CVS

Question 1

How to manage ACS in GP setting

Answer 1

2 wide bore cannulas, send for blood cross match 
Start on O2 
Monitor vital signs & pulse oxygen
Monitor ECG 
Morphine 
Sublingual GTN 
Call for ambulance, explain what will be done at hosp 
Explain to patient need for follow-up 
Don’t start aspirin in GP

Question 2

Investigations for angina

Answer 2

FBC, U&E, lipid profile, LFT, HBA1C
Resting ECG
Echo
Exercise stress ECG, CT-Angio

Question 3

Management for angina

Answer 3

Lifestyle mod: diet, smoking, physical activity, RF management, LOW 
Antiplatelets: Aspirin 75-150mg daily 
Statin: LDL-C < 1.8mmol 
B-blockers: atenolol, bisoprolol 
CCB 
GTN - sublingual (SE headache, hypotension), spray for prophylaxis 
ACE-I if LVEF less than 40%
Ivabradine/Nicorandil/Ranolazine
Revascularisation

Question 4

How to manage acute heart failure

Answer 4

Call emergency of hospital to notify 
Insert 2 wide bore cannulas 
Lasix - 20mg furosemide bolusb
Morphine 
Sublingual nitrates 
Start oxygen 10-15 via Hudson mask 
Posture upright 
Chewable aspirin

Question 5

How to investigate for heart failure

Answer 5

FBC, UEC, LFT, FBG, lipid profile, urinalysis, BNP
ECG, CXR, echo
when indicated: CKMB, TFT, GGT, viral studies, exercise test, coronary angio, biopsy

Question 6

Chronic HF management

Answer 6

No smoking, alcohol, reduce salt, optimize diet and weight, exercise, fluid restriction 
Control HTN, DM, lipids, U/L disease 
Annual flu vaccine + pneumococcal 
Diuretics of fluid overload 
ACE-i for ALL 
B-blocker bisoprolol (need to be stable and not acute HF) 
MRA Spironolactone 
ARNI to replace ACE 
Ivabradine 
Digoxin 
Nitrates

Question 7

If SBP 130-159 and/or DBP 80-99 and global CVS risk low-intermediate…

Answer 7

3-6 monthly follow-up with advice on non-pharmaco management and reassessment of CVS risk.

if SBP is 140 or more and/or DBP 90 or more, give meds

Question 8

if SBP 160 or more and/or DBP 100 or more…

Answer 8

drug treatment right away

Question 9

Management of HTN

Answer 9

Lifestyle: LOW, diet, exercise, no smoking or alcohol
Drug therapy
- step 1: ACEi/ARB + CCB/diuretic
- step 2: ACEi/ARB + CCB + diuretic
- step 3: above + spironolactone 25-50mg od or other diuretic/alpha-blocker
- consider beta blocker if there is HF, angina, post-MI, AF, pregnant women

Question 10

Tests for HTN

Answer 10

FBC, UEC, LFT, lipids, coag, uric acid, FBG

ECG

Question 11

CHA2DS2VASc score

Answer 11

CHF/LVEF 40 or less 
HTN 
Age >75
Diabetes 
Stroke 
Vascular disease 
Age 65-74
Female

Question 12

Management for AF

Answer 12

Rate control:
B-blocker/CCB

Rhythm control
Amiodarone/sotalol/flecainide
Catheter ablation
If present within 48 hours and no structural heart disease: immediate cardioversion with heparin cover
If present >48 hours, anticoagulants for 3 weeks then cardiovert and continue coagulation for 4 weeks after

Question 13

VTach management

Answer 13

Non-sustained: beta blocker/amiodarone

Can use ICD/catheter ablation

Question 14

DVT investigations

Answer 14

Duplex Ultrasound - repeat in 1 week if normal
Contrast venography
MRI
FBC (platelets) UEC APTT INR

Question 15

Treatment of DVT

Answer 15

Education and counselling
Admit to hospital 
LMWH - enoxaparin 
Warfarin for 3 months, monitor INR 
No aspirin
Mobilize
Compression stocking