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(Y5) ACT conditions management > Cardiology > Flashcards

Cardiology Flashcards

1
Q

4Hs and 4Ts causing cardiac arrest

A

Hypoxia
Hypothermia
Hypovolaemia
Hyper/hypokalaemia

Thrombosis
Toxins
Tamponade (cardiac)
Tension pneumothorax

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2
Q

Shockable rhythms + their treatment

A

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

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3
Q

Non-shockable rhythms + their treatment

A

Pulseless electrical activity + asystole

CPR (30:2)
1mg IV adrenaline ever 3-5 mins

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4
Q

What to do if circulation resumes during cardiac arrest

A 
ECG
Maintain O2 94-98% 
Aim for normal CO2 
Treat cause 
Control temperature
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5
Q

Investigations needed in MI

A 
ECG
FBC 
Troponin 
CK 
Glucose 
LFTs + UEs 
Random blood glucose 
Lipids

CXR (HF signs)

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6
Q

Initial management of MI

A

AMON

Aspirin 300mg PO
Morphine 5-10mg PO (+anti-emetic)
Oxygen (if O2 <94%)
Nitrates (GTN, IV if fails)

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7
Q

When to do PCI for STEMI + other tx also needed

A

<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)

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8
Q

When to do fibrinolysis for STEMI + other tx also needed

A

<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

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9
Q

When is fibrinolysis contraindicated

A 
Recent stroke (<3 months) 
Malignancy
GI bleed
Aortic dissection
HTN (>200/120)
Trauma (including recent CPR)
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10
Q

Treatment for stable NSTEMI

A

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)
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11
Q

When is an NSTEMI unstable + what is the tx

A 
Haemodynamic instability 
Pain continuing despite tx 
Dynamic ECG changes 
LVF 
Life threatening arrythmias

refer for coronary angiography + revascularisation
then commence BATMAN

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12
Q

Ix if ? acute left ventricular failure

A 
ECG - often ischaemic changes 
CXR - 80% have signs of HF 
Troponin - ?MI precipitating cause 
Baseline bloods 
ABG - T1 respiratory failure 
Echo
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13
Q

Initial Tx for acute left ventricular failure

A 
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)
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14
Q

When is specialist input needed for acute left ventricular failure

A

Input from HF specialist within 24h.

If cardiogenic shock (SBP <100) = refer to ICU

  • inotropes (dobutamine)
  • vasopressers (adrenaline)
  • to increase BP and maintain perfusion
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15
Q

Management of acute left ventricular failure once patient is stable

A

daily weights
switch to oral furosemide
ACEi if LVEF <40%
repeat CXR

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16
Q

When is referral for same day assessment needed in HTN?

A

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

17
Q

Immediate treatment for accelerated hypertension

A

20mg IV labetalol every 10 mins according to response

Maximum dose = 300mg

18
Q

Who gets ACEi 1st line for HTN (+ doses + monitoring)

A

T1DM + <55s

  1. 5-2.5mg PO ramipril OD.
    - Increase up to 10mg if necessary at 2-4w intervals
    - U&Es 2 weeks after initiation
19
Q

Alternative to ACEi (+ dose)

A

ARBs

50mg PO Losartan OD

  • increase up to 100mg if necessary
  • start with 25mg if >76
20
Q

Who gets CCB 1st line for HTN (+ doses + monitoring)

A

Black people + >55s

5mg PO amlodipine OD
- Increase to 10mg if necessary

21
Q

Dose of thiazide diuretic used in HTN

A
  1. 5mg PO indapamide OD
    - take in morning
    - U&Es before and 2-4w after
22
Q

How to confirm diagnosis of HTN

A

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
23
Q

When to refer HF patients to a specialist

- BNP values + others

A

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)
24
Q

Treatment of reduced ejection fraction HF

A

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
25
Q

Treatment of preserved ejection fraction HF

A

Loop diuretic

- up to 80mg furosemide

26
Q

Ix and action if ? DVT

A 
Wells score + Ix within 4 hours 
<2 = DVT unlikely 
- D-dimer then USS if +ve
>2 = DVT likely 
- Proximal leg USS

Baseline bloods if starting anticoagulants
- do not delay tx for results, but review in 24 hours

27
Q

1st line tx for DVT (2 )

A

Anticoagulation

  • 10mg Apixiban PO BD for 7 days –> 5mg BD maintenance
  • 15mg Rivaroxiban PO BD for 21 days –> 20mg OD maintenance
28
Q

2nd line tx for DVT

A

SC LMWH for 5-10 days
- e.g. 1.5mg/kg fondaparinux

THEN

  • dabigatran
  • edoxoban

If pregnant = LMWH

29
Q

How long to anti-coagulate for in DVT

A

Provoked = 3m then review

Unprovoked = at least 6 months

30
Q

When to refer pt with DVT

A
  • Pregnant/given birth within past 6 months
  • If Ix needed for ?cancer
  • If Ix needed for ?thrombophilia
31
Q

Ix if ? acutely ischaemic limb

A

ABPI (PAD if <0.9)

Duplex ultrasound = assess degree of stenosis

ECG (underlying cardiac probs causing embolism)

Bloods

  • FBC, ESR
  • thrombophilia screen
  • lipids
32
Q

Management of acutely ischaemic limb

A

Urgent vascular referral!!

  • endovascular thrombolysis/thrombectomy
  • surgical thrombolysis/thromectomy/angioplasty
  • amputation if non-viable limb

Meanwhile

  • anti-platelet (75mg aspirin/clopidogrel)
  • anti-coagulant
  • analgesia
33
Q

When should patient with superficial thrombophlebitis be referred to a specialist

A
  • underlying cause thought to be due to cancer

- signs of infection

34
Q

Signs that superficial thrombophlebitis might progress to DVT and how to manage this?

A
  • Superficial thrombus >5cm
  • Superficial thrombus at junction joining superficial and deep veins (e.g. sapheno-femoral)
  • Superficial thrombus not associated with varicose vein
  • Patient immobile
  • Patient has cancer

Anticoagulate (e.g. 10mg apixiban BD –> 5mg BD)

35
Q

Management of simple thrombophelbitis

A
  • Analgesia (paracetamol, NSAID, topical NSAID)
  • keep leg elevated
  • stay mobile
  • warm towel to relieve discomfort
  • treat underlying varicose veins
  • Compression stockings (rule out PAD 1st)
36
Q

Initial management of complete heart block

A

500 micrograms IV atropine

can repeat dose up to 3mg

37
Q

Management if complete heart block refractory to initial tx or risk of asystole

A

SEEK HELP

Repeat IV atropine up to 3mg

? transcutaneous pacing

5 micrograms IV isoprenaline

2-10 micrograms IV adrenaline

38
Q

What increases risk of asystole in complete heart block

A
  • recent asystole
  • broad QRS
  • ventricular pause >3 seconds
39
Q

Medications to treat postural hypotension

A

1st line

  • 0.1-0.2mg fludrocortisone + 1mg of NaCl with meals
  • SE: hypertension, AKI, cardiac fibrosis

2nd line = sympathomimetics
- 2.5mg midodrine TDS

(Y5) ACT conditions management (5 decks)

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