Cardio conditions

Question 1

Angina (stable)

Answer 1

Ix: troponin (if unstable/?ACS), FBC (for anaemia), U+E (before starting ACEi/diuretics), LFT (before starting statin) , BNP (for HF), lipid profile (for hypercholesterolaemia), clotting/INR (for anticoag).
Imaging: CT coronary angiogram, ECG, Echo
Mx (RAMP): Refer to cardio + advise about condition, Medical - GTN spray PRN, long term b.blocker or/+ cacb, if doesnt work add long acting nitrates using asymmetrical dosing regime, Surgical - PCI/CABG
Secondary CV RFs management(4As): lifestyle/diet, ACEi, Atorvastatin, Aspirin, Already on BB

Question 2

ACS

Answer 2

Ix: troponin, (FBC, U+E, LFT), BNP, lipid profile, clotting.
Imaging: ECG (if v symptomatic straight to ECG), Echo, CTCA
Mx: if STEMI + hemodynamically unstable need urgent PCI if centre <2h away (CABG if unsuitable for PCI or PCI fails), Thrombolysis if >2h away, if NSTEMI (BATMAN - bb, aspirin, ticagrelor, morphine, anticoag with LMWH, nitrates (GTN)), O2 (if sats<94%)
Secondary management of CV RFs (6As): lifestyle/diet, b blockers, atorvastatin, aspirin + another anticoag, ACEi, aldosterone antagonist

Question 3

Heart failure

Answer 3

Ix: BNP (NT BNP for chronic HF), (FBC, U+E, LFT), troponin, lipid profile, clotting.
Imaging: Echo, CXR, ECG
Mx: Acute (Pour SOD): Stop IV fluids, sit patient up, oxygenate if low sats, IV furosemide
Chronic Mx (ABAL): ACEi + BB (+aldosterone antagonist + loop diuretics)
Secondary management of CV RFs.

Question 4

AF/Arrhythmias

Answer 4

Ix: to look for causes (Mrs SMITH)
FBC, U+E, LFT, TFT,?trop, BNP, clotting, BP
Imaging: ECG, Echo, CTCA
Mx: Rhythm + rate control. Rhythm control with cardioversion (electric/chemical) + long term bb, dronedarone/amiodarone. Done if pt haemodynamically unstable, new onset (<48h), reversible cause, if >48h elective cardioversion with 3 weeks anticoag
otherwise rate control with b blockers/cacb.digoxin if nothing works. Management of secondary RFs (4As)

Question 5

Murmurs

Answer 5

systolic: AS (crescendo decrescendo ESM radiating to carotids, slow rising pulse, narrow PP, causes syncope) - causes: age related calcification, RHD,
MR (pansystolic murmur radiating to axilla, causes HF and S3): causes: age related weakening, IHD, IE, RF, connective tissue disorders

Diastolic: MS (mid diastolic murmur low pitch rumbling, assosc with malar flush) causes: IE/RHD
AR (early diastolic, assosc with collapsing pulse, quinke, demusset signs). Causes: age related weakening, connective tissue disorders

Ix: Blood cultures, CRP, (FBC, U+E, LFT), [trop, BNP, lipids, clotting]
Imaging: Echo
Assess using SCRIPT
Grading (1-6), normally 2 or 3
Mx: treat assosc conditions, valve replacement surgery (bioprostetic/metallic valve), TAVI in AS where pt is unsuitable for surgery

Question 6

Endocarditis/Pericarditis

Question 7

HTN

Answer 7

Ix: Clinic/ambulatory BP monitoring (>140/90 or 135/85) + other routine cardio bloods.
Mx: <55 acei/arb, >55 cacb/black, next A+C, then A+C+D (indapamide), a blocker, if K+<4.5 spironolactone, refer to specialist, diabetics acei/arb if black