1. Cardiology in the Hospice Environment

3. 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

4. Coronary artery disease?

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

8. When they know, they’re good to go

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

11. Hypertension

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

13. 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

14. Hypertension
Symptoms
Other
Treat?

15. 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

16. 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

17. Atrial Fibrillation

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

19. 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

20. CHF Stroke Symptoms Atrial Fibrillation Rhythm control?
Anticoagulation
Rate control

21. Atrial Fibrillation

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

23. Coronary Artery Disease

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

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

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

27. Coronary Artery Disease

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

29. Congestive Heart Failure

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

31. Congestive Heart Failure
Volume

32. CHF
Hospital
SOB
Edema
Fatigue
Maintain therapy?
VOLUME!

33. Congestive Heart Failure
Volume

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

35. Diastolic Dysfunction

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

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

38. Diastolic Dysfunction
Spironolactone
Diuretic

39. HFpEF
Volume

40. HFpEF
Hospital
SOB
Edema
Fatigue
Mimicks of HFpEF
VOLUME

41. HFpEF
Volume

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

43. Valve Disease

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

45. Valve Disease
Hospital
SCD
SOB
Diuretic

46. Valve Disease

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

48. Pacemaker

49. Pacemaker
Magnet
Reprogram

50. Pacemaker
Hospital
Dizziness
Syncope
Inury
Fatigue
Reprogram?
Magnet

51. Pacemaker

52. Pacemaker
Magnet
Turn off pacemaker

53. ICD

54. ICD
Magnet
Reprogram

55. ICD
Hospital
Pain
Syncope
Inury
Shocks
Reprogram?
Magnet

56. ICD

57. ICD
Magnet
Turn off shocks
Turn off ATP

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