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Cardiovascular > HTN, AF + Flutter > Flashcards

HTN, AF + Flutter Flashcards

(46 cards)

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1
Q

How to diagnose AF?

A

ECG - loss of p waves

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2
Q

When is TTE used?

A

(transthoracic echocardiography) For people with AF if: High risk of heart disease

Cardioversion is being considered

Baseline echo is needed for management plan

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3
Q

When is a TOE used?

A

Transoesophageal echocardiography

Used in people with AF when:

TTE demonstrates abnormality

TTE is difficult to perform

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4
Q

When should anticoagulants be considered in AF?

A

CHADS2-VASc

CHF

HTN

Age >65

DM

Stroke/ TIA/ VTE

Vascular disease

Age >75

Sex

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5
Q

Warfarin regime for AF

A

Slow loading regime - reaching therapeutic levels in 3-4 weeks 1-2mg initially Average daily maintenanec = 5mg INR to be measured daily until within therapeutic range (2-3), then twice weekly for 1-2 weeks, then every 12 weeks

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6
Q

Why are NOACs good, what monitoring is needed?

A

No need for regular INR tests Baseline clotting screen, renal + liver function before treatment Assess every 3 months Repeat tests once a year

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7
Q

Management of acute AF

A

Emergency electrical cardioversion if haemodynamically unstable

Rate or rhythm control if stable

Anticoagulate with heparin

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8
Q

How is HTN diagnosed?

A

Ambulatory BP monitoring or home BP monitoring

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9
Q

Classification of severity of HTN

A

Stage 1: 140/90 in clinic Stage 2: 160/100 in clinic Severe: 180/110 in clinic Accelerated: 180/110 + signs of papilloedema/ retinal haemorrhage

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10
Q

RF for HTN

A

Age Males Genetics Social deprivation Anxiety Smoking, poor lifestyle

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11
Q

What does HTN increase the risk of?

A

HF CHD Stroke CKD Peripheral artery disease Vascular dementia

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12
Q

How do you assess CV risk?

A

BP, total cholesterol + HDL Estimate 10 year risk using QRISK2

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13
Q

Management for HTN <55

A

1st line: ACEi or ARB 2nd line: ACEi or ARB + Ca channel blocker 3rd line: ACEi or ARB + Ca channel blocker + thiazide diuretic

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14
Q

Management for HTN >55 or black person

A

1st line: Ca channel blocker 2nd line: ACEi or ARB + Ca channel blocker 3rd line: ACEi or ARB + Ca channel blocker + thiazide diuretic

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15
Q

What is the CHA2DS-VASc score + what are the RF?

A

Score to assess risk of stroke in someone with AF

Congestive HF

HTN >75

DM Stroke/ TIA (2)

Vascular disease

Age >65

Sex (female)

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16
Q

What is the HAS-BLED score?

A

Score to assess 1 year risk of major bleeding in pts taking anticoagulants for AF

HTN

Abnormal renal + liver function

Stroke

Bleeding

Labile INR

Elderly

Drugs/ alcohol

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17
Q

What is the definition of AF?

A

Cardiac arrhythmia with absolutely irregular RR intervals

No distinct P waves on ECG

Rapid + chaotic atrial activity

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18
Q

What are the different classifications of AF?

A

Initial episode: >30s on ECG

Paroxysmal: recurrent >2 episodes that terminate within 7 days

Persistent: continous >7 days

Long standing persistent: continuous AF >12 months Permanent: decision made by pt and clinician

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19
Q

AF related symptoms

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A

Palpitations SOB Fatigue Dizziness Syncope

20
Q

What is the link between AF + stroke?

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A

AF increases stroke risk by 5% Associated with larger infarcts, increased disability + death

21
Q

When to offer anticoagulation in AF?

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A

CHA2DS2VASC score >2 = offer warfarin or novel anticoagulant Score >1 = consider anticoagulation Score 0 = do not offer

22
Q

What needs to be given if AF >48 hours before cardioversion?

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A

Minimum 3 weeks warfarin before + 4 weeks after

23
Q

What is catheter ablation?

