Cardiology Flashcards
(30 cards)
What are some non- cardiac causes of AF
- Thyrotoxicosis (check tfts)
- Acute infection
- Pulmonary disease (check cxr)
- Alcohol excess (acute or chronic)
- The peri operative period
Which cardiology medication should be stopped in patients with AF & why?
Ivabradine- ineffective
How is acute onset AF (<48 hours) managed?
- HR controlled
- Offered cardioversion
- If haemodynamically unstable, DC cardioversion
- If haemodynamically stable, pharmacological- dc if this fails
What medications are used for pharmacological cardioversion in ACUTE AF?
amiodarone
vernaket
Flecainide
Terms for cardioversion if AF has been present >48 hours?
- Electrical cardioversion preferred
- Attempt after at least 3 weeks of anticoagulation/
- rule out left atrial thrombus & start parenteral anticoag
- after cardioversion, oral anticoag minimum 4 weeks
What is first line for long term rhythm control in AF?
B blockers
What are 2nd line for long term rhythm control in AF? What are the contraindications of each?
- Flecainide or propafenone (if no IHD, structural heart disease or heart failure),
- dronedarone (if no LVSD or heart failure present)
- amiodarone
What drug is first line for AF if patient has acute heart failure and why?
Digoxin
Because b blockers contraindicated in acute HF
RLCCBs contraindicated in HF
What medication can be used for pill in the pocket for paroxysmal AF?
- flecainide (300mg for patients >70kg, 200mg if <70kg)
- propafenone (600mg for patients >70kg, 450mg if <70kg).
MAX 1 dose in 24 hours
Which AF drug should be avoided in paroxysmal AF?
digoxin as it can flip them from sinus rhythm into af & worsen the af
What is the main risk of cardio version >48 hours?
There is a risk that a thrombus has formed and successful cardioversion could lead to a stroke.
Which cardiology drug can double digoxin levels?
amiodarone
Which medicines are contraindicated in HF & why?
NSAIDs (na retention)
RLCCBs
pioglitazone
dronedarone, flecanide,
What is first line treatment for HF- REF?
Bblocker + ACE inhibitor
ARB if ACE not tolerated
SPECIALIST- Hydralazine + Isosorbide if ACE/ARB not tolerated
How is chronic hyperkalaemia due to CKD/ ACE inhibitor use in HF managed?
Patriomer - 8.4g OD
Sodium zirconium cyclosilicate - 10g TDS then 5mg OD maintenance
After first line treatment for HF what are second and third line options?
2nd line- add MRA to BB + ACEi
(spironolactone/eplerenone)
3rd line- specialist
- ADD Ivabradine (if in sinus rhythm)
- replace ACE with sacubitril valsartan
- digoxin (if in sinus rhythm)
Medicines to hold in AKI
Contrast media (for scans) ACEi/ ARBs NSAIDs/ COX2i Diuretics metformin renally cleared opioids DMARDs (e.g methotrexate)
When must ACEi be stopped before entresto is started?
36 hour wash out period so in practice 2 days.
Reason: increased risk of angiodema with sucabitril & ACEi.
What does QRISK assess
10 year cardiovascular risk and how this compares to a healthy person of the same age.
Used for PRIMARY prevention only
What is the treatment for hypertension
Step 1 <55/ white: ACE (or ARB)
Step 1 >55/black : CCB (or thiazide like indapamide)
Step 2: Combo of ACE/ARB + CCB/thiazide
Step 3: ACE/ARB + CCB + thiazide
Step 4: spironolactone/ Ablocker/ Bblocker
What is recommended for primary prevention of CVD and when?
Atorvastatin 20mg OD is recommended if:
- QRISK2 score is >10%
- patient has type 1 diabetes
- > 85 years old if life expectancy is long
How is stable angina managed?
Treatment: GTN spray
1st line : Bblocker/ RLCCB
2nd line: combo Bblocker + normal CCB
3rd line: isosorbide, Ivabradine, nicorandil, ranolazine
Secondary prevention CVD:
- aspirin (+PPI if needed)
- atorvastatin 80mg OD regardless of lipids
What are the post MI secondary prevention medication
BADS
Bblocker
ACEi
Dual antiplatelets 12 months then stop one (+/- PPI)
Statin (atorva 80mg OD)
What is alteplase & when can it be given?
Thrombolyic agent for ischaemic strokes
Give within 4.5 hours of symptom onset
