Hypertension in pregnancy The classification of hypertension in pregnancy is complicated and varies. Remember, in normal pregnancy: blood pressure usually falls in the first trimester (particularly the diastolic), and continues to fall until 20-24 weeks after this time the blood …
Digoxin is strongly indicated for coexistent atrial fibrillation and heart failure. Beta-blockers should not be introduced until any heart failure has been stabilised. Giving amiodarone or flecainide may result in cardioversion before the patient has been adequately anticoagulated If there …
NICE NSTEMI/unstable angina guidelines are based on 6 month mortality risk: if > 1.5% clopidogrel for 12 months if > 3% angiography within 96 hours Acute coronary syndrome: management NICE produced guidelines in 2010 on the management of unstable angina …
This is most typical of a left circumflex occlusion although may rarely be seen if the left anterior descending is affected ECG: coronary territories The table below shows the correlation between ECG changes and coronary territories: ECG changes Coronary artery …
Prosthetic heart valves – antithrombotic therapy: bioprosthetic: aspirin mechanical: warfarin + aspirin Prosthetic heart valves The most common valves which need replacing are the aortic and mitral valve. There are two main options for replacement: biological (bioprosthetic) or mechanical.  …
Infective endocarditis – streptococcal infection carries a good prognosis Infective endocarditis: prognosis and management Poor prognostic factors Staph aureus infection (see below) prosthetic valve (especially ‘early’, acquired during surgery) culture negative endocarditis low complement levels Mortality according to organism staphylococci …
Atrial fibrillation: rate control and maintenance of sinus rhythm The Royal College of Physicians and NICE published guidelines on the management of atrial fibrillation (AF) in 2006. The following is also based on the joint American Heart Association (AHA), American …
The NICE guidelines would advocate the use of fondaparinux in this scenario. Given the clinical details in this case it is unlikely that angiography will be performed in the next 24 hours and hence unfractionated heparin is not required. Acute …
The CHA2DS2-VASc for this patient is 3 – 2 for the transient ischaemic attack and 1 for being female. She should therefore be offered anticoagulation with warfarin. Atrial fibrillation: anticoagulation The European Society of Cardiology published updated guidelines on the …
Hypertension – step 4 K+ < 4.5 then spironolactone K+ > 4.5 then higher-dose thiazide-like diuretic This patient has reached step 4 in the NICE hypertension guidelines. As their potassium is less than 4.5 mmol/l spironolactone 25mg od should be …