what treatments would you discuss with them?

Question 1

DVT

Answer 1

primary goal to prevent PE

1st= Direct Oral Anticoagulants (dabigatran, rivaroxaban, apixaban, edoxaban)

then Vitamin K Antagonists

then LMWH (but preferred if associated with malignancy)

Question 2

Angina (medical)

Answer 2

Immediate symptomatic relief= GTN spray for vasodilation

if still in pain after 5 mins call an ambulance

Long term:

Beta-blocker e.g. bisoprolol 5mg once daily

Calcium-channel blocker e.g. amlodipine 5mg once daily

Question 3

how do you differentiate between unstable angina and NSTEMI after investigation

Answer 3

both will present with chest pain with non-descript ECG

unstable angina has normal troponin

NSTEMI has raised troponin

Question 4

MI immedaite management

Answer 4

MONAT

Morphine
Oxygen
Nitrates (vasodilation to not overload the heart so less pain)
Aspirin

Thrombolysis e.g. TPA (altplase)

Question 5

Angina (surgical)

Answer 5

Percutaenous Coronary Intervention:

• stent inserted
• catheter up femoral artery with contrast to highlight stenosis

Coronary Artery Bypass Graft:

• severe stenosis
• open chest
• graft vein from the leg and sew it to affected coronary artery to bypass stenosis

Question 6

Atrial Fibrillation

Answer 6

Assess for haemodynamic stability

Rate control:

• beta blocker (bisoprolol)
• rate limiting calcium channel blocker (dilitiazem)
• digoxin if sedentary

Rhythm control:

• acute= flecainide, amiodarone
• non acute= beta blocker (bisoprolol)

Anticoagulation:

• warfarin (with LMWH to start)
• DOACs e.g. rivaroxaban (less bleeding risk)
• LMWH (rare+ daily injections)

Question 7

Heart Failure

Answer 7

1st line:

• beta blocker (bisoprolol) and ACE inhibitor (ramipril)
• Digoxin (if AF)
• loop diuretics e.g. furosemide (increases mortality but decreases morbidity)

2nd line:
- aldosterone antagonist for fluid restriction (monitor K+ levels)

Question 8

DVT

Answer 8

Anticoagulation:

• DOAC, LMWH, warfarin
• for 3 months

Percutaneous mechanical thrombectoru for a massive DVT

Question 9

MI secondary prevention

Answer 9

Dual Antiplatelet therapy= aspirin and clopidogrel

ACE inhibitor e.g ramipril

Beta- blocker e.g. bisprolol

Statin e.g. simvastatin

Question 10

acute heart failure

Answer 10

sit patient up

oxygen

IV furosemide

morphine