AEIOU

anticipated problems
E - psychoscoial
I - prevent further injury
O - optimise care
U - treat underlying cause

AFlutter:
- acute unstable : electrical cardioversion
- acute stable :
. rate - BB, CCB (diltiazem, varapil), digoxin
. chemical cardioversion - sotalol, amiodarone, type 1 (flecainide)
- long term:
. sotalol, amiodarone
. RF ablation

MAT:
- underlying cause (COPD, hypoxemia, sepsis, theophylline, digitalis)
- CCB
(contra - BB in COPD, cardioversion, antiarrhythmics, ablation)

AFib: RACE
- rate: BB, CCB, digoxin/amiodarone
- anticoag: warfarin or DOACs
- cardioversion w/o anticoag if <24, w anticoag if >24 + 4 wk after
- eti - "Atrial Fib"
Alcohol Abuse
Thyroid Disease
Rheumatic Heart Disease
Ischemic Heart Disease
Atrial Myxoma
Lung (Pulmonary Embolism, COPD)
Pheochromocytoma
Idiopathic
Blood Pressure (Hypertension)

AVNRT:
acute
1. valsalva/carotid + metoprolol, digoxin, diltiazem, EC version
2. adenosine
long:
1. BB, diltiazem , digoxin
2. type 1c (flecainide, propafenone)
3. ablation

AVRT:
acute: valsalva/carotid + metoprolol, EC version
long: flecainide, procainamide, ablation

Torsade:
IV Mg
pacing
isoproterenol
EC version

Stable angina: AEIOU

Injury = Prevent further injury:
- reduce MyoC O2 demand
- incr O2 supply
 - reduce RF (life-style, diet, exercise, statins, hypertension)
- prevent plaque rupture and thrombosis
Optimise current therapy:
1st. ASA or clopidogrel
BB (improves survival) - B1 selective metoprolol, atenolol
2nd. CCB
Nitrates
HTN/DM - ACEI

PRINZTMETAL vasospasm angina

- nitrates + CCB

NSTEMI
acute
- BEMOAN (+1 and 8 hr - telemetry+troponin-I)
betablocker
enoxaparin (LMWH) + clopidogrel
morphine
o2
nitrates sublingual then IV
aspirinv
- clopidogrel + LMWH
- stress test (exercise or dipyradamole/adenosine + radiolabelled sestamibi)
(+) or Trop (+) or pain or LVEF <40%
- abciximab + CTCA + revascularisation

STEMI
acute
- MONA BasH (+1 and 8 hr - telemetry+troponin-I)
morphine
o2
nitrates sublingual then IV
aspirin
BB metoprolol
Heparin

- PCI w/i 4 hr pain OR anytime but unstable = abciximab + CTCA + PCI

- no PCI w/i 4hr of pain = thrombolysis, then stress testing
. if stress test positive then => ticagrelor + CTCA + coronary
revascularisation

Anticipate: MI, ecg, echo

long
1. Educate + RF modification (PT, exercise, diet)
2. dual antiplatelet = ASA + ticagrelor (ADP blocker)
3. BB (met/atenolol) or in context of COPD use CCB
4. Nitrates (Sx)
5. ACEI
6. Aldosterone antagonist IF LVEF < 40 and CMF or DM - Eplerenone
7. monitor for complications MI CRASH PAD (cardiac rupture, arrhythmia,
shock, htn/heart failure, pericarditis/pulmonary emboli, aneurysm, DVT

PE= LMNOP
-lasix
-morphine
-nitrates
-oxygen
-position + CPAPA
CHF
- O2, bed rest, elevate head
- lifestyle - diet, exercise, DM, smoking, etoh, education, salt/fluid
restriction
- MDT
- cardiac rehab

ABCDE (acei, bb, anticoag, antiarrhythmics, diuretic, aldosterone receptor

inhibitor, inotrope)
- ACEI (HFREF, post MI, NYHA>1)
- BB (esp cardelilol)
- Diuretic (furosemide + metolazone)
- Digoxin, amiodarone (anti-arhtyhmics)
- Eplerenone or spironolactone

Dilated cardiomyopathy - tx for CHF

HOCM:
- avoid incr obstruction - hypovolaemia
- avoid competitive sport
- BB
- disopyramide
- verapamil
- phenylepphrine for shcok
- myectomy, septal alcohol ablation, dual chamber pacing
- ICD***

restrictive cardiomyopathy
- investigate infiltrative (amyloid - paraproteins)
- investigate non-infiltrative (scleroderma scl-70)
- investigate storage dz (haemachromatosis, Fabry diz, gaucher, glycogen
storage)
- CXR
- ECG
- echo
- CT
- biopsy
- Mx underlying
- Mx CMF + arrhythmias

Effusion/tamponade
- hypotension, pulsus paradoxus, muffled heart sounds, JVP
- ECG
- echo
- cardiocentesis + echo

Constrictive pericarditis (coxsackie, TB, radiation, collagen vascular disease)

- ecg (lo, flat T, Afib)
- CXR (calcification, effusion)
- echo/CT
- diuretic + salt restriction

Breast Cancer
incr risk - pos hx, 1st degree, BRCA1/2, chest wall radiation
RF - hi breast density, nulliparity, 1st pregnancy >30, menarche <12, menopause
>55, radiation, >5yr HRT, >10yr OCP, BRCA 1/2, alcohol, obesity, sedentary

Ix:
 - mammogram (calcification, distortion, changes)
- USS cystic vs solid
- MRI
- galactogram
- mets workup (bone scan, abd USAS, CXR, CT head
- Dx - FNA or core needle biopsy or excisional
- Genetic BRCA1/2 for <35 yr, bilateral < 50 yr
- receptor biology (ER, PR, Her2)

Mx:
- DCIS - lumpectomy + RadTx (ductal epithelial contained with breast ducts)
- LCIS -
- Invasive ductal carcinoma

Stage 0 = insitu
1 = <2 cm, LN0, M0
2 = LN+, M0
3 = invasion, AxN
4 = mets

(mastectomy is an alternative to conservative sx)

St 0/insitu = conserving sx + RTx + tamoxifen ER + trastuzumab HER2

St 1-2 = conserving + AxN + RTz +/- chemo/tamoxifen
St 3-4 = mastectomy + AxN + RTx + Chemo

F/U
-q 3mo exam for 2 yr then annual
-q6 mammography if conservtive sx
-gync surveillance endometrial cancer if tamoxifen used
- breast reconstruction
- psychosocial support
- mets surveillance Bones>lungs?pleura> liver>brain....palliate w hromone therapy,
chemoherapy, radiation

CML:
PC - systemic, splenic (early fullness, LUQ, shoulder tip pain, splenomegaly,
anemia, bleeding platellet dysfn, pruritus, PUD, leukostasis, priapism,
encephalopathy)
Sx - allopurinol, antihistamines
chronic - imatinib mesylate (2ndgen dasatinib, nilotinib) + INF + hydroxyurea
Curative ? HSCT