Ischaemic Heart Disease Flashcards

Question

How is AF detected?

Answer 1

person is symptomatic or detected incidentally if a person has an irregular pulse on examination or irregular heart rhythm on an electrocardiogram (ECG)

Answer 2

Has irregular pulse Breathlessness and/or reduced exercise tolerance Palpitations Dizziness or syncope Fatigue, tiredness, sleep disturbances person presents with a self-initiated mobile or wearable device-provided irregular pulse notifications or ECG tracings

Answer 3

On 12 lead ECG: confirmed if the heart rhythm shows an absence of distinct repeating P waves, irregular atrial activations, irregularly irregular R-R intervals, and a narrow QRS complex

Answer 4

Stroke Heart failure exacerbate symptoms of myocardial ischaemia may cause tachycardia-induced cardiomyopathy and ventricular dysfunction increased risk of cognitive impairment and vascular dementia

Answer 5

Palpate the radial pulse and auscultate the heart at the apex to check pulse rate and regularity Check BP manually Assess for signs of haemodynamic instability, such as tachycardia, hypotension, severe dizziness, syncope, chest pain Auscultate the heart for a murmur that may suggest other pathology Examine the lungs to assess for pulmonary oedema and/or an underlying cause Check for other signs of heart failure such as ankle or leg oedema

Answer 6

Cardiac or valve conditions Acute illness e.g. pneumonia COPD CKD Electrolyte imbalance Thyrotoxicosis Increasing age Alc excess Obesity Smoking Medications such as thyroxine, lithium, or beta-2 agonist bronchodilators

Answer 7

used to assess a person's stroke risk: Congestive heart failure/left ventricular dysfunction (heart failure with reduced ejection fraction or people with recent decompensated heart failure requiring hospitalization, irrespective of ejection fraction) = 1 Hypertension (defined as a resting blood pressure greater than 140 mmHg systolic and/or greater than 90 mmHg diastolic on at least 2 occasions or current antihypertensive drug treatment) = 1 Age older than or equal to 75 years = 2 Diabetes mellitus (defined as fasting plasma glucose level of 7.0 mmol/L [126 mg/dL] or more, or treatment with oral hypoglycaemic drugs and/or insulin) = 1 Stroke/transient ischaemic attack = 2 Vascular disease (prior myocardial infarction, peripheral arterial disease, or aortic plaque) = 1 Age 65–74 years = 1 Sex category (female) = 1

Answer 8

identify people at high risk of bleeding to help guide decisions on anticoagulation treatment and monitoring Scores range from 0 to 7: There is a score of 2 points for: -Males with haemoglobin less than 130 g/L or haematocrit less than 40%. -Females with haemoglobin less than 120 g/L or haematocrit less than 36%. -People with a history of bleeding (for example, gastrointestinal or intracranial bleeding or haemorrhagic stroke). There is a score of 1 point for people: -Aged over 74 years. -Who have an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73m2. -Treated with antiplatelet drugs.

Answer 9

0-2 low risk 3 medium risk 4-7 high risk

Answer 10

Anticoags: -If a person is taking a direct-acting oral anticoagulant (DOAC), assess adherence to treatment and ask about any adverse effects -If a person is taking a vitamin K antagonist such as warfarin, ensure anticoagulation control is reviewed regularly - INR Rate control: -Arrange to review the person within one week of starting rate-control treatment or each dose titration, to assess symptom control, resting heart rate, blood pressure, adherence to treatment, and any adverse effects

Answer 11

DOAC if CHA2DS2VASc score 2 or higher (or 1 in men) If a DOAC is contraindicated, not tolerated, or not suitable, offer treatment with a vitamin K antagonist such as warfarin Rate control if reversible cause not found: standard beta-blocker (other than sotalol) or a rate-limiting calcium-channel blocker (diltiazem [off-label indication] or verapamil) first-line

Answer 12

with life-threatening haemodynamic instability caused by new-onset atrial fibrillation should undergo emergency electrical cardioversion without life-threatening haemodynamic instability, rate or rhythm control can be offered if the onset of arrhythmia is less than 48 hours

Answer 13

Heart pumps normally but too stiff to fill properly LVEF >50%

Answer 14

Left ventricle pumps out less blood than normal - weak muscles LVEF <40%

Answer 15

-Detailed history and examination -Measure NT-proBNP -if 400 ng/l or higher refer for ECHO

Answer 16

Diuretics for congestive symptoms and fluid retention

Answer 17

1) manage comorbidities 2) offer personalised exercise-based cardiac rehab programme unless unstable 3) loop diuretic for relief of fluid retention

Answer 18

serum potassium and sodium, renal function, and blood pressure should be checked prior to starting treatment, 1-2 weeks after starting treatment, and at each dose increment treatment should be monitored monthly for 3 months and then at least every 6 months, and if the patient becomes acutely unwell.

Answer 19

1) offer ACEi or beta-blocker. Add MRA if symptoms continue 2) Offer a personalised exercise- based cardiac rehabilitation programme 3) If symptoms persist despite first-line treatment,seek specialist advice, consider adding one of: -Replace ACEI (or ARB) with sacubitril valsartan* if ejection fraction <35% - Add ivabradine for sinus rhythm with HR >75bpm and ejection fraction <35% -Add hydralazine and nitrate (esp if Afro-caribbean) -Digoxin for symptoms

Ischaemic Heart Disease Flashcards

(45 cards)