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47 Cards in this Set
- Front
- Back
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Gold standard for diagnosing hypertension |
ABPM - 2 measurements/hour, average > 14 values HBPM - each measure do 2 - 1 minute apart, 2 daily, >= 4 days - ideally 7, discard 1st day and average the rest. |
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Q risk |
10 year isk of having a cardiac event Sex, age, systolic BP, BMI, total and HDL cholesterol, ethnicity, smoking, diabetes, FHx of IHD, treated for hypertension, AF, RA, CKD, personal hx of IHD. |
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Stage 1 hypertension |
Clinic BP >= 140/90 + ABPM daytime/HBPM >= 135/85 No treatment if > 80 years Treat if < 80 AND target organ damage/IHD/CKD/DM/Q risk > 20 % |
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Stage 2 hypertension |
Clinic BP >=160/100 + ABPM daytime/HBPM >= 150/95 Treat according to guidelines regardless of age If < 40 years consider specialist referral for secondary causes |
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Severe hypertension |
Clinic BP>=180/110 Consider immediate treatment If signs of papilloedema/retinal haemorrhages - same day specialist |
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BP Management < 55 years |
1) ACEi/ARB 2) CCB 3) Thiazide like diuretic - indamide 1.5mg MR / 2.5mg OD or chlortalidone 12.5-25 mg 4) If K+ =< 4.5 - spironolactone 25mg OD If K+ > 4.5 increase dose of step 3. |
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BP Management > 55 years |
Also for Afro-carribeans 1) CCB 2) ACEi/ARB 3) Thiazide like diuretic - indamide 1.5mg MR / 2.5mg OD or chlortalidone 12.5-25 mg 4) If K+ =< 4.5 - spironolactone 25mg OD If K+ > 4.5 increase dose of step 3. If intolerant - consider alpha/beta-blocker |
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BP Targets |
< 80 years: clinic - 140/90, home - 135/85 > 80 years: clinic - 150/90, home - 145/85 T2DM + end-organ damage: < 130/80 T2DM: < 140/80 CKD + albumin:creatinine >70: <130/80 |
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Secondary prevention of MI |
Dual antiplatelets ACEi Beta-blocker Statin |
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CHA2DS2VS Score |
Congestive Heart failure - 1 Hypertension - 1 Age >= 75 years - 2, 65-74 - 1 Diabetes - 1 Prior stroke/TIA - 2 Vascular disease - 1 Sex - female - 1 |
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AF Management |
If CHA2DS2VS score: 0 - no treatment 1 - males consider treatment, females no treatment >= 2 - treatment |
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Bleeding risk + warfarin |
HASBLED: Hypertension - systolic > 160 - 1 Abnormal renal/liver function - 1 each Stroke - 1 Bleeding - 1 Labile INRs - 1 Elderly > 65 years - 1 Drugs increasing bleeding or > 8 drinks/week - 1 Score >= 3 - high risk of bleeding |
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Heart Failure Mx |
1) ACEi + beta blocker (ACEi first) 2) Aldosterone antagonist (spironolactone) or angiotensin II blocker or hydralazine and a nitrate 3) Digoxin or cardiac resynchronisation therapy 4) Diuretics for fluid overload 5) Annual influenza 6) One-off pneumococcal |
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Investigation of angina type pain |
NICE risk: > 90 % - treat as angina 61-90 % - invasive coronary angiography 30-60 % - functional imaging - SPECT, MR, stress ECHO 10-29 % - CT calcium < 10 % - angina unlikely |
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Definition of angina pain |
1) Constricting discomfort in chest, neck, shoulders, jaw or arms. 2) Precipitated by physical exertion 3) Relieved by rest or GTN in 5 mins If all 3 - typical angina 2 - atypical angina 1 or none - non-anginal chest pain |
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Aortic stenosis |
Syncope, angina, dysnopoea on exertion Ejection systolic murmur Narrow pulse pressure Slow rising pulse Apex thrill S4 - ventricular hypertrophy soft/absent S2 |
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AF rate control |
Age > 65 years, history of IHD Beta blockers preferred to digoxin (unless heart failure) - bisoprolol is more cardiac selective than atenolol. CCB |
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AF rhythm control |
Age < 65 years, heart failure, symptomatic, first presentation Sotalol Flecainide Amiodarone |
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Wells score and DVT |
>= 2 - DVT likely - USS within 4 hours - if negative - D-dimer. If not possible heparin + D-dimer =< 2 - DVT unlikely - D-dimer - if positive USS within 4 hours - if not possible - heparin |
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ACEi side-effects |
Cough Angioedema First dose hypotension Hyperkalaemia Acceptable for creatinine to rise 30 % and K+ < 5.5 |
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Heart Failure diagnosis |
1) Previous MI - ECHO within 2 weeks 2) No previous MI - BNP - if: > 400 - ECHO in 2 weeks 100-400 - ECHO in 6 weeks < 100 - normal |
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Increase BMP |
