Cardio

Question 1

Immediate management of suspected ACS

Answer 1

GTN
Aspirin 300mg
Perform ECG
Referral to hospital
- if <12 hrs + ECG changes = emergency admission
- if 12-72 hrs = same-day assessment
- if > 72 hrs = Trop + ECG before deciding further action

Question 2

Investigations (in order) for angina

Answer 2

1. CT coronary angiography
2. non-invasive functional imaging (myocardial perfusion, cardiac MR, stress echo)
3. Invasive cardio angiography

Question 3

When are nitrates contraindicated?

Answer 3

Hypotension
Bradycardia
Phosphodiesterase-5 inhibitor (sildenafil) in last 24-48hrs

Question 4

Management of NSTEMI

Answer 4

All patients

• Aspirin 300mg
• Nitrates or Morphine for pain

Anti-thrombin:

• Fondaparinux if not gonna get angiography within 24hrs
• if angiography likely or CR > 265 - unfractionated heparin
• Ticagrelor for 12 months (or prasugrel if going to have PCI)

IV eptifibatide or tirofiban

Coronary angiogram considered within 96 hrs

Question 5

Posterior MI on ECG

Answer 5

ST depression

Question 6

Mx of post-stroke AF

Answer 6

NOAC - 2 weeks later

Question 7

1st line treatment for sinus bradycardia

Answer 7

IV atropine