cardio conditions Flashcards by Susannah Welch

whats the first line treatment for a 45 year old afroCaribbean with hypertension?

CCB (amlodipine)

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how do you treat resistant hypertension?

low dose spironolactone - monitor U&Es

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what are investigations for angina?

CT coronary angiography (CTCA) - young atypical symptoms

exercise tolerance test (ETT) - old classic symptoms but normal ECG

old + classic symptoms = clinical diagnoses

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whats the first line treatment for angina?

symptomatic relief = GTN spray (vasodilator)

beta blocker - bisoprolol
CCB - amlodipine

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how do you diagnose acute coronary syndrome?

unresponsive to GTN

ST elevation or new LBBB = STEMI

raised troponin or other ECG change = NSTEMI

none of above = unstable angina or MSK chest pain

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what is meant by serial troponins and when are they commonly done?

used in ACS diagnosis

should be done on arrival to hospital then 6-12hrs later
- a rise is consistent with myocardial ischemia (released from ischaemic muscle)

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what is the treatment of an acute STEMI?

within 2hrs of presentation = PCI

after 2 hrs = thrombolysis (injecting fibrinolytic medication which break down fibrin + rapidly dissolves clot)

( + MONAA)

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what is the treatment for an acute NSTEMI?

MONAA

M - morphine
O - oxygen (<95%)
N - nitrates - sublingual GTN
A - aspirin (antiplatelet)
A - antiplatelet = ticagrelor

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what is the GRACE score used for?

gives 6 month risk of death or repeat MI after NSTEMI

<5% = low risk
5-10% = medium risk
> 10% = high risk

medium or high risk - early PCI to treat underlying CAD

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what are the 6 As of secondary prevention management of ACS?

Aspirin
Another antiplatelet - clopidogrel, ticagrelor
Atorvastatin
ACEi - ramipril
Atenolol - or other betablocker
Aldosterone antagonist for those with clinical HF (spironolactone)

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what are symptoms of limb ischaemia?

limb ischaemia = arteries = ARTS

A - absent pulse + hair
R - red sores (ulcers)
T - toes + feet pale or black
S - sharp calf pain

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what are the 6 Ps of acute limb ischaemia?

pain - unrelieved
paraesthesia - tingling + numbness
pulseless
pallor - pale
polar - cold
paralysis

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what are investigations for limb ischaemia?

artery brachial index (ABI)

normal = 0.9 - 1.3
claudication = 0.4 - 0.85
severe = 0 - 0.4

doppler ultrasound

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how do you manage limb ischaemia?

LWMH
anti-platelet - aspirin
cholesterol lowering - statins

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what are aneurysms? what are pseudoaneurysms?

permanent dilatation of the artery to twice the normal diameter

false aneurysm = pseudoaneurysm = surrounding tissue form wall of aneurysm

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when should you repair an abdominal aortic aneurysm?

> = 5.5cm in diameter
expanding at a rate of >1cm/year
symptomatic

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what are symptoms of abdominal aortic aneurysms?

mostly asymptomatic but if rapid expansion / rupture:

severe pain - epigastric, radiating to the back
hypotension, tachycardia, profound anaemia, sudden death
trashing - discolouration due to emboli from aortic thrombus

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what is the management of a DVT?

6 weeks anti-coagulation = LWMH
thrombolytic therapy for large iliofemoral thrombosis
compression stockings

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what is the acute management of supraventricular tachycardia?

step wise with continuous monitoring:

valsalva manoeuvre - NOT in patients with clot risk
carotid sinus massage - “
adenosine - rapid bolus, feel like dying - contraindicated in asthmatics
verapamil (CCB)
DC cardioversion - if haemodynamically unstable do first

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long term management of SVTs?

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CCBs - verapamil, diltiazem
beta blockers
flecainide / amiodarone
radiofrequency ablation

when would you not give rate control in AF?

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reversible
new onset - within 48hrs
causing HF
remain symptomatic despite rate control

the moment AF switches to sinus rhythm is when there’s the highest risk for embolism leading to stroke

how can this risk be reduced?

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CHAD2Ds2-VASc - assess risk of emboli stroke (>2 anticoagulate)
HASBLED - risk of bleeding

anticoagulation:

warfarin= vitamin K antagonist (give K to counteract)
- maintain INR between 2-3
- needs monitored, interaction problems, long half life
DOACs
- shorter half life
- apixaban, edoxaban, rivaroxaban = factor Xa inhibitors
- dabigatran = thrombin inhibitor

what is the most common method of rhythm control?

