Cardiology Flashcards
(39 cards)
4Hs and 4Ts causing cardiac arrest
Hypoxia
Hypothermia
Hypovolaemia
Hyper/hypokalaemia
Thrombosis
Toxins
Tamponade (cardiac)
Tension pneumothorax
Shockable rhythms + their treatment
Ventricular tachycardia + ventricular fibrillation
CPR (30:2)
Shock
Resume CPR for 2 mins then reassess
1mg IV adrenaline every 3-5 mins
300mg IV amiodarone after 3 shocks
150mg IV amiodarone after 5 shocks
Non-shockable rhythms + their treatment
Pulseless electrical activity + asystole
CPR (30:2)
1mg IV adrenaline ever 3-5 mins
What to do if circulation resumes during cardiac arrest
ECG Maintain O2 94-98% Aim for normal CO2 Treat cause Control temperature
Investigations needed in MI
ECG FBC Troponin CK Glucose LFTs + UEs Random blood glucose Lipids
CXR (HF signs)
Initial management of MI
AMON
Aspirin 300mg PO
Morphine 5-10mg PO (+anti-emetic)
Oxygen (if O2 <94%)
Nitrates (GTN, IV if fails)
When to do PCI for STEMI + other tx also needed
<12h since symptom onset
Within 120m of when fibrinolysis could have been given.
DAPT
- Aspirin 300mg loading dose –> 75mg OD
+ 60mg Prasugrel loading dose –> 5mg OD (low bleeding risk) OR
+ 300mg clopidogrel loading dose –> 75mg OD (high bleeding risk)
Anticoagulation (e.g. 2.5mg fondaparinux)
When to do fibrinolysis for STEMI + other tx also needed
<12h since symptom onset
PCI not available within 120m.
DAPT - Aspirin 300mg loading dose –> 75mg OD
+ 180mg ticagrelor loading dose –> 90mg OD (low bleeding risk) OR
+ 300mg clopidogrel loading dose –> 75mg OD (high bleeding risk)
Anticoagulation (e.g. 2.5mg fondaparinux)
Repeat ECG in 60-90 mins.
If STE not resolved –> urgent PCI
When is fibrinolysis contraindicated
Recent stroke (<3 months) Malignancy GI bleed Aortic dissection HTN (>200/120) Trauma (including recent CPR)
Treatment for stable NSTEMI
BATMAN
- bisoprolol (2.5mg OD)
- Aspirin (300mg loading –> 75mg OD)
- Ticagrelor (180mg loading –> 90mg OD)
- Morphine (+anti-emetic)
- Anticoagulant (2.5mg SC fondaparinux for 8 days)
- Nitrate (GTN)
When is an NSTEMI unstable + what is the tx
Haemodynamic instability Pain continuing despite tx Dynamic ECG changes LVF Life threatening arrythmias
refer for coronary angiography + revascularisation
then commence BATMAN
Ix if ? acute left ventricular failure
ECG - often ischaemic changes CXR - 80% have signs of HF Troponin - ?MI precipitating cause Baseline bloods ABG - T1 respiratory failure Echo
Initial Tx for acute left ventricular failure
SIT UP Stop IV fluids Oxygen if hypoxic 40mg IV furosemide 2.5-5mg IV diamorphine (can act as vasodilator) GTN (2 SL sprays - acts as vasodilator)
When is specialist input needed for acute left ventricular failure
Input from HF specialist within 24h.
If cardiogenic shock (SBP <100) = refer to ICU
- inotropes (dobutamine)
- vasopressers (adrenaline)
- to increase BP and maintain perfusion
Management of acute left ventricular failure once patient is stable
daily weights
switch to oral furosemide
ACEi if LVEF <40%
repeat CXR
When is referral for same day assessment needed in HTN?
If ? accelerated hypertension.
BP >180/110 AND
- signs of retinal haemorrhage/papilloedema
- signs of end organ damage (AKI, HF, chest pain, new confusion)
if ?phaeochromocytoma
Immediate treatment for accelerated hypertension
20mg IV labetalol every 10 mins according to response
Maximum dose = 300mg
Who gets ACEi 1st line for HTN (+ doses + monitoring)
T1DM + <55s
- 5-2.5mg PO ramipril OD.
- Increase up to 10mg if necessary at 2-4w intervals
- U&Es 2 weeks after initiation
Alternative to ACEi (+ dose)
ARBs
50mg PO Losartan OD
- increase up to 100mg if necessary
- start with 25mg if >76
Who gets CCB 1st line for HTN (+ doses + monitoring)
Black people + >55s
5mg PO amlodipine OD
- Increase to 10mg if necessary
Dose of thiazide diuretic used in HTN
- 5mg PO indapamide OD
- take in morning
- U&Es before and 2-4w after
How to confirm diagnosis of HTN
Suspect if clinic BP >140/90
- measure in both arms
- repeat
Ambulatory BP monitoring to confirm - >135/85 or Home BP monitoring if not tolerated - 2 consecutive measures, 1 min apart - morning + eve for 7 days
When to refer HF patients to a specialist
- BNP values + others
2 weeks if BNP >2000
6 weeks if BNP >400
HF not responding to tx HF resulting from valvular heart disease LVEF <35% Severe HF (NYHA IV) ? if co-morbidities (e.g. CKD)
Treatment of reduced ejection fraction HF
Loop diuretic - Furosemide
- 20-40mg PO OD (increase to 120mg if needed)
- Check U&Es/BP before and 1-2 weeks after
ACEi - Ramipril
- 2.5mg PO OD (increase to 10mg if needed)
- Check U&Es/BP before and 1-2 weeks after
- 1st line if DM/signs of fluid overload
Beta blocker - bisoprolol
- 1.25mg PO OD (increase to 10mg if needed)
- 1st line if angina symptoms
EVENTUALLY COMBINE ACEi + BB
Spironalactone
- 25mg PO OD (can increase)
- improves mortality
