Cardiovascular Ix and Mx

Question 1

Acute coronary syndrome Investigations

Answer 1

• ECG 12 lead
• Full blood count + troponin + glucose + lipids
• U&Es
• TFTs
• CRP
• CXR
• Echocardiogram

Question 2

Acute coronary syndrome STEMI Management

Answer 2

• ABCD approach
• Morphine + antiemetic (metoclopramide or cyclizine)
• Oxygen if sats

Question 3

Acute coronary syndrome NSTEMI Management

Answer 3

• ABCD approach
• Morphine + antiemetic (metoclopramide or cyclizine)
• Oxygen if sats

Question 4

Heart failure Investigations

Answer 4

• Full blood count + glucose + lipids + B-type natriuretic peptide + troponin (if chest pain)
• U&E
• CXR
• ECG
• Echocardiogram

Question 5

Heart failure management

Answer 5

• ABCD approach
• Oxygen
• Diuretics e.g. furosimide or bumetanide
• ACE-inhibitors (lisinopril)
• B-Blockers (e.g. carvedilol)
• Spironolactone (K+ sparing diuretic)
• Digoxin helps symptoms even in those with sinus rhythm
• Vasodilators → the combination of hydralazine and isosorbide dinitrate should be used if intolerant of ACEi
• Treat risk factors → discourage smoking, eat less salt, optimize weight and nutrition.
• Treat the cause → e.g. dysrythmias or valve disease
• Avoid exacerbating factors → e.g. NSAIDs (fluid retention) and verapamil (-ve inotrope)

Question 6

Hypertension investigations

Answer 6

Quantify overall risk:
• Fasting glucose and cholesterol

To look for end-organ damage:
• ECG → any LV hypertrophy? Past MI?
• Echocardiogram → any LV hypertrophy?
• Urine analysis → any protein or blood

To exclude secondary causes:
• U&Es → K+ is reduced in chrons
• Ca2+→ increased in hyperparathyroidism

Question 7

Hypertension Management

Answer 7

• Stop smoking 
• Low fat diet 
• Reduce alcohol intake 
• Reduce salt intake 
• Increase exercise 
Drugs:
     o If >55 and in black patients of any age 1st choice is Ca2+-channel blocker (nifedipine) or thiazide (chlortalidone)
     o If

Question 8

Hyperlipidaemia Investigations

Answer 8

• Fasting lipid profile

Question 9

Hyperlipidaemia Management

Answer 9

• Modify diet so 20% irrespectable of baseline lipid levels.

Question 10

Chronic Atrial fibrillation Investigations

Answer 10

• FBC + glucose +Ca2+ + Mg2+ + cardiac enzymes
• U&Es
• TFT
• ECG
• 24h ECG tape
• Exercise ECG
• Echocardiogram

Question 11

Chronic Atrial fibrillation Management

Answer 11

• IV access
• O2 if hypoxic
• ECG continuous trace
• Anticoagulation (to reduce risk of stroke):
o Heparin until a full risk for emboli is made
o Use warfarin if emboli risk is high
o Use no anticoagulation if sinus rhythm is restored and no risk factors for emboli, and AF reoccurrence is unlikely
• Rate control with B-Blocker (metoprolol) as 1st choice. If this fails add Digoxin, then consider amiodarone.

Question 12

Supraventricular tachycardia Investigations

Answer 12

• FBC + glucose +Ca2+ + Mg2+
• U&Es
• TFT
• ECG
• 24h ECG tape
• Exercise ECG
• Echocardiogram

Question 13

Supraventricular tachycardia Management

Answer 13

• IV access
• O2 if hypoxic
• If rhythm is not regular treat as AF
• If regular rhythm:
o ECG continuous trace
o Perform vagal manoevers
o Adenosine (causes transient heart block in the AV node) 6mg bolus injection followed by 12mg (verapamil if contraindicated)
• If no adverse signs (hypotension, Heart failure, Impaired consiousness, HR >200 bpm):
o B-blocker (metoprolol) to slow the rate
o Digoxin if needed
o Amioderone IV over 1h, which may be reeated if necessary
o Overdrive pacing