Ph1: Cardiovascular

Question 1

What are the treatment options for Classic angina?

Answer 1

Beta Blocker
or Beta Blocker + DHP
or Rate Limiting CCB

Question 2

What are the treatment options for Variant angina?

Answer 2

Nitrates
Rate Limiting CCB or DHP

Question 3

You suspect ACS in a patient, what tests do you run?
What results do you expect?

Answer 3

Blood troponin
UA (<0.04ng/ml) NSTEMI (>0.04)
Electrocardiogram
ST elevation (STEMI) else NSTEMI

Question 4

What are the symptoms of ACS?

Answer 4

Sudden chest pain (getting worse), breathlessness, sweating, syncope, malaise and dread.

Question 5

What are the requirements for diagnosis of STEMI?

Answer 5

Troponin > 99% reference range and evidence of rise and fall and one of the following:
- Imaging to show thrombus
- Imaging to show lost myocardium
- ECG changes (ST, T, Q waves)

Question 6

What is the emergency treatment of ACS symptoms?

Answer 6

Aspirin 300mg (PO) STAT
Morpine for any severe pain
Glyceryl Trinitrate
Beta Blocker (IV) STAT
Supplementary O2 if SaO2 < 94%

Question 7

What tests do we use to assess a patients cardiovasculat risk?
What are we assessing?

Answer 7

GRACE / TIMI score
The 6 month risk of patient suffering from cardiovascular disease

Question 8

How should you manage an ACS patient with <3% 6month CV risk?

Answer 8

Antithrombotic Therapy and lifestyle changes

Question 9

How should you manage an ACS patient with >=3% 6month CV risk?

Answer 9

Early PCI and Antithrombotic therapy

Question 10

How does a GRACE score assess a patients risk?

Answer 10

Assess cardiac condition on presentation (Age, Systolic Bp, Heart rate, Creatinine) and Killip class

Question 11

What does Killip Class measure and how is it measured?

Answer 11

Measures the degree of Heart Failure following a cardiovascular event.
Class I: No signs of CHF
Class II: Rales on ascultation/JVP
Class III: Pulmonary oedema
Class IV: Hypotension/Shock