01.01 Cardio

Written By Joan

01.01 Cardiology [PDF link]: Acute coronary syndrome (ACS) – including STEMI, NSTEMI, unstable angina. ECG cardiac territories. Hypertension (HTN) – including antihypertensives – continued on 01.09.

External links

  • HEART score for acute chest pain: MDCalc
    (Risk of major acute coronary event in 30 days in pts presenting with cardiac chest pain)

  • GRACE score for NSTEMIs: MDCalc

  • NICE guidelines for cardiac chest pain: NICE

Extra notes – ACS

  • Management of STEMI (see also NICE NG185)

    • PCI

      • Thrombus aspiration recommended as opposed to mechanical thrombus extraction

      • Complete revascularisation (including culprit + other vessels) if no cardiogenic shock

        • If there is cardiogenic shock, then target only culprit vessel

    • Fibrinolysis

      • If no ECG resolution 60-90 min after administration, offer immediate coronary angiogram ± follow-on PCI

      • If treating with fibrinolysis

        • Give fibrinolytic (eg alteplase)

        • Give antithrombin (eg UFH, enoxaparin)

        • Give ticagrelor or clopidogrel

          • NICE’s first line is ticagrelor, but the European Society of Cardiology recommends clopidogrel as first line

  • Management of NSTEMI (same set of guidelines)

    • Some nuance to the use of prasugrel in pts undergoing PCI – prasugrel to be given only when coronary anatomy has been defined and PCI is intended

  • Cocaine-associated chest pain / ACS

    • AHA guideline article that explains pathophysiology and management and runs through evidence.

      • McCord J, Jneid H, Hollander JE, Lemos JA de, Cercek B, Hsue P, et al. Management of Cocaine-Associated Chest Pain and Myocardial Infarction. Circulation 2008.

    • Avoid beta-blockers due to risk of unopposed alpha-agonism

      • Cocaine is a sympathomimetic, and stimulates the alpha-adrenergic receptors in smooth muscle

    • Consider use of CCBs (eg verapamil) if pt not responding to GTN or benzodiazepine

  • Use of PDE-5 inhibitors (eg sildenafil) after MI – see NICE CKS for more information.

    • Uptodate drug information on sildenafil also recommends caution for use of sildenafil if stroke/MI in last 6 months.

Extra notes – Hypertension

  • NICE guideline NG136

  • Endocrine Society Clinical Practice Guideline from Sep 2025 now recommends testing for primary aldosteronism in all patients presenting with hypertension

    • This involves measuring aldosterone and renin and determining the aldosterone to renin ratio

    • Adler GK, Stowasser M, Correa RR, Khan N, Kline G, McGowan MJ, et al. Primary Aldosteronism: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism 2025;110:2453–95. https://doi.org/10.1210/clinem/dgaf284.

Joan
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01.02 Cardio