01.08 Cardio
01.08 Cardiology [PDF link]: Deep vein thrombosis (DVT) – Well’s score + anticoagulation. Pulmonary embolism (PE) – Well’s score, PERC score. Infective endocarditis – HACEK organisms. Pericarditis – pericardial rub, Dressler’s syndrome.
More on VTE
NICE guideline NG158 (last updated Aug 2023)
There’s a nice visual summary and algorithm here as well: link
Duration of treatment for unprovoked DVT/PE
Not specifically stated in NICE guidelines that treatment should be for 6 months, just “consider continuing anticoagulation beyond 3 months” (1.4.3)
Classically taught that it should be 6 months
Advice for travellers: see NICE CKS.
If no known risk factors, risk of developing VTE is very low
Risk increases with increased duration of flight
General advice: avoid immobility, frequent calf muscle exercises, maintain normal fluid intake, avoid excessive alcohol consumption. If they develop any smx suggestive of VTE, immediately seek medical attention.
If pt is at high risk for developing VTE (see risk factors on NICE CKS website), give general advice as above, advise use of graduated compression stockings ± consider use of LMWH.
Aspirin is not recommended.
Doses for DVT/PE treatment & prophylaxis [per BNF]
Treatment dose: 10 mg BDS for 7 days (loading dose), followed by maintenance 5 mg BDS
Prophylactic dose (prevention of recurrent DVT/PE or post knee/hip replacement): 2.5 mg BDS, following completion of 6 months anticoagulant treatment.
Treatment dose: 15 mg BDS for 21 days, then maintenance 20 mg OD
Prophylactic dose (prevention of recurrent DVT/PE): 10 mg OD
See BNF for other indications/doses
Enoxaparin (LMWH)
Treatment dose for uncomplicated patients: 1.5 mg/kg OD
Treatment dose in complicated pts (eg obese, cancer, etc): 1 mg/kg BDS
See BNF for other indications/doses
More on infective endocarditis
References (no NICE guidelines)
Delgado V, Ajmone Marsan N, de Waha S, Bonaros N, Brida M, Burri H, et al. 2023 ESC Guidelines for the management of endocarditis. Eur Heart J 2023;44:3948–4042. https://doi.org/10.1093/eurheartj/ehad193.
Baddour LM, Wilson WR, Bayer AS, FowlerJr VG, Tleyjeh IM, Rybak MJ, et al. Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications. Circulation 2015. https://doi.org/10.1161/CIR.0000000000000296.
Modified Duke Criteria – Fowler VG, Durack DT, Selton-Suty C, Athan E, Bayer AS, Chamis AL, et al. The 2023 Duke-International Society for Cardiovascular Infectious Diseases Criteria for Infective Endocarditis: Updating the Modified Duke Criteria. Clinical Infectious Diseases 2023;77:518–26. https://doi.org/10.1093/cid/ciad271.
There is limited space in the notes to cover all of this, so either read the paper or use MDCalc
Recommended 3 sets of blood cultures (i.e. 3 x 2 bottles [anaerobic + aerobic]) 30 min apart from different venepuncture sites – but this should not delay administration of abx
Diagnosis – refer to the Modified Duke Criteria. The 2023 ESC guidelines also has a section on diagnostic criteria which is quite similar.
Choice and duration of abx – no guidelines from NICE, but there are suggestions from the BNF. As usual, refer to local trust guidelines if available
Prophylaxis against IE – see NICE clinical guideline CG64 (last updated Jul 2016)
Antibiotic prophylaxis not routinely advised for dental procedures and non-dental procedures (including procedures involving GI tract, genitourinary tract, respiratory tract).
If patient is undergoing GI or GU procedure where there is active infection there, they should receive an antibiotic that covers organisms that may cause IE
More on pericarditis
There used to be a section on constrictive pericarditis, but this has been shortened and moved to 01.09 due to lack of space
No NICE guidelines on pericarditis specifically
References
Schulz-Menger J, Collini V, Gröschel J, Adler Y, Brucato A, Christian V, et al. 2025 ESC Guidelines for the management of myocarditis and pericarditis: Developed by the task force for the management of myocarditis and pericarditis of the European Society of Cardiology (ESC)Endorsed by the Association for European Paediatric and Congenital Cardiology (AEPC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2025:ehaf192. https://doi.org/10.1093/eurheartj/ehaf192.
