cardio treatments

Question 1

shock

Answer 1

• ABCDE approach
• High flow oxygen
• Volume replacement for hypovolaemic shock (not for cardiogenic shock)
• Immediate chest drain for tension pneumothorax
• Adrenaline for anaphylactic shock
• Vasopressors for septic shock

Question 2

hypertension

Answer 2

lifestyle

> 55 or black = CCB
<55 or type 2 diabetes = ACEI

A/C + D
A + C + D

Question 3

intermittent claudication

Answer 3

exercising helps!!
lifestyle - smoking cessation

• Antiplatlet: asprin or clopridogel
• Lipid lowering: statins

Angioplasty or bypass graft in patients with very severe symptoms or if tissue damage present

SEVERE critical limb ischaemia = amputation (life or limb)

Question 4

stable angina

Answer 4

lifestyle - smoking cessation
GTN spray

Long term symptomatic relief
- β-blocker or CCB if not tolerated, can be used in combination if insufficient control on β-blocker alone

Secondary prevention
- Aspirin
- Atorvastatin
- ACE inhibitor

Question 5

acute coronary syndromes initial management

Answer 5

MONAT

• Morphine (+ metoclopramide)
• Oxygen if hypoxic
• Nitrates if patient hypertensive or in acute LVF
• Aspirin
• Ticagreor/clopidogrel

Question 6

STEMI definitive management

Answer 6

• Percutaneous Coronary Intervention PCI (if available within 2 hours of pain onset)
• Thrombolysis (if PCI not available within 2 hours)

Question 7

NSTEMI definitive managemt

Answer 7

Grace score
aspirin
anticoagulant
consider PCI
antiplatlet

Question 8

general secondary prev for acute coronary syndromes

Answer 8

Medications - DAB

• Dual antiplatelet – aspirin for life, 6-12 months of a P2Y12 inhibitor (e.g. ticagrelor)
• ACEi
• β-blocker started within 24h of confirmed ACS
• Statin

Others:

• GTN for angina symptoms
• Aldosterone antagonists for patients with symptoms and/or signs of heart failure and LV systolic dysfunction

Question 9

DVT

Answer 9

acute management =
Anticoagulation - apixaban or rivaroxaban (DOACs) first line

secondary prevention =
- Inhibit clotting cascade, prevent clot formation (dont breakdown clots)
- Long term anticoagulation -warfarin, a DOAC or LMWH

Question 10

aortic dissection

Answer 10

type A (proximal)
- Emergency surgical repair:
open lap or TEVAR

Type B (distal)
- Beta blockers (e.g. bisoprolol)

Question 11

Afib

Answer 11

CHA2DS2-VASc
anticoagulation = DOAC

Carry out emergency electrical cardioversion in patients with life-threatening haemodynamic instability caused by new-onset AF

rate control:
- beta blockers
- CCB
- Digoxin

rhythm = cardioversion

Question 12

Bradycardia

Answer 12

Atropine

• sometimes pacemaker

Question 13

ventricular tachycardia

Answer 13

• Unstable with pulse - DCCV
• Pulseless - defibrillation (see cardiac arrest)
• Stable - anti-arrhythmic drugs first line (amiodarone or lignocaine), DCCV if medical therapy fails