Left ventricular hypertrophy MI AF Pulmonary hypertension Hypoxia Liver failure COPD CKD PE Diabetes Sepsis > 70 years Woman |
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Decrease BMP |
Aldosterone antagonists ACEi Angiotenson II receptors antagonists Diuretics Beta-blockers |
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Right bundle branch block |
Wide QRS and last part of QRS in V1 is positive Normal variant Right ventricular hypertrophy Cor pulmonale PE MI ASD Cardiomyopathy Myocarditis |
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Angina Management |
Aspirin, statin and GTN spray Beta-blocker CCB - verapamil or diltiazem - do not use verapamil with beta-blocker If not tolerant of CCB/beta-blocker - long-acting nitrate, ivabradine, nicroandil, ranolazine |
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Amiodarone monitoring |
Prior to starting - UE, TFT, LFT, CXR Every 6 months - LFT, TFT |
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Medications that worsen heart failure |
Pioglitazone Verapamil NSAIDS Steroids Flecainide |
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Dabigatran |
Contraindicated with heart valves Prophylaxis of VTE following knee/hip surgery Stroke prevention with non-valvular AF - previous embolic event, LVF < 40%, symptomatic heart failure, > 75 years, > 65 years + DM, CAD, hypertension Reduce dose in CKD Not used if creatinine clearance < 30 |
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Reflex syncope |
Neurally mediated Vasovagal Situational - cough, micturition, GI Carotid sinus syncope |
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Orthostatic syncope |
Primary autonomic failure - PD, Lewy body dementia Secondary autonomic failure - DM, amyloidosis, uraemia Drugs - vasodilators, alcohol, diuretics Volume depletion |
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Cardiac syncope |
Arrythmias Structural PE |
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Syncope Investigations |
Cardiovascular examination Postural BP - change in BP > 20/10 or decrease in systolic BP to < 90 Cartoid sinus massage ECG Tilt table 24 hour ECG |
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Side effects of beta blockers |
Sleep disturbances including nightmares Bronchospasm Cold peripheries Fatigue |
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Beta blockers - contraindications |
Asthma Uncontrolled heart failure Sick sinus syndrome Concurrent varapamil use |
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ACEi contraindications |
Pregnancy Aortic stenosis Renal vascular disease High dose furosemide therapy Hereditary idiopathic angioedema |
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Nitrate side-effects |
Hypotension Tachycardia Headache Flushing |
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Pericarditis ECG |
Widespread ST elevation - saddle shaped PR depression |
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ACS Referral |
Current or chest pain in last 12 hours + abnormal ECG - emergency admission Chest pain 12-72 hours ago - refer for same day assessment Chest pain > 72 hours ago - Assessment, ECG, troponin before deciding further action |
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Left bundle branch block |
Wide QRS and last part of QRS in V1 is negative IHD Hypertension Aortic stenosis Cardiomyopathy Idiopathic fibrosis Hyperkalaemia Digoxin toxicity |
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New York Heart Association Classification |
I - No symptoms and no limiation II - Mild symptoms and slight limitation of physical activity III - Moderate symptoms and marked limitation of activities but comfortable at rest IV - Severe symptoms and present at rest |
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Digoxin toxicity Features |
Generally unwell, lethargy, nausea and vomiting, anorexia, confusion, yellow-green vision Arrhythmias |
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Digoxin toxicity precipitating factors |
Hypokalaemia Increasing age Renal failure MI Low Mg, high Ca, high Na, acidosis Low albumin Hypothermia Hypothyroidism Drugs - quinidine, varapamil, diltiazem, spironolactone, ciclosporin |
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Complete heart block |
No association between QRS and P waves Syncope Heart failure Regular bradycardia Wide pulse pressure Variable intensity of S1 |
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Second degree heart block |
Type 1 - Mobitz I / Wenckebach - prgressive prolonging of PR interval and then dropped QRS Type 2 - Mobitz II - constant PR interval, but P wave not always followed by QRS |
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Target INR Valve replacement |
Bioprothetic - none needed - may be in 1st 3 months - lifelong aspirin. Aortic mechanical - 2-3 Mitral mechanical - 2.5-3.5 Aspirin normally given in addition unless contraindication |
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Anticoagulation following cardioversion |
Continue for >= 4 weeks and then make a decision based on individual |
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Digoxin montitoring |
6 hours post dose |