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cardioversion

DC cardioversion = timed electric shock

must have had symptoms <48hrs or be anticoagulated prior
echo first to look for emboli

pharmacological cardioversion

flecainide = Na channel blocker
amiodarone = K channel blocker

if neither work - catheter ablation

what does an ECG of atrial flutter look like?

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regularly irregular
no p waves - “saw tooth T waves”
normal QRS duration

what does an ECG of Wolff-Parkinson White look like? how is this treated?

short PR interval <0.12s wide QRS complex >0.12s delta wave - slurred upstroke of QRS definitive treatment = radiofrequency ablation of the accessory pathway.

how can supraventricular tachycardia and ventricular tachycardia be differentiated?

adenosine no effect in VT but will help SVT

what is torsades de pointes?

ventricular contraction prior to proper repolarisation polymorphic VT - QRS progressively smaller then larger over and over occurs in patients with prolonged QT interval terminate spontaneously or progress into VT

what does an ECG of Brugada syndrome look like?

ST elevation with RBBB in leads V1-3 changes may be seen after administering flecainide - Na channel blocker

what is the treatment for 2nd (mobitz II) and 3rd degree heart block?

first line = atropine IV ``` no improvement - other inotropes (noradrenalin) defibrillate ``` long term = pacemaker

how is heart failure classified?

New York Heart Association (NYHA) classification - - class I = no exercise limitation, no fatigue, dyspnoea or palpitations - class II = mild limitation, comfortable at rest but normal physical activity produces fatigue, SOB or palpitations - class III = marked limitation, comfortable at rest but gentle activity produces symptoms - class IV = symptoms of heart failure occur at rest and are exacerbated by any physical activity

what are the symptoms of heart failure?

exertional dyspnoea orthopnoea - SOB when lying down, relieved by standing (how many pillows? paroxysmal nocturnal dyspnoea - sudden awake with SOB + cough cough - white/pink frothy sputum peripheral oedema - pitting

signs of HF?

bi-basal crackles elevated JVP 3rd and 4 th heart sounds cardiomegaly

what is an elevated BNP a sign of?

heart failure

what is the drug therapy for heart failure?

ACEi - ramipril (avoid with valvular heart disease) beta-blockers - bisoprolol (not for asthmatics) spironolactone in HFrEF + symptoms not controlled with ACE + Beta - (thin, weak, unable to eject fully, EF <=40%)

treatment for LVF + pulmonary oedema?

Pour SOD pour - pour away (stop) IV fluids S - sit up - takes fluid to bases O - oxygen if <95% D - diuretic(loop) = furosemide (reduces circulating volume)

causes of infective endocarditis?

bacteraemia - poor dental hygiene, IV drugs, prosthetic heart valves rheumatic disease congenital abnormalities + degeneration * valve disease promotes platelet/fibrin deposition

signs of infective endocarditis?

new/changing heart murmur sepsis/embolic event of unknown origin splinting haemorrhages - bloody lines in nail beds roth spots - red spots in back of the eye with pale centres janeway lesions - nonpainful, red spots on hand palms or feet soles osler nodes - painful, bloody nodules on finger tips/toes

what are the causative organisms of infective endocarditis?

staph aureus - IV drug users - usually tricuspid valves staph epidermis - prosthetic valves strep viridans - after dental surgery ``` HACEK group (gram -ves) Haemophilus Actinobacillus Cardiabacteria Eikenella Kingella ```

investigations for infective endocarditis?

take 3 sets of blood cultures from different sites - before treatment --> if negative think atypical echo for endocardial involvement - vegetation, abscess, dodgy prosthetic CRP, inflammatory markers, FBC

patient gets pericarditis 4-6weeks post MI

Dressler's syndrome

what is the wells score used for?

DVT risk calculation

A 60-year-old man with a history of late-stage cirrhosis and alcohol abuse is being managed on the gastroenterology ward. An abnormality is found on his most recent echocardiogram. What is the MOST LIKELY diagnosis?

dilated cardiomyopathy

treatment for native valve infective endocarditis

amoxicillin, gentamicin IV for 4-6weeks --> step viridans (after dental) (Already Got native valve)

treatment for prosthetic valve infective endocarditis

Vancomycin, Gentamicin IV + Rifampicin PO for 4-6 weeks --> staph epidermidis (prosthetic valve has Very Good Rhythm)

treatment for staph aureus infective endocarditis

flucloxacillin IV 4-6weeks

treatment for suspected MRSA infective endocarditis

vancomycin, rifampicin, gentamicin IV 4-6weeks

treatment of first degree heart block

no intervention (if stable) | PR >0.2s

tachycardia treatment of an unstable patient

up to 3 synchronised shocks | amiodarone IV

treatment of stable ventricular tachycardia

amiodarone infusion

cardio conditions Flashcards

(49 cards)