Cardio6 Flashcards
(39 cards)
What is the prevalence of in AUS - a) CV death b) AF c) Heart Failure d) Idiopathic pulmonary hypertension
a) second only to cancer b) 2% c) 1-2% d) 30 per 1 million
What is cardiac asthma?
Bronchospasm in the setting of congestive cardiac failure
Caused by intersitital oedema
BNP cut offs for HF?
BNP (ng/L)
Heart Failure rule in:
<100
Heart Failure rule out:
>400
What are ways of improving medication compliance and patient understanding in heart failure?
- Nurse led heart failure clinics
- Dosing aids - eg Webster packs
- Daily weights to quantify fluid status changes
If first line meds fail in heart failure what can you consider?
Ivabradine (induces bradycardia and decreases cardiac load) or ARNI eg sacabutril/Valsartan combo
Risk factors for AF?
AF incidence is increased with hypertension, obesity, alcohol use, obstructive sleep apnoea and diabetes.31
When would you admit to hospital in AF?
was unwell
had chest pain
was short of breath at rest
had clear signs of cardiac failure with lung crackles.
Symptomatic AF, or onset in 48 hours to consider cardioversion
What are the appropriate first line meds for AF?
The first-line medications are a beta blocker or non-dihydropyridine calcium antagonist, such as:
atenolol 25 mg daily, increasing to 50–100 mg daily
metoprolol 25 mg twice daily, increasing to 100 mg twice daily
diltiazem sustained-release 180–360 mg
verapamil 180–480 mg.
What kind of Calcium channel blocker can be used in AF rate control?
NON dihydropydridine
as they act on the AV node
the dihydros act peripherall and not on the AV node so they’re not helpful in rate control
Warfarin vs DOACs in terms of effectiveness?
DOACs have been shown to be equivalent to warfarin in preventing thromboembolism and may have a lower risk of causing bleeding.
What is the PBS criteria for DOAC in AF?
2019, DOACs are available only on the Pharmaceutical Benefits Scheme by Authority for AF with an additional CHADS2 factor
What monitoring is required for warfarinised patients?
INR will need regular testing to confirm a level between 2 and 3 is maintained. This may be done by a pathology service, a general practitioner or the patient using a point-of-care device (eg CoaguChek).
General advice to patients with AF? Lifestyle mods? Anticoag advice?
Explanation of the abnormal rhythm is important.
Lifestyle modification may be very helpful for some patients, particularly those with significant symptomatic paroxysmal AF. Alcohol reduction or abstinence, weight loss, increased physical activity and control of obstructive sleep apnoea and hypertension may reduce the frequency of recurrences.
When taking anticoagulation medication, the patient’s self-care is vital. If Kabir injures himself, he will have increased bleeding, and if he has a head injury, he may be at high risk of intracranial bleeding. Explain to Kabir that he should have a low threshold for presenting to you or to a hospital emergency department if such a situation arises. If Kabir requires surgery, the anticoagulant will need to be managed – not necessarily ceased – both preoperatively and postoperatively.
Factors favouring rhythm control?
severe symptoms, younger age and cardiac dysfunction
Factors favouring rate control?
Factors favouring a rate-control strategy include lack of symptoms, older age (>70 years) and previous side effects with anti-arrhythmic medicines.
Risk factors for ischaemic stroke?
hypertension, hypercholesterolaemia, diabetes, atrial fibrillation (AF), smoking and a family history of stroke. Other risk factors for ischaemic stroke include oral contraception, hormone replacement therapy or a history of patent foramen ovale
Suspected ischaemic stroke?
The Stroke Foundation recommends that patient are transferred by ambulance services to a hospital with reperfusion therapies and a stroke unit
What is involved in secondary prevention of stroke?
management of risk factors for recurrent stroke including addressing smoking, diet, physical activity, obesity and alcohol.
Patients should also be screened for depression.
Blood pressure, antiplatelet therapy/anticoagulation, cholesterol and diabetes can be managed comprehensively through a GP Chronic Disease Management Plan and a Team Care Arrangement.
Vilija may be taking multiple new medications following discharge. A Home Medicines Review with the community pharmacist could address her adherence to therapy and Vilija’s (and her husband’s) understanding of her condition.
Driving post stroke?
Patients are instructed not to return to driving private vehicles for at least four weeks post-stroke.
Peer support for strokes?
Groups such as those listed by the Stroke Foundation can provide peer support,
What are the categories of pulmonary hypertension?
Group 1 or pulmonary arterial hypertension (PAH). In this group, the distal pulmonary arterioles (and some venules) obstruct and obliterate over time, resulting in an increased pulmonary vascular resistance. Although rare, affecting up to 100 patients per million, this group currently has the most available treatment options. Idiopathic and autoimmune connective tissue diseases are the two most common causes, respectively.
Group 2 or pulmonary hypertension due to left heart disease. Referred to as post-capillary pulmonary hypertension or pulmonary venous hypertension, this group is the most common cause of pulmonary hypertension and usually reflects conditions that cause dysfunction of the left ventricle or valvular problems.
Group 3 or pulmonary hypertension due to lung disease or hypoxia. In these conditions, primary respiratory conditions such as chronic obstructive pulmonary disease, interstitial lung disease and obstructive sleep apnoea are the chief causes. Notably, only a small number of patients with these conditions develop pulmonary hypertension, but a history of these conditions often signifies a worse prognosis.
Group 4 or pulmonary hypertension due to chronic thomboembolic disease (CTEPH) reflects non-resolving occlusive pulmonary thromboembolic disease. Importantly, surgical resection can greatly improve the condition, and select vasodilators may be helpful.
Group 5 or pulmonary hypertension due to multifactorial or unclear mechanisms.
Initial investigations in pulmonary hypertension?
FBE, Bedside spirometry and Transthoracic Echocardiogram
Secondary assessment in Pulmonary hypertension?
Refer to Pulmonary hypertention specialist centre
Aside from a clinical assessment, this will usually involve detailed review of the echocardiogram; high-resolution computed tomography (CT) of the chest to evaluate for significant parenchymal lung disease, ventilation–perfusion study to evaluate for chronic thromboembolic pulmonary embolism (as distinct from acute pulmonary embolism), and pulmonary function tests (PFTs) to evaluate for parenchymal disease and gas transfer. Additional tests such as autoimmune serology (eg anti-nuclear antibody and extractable nuclear antigen) and a sleep study are often considered.
A right heart catheter procedure, while invasive, is considered a safe and essential test with a much lower morbidity when compared with the much more commonly performed left heart catherisation for coronary artery disease. It is also a requisite for accessing high specialised Group 1 PAH (and less commonly Group 4 CTEPH) therapy via the Pharmaceutical Benefits Scheme (PBS).
