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First Year Revision > Cardiovascular Treatment Pathways > Flashcards

Cardiovascular Treatment Pathways Flashcards

1
Q

What are the 3 first line medications in CCF (with and without reduced ejection fraction)?

A
  1. Spironolactone in low ejection fraction heart failure, loop diuretics in preserved ejection fraction
  2. ACEIs or ARB.
  3. B-blockers (start low, go slow).
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2
Q

What drug would you add if CCF was not adequately controlled by first line medication?

A

Spironolactone.

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3
Q

When would you use digoxin in CCF?

A

If signs or symptoms of heart failure on standard therapy or have AF.

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4
Q

When would you use other vasodilators in CCF e.g. nitrates or hydralazine?

A

If patient intolerant to ACEIs or ARBS or are afro-Caribbean.

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5
Q

What drug would you use in CCF if HR is fast despite beta-blockers?

A

Ivabradine.

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6
Q

What are 3 other therapies for CCF?

A

ICDs, cardiac resynchronisation therapy (for prolonged QRS), transplant.

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7
Q

What is the treatment for right sided heart failure (cor pulmonale)?

A

Diuretics and oxygen.

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8
Q

What is the treatment for CCF caused by valvular disease?

A

Surgery.

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9
Q

What is the treatment for CCF caused by fast AF?

A

Digoxin or DC cardioversion.

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10
Q

What are the 5 steps in acute LVF therapy?

A
  1. Sit patient upright.
  2. High flow oxygen if hypoxic (care in COPD).
  3. IV furosemide.
  4. IV diamorphine.
  5. GTN if systolic BP greater than or equal to 90.
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11
Q

What is the acute treatment for a STEMI after taking an ECG?

A 
M - morphine and anti-emetic. 
O - oxygen if hypoxic. 
N - nitrates (GTN spray) if BP >90mmHg. 
A - aspirin 300mg PO. 
\+
T - ticagrelor 180mg PO.
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12
Q

When would you do PCI and when would you do thrombolysis?

A

PCI if can be done within 120 mins of first medical contact, otherwise thrombolysis.

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13
Q

What are the major contraindications for thrombolysis?

A

Previous intracranial haemorrhage, ischaemic stroke (<6 months), cerebral malignancy or AVM (arteriovenous malformation), recent major trauma/surgery/head injury (<3 weeks), GI bleeding, known bleeding disorder, aortic dissection, non-compressible punctures.

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14
Q

What is the acute treatment for unstable angina or an NSTEMI?

A

Same treatment as STEMI (MONA+T).

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15
Q

What would you do to guide next steps in unstable angina or an NSTEMI?

A

Measure troponin and clinical parameters to assess risk e.g. GRACE score2.

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16
Q

What would a high risk patient with unstable angina or an NSTEMI have?

A

Rise in troponin, dynamic ECG changes or significant co-morbidities.

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17
Q

What would a low risk patient with unstable angina or an NSTEMI have?

A

No chest pain recurrence, no signs of heart failure, normal ECG, no troponin rise (repeat).

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18
Q

What would you do with a high risk patient with unstable angina or an NSTEMI?

A

Get a cardiologist review for angiography and PCI.

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19
Q

What times should angiography be done in unstable angina or an NSTEMI?

A
  1. <2 hours after presentation if ongoing angina or evolving ST changes, cardiogenic shock or life-threatening arrhythmias.
  2. <24 hours if high risk patient.
  3. <72 hours if low risk patient.
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20
Q

What would you do with a low risk patient with unstable angina or an NSTEMI?

A

Discharge, arrange further outpatient investigations e.g. stress test.

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21
Q

In continuous ACS management, what would you use to manage pain?

A

GTN and opiates.

22
Q

How would you modify risk factors in continuous ACS management?

A
  1. Avoid smoking
  2. Healthy diet
  3. Daily exercise and cardiac rehabilitation
  4. Identify and treat diabetes, hypertension and hyperlipidaemia
  5. Get BP down to 140/85mmHg (if diabetes, renal disease or target organ damage then <130/80mmHg).
23
Q

What cardioprotective medications would you put someone who had an ACS on?