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A

Electrical isolation of pulmonary veins Prevents triggers of AF Blocks PV ectopics from entering left atrium Needs to have warfarin for 3 weeks before + 4 weeks after

24
Q

Caution with amiodarone

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A

Thyroid risk = TFTs

Check LFTs due to hepatotoxicity

Pulmonary toxicity - CXR

Corneal whirls

Amiodarone has long half life

25
Interactions of digoxin
Interactions with diuretics = causes hyperkalaemia (particularly furosemide)
26
Mechanism of action, uses, SE + CI of indapamide
Thiazide like diuretic, alternative to CCB. Inhibit Na+/ Cl+ co-transporter in distal convuluted tubule. Useful to combine with ACEi + ARBs as these cause hyperkalaemia CI in oedema + HF SE: Impotence, hyponatraemia, hypokalaemia (causing cardiac arrhythmias) Can increase plasma glucose
27
Mechanism of action, uses, SE + CI of beta blockers
Used for CVD, HF, AF, SVT, HTN Beta 1 blockers - reduce force of contraction + speed of conduction in the heart Prolong refractory period at AV node SE: fatigue, cold extremities, headache, GI S+S, impotence CI in asthma
28
Mechanism of action, uses, SE + CI of ARBs
Used in HTN, HF, CVD, diabetic nephropathy + CKD Block action of angiotensin 2 on AT1 receptor Reduces peripheral vascular resistance, lowering BP. Less likely to cause angioedema so good in Africans SE: hypotension, hyperkalaemia, renal failure CI: pregnancy, renal artery stenosis, AKI
29
Mechanism of action, uses, SE + CI of ACEi
HTN, HF, CVD, diabetic nephropathy + CKD Block action of ACE to prevent conversion of angiotensin 1 to 2 SE: hypotension, dry cough, hyperkalaemia, angioedema CI: pregnancy, AKI, renal artery stenosis NSAIDs increase risk of renal failure Take first dose before bed
30
Mechanism of action, uses, SE + CI of CCB
HTN (amlodipine), SVT (diltiazem + verapamil) Vasodilation of arterial smooth muscle SE amlodipine: ankle swelling, flushing, headache, palpitations SE verapamil: constopation, bradycardia, heart block, HF Diltiazem - any of these SE Diltiazem + verapamil CI in HF Amlodipine CI in severe aortic stenosis
31
Stage 1 + 2 HTN + management
* Stage 1 = 140/90 = lifestyle + diet (unless comorbidity), review in 2-4 weeks * Stage 2 = 160/100 AND 150/95 ABPM = begin medical management
32
Describe management of AF
Rate control first * Beta blocker 1st line * Diltiazem 2nd line * Digoxin if sedentary * Combine Except (when not to use rate control): * whose atrial fibrillation has a reversible cause * who have heart failure thought to be primarily caused by atrial fibrillation * with new-onset atrial fibrillation * with atrial flutter whose condition is considered suitable for an ablation strategy to restore sinus rhythm Rhythm control * If over 48hrs, electrical * Use amiodarone 4 weeks before + 12 months after electrical * Drug treatment: BB or amiodarone if HF * Dronedarone after successful cardioversion 2nd line
33
What is the pill in the pocket?
BB or flecanide
34
How do you treat HTN with CKD?
High BP in CKD – ACEi (regardless of age or race)
35
What is the target BP for DM?
\<140/80 or 130/80 if there are any complications of DM present
36
Causes of AF
PIRATES Pulmonary causes Ischaemia/ infarct Rheumatic disease Alcohol + anaemia Thyrotoxicosis/ toxins Electrolytes + endocarditis Sepsis
37
Management of atrial flutter
DC cardioversion \>48hrs perform TOE Cardiovert with LMWH cover Rate control with digoxin, verapamil or BB
38
Management of AF
Rate control 1st line BB 1st, CCB 2nd (not in HF) Rhythm control if symptoms persist - cardioversion or medical anti-arrhythmics (amiodarone) - only if symptoms \<48hrs or if they are anticoagulated for 3 weeks prior Catheter ablation if AF persistent despite rate + rhythm control
39
What is atrial flutter?
Rhythm with rapid regular atrial depolarisations at 300 bpm + venticular rate of 150 bpm
40
What is atrial flutter associated with?
Mitral valvular disease, post-cardiac surgery, pericardial disease, pulmonary disease
41
Management of atrial flutter
Same as AF (rate control + anticoagulation) DC cardioversion or amiodarone Ablation for long term therapy
42
What is a hypertensive emergency?
Onset or progression of end-organ damage due to cerebrovascular, cardiovascular or renalvascular system
43
What is accelerated HTN?
Defined by retinal damage (hemorrhages, exudates + arteriolar narrowing)
44
What is malignant HTN?
Accelarated HTN + papilloedema Usually when diastolic is \>140
45
Why is adenosine not helpful in AF/ flutter?
Adenosine doesn't affect atria
46
What is multifocal atrial tachycardia?
P waves change every beat Due to random pacemakers setting off beats Occurs when heart is under strain

Cardiovascular (15 decks)

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