Cardio Management

Question 1

stable angina

Answer 1

change lifestyle
SHORT TERM- GTN spray
LONG TERM - BB or CCB

secondary prevention - aprin, statin, acei

Question 2

Unstable angina

Answer 2

change lifestyle
SHORT TERM- GTN spray
LONG TERM - BB or CCB

secondary prevention - aprin, statin, acei

Question 3

STEMI

Answer 3

Acute
MONA T
morphine
oxygen if needed
Nitrate if hypertensive (GTN)
Aspirin 300mg to chew on
Ticagrelor / clopidogrel - anti coagulants

Longerterm
DABS
Dual anti platelet therapy - aspirin and smfn else
ACEi
Beta blockers
Statins

PCI if under 2hrs but if longer then thrombolysis

Question 4

NSTEMI

Answer 4

Acute
MONA T
morphine
oxygen if needed
Nitrate if hypertensive (GTN)
Aspirin 300mg to chew on
Ticagrelor / clopidogrel - anti coagulants

Longerterm
DABS
Dual anti platelet therapy - aspirin and smfn else
ACEi
Beta blockers
Statins

Thrombolysis and consider PCI or discharge depending on troponin

Question 5

Dressler’s

Answer 5

NSAIDS

Question 6

Aortic dissection

Answer 6

TYPE A
treat immediately with surgery - open lap / TEVAR

TYPE B
Betablockers

Question 7

Abdominal Aortic aneurysm

Answer 7

if <3 cm discard w no follow up
if 3 - 4.4 follow up every 12 months
if 4.5-5.4 follow up in 3 months
if >5.5 cm urgent referral

Ruptured - Repair by EVAR or Open Lap
Non Ruptured - Elective aneurysm repair

Question 8

AFib

AFlutter

Answer 8

1. Vagal maneuvers (if young) - Valsalva if old
2. if hemodynamically unstable - Cardioversion
3. Rate - BB / CCB
   Rhythm - amiodarone

ADD ANTICOAG - Apixiban

A flutter - same except the definitive management is RF ablation

Question 9

what is the acute management of Wolf Parkinson White Syndrome and what is the logn term managemnt
- another question - this is a type of what

Answer 9

(wide QRS supraventricular tachycardia)
if heamodynamically unstable - -cardioversion
if not
1. vagal maneuver
2. adenosine
3. amiodarone or procainamide

Radiofrequency ablation is definitive management

Question 10

Brugada Syndrome (also, what is this a type of)

Answer 10

(genetic VF)
genetic testing the family
ICD - long term
avoid triggers

shockable rhythm by defib

Question 11

Long QT syndrome (is a type of what)

Answer 11

(torsades de pointes)
acute
1. shockable by defib if in VT
2. magnesium infusion
3. treat underlying

long term
1. BB
2. avoid QT prolong drugs - clarithromycin
3. avoid triggers
4. pacemaker therapy

Question 12

VT

Answer 12

defib if no pulse
unstable with pulse - Cardioversion
stable - cardioversion/ antiarrhymic drugs (amiodarone, Lidocaine)

long term - Implantable cardio defiv

Question 13

VF

Answer 13

shockable rhythm by defib
long term - ICD

Question 14

Supraventricular tachycardias Narrow QRS

Answer 14

vagal manuvers
adenosine
verapamil or diltiazem/ IV BB

if heamodynamically unstable then cardioversion

Question 15

Supraventricular tachycardias wide QRS

Answer 15

vagal manuvers
adenosine
amiodarone or procainamide

if heamodynamically unstable then cardioversion

long term - RF Ablation

Question 16

Pericarditis

Answer 16

NSAID
pericardiocentisis

Question 17

Myocarditis

Answer 17

supportive - treat underlying cause
severe cases give heart transplant

Question 18

infective endocarditis (organism specific)

Answer 18

Staph aureus - Flucloxacillin
Strep Viridens - benzylpenacillin and gentamicin
strep epidermis and MRSA - vancomycin and gentamicin
Enterococcus - amoxicillin/vncomycin + gentamicin

Question 19

infective endocarditis (empirical)

Answer 19

native valve IE (same as PWID) - Flucloxicillin
native valve subacute- amoxicillin + gentamicin
Prosthetic Valve - vancomycin + gentamycin (add rifampacin)
Suspected MRSA - Vancomycin + gentamicin (add rifampicin)

Question 20

Hypertrophic Cardiomyopathy

Answer 20

ICD insertion if many risk factors
for symptoms of chest pain/arrhythmia treat with BB and rate CCB
DO NOT GIVE DIGOXIN

Question 21

Dilated Cardiomyopathy

Answer 21

manage HF
consider ICD
Left ventricular assistant device

Question 22

Restrictive Cardiomyopathy

Answer 22

manage HF
manage underlying pathology eg amyloidosis

Question 23

Pulmonary Embolism

Answer 23

Oxygen if hypoxic
DOAC (apixaban or rivaroxaban) if suspicion of PE
(or warfarin/LWMH if DOAC unsuitable) - at least 3 months

massive PE or unstable (BP low) - thrombolysis

Question 24

Hypertension

Answer 24

if diabetic or <55 yo either an ACEi or ARB
then
ACEi + CCB/Thiazide Diuretic
the
ACEi + CCB + Thiazide Diuretic
then
reasses
then
if K is above 4.5 give BB or AB
if K is under 4.5 give spirolacetone

if over 55 yo, non diabetic or any age of afro-carribean
CCB
then
CCB + ACEi/Thiazide Diuretic
the
ACEi + CCB + Thiazide Diuretic
then
reasses
then
if K is above 4.5 give BB or AB
if K is under 4.5 give spirolacetone

Question 25

Cardiac tumours

Question 26

Stroke

Answer 26

Ischaemic stoke - thrombolysis or thrombectomy Haemorrhagic stroke - supportive Secondary prevention - control risk factors embolic stoke - aspirin/ warfarin

Question 27

Peripheral vascular disease

Answer 27

Lifestyle - smoking cessation, exercise, lose weight Control risk factors - diabetes, hypertension Drugs - antiplatelet or clopidogrel lipid- lowering = statins

Question 28

DVT

Answer 28

1st - DOAC (apixaban or rivaroxaban) 2nd - LWMH (dabigatran or edoxaban) OR warfarin secondary prevention (long term) - inhibit clotting cascade -prevent clot formation -long term DOAC, warfarin or LMWH 3 months