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Finals > CVS guidelines > Flashcards

CVS guidelines Flashcards

1
Q

angina first Ix

A

CT angiogram

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2
Q

Tx of angina escalation

A 
A(ngina)BC
Everyone = GTN, aspirin, statin 80
1st = bb or ccb (verapamil [not in HF] or diltiazem)
2nd = max that dose
3rd = BB + CCB (use MR nifedipine)
4th = CABG or PCI or long acting nitrate
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3
Q

Primary prevention diabetics: who?

A

If you’re under 40 and haven’t had it for 10 years and your 10 yr risk is >10% with no end organ damage, dw bout it

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4
Q

when do you measure what for statin monitoring

A

LFTs and baseline, 3m, 12m

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5
Q

What you aim to see after starting statin

A

40% reduction in non-HDL after 3m

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6
Q

When do you stop a statin

A

patient choice
CK 5x
LFTs 3x

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7
Q

CI of statin

A

macrolide use

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8
Q

How do you diagnose heart failure

A

do a NT-proBNP
if high –> specialist 2w
If raised –> specialist 6w

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9
Q

Treatment escalation for heart failure

A 
1st = ACEi + BB
2nd = spironolactone 
3rd = cardiac desynchronise or digoxin or ivabradine

furosemide if symptomatic

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10
Q

when can you give ivabradine

A

if HR >75 and LVEF <35%

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11
Q

when do you send someone in for same day assessment with hypertension

A

end organ damage (papilloedema, retinal haemorrhage)

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12
Q

stages of HTN

A 
1 = 140/90 (135/85)
2 = 160/100 (150/95)
3 = 180/110
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13
Q

in who do you NOT treat HTN

A

anyone >80 years old

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14
Q

HTN escalation

A 
1 = A (diabetes, <55) or C (black, >55)
2 = A + C or A + D
3 = A + C + D
4 = spironolactone if <4.5K, a or b if >4.5 K+
5 = specialist
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15
Q

BP targets

A

normal = 140/90
over 80 = 150/90
diabets = 130/90
diabetes with end organ = 130/80

ambulatory are 5 lower

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16
Q

surgery indication for AS

A

symptoms

asymptomatic + pressure gradient >40 and LV dysfuntion

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17
Q

NSTEMI acute Tx

A

GTN, morphine, oxygen
300mg aspirin
300mg clopidogrel (prasugrel better)

LMWH (or unfrac heparin if PCI <24hrs or CKD)

Extra if GRACE high enough

  • — tirofiban (G2b3a)
  • — PCI within 96 hours
18
Q

STEMI acute

A

GTN, morphine, oxygen
300mg aspirin
300mg clopidogrel (prasugrel better)

PCI within 2 hours

19
Q

what if you cant get to cath lab within 2 hours

A

Do tPA

If ST-e not resolved in 90 mins, send for PCI

20
Q

Reccured pain after PCI?

A

CABG

21
Q

CI to thrombolysis (stroke timeline)

A

stroke within 3m

22
Q

Ongoing Mx for ACS

A

BB + ACEi + statin

  • aspirin lifelong
  • clopidogrel/ticagrelor for 12m
23
Q

After ACS

  • no sex for
  • no viagra for
A

no sex for 1m

No viagra for 6m

24
Q

when do you cardiovert AF

A

Unstable = DC now
<48 hours = flecainide (no defect) or sotalol
>48 hours = anticoagulant for 3w then DC

25
Q

rate vs rhythm control

A

> 65 with ischaemic heart disease

26
Q

rate control drugs

which if heart failure

A

BB or rate-limiting CCB (verapamil/diltiazem)

Use digoxin if HF

27
Q

CHADSVASC

A 
CHF = 1
HTN = 1
Age >75 = 2; >65 = 1
Diabetes = 1
Stroke/TIA = 2
PVD/CAD = 1
Female = 1

anticoagulant if 1 or more (2 or more in woman)

28
Q

INR target on warfarin

  • normal
  • recurrent
  • mechanical valves
A

normal is 2.5
recurrent is 3,5
mech valve depends on type but mitral is most

29
Q

when do you start DOAC post-stroke if it was caused by AF

A

2 weeks later

30
Q

svt treatment

A 
unstable = DC shock
otherwise = vagal, adenosine 6 12 12, shock
31
Q

SVT prevention of future episodes

A

BB and ablation

32
Q

VT treatment

A 
unstable = shock
pulseless = ATLS
stable = loading dose amiodarone and then 24 hour infusion
33
Q

Cardiac arrest

A

look listen feel
start CPR 30:2 and put out call
attach monitoring
if PEA/asystole, adrenaline now and every 3-5 mins
If shockable:
- shock, CPR 2 mins repeat
- after 3rd shock, adrenaline 1mg + amiodarone 300mg

34
Q

Dukes criteria

A

For infective endocarditis (3M, 1M3m, 5m)
Major = echo confirmation, 2culture of virdans, 3 cultures otherwise
Minor = embolic stuff, immune stuff, fever, predisposing heart condition

35
Q

IE Abx therapy
native valve
severe sepsis
prosthetic valve

A

amoxicillin + gent
Vanc + gent
vanc + gent + rifamp

36
Q

Surgery indications in IE

A

CCF
persistent embolic events
aortic abscess (daily ECGs)

37
Q

Type A aortic dissection

A

surgery

38
Q

type B aortic dissection

A

control BP and conservative

?endovasc repair

39
Q

Acute pulmonary oedema

A 
Position upright
Oxygen then CPAP then BiPAP
Diuretic furosemide
Morphine 
Antiemetic
Nitrate (not if systolic <90)
- start with GTN then can put infusion up
40
Q

HASBLED criteria

A 
hypertension
abnormal renal or liver function
history of stroke
history of bleeding
labile INR
elderly >65
drugs predisposing to bleeding
alcohol use

score of 3+ means high risk of bleeding on warfarin

41
Q

Bug types for infective endocarditis

  • staph aureus
  • S epidermidis
  • strep mitis/sanguinis
  • strep bovis
A
  • staph aureus = most common and IVDU
  • S epidermidis = first 2 months after prosthetic valve surgery
  • strep mitis/sanguinis = viridans type = dental stuff
  • strep bovis = CRC

Finals (13 decks)

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