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Concise summary of the Cardiovascular System

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Detailed summary of the cardiovascular chapter of BNF

Preview 2 out of 11  pages

  • No
  • Chapter 2 - cardiovascular system
  • November 4, 2020
  • 11
  • 2020/2021
  • Summary

2  reviews

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By: rubana8 • 2 year ago

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By: ayodeledelrah • 2 year ago

Sry it was a typo my bad, really like this, have you got one for MEP to purchase?

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By: anmoll • 2 year ago

Only 1? Any reason?

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By: ayodeledelrah • 2 year ago

Translated by Google

Typo

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By: anmoll • 2 year ago

Okay no worries. I think I do - will try and upload by the end of today. Thanks

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By: anmoll • 2 year ago

Hi, yes I do - please see under 'Summary of the MEP' and 'MEP: Summary of Controlled Drugs'. Hope you find them useful.

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2 – Cardiovascular System



Drug Tx options for rhythm control post-
Chapter 2 – cardioversion:
Cardiovascular System 1. Standard BB
2. Sotalol
3. Flecainide or propafenone – avoid in
ARRHYTHMIAS
ischaemic or structural heart disease
Ectopic beats – if spontaneous and in a normal 4. Amiodarone – if necessary, start 4 weeks
heart, Tx with beta-blockers is not required before and continue for up to 12 months
post-electrical cardioversion to increase
Atrial fibrillation
success of procedure and maintain rhythm
 If Tx fails to control symptoms, refer within
Tx for Paroxysmal AF
4 weeks and consider ablation strategies
1. Standard BB or dronedarone, sotalol,
 Review anticoagulation, stroke and bleeding
flecainide, propafenone or amiodarone
risk annually
2. ‘Pill-in-the-pocket’ – useful in Pts with
Acute presentation infrequent episodes. It involves taking
 All Pts with fatal haemodynamic instability flecainide or propafenone to self-treat an
caused by new-onset AF = emergency episode of AF
electrical cardioversion
Stroke prevention
 All Pts with non-fatal haemodynamic
instability = rate or rhythm control if onset Stroke risk:
is < 48 hours or uncertain
Urgent rate control = IV verapamil or a BB
Cardioversion
 If AF is present for >48hrs – electrical
cardioversion is preferred. Do NOT start
until Pt has been anticoagulated for at least
3 weeks. If not possible, use parenteral
Bleeding risk:
anticoagulation
 Pharmacological cardioversion = IV
amiodarone or flecainide acetate
Drug Tx
1st line = rate control except in Pts with new-
onset AF, atrial flutter suitable for ablation, AF
with a reversible cause or if rhythm control is
more suitable based on judgement
Atrial flutter
Rate control options:  Rate control = BB, diltiazem, verapamil,
1. Standard BB (not sotalol) digoxin
2. Verapamil or diltiazem  Rhythm control = electrical cardioversion,
3. Digoxin is only effective for controlling the pharmacological cardioversion, ablation
rate at rest hence use only in sedentary Pts
with non-paroxysmal AF. It’s also used in AF
with congestive heart failure

, 2 – Cardiovascular System


Paroxysmal supraventricular tachycardia arrhythmias or bradyarrhythmias unresponsive
 Usually terminates spontaneously or with to atropine
reflex vagal stimulation like Valsalva
Digoxin – useful for controlling ventricular
manoeuvre, immersing face in cold water or
response in persistent and permanent AF
carotid sinus massage
 Hypokalaemia predisposes Pt to digitalis
Arrythmias post MI toxicity – managed by K+ sparing diuretics
 Treat bradycardia with atropine. If
unresponsive, treat with adrenaline/e BLEEDING DISORDERS

Ventricular tachycardia Tranexamic acid – impairs fibrin dissolution
 Treat ASAP with immediate defibrillation Desmopressin – used in mild-to-mod
 If stable – treat with anti-arrhythmics haemophilia and von Willebrand’s disease
Torsades de pointes – ventricular tachycardia Etamsylate – reduces capillary bleeding in the
associated with a long QT syndrome. presence of a normal number of platelets; it
 Causes = drugs, hypokalaemia, severe doesn’t act by fibrin stabilisation
bradycardia and genetics.
 Tx = magnesium sulfate, beta blocker (not VENOUS THROMBOEMBOLISM
sotalol) or atrial pacing
RFs = low mobility, obesity, malignant disease,
 Avoid anti-arrhythmics (QT prolong risk)
H/O venous thromboembolism, thrombophilic,
Vaughn Williams classification of anti- pregnancy, post-partum, Pts aged >60 years
arrhythmics:
Mechanical prophylaxis: Stockings
- Class I = membrane stabilising drugs
 Provide graduated compression and calf
(lidocaine, flecainide) pressure of 14-15mmHg.
- Class II = beta blockers  Wear during day and night until mobile.
- Class III = amiodarone, sotalol  Avoid in acute stroke and PAD
- Class IV = CCBs (not DHP CCBs)
Pharmacological prophylaxis
Negative ionotropic effect of anti-arrhythmics  Start ASAP or within 14 hours of admission
can be additive. Hypokalaemia can enhance the  RFs for bleeding = acute stroke, etc
arrhythmogenic effect of many drugs  If bleeding risk, only receive
Supraventricular arrhythmias pharmacological prophylaxis if risk of VTE is
 Adenosine = preferred Tx greater than risk of bleeding
 Digoxin = slows ventricular response Surgical Pts
 Verapamil = initial IV dose may be followed
by oral Tx. AVOID in AF in Wolff-Parkinson-  Offer mechanical prophylaxis to Pts with
White syndrome and children major trauma or surgery. Continue until Pt
 Beta blocker (e.g. esmolol, propranolol) – is mobile or discharged from hospital (or for
for rapid control of ventricular rate 30 days in spinal injury, spinal surgery or
cranial surgery)
Supraventricular and ventricular arrhythmias  Offer pharmacological prophylaxis (LMWH,
 Amiodarone – useful when another Tx fails. unfractionated heparin to Pts undergoing
It has a very long half-life. general or orthopaedic surgery
Digoxin-specific antibody – indicated for Tx of  Pharmacological prophylaxis in general
digoxin toxicity associated with ventricular surgery should continue for at least 7 days
post-surgery or until mobile. Extend

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