Cardiology Flashcards
What are the indications for heart transplant?
- Cardiogenic shock requiring either continuous intravenous inotropic support or circulatory support with a balloon pump or LVAD
- NYHA III-IV symptoms despite max medical and surgical Mx
- Intractable or severe angina coronary artery disease not amenable to PCI or CABG.
- Intractable life-threatening ventricular arrhythmias (+/- frequent AICD firing) unresponsive to medical therapy, catheter ablation, surgery, and/or ICD
- Selected patients with restrictive and hypertrophic cardiomyopathies and NYHA Class III to IV HF
- Selected congenital heart disease
What dietary advice should be given to reduce CV risk?
- 6 serves of carbs daily
- 5(females) to 6(males) serves (75g each) of vegetables daily
- 2 serves (150g each) of fruit daily
- 2.5 serves dairy daily
- 2.5-3 serves of protein (meat, legumes, nuts) daily
What are the contraindications for heart transplant?
- Active malignancy
- Complicated diabetes with end-organ disease or HbA1c>7.5%
- BMI>30
- HIV
- Advanced disease of any system that precludes cardiac rehab post-transplant
- Active substance abuse: EtOH, ongoing tobacco, illicit drugs (must be clean for >6 months)
- Inability to comply with complex medical regimes
- Active medical conditions: sepsis, PE, active peptic ulcer disease, etc
What are the crteria for diagnosis of HFrEF?
Symptoms and signs of heart failure and EF < 40%
OR
Symptoms and signs of heart failure and EF 41-49% AND evidence of diastolic dysfunction with high filling pressures on right heart cath / TTE / BNP
Who is eligible for evolocumab (PCSK9 inhibitor)
- Homozygous familial hypercholesterolaemia
- Heterozygous familial hypercholesterolaemia not responsive to or intolerant of statins
- Primary hypercholesterolaemia and pre-existing ischaemic cardiovascular disease (CVD) after inadequate response or intolerance to statins
What are the causes of dilated cardiomyopathy?
HTN Valvular heart disease Persistent rapid AF >10% VEBs SVT EtOH Chemotherapy Hyperthyroidism Viral Autoimmune Amyloid Sarcoid Iron overload Post-partum Genetic
What are the indications for IVC filter?
- Contraindication to anticoagulation
- Recent haemorrhage
- Impending surgery
- Documented failure of anticoagulation
- Complications of anticagulation
- High risk of PE despite anticoagulation
- High risk bleeding area such as neuroaxial surgery
- Large, free-floating thrombus
- Massive PE and DVT in patients with limited cardiopulmonary reserve
What is the treatment for anthracycline induced cardiomyopathy?
ACEIs and ARBs shown to slow progression of left ventricular dysfunction
Which HFrEF patients are potential candidates for heart transplantation?
- NYHA III-IV refractory to optimal Rx
- Severe LV dysfunction
- VO2 max ≤12 mg/kg/min
- Seattle Heart Failure Model one-year estimated
survival <80% - No contraindication to heart transplantation
What are the relative contraindications to heart transplant?
- CrCl<40
- Bili > 50 mol/L
- Intractable ascites with hypoalbuminaemia
- Fixed pulmonary HTN with transpulmonary gradient > 15mmHg or PVR > 4 Woods units after pulmonary vasodilator challenge (IV GTN, IV prostacyclin or inhaled nitric oxide)
What should be considered in patients with fixed pulmonary HTN needing heart transplant?
Heterotropic (piggy-back; native heart left in parallel) heart transplant or long term mechanical circulatory support
What is the optimal age of a heart donor?
30years or under
- Mortality increases progressively from there onwards
What is the optimal total ischaemic time (aortic clamp in donor to aortic clamp release in recipient)?
200min
- Progressive increase in 1 year post-transplant mortality
What viral serology needs to be performed in donors pre-transplant?
HIV, Hep B, Hep C, CMV, EBV
In older women aged 50-79, which antihpertensive class has the highest CV mortality rate?
CCB (dihydropyridines worse than nondihydropyridines)
Diuretics, beta blockers, ACEIs better
(JAMA 2004)