A
  1. Antiplatelets (aspirin and ticagrelor) for at least 12 months.
  2. B-blockers (start low, go slow).
  3. ACEIs in patients with LV dysfunction, hypertension or diabetes.
  4. High dose statin.
24
Q

What are the laws on driving after an ACS if you have a group 1 licence (cars and motorbikes)?

A

Can drive 1 week after successful angioplasty, 4 weeks without angioplasty.

25
Q

What are the laws on driving after an ACS if you have a group 2 license (lorries)?

A

Must inform DVLA and stop driving for 6 weeks. Must undergo functional tests before they can start work again.

26
Q

What determines how quickly a person who had an ACS can go back to work?

A

Clinical progress and nature of work.

27
Q

What 2 professions have to stop work if they have an ACS?

A

Airline pilot, air-traffic controller.

28
Q

What would you do if a patient had acute AF and was haemodynamically unstable?

A

DC cardioversion, amiodarone if unsuccessful.

29
Q

What would you do if a patient had AF for <48 hours and were stable?

A

DC cardioversion or pharmacological cardioversion with flecainide or amiodarone.

30
Q

What would you do if a patient had AF for >48 hours or were unsure when it started and were stable?

A

Rhythm control with bisoprolol or diltiazem.

31
Q

What else would you try and correct in acute AF?

A

Electrolyte imbalances.

32
Q

What should you do about anti-coagulation in acute AF?

A

Give heparin until full risk assessment is made (don’t delay treatment to give anticoagulants if unstable).

33
Q

For chronic AF, when may rhythm control be appropriate?

A

If symptomatic or have CCF, younger, presenting for 1st time with lone AF or AF from a corrected precipitant.

34
Q

What is the first line treatment for rate control in chronic AF?

A

B-blocker or rate-limiting calcium blocker.

35
Q

If first line treatment for rate control in chronic AF fails, what should you do?

A

Add digoxin or consider amiodarone.

36
Q

What are the 2 main treatments for rhythm control in chronic AF?

A

Elective DC cardioversion, elective pharmacological cardioversion (flecainide).

37
Q

What are 3 other possible treatments for rhythm control in chronic AF?

A

AVN ablation and pacing, pulmonary vein ablation, Maze procedure (number of incisions in atria are made to produce scar tissue to prevent conduction).

38
Q

What is the treatment for paroxysmal AF?

A

Sotalol or flecainide PRN.

39
Q

How would you work out whether to anticoagulate someone with chronic AF?

A

Use CHA2DS2-VASc score to assess embolic risk and balance with risk of bleeding.

40
Q

What factors would make you consider anticoagulation in someone with chronic AF?

A

Valvular AF, age >75 years, hypertension, heart failure, previous stroke/thromboembolism, CAD/DM, diabetes.

41
Q

What anticoagulants would you use in chronic AF?

A

DOAC or warfarin.

42
Q

What is the treatment for atrial flutter?

A

Similar to AF.

43
Q

What are the 3 main components of stable angina management?

A
  1. Address exacerbating factors.
  2. Secondary prevention.
  3. Anti-anginal medication.
44
Q

What provides symptomatic relief in stable angina?

A

GTN spray or sublingual tabs.

45
Q

When should someone with stable angina phone an ambulance?

A

If pain still present 5 mins after second dose.

46
Q

What are the first line anti-anginal medications?

A

B-blocker or calcium channel blocker.

47
Q

What is the second line anti-anginal medications?

A

Both B-blocker and calcium channel blocker (not rate-limiting).

48
Q

What are the third line anti-anginal medications?

A
  1. Long acting nitrate (ISMN).
  2. Ivabradine.
  3. Ranolazine.
  4. Nicorandil.
49
Q

When should you give a 3rd drug to someone with stable angina?

A

If symptoms are not satisfactorily controlled on 2 drugs and patient is waiting for revascularisation or revascularisation not considered appropriate or acceptable.

50
Q

What are the 4Hs that are reversible causes of cardiac arrest?

A

Hypoxia, hypovolaemia, hypo/hyperkalaemia/metabolic, hypothermia.

51
Q

What are the 4Ts that are reversible causes of cardiac arrest?

A

Thrombosis (coronary or pulmonary), tension pneumothorax, cardiac tamponade, toxins.

First Year Revision (31 decks)

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