Cardiology in the Hospice Environment

I pretty much know what is in the box What’s in the box? CT Scan Biopsy I pretty much know what is in the box

Coronary artery disease?

Coronary artery disease? CT Scan Biopsy I pretty much know the answer to this question

When they know, they’re good to go

Hypertension Atrial fibrillation Coronary Artery Disease Congestive Heart Failure Valve Disease Pacemaker ICD Case Scenarios

Hypertension

Calcium channel blocker Hypertension ACEI/ARB Beta blocker Calcium channel blocker Amlodipine: no HR effect Diltiazem/verapamil: bradycardia Diuretic Nitro Others

Most people would rather eat bacon and eggs than a bunch of pills Hypertension Most people would rather eat bacon and eggs than a bunch of pills

Hypertension Symptoms Other Treat?

Most people would rather eat bacon and eggs than a bunch of pills Hypertension Most people would rather eat bacon and eggs than a bunch of pills

Nitro 0.4 mg SL Clonidine Amlodipine ACEI/ARB Diuretic Hypertension BP Spike Longer Acting Nitro 0.4 mg SL Clonidine Amlodipine ACEI/ARB Diuretic

Atrial Fibrillation

Non-dihydrophyridine CCB Digoxin (Amiodarone) Warfarin NOAC Atrial Fibrillation Rate Control Anticoagulation Beta blocker Non-dihydrophyridine CCB Digoxin (Amiodarone) Warfarin NOAC

Non-dihydrophyridine CCB Digoxin Warfarin NOAC Atrial Fibrillation Rate Control Anticoagulation Beta blocker Non-dihydrophyridine CCB Digoxin Warfarin NOAC Antiarrhythmic Flecainide Amiodarone Tikosyn Sotalol others

CHF Stroke Symptoms Atrial Fibrillation Rhythm control? Anticoagulation Rate control

Atrial Fibrillation

Amiodarone (caution if no AC) Atrial Fibrillation Rate Control Diltiazem Beta blocker Amiodarone (caution if no AC)

Coronary Artery Disease

Coronary Artery Disease Obstructive Plaque stabilization Nitrates Beta blocker Calcium channel blocker Ranexa Aspirin etc. ACEI Statin

Coronary Artery Disease Obstructive Plaque stabilization Nitrates Beta blocker Calcium channel blocker Ranexa Aspirin etc. ACEI Statin

ACS Angina Hospital Coronary Artery Disease Plaque stabilization Anti-anginal Aspirin

Coronary Artery Disease

Coronary Artery Disease Anti-anginal ACS Nitro Imdur Beta blocker Amlodipine Ranexa MSO4 Hospital

Congestive Heart Failure

Congestive Heart Failure RAAS/Hormone/Other Symptoms Beta blocker Entresto (ACEI/ARB) Spironolactone/Eplerenone Corlenor Loop diuretic Nitro MSO4

Congestive Heart Failure Volume

CHF Hospital SOB Edema Fatigue Maintain therapy? VOLUME!

Congestive Heart Failure Volume

Lasix -> torsemide (potassium) Metolazone Oxygen CHF Nitro MSO4 Lasix -> torsemide (potassium) Metolazone Oxygen

Diastolic Dysfunction

Diastolic Dysfunction HFpEF Contenders EF >50% (45%) HFmrEF EF 40-50%

Diastolic Dysfunction HFpEF Contenders EF >50% (45%) HFmrEF EF 40-50% HFpnEF HFpeEF HFhoEF HFscumEF

Diastolic Dysfunction Spironolactone Diuretic

HFpEF Volume

HFpEF Hospital SOB Edema Fatigue Mimicks of HFpEF VOLUME

HFpEF Volume

Lasix -> torsemide (potassium) Metolazone Oxygen HFpEF Nitro MSO4 Lasix -> torsemide (potassium) Metolazone Oxygen

Valve Disease

Afterload reduction if AI? Mitral Aortic Valve Disease Regurgitation Stenosis Diuretic Afterload reduction if AI? Mitral Heart rate control Aortic Um… it’s complicated

Valve Disease Hospital SCD SOB Diuretic

Valve Disease

Heart rate control if mitral stenosis Valvuloplasty if aortic stenosis Valve Diuretics Heart rate control if mitral stenosis Valvuloplasty if aortic stenosis

Pacemaker

Pacemaker Magnet Reprogram

Pacemaker Hospital Dizziness Syncope Inury Fatigue Reprogram? Magnet

Pacemaker

Pacemaker Magnet Turn off pacemaker

ICD

ICD Magnet Reprogram

ICD Hospital Pain Syncope Inury Shocks Reprogram? Magnet

ICD

ICD Magnet Turn off shocks Turn off ATP

Telephone number to cardiologist Hospice Backpack Aspirin Amlodipine Diltiazem Metoprolol Lasix, torsemide, metolazone Nitro Amiodarone NOAC/warfarin Magnet Telephone number to cardiologist