CVS guidelines

Question 1

angina first Ix

Answer 1

CT angiogram

Question 2

Tx of angina escalation

Answer 2

A(ngina)BC
Everyone = GTN, aspirin, statin 80
1st = bb or ccb (verapamil [not in HF] or diltiazem)
2nd = max that dose
3rd = BB + CCB (use MR nifedipine)
4th = CABG or PCI or long acting nitrate

Question 3

Primary prevention diabetics: who?

Answer 3

If you’re under 40 and haven’t had it for 10 years and your 10 yr risk is >10% with no end organ damage, dw bout it

Question 4

when do you measure what for statin monitoring

Answer 4

LFTs and baseline, 3m, 12m

Question 5

What you aim to see after starting statin

Answer 5

40% reduction in non-HDL after 3m

Question 6

When do you stop a statin

Answer 6

patient choice
CK 5x
LFTs 3x

Question 7

CI of statin

Answer 7

macrolide use

Question 8

How do you diagnose heart failure

Answer 8

do a NT-proBNP
if high –> specialist 2w
If raised –> specialist 6w

Question 9

Treatment escalation for heart failure

Answer 9

1st = ACEi + BB
2nd = spironolactone 
3rd = cardiac desynchronise or digoxin or ivabradine

furosemide if symptomatic

Question 10

when can you give ivabradine

Answer 10

if HR >75 and LVEF <35%

Question 11

when do you send someone in for same day assessment with hypertension

Answer 11

end organ damage (papilloedema, retinal haemorrhage)

Question 12

stages of HTN

Answer 12

1 = 140/90 (135/85)
2 = 160/100 (150/95)
3 = 180/110

Question 13

in who do you NOT treat HTN

Answer 13

anyone >80 years old

Question 14

HTN escalation

Answer 14

1 = A (diabetes, <55) or C (black, >55)
2 = A + C or A + D
3 = A + C + D
4 = spironolactone if <4.5K, a or b if >4.5 K+
5 = specialist

Question 15

BP targets

Answer 15

normal = 140/90
over 80 = 150/90
diabets = 130/90
diabetes with end organ = 130/80

ambulatory are 5 lower

Question 16

surgery indication for AS

Answer 16

symptoms

asymptomatic + pressure gradient >40 and LV dysfuntion

Question 17

NSTEMI acute Tx

Answer 17

GTN, morphine, oxygen
300mg aspirin
300mg clopidogrel (prasugrel better)

LMWH (or unfrac heparin if PCI <24hrs or CKD)

Extra if GRACE high enough

• — tirofiban (G2b3a)
• — PCI within 96 hours

Question 18

STEMI acute

Answer 18

GTN, morphine, oxygen
300mg aspirin
300mg clopidogrel (prasugrel better)

PCI within 2 hours

Question 19

what if you cant get to cath lab within 2 hours

Answer 19

Do tPA

If ST-e not resolved in 90 mins, send for PCI

Question 20

Reccured pain after PCI?

Answer 20

CABG

Question 21

CI to thrombolysis (stroke timeline)

Answer 21

stroke within 3m

Question 22

Ongoing Mx for ACS

Answer 22

BB + ACEi + statin

• aspirin lifelong
• clopidogrel/ticagrelor for 12m

Question 23

After ACS

• no sex for
• no viagra for

Answer 23

no sex for 1m

No viagra for 6m

Question 24

when do you cardiovert AF

Answer 24

Unstable = DC now
<48 hours = flecainide (no defect) or sotalol
>48 hours = anticoagulant for 3w then DC

Question 25

rate vs rhythm control

Answer 25

> 65 with ischaemic heart disease

Question 26

rate control drugs

which if heart failure

Answer 26

BB or rate-limiting CCB (verapamil/diltiazem)

Use digoxin if HF

Question 27

CHADSVASC

Answer 27

CHF = 1
HTN = 1
Age >75 = 2; >65 = 1
Diabetes = 1
Stroke/TIA = 2
PVD/CAD = 1
Female = 1

anticoagulant if 1 or more (2 or more in woman)

Question 28

INR target on warfarin

• normal
• recurrent
• mechanical valves

Answer 28

normal is 2.5
recurrent is 3,5
mech valve depends on type but mitral is most

Question 29

when do you start DOAC post-stroke if it was caused by AF

Answer 29

2 weeks later

Question 30

svt treatment

Answer 30

unstable = DC shock
otherwise = vagal, adenosine 6 12 12, shock

Question 31

SVT prevention of future episodes

Answer 31

BB and ablation

Question 32

VT treatment

Answer 32

unstable = shock
pulseless = ATLS
stable = loading dose amiodarone and then 24 hour infusion

Question 33

Cardiac arrest

Answer 33

look listen feel
start CPR 30:2 and put out call
attach monitoring
if PEA/asystole, adrenaline now and every 3-5 mins
If shockable:
- shock, CPR 2 mins repeat
- after 3rd shock, adrenaline 1mg + amiodarone 300mg

Question 34

Dukes criteria

Answer 34

For infective endocarditis (3M, 1M3m, 5m)
Major = echo confirmation, 2culture of virdans, 3 cultures otherwise
Minor = embolic stuff, immune stuff, fever, predisposing heart condition

Question 35

IE Abx therapy
native valve
severe sepsis
prosthetic valve

Answer 35

amoxicillin + gent
Vanc + gent
vanc + gent + rifamp

Question 36

Surgery indications in IE

Answer 36

CCF
persistent embolic events
aortic abscess (daily ECGs)

Question 37

Type A aortic dissection

Answer 37

surgery

Question 38

type B aortic dissection

Answer 38

control BP and conservative

?endovasc repair

Question 39

Acute pulmonary oedema

Answer 39

Position upright
Oxygen then CPAP then BiPAP
Diuretic furosemide
Morphine 
Antiemetic
Nitrate (not if systolic <90)
- start with GTN then can put infusion up

Question 40

HASBLED criteria

Answer 40

hypertension
abnormal renal or liver function
history of stroke
history of bleeding
labile INR
elderly >65
drugs predisposing to bleeding
alcohol use

score of 3+ means high risk of bleeding on warfarin

Question 41

Bug types for infective endocarditis

• staph aureus
• S epidermidis
• strep mitis/sanguinis
• strep bovis

Answer 41

• staph aureus = most common and IVDU
• S epidermidis = first 2 months after prosthetic valve surgery
• strep mitis/sanguinis = viridans type = dental stuff
• strep bovis = CRC