if evidence of structural heart disease

amiodarone 900mg over 24 hours

1st line rhythm control in AF if no evidence of structural heart disease

flecainide

when is rhythm control indicated in AF

symptoms for < 48 hours or be anticoagulated

if AF > 48 hours how long must someone be taking heparin before cardioversion

3 weeks

treatment chronic AF

BB or CCB

3rd line treatment chronic AF if BB or CCB not worked

digoxin

when would rhythm control be used in chronic AF

```  Symptomatic.  CCF present.  Younger patient.  Presenting for the first time with lone AF.  Reversible cause ```

what is the drug used in rhythm control in chronic AF

sotalol or amiodarone for 4 weeks

anticoagulation in AF stroke risk score assessment

CHADVASC

what drug is used as anticoagulation in chronic AF

noac - edoxaban, apixaban, rivaroxaban, dabigatran

treatment atrial flutter

beta blocker | RFA

treatment unstable VT

DCCV

sustained VT

amiodarone central line

treatment V fib

DCCV

what drugs can cause TdP

macrolides - clarithromycin etc

tx LQTS

low risk - lifestyle modifications and beta blockers | high risk- lifestyle + ICD +/- BB

unstable bradycardia

atropine 500mcg IV repeat up to 3mg at 2-3 min intervals

tx mobitz type 1

nothing unless associated with haemodynamic instability / collapse - if so atropine, TC pacing

tx mobitz type 2

ventricular pacemaker

tx 3rd degree heart block

ventricular pacing

when is HTN treated

``` stage 2 and above or stage one if  Diabetes.  Renal disease.  End organ damage.  Established cardiovascular disease.  10-year cardiovascular risk > 10%. ```

tx HTN in diabetes

ACEI 1st line

tx HTN in young patients with diabetes if ACEI not tolerated or may become pregnant or have clear sign of sympathetic drive i.e. sweating, palpitations

tx pathway HTN < 55 or T2DM

1) ACEI 2) ACEI + CCB or ACEI + thiazide 3) ACEI + CCB + thiazide 4) spironolactone (if K<4.5) or alpha or beta blocker if K >4.5

tx pathway HTN non diabetics > 55 or afrocarribean

1) CCB 2) ACEI + CCB or ACEI + thiazide 3) ACEI + CCB + thiazide 4) spironolactone (if K<4.5) or alpha or beta blocker if K >4.5

hypertensive crisis

no end organ damage - oral treatment end organ damage but no LVF - labetolol end organ damage with LVF - furosemide and hydralazine

ix HF

raised BNP - 1st line

non-pharmacological tx HF

weight loss fluid restrict salt restrict exercise

1st line tx heart failure

ACEI + BB

2nd line tx HF

spironolactone

risk of spironolactone + ACEI

hyperkalaemia - monitor

3rd line HF

digoxin ivabradine hydralazine sacubitril-valsartan

acute tx HF

``` sit up high flow O2 furosemide IV diamorphine IV nitrates IV CPAP ``` some others find dinner not crucial

when should diamorphine not be used in HF

COPD

ix endocarditis

blood cultures from 3 separate sites time and person | 1st line imaging TTE

imaging in endocarditis if prosthetic valve, vegetations or non-diagnostic image on TTE

TOE

native valve endocarditis tx

amoxicillin and gent

severe native valve endocarditis tx or penicillin allergy or MRSA

vanc and gent

staph aureus endocarditis tx

flucloxicillin

strep viridans endocarditis tx

benzylpenicillin

prosthetic valve staph endocarditis tx

fluclox + rifampicin + gent

prosthetic valve staph endocarditis treatment penicillin allergy

vanc + rifampicin + gent

enterococcus endocarditis tx

amox/vanc + gent

prosthetic valve blind endocarditis tx

vanc + gent + rifampicin

symptom control HOCM

Bblockers / verapamil

tx arrhythmic right ventricular cardiomyopathy

rhythm control - bb / amiodarone | ICD

pericarditis tx

NSAID and colchicine

pericardial effusion tx

pericardiocentesis

cardiac tamponade tx

pericardiocentesis

diagnostic ix aortic dissection

CT angio CAP

tx aortic dissection

analgesia and bed rest type A - open or endovascular repair and maintain BP between 100-120 type B - beta blockers

AAA screening

all men > 65 - single ultrasound

ruptured AAA investigation

ruptured AAA treatment

open or endovascular repair - infrarenal EVAR - suprarenal TVAR

AAA < 5.5cm

monitor

how often do you scan AAA 3-4.4cm

yearly

how often do you scan AAA 4.5-5.4cm

3 monthly

first line investigation peripheral arterial disease

duplex US

tx peripheral arterial disease

clopidogrel and statin lifestyle - exercise beyond pain surgical - stent, endartarectomy, BPG

acute limb-threatening ischaemia investigation

hand held doppler examination + ABPI

acute limb-threatening ischaemia treatment

IV opioid and IV unfractionated heparin

superficial thrombophlebitis tx

LMWH for 30 days or fondaparinaux for 45 | oral NSAID 2nd line

DVT treatment 1st line

NOAC e.g. rivaroxaban

DVT 2nd line treatment

LMWH + warfarin or LMWH + dabigatran/edoxaban

how long should anticoagulation continue in unprovoked DVT

6 months

how long should anticoagulation continue in provoked DVT

3 months

PE treatment 1st line

rivaroxaban

PE treatment 2nd line

LMWH + dabigatran or edoxaban | or LMWH + warfarin

when would LMWH + warfarin be used in PE/DVT treatmetn

renal failure and APLS

HTN treatment in patients with CKD and ACR > 30 regardless of age

ACEI / ARB

Cardio Flashcards

(106 cards)