Aortic Regurgitation
ACE Inhibitors
Supraventricular Tachycardia
Adenosine
Beta-blockers
Unstable SVT -DC cardiovert
Torsades de Pointes
Type of ventricular tachycardia
Magnesium Sulphate
Sinus Sick Syndrome (SA node dysfunction)
Pacing
Sinus Bradycardia (<60bpm)
Common in inferior STEMIs
Atropine (>600mg)
Myocarditis
Supportive Treatment
Tetralogy of Fallot
Oxygen Beta-blockers Endocarditis Prophylaxis Surgery
Pericarditis
Supportive for viral causes
Antibiotics for specific bacterial cases
Coarctation of the aorta
Balloon dilation
Stenting surgery
Cardiomyopathy
Treat underlying cause ACE Inhibitors Angiotensin II receptor antagonist Beta blockers Calcium channel blockers Diuretics Anti-arrhythmic Amiodarone and digoxin
Cardiac Tamponade
Pericardialcentesis
Aortic Regurgitation
Valve replacement
ACE Inhibitors
Angiotensin II receptor Antagonist
Diuretics
Mitral Stenosis
Valve replacement Mitral ballon valvuloplasty Loop diuretics (Furosemide) Beta-blockers Digoxin Warfarin
Mitral Regurgitation
Valve replacement Percutaneous mitral valve repair Loop diuretics (furosemide) ACE Inhibitors (Ramipril, Lisinopril, Perindopril) Digoxin Warfarin
Aortic Stenosis
Valve replacement
Ballon valvotomy
TAVI (valve implantation)
Pulseless electrical activity
Resuscitation CPR Atropine Vasopressin Adrenaline Oxygen and intubation
Asystole
Adrenaline 1mg IV
Every 3-5mins following CPR
Atropine
Intubation and IV access
Ventricular Fibrillation
Defibrillation shock
Adrenaline
Consider adenosine
Pulseless VT
Defibrillation shock
Atrial Fibrillation
ABCDD Amiodarone (anti-arrhythmic) rhythm B1 beta blockers (bisoprolol) rate Calcium channel blockers (verapamil) rate Digoxin (anti-arrhythmic) rate DC Cardioversion- rhythm Anti-coagulation Maze procedure
Ventricular Tachycardia
Acute (unstable)= DC cardioversion
Paroxysmal (stable)=amiodarone
If unsure between VT and SVT give adenosine (anti-arrhythmic)
Chronic Arrhythmias
Radiofrequency ablation which is a selective cauterisation of cardiac tissue to prevent tachycardia
Supraventricular Arrhythmias
A. Fib, Atrial flutter, ectopic atrial tachycardia
VAV
Vagal manoeuvres and carotid massage
Adenosine IV
Verapamil IV
Unstable- DC Cardiovert
Acute STEMI
MONA C Morphine + anti-emetic Oxygen Nitrate Aspirin (300mg) Clopidogrel
PCI within 90mins, not possible= thrombolysis
Post MI
SABA + C Statin ACE Inhibitor Beta-blocker Aspirin \+Clopidogrel for 4 weeks
Calcium channel blockers can be used instead of BB and warfarin instead of aspirin
Stroke
Ischaemic (blood clot) SATS Statins Aspirin Thrombolysis (tPA) Supportive
Haemorrhagic (aneurysm)
Supportive
Refer to stroke unit
Anti-hypertensives
Varicose Veins
Foam sclerotherapy (chemical thrombophlebitis) Endovenous ablation Compression stockings
AAA
Endovascular Aneurysm Repair
Stent passed through artery in groin, seals off aneurysm from inside artery)
Limb Ischaemia
ALPS
Anti-platelets
Lifestyle change (stop smoking, exercise more)
PCI or vascular bypass
Statins
Phlegmasia Dolens (DVT obstruction)
ICV filter through femoral artery which prevents thrombus entering lungs (PE prophylaxis)
Long term-anticoagulations
DVT
Anticoagulation with Low weight molecular heparin
Warfarin (but not in pregnancy)
TED compression stockings
Acute pulmonary oedema
Furosemide
Heart failure
Acute- take a SMINT Sit up + give oxygen Morphine IV diuretic (furosemide) Nitrate (GTN Spray) Tailor further management
Standard therapy- DABS and digoxin Diuretic ACE inhibitor Beta blocker Spironolactone
Heart failure- Cor Pulmonale
Diuretics + Oxygen
Heart Failure- Vascular disease
Surgery
Heart Failure- A. Fib
Digoxin
DC Cardioversion
Angina
ABC BAGS P
Aspirin
B1 blockers
Ca channel blockers
By pass
Angioplasty
GTNs
Statins (if cholesterol >5mm/l)
Potassium channel openers (nicorandil, minoxidil)
Unstable Angina
HAG
Heparin IV
Aspirin
GTN IV
Coronary Artery Spasm
Ca channel blockers
Isosorbide mononitrate
Hypertension <55 yrs old
Step 1: ACE Inhibitors
Step 2: Ca channel blockers
Step 3: Thiazide diuretics
Step 4: Beta blockers or alpha blockers or spironolactone
Exchange ACE for ARB
Hypertension >55 yrs + Afro-Caribbean
Step 1: Ca channel blocker
Step 2: ACE Inhibitors
Step 3: Thiazide diuretics
Step 4: Beta blockers or alpha blockers or spironolactone
Exchange ACE for ARB
Hypertension with secondary disease
Angina: Beta blockers and ca channel blockers never together
Heart failure: Beta blockers and ACE Inhibitors
Diabetic nephropathy: ACE and ARBs
Prostatism: alpha blockers
Elderly: Thiazide diuretics