Cardiology Flashcards
(33 cards)
After reperfusion with fibrinolytics for a STEMI, how long should anticoagulation therapy continue for?
48 hours or up to 8 days
What is part of long term management after ACS?
DAPT (ASA + ticagrelor, prasugrel or clopidogrel)
B blockers for 3 years
ACE
Potentially aldosterone receptor blockers if already on ACE/beta blocker
High intensity statin
What comprises the TIMI score?
65 year old, 3 or more risk factors for CAD, ST deviation, 2 or more anginal events in previous 24 hours, use of ASA in previoius 7 days, elevated cardiac biomarkers, prior coronary stenosis 50%
Which patients are indicated for ischemia guided therapy?
TIMI 0 or 1
Low likelihood of ACS with negative troponins
Which patients are indicated for GP IIb/IIIa inhibitors?
High risk features (elevated troponins) may/may not have inadequate clopidogrel or ticagrelor pretreatment
What is an optimal anticoagulation treatment for STEMI patients with a high risk of bleeding?
Bivalirudin and GPIIb/IIIa
Which ACS indication is bivalirudin not indicated?
Post-Fibrinolytic therapy
When should fibrinolytic therapy be indicated?
> 120 min after medical contact
How long should clopidogrel and ticagrelor be discontinued before ELECTIVE CABG?
Clopidogrel/ticagrelor: 5 days
What prerequirement is there before initiating inotropic therapy in HF patients?
Make sure PCWP is 15-18 mm Hg which gives adequate filling pressures
What agents can be used as refractory therapy to diuretics in HF?
Vasodilators like nitroglycerin and nitroprusside
What are indications to use milrinone or dobutamine in HF?
Used primarily to manage hypoperfusion with adequate filling pressures
Dobutamine: hypotensive
Milrinone: if using B blocker
What can be used for REGULAR narrow complex tachycardia?
Adenosine
What can treat wide complex ventricular tachycardia?
IV procainamide, amiodarone, lidocaine (2nd line)
What antiarrhythmics should be avoided due to QTC prolonging?
Procainamide, sotalol, dofetilide, ibutilide, dronedarone
What contraindication is there for Class Ic antiarrhythmics (propafenone, flecainide) for AF conversion/maintenance?
HF or post-MID to increase risk of sudden death
What medication considerations should you make when implanting an ICD?
Beta blockers are mainstay therapies and effective in reducing SCD
What medications are best for HF patients with arrhythmias?
Amiodarone and dofetilide
AVOID class Ia, Ic and dronedarone
What medications are best for acute MI patients with arrhythmias?
Amiodarone and dofetilide
AVOID class Ia and Ic (CAST: showed mortality with dofetilide)
Which antiarrhythmics are more indicated for maintenance THAN chemical conversion of arrhythmias?
Sotalol and dronedarone
Which IV hypertensives should be avoided in those with MI or HF?
MI: nicardipine, hydralazine (reflex tachycardia)
HF: Esmolol, labetalol, clevidipine, nicardipine
What IV hypertensives should be avoided in elevated ICP?
Sodium nitroprusside, nitroglycerin, hydralazine
What are the CI for sodium nitroprusside?
Renal and hepatic failure due to cyanide toxicity
What are the CIs for Enalaprilat?
Pregnancy, renal artery stenosis and angioedema